[Intestinal tuberculosis. A diagnostic challenge]. / Tuberculosis intestinal. Un reto diagnóstico.

Tuberculosis (TB) is a common disease in Spain, whose incidence has increased due to AIDS, immunotherapy and immigration. Intestinal disease is rare and can be difficult to diagnose because its symptoms and laboratory results are nonspecific. In addition, endoscopic lesions resemble those of other diseases such as Crohns disease (CD). Differentiating between intestinal TB and CD is very important since steroid treatment con be life saving in CD and lethal in intestinal TB. Colonoscopy plays an important role in establishing a suspected diagnosis. The endoscopic findings most characteristic of intestinal TB are circular ulcers, small diverticula (3-5 mm), and sessile firm polyps. The suspected diagnosis must be confirmed by the presence of caseating granulomas and/or acid fast bacilli. Polymerase chain reaction is currently recommended for assessing the presence of tubercle bacilli in tissue specimens obtained by endoscopic biopsy. We report a case of intestinal TB in a female renal transplant recipient that demonstrates the difficulty of making this diagnosis.

[Gastroenteritis eosinophilic presenting as colitis with acute abdomen]. / Presentación de gastroenteritis eosinofílica como brote de colitis con abdomen agudo.

Eosinophilic gastroenteritis is rare. Fewer than 30 cases have been published in the Spanish literature, although Kaijser first described this entity in 1937. Its etiology is still unknown and it has frequently been reported to involve the stomach and small bowel, with characteristic eosinophilic infiltration of the bowel wall. The colon has rarely been reported as a site of this condition, which manifests as acute abdominal pain due to intestinal obstruction. We report the case of a 38-year-old woman who presented eosinophilic gastroenteritis. Onset was acute colitis causing acute abdomen. The patient received conservative treatment and responded well to steroids. To our knowledge, such a case has not previously been reported.

[Purtscher's retinopathy and acute alcoholic pancreatitis]. / Retinopatía de Purtscher y pancreatitis aguda alcohólica.

We report the case of a 27-year-old man with alcoholic acute pancreatitis, who developed an acute loss of visual acuity; a bilateral Purtscher's retinopathy, a rare complication of acute pancreatitis, was confirmed by ophthalmoscopy.

[Association of porphyria cutanea tarda and hepatitis C virus]. / Asociación entre porfiria cutánea tarda y virus de la hepatitis C.

UNLABELLED: Porphyria cutanea tarda (PCT) is caused by reduced activity of hepatic uroporphyrinogen decarboxylase. However extrinsic factors such as alcohol abuse and drug intake are required for the clinical manifestation of the disease. Hepatitis C virus antibodies have been detected in a high percentage of patients with PCT. Hepatitis C virus is probably the main pathogenetic factor of liver damage in patients with PCT. AIM: To study the association between hepatitis C virus and PCT in our patients with PCT. MATERIAL AND METHODS: We have investigated six patients diagnosed of PCT in order to detect the presence of hepatitis C virus and other possible causes of the disease. RESULTS: We have found that 66% of our patients had hepatitis C virus antibodies, 50% ethanol abuse, of which 2/3 presented hepatitis C virus antibodies, and one case of HIV.

[Wegener's granulomatosis with gastrointestinal involvement]. / Granulomatosis de Wegener con afectación gastrointestinal.

Wegener's granulomatosis is a necrotizing granulomatous vasculitis often characterized by involvement of the upper respiratory tract, lungs and kidney, although any organic system can be affected. We present the case of a female patient with Wegener's granulomatosis diagnosed by biopsy of the kidney, and severe gastrointestinal bleeding with fatal course. Endoscopic findings of the colon and the histopathology of the biopsy are discussed.

[Caroli's syndrome: a variable entity]. / Síndrome de Caroli: una entidad variable.

We present the case of a 56 year old woman with Caroli's disease associated to congenital liver fibrosis, renal nephrocalcinosis and cutaneous vasculitis of the legs. Clinical signs of portal hypertension were treated by a shunt technique. After an asymptomatic period, the patient suffers now from crisis of angiocholitis.