Usefulness of intraoperative esophagogastroduodenoscopy in a patient with lupus enteritis.

A 19-year-old Japanese woman had melena 2 months after systemic lupus erythematosus was diagnosed. Colonoscopy showed diffuse ulceration with bleeding in the ileum, suggesting that the melena was due to ischemic enteritis associated with lupus enteritis. Because treatment with high doses of steroid, anticoagulants, and cyclophosphamide pulse was ineffective, surgical intervention was planned. On exploration, it was impossible to determine the extent of resection visually. Intraoperative esophagogastroduodenoscopy clearly revealed the border between the ulcer and normal area, permitting successful resection of the ileum and ileostomy. This is the first report to document the usefulness of esophagogastroduodenoscopy in surgical treatment of ischemic enteritis in a patient with systemic lupus erythematosus.

A case of steroid-refractory ulcerative colitis complicated with cytomegalovirus pneumonia.

We present a case of late-onset ulcerative colitis (UC) complicated with cytomegalovirus (CMV) pneumonia revealed by autopsy. A 77-year-old woman had a diagnosis of UC, and received high-dose steroids and leukocytapheresis. Then she received ganciclovir because CMV-pp65 antigenemia test revealed positive which suggested systemic or colonic CMV infection. But ganciclovir was discontinued because of thrombocytopenia and liver dysfunction. After that she had interstitial pneumonia and died of a respiratory failure. Autopsy revealed CMV colitis based on UC, and CMV pneumonia with diffuse alveolar damage. Evaluation of CMV infection in patients with steroid-refractory UC should be considered before proceeding with immunosuppressive therapy or surgery, especially in elderly patients.

Anti-calreticulin antibodies in patients with inflammatory bowel disease.

PURPOSE: Although the pathogenesis of inflammatory bowel disease (IBD) is unclear, autoimmune processes seem to play roles in IBD because several types of autoantibodies have been found in it. Calreticulin (CRT) is a soluble Ca2+ binding protein which is present in a wide variety of cells. CRT is localized mainly in the endoplasmic reticulum and is often a target for autoantibodies. The aim of this study was to evaluate the clinical significance of anti-CRT antibodies measured by enzyme-linked immunosorbent assay (ELISA) using the sera of patients with ulcerative colitis (UC) and Crohn's disease (CD). METHODS: We measured the serum anti-CRT antibodies of 31 Japanese patients with UC and 24 with CD by ELISA. The controls were 105 subjects: 30 healthy persons, 44 patients with primary biliary cirrhosis (PBC), 21 with systemic lupus erythematosus (SLE) and 10 with acute colitis (AC). RESULTS: The mean titer of anti-CRT antibodies was significantly higher in patients with UC than in healthy individuals (p <0.05). The prevalence of anti-CRT antibodies in these patients was significantly higher during the initial phase than during the passing phase (p <0.05). In patients with CD, the mean titer of anti-CRT antibodies was not significantly higher than in healthy individuals. The positivity for anti-CRT antibodies, however, was about 30% in those patients, which was as high as in patients with UC, SLE and PBC. In patients with AC, anti-CRT antibodies were all negative. CONCLUSIONS: The positivity of anti-CRT antibodies may have a diagnostic value for IBD, especially in the initial phase of UC.

HLA-B52-positive vasculo-Behçet disease: usefulness of magnetic resonance angiography, ultrasound study, and computed tomographic angiography for the early evaluation of multiarterial lesions.

We report a case of HLA-B52-positive Behçet disease accompanied by multiarterial lesions. A 24-year-old woman was suffering from sporadic high fever and recurrent oral and genital ulcers, and laboratory data revealed severe inflammation. A diagnosis of Behçet disease was made. Magnetic resonance angiography, ultrasound study, and computed tomographic angiography demonstrated multiarterial lesions that had caused no symptoms. These noninvasive examinations were extremely useful in evaluating asymptomatic early vascular lesions.

Hepatocellular carcinoma associated with Wilson's disease.

A 23-year-old man was admitted to our department due to hemorrhage from gastric varices. He had been diagnosed as having Wilson's disease at the age of 17. Abdominal ultrasonography and computed tomography (CT) showed portal thrombosis and a large mass occupying most of the right lobe in the liver. The tumor was diagnosed as hepatocellular carcinoma (HCC) by image views and tumor markers. He died 3 months after the diagnosis, and an autopsy was performed. Histologic examination of the tumor showed moderately to poorly differentiated HCC. The nontumorous lesion of the liver revealed cirrhosis. HBX-DNA sequence was not detected in the liver. Hepatic cirrhosis is a well-recognized complication of Wilson's disease, but HCC is extremely rare. We describe the clinical findings of this patient and discuss the relationship of the development of HCC with a review of the relevant literature.

Ulcerative colitis occurring in the course of rheumatoid arthritis: a case successfully treated with mesalamine enema.

We report a case of ulcerative colitis (UC) that occurred during the course of rheumatoid arthritis (RA). A 29-year-old woman with a 25-year history of RA was hospitalized for high fever, abdominal pain and hematochezia. Colonoscopy revealed erosive and reddish mucosa from the distal transverse colon to rectum. Histology revealed cryptitis (mainly caused by neutrophils), mild crypt abscess and goblet cell depletion. She was diagnosed with left-sided UC and treated with mesalamine enema. The abdominal symptoms and colonoscopic findings were greatly ameliorated. We conclude that the mesalamine enema was effective in this case of UC occurring during the course of RA.