Mortality, recurrence, and hospital course of patients with systemic sclerosis-related acute intestinal pseudo-obstruction.

OBJECTIVE: Acute intestinal pseudo-obstruction is a rare gastrointestinal manifestation of systemic sclerosis (SSc) with few data existing as to its demographics, clinical course, outcomes, and mortality. METHODS: We undertook a case-control study to describe 64 cases in 37 unique patients, of whom 70% had spontaneous resolution with conservative measures of intravenous hydration and bowel rest, 9% underwent surgical resection, and 25% required prolonged total parenteral nutrition (TPN). RESULTS: Hospital course was for a mean of 12 ± 12.5 days and there was a 16% patient mortality in our population. In a subgroup analysis, patients who had recurrent episodes of pseudo-obstruction were less likely to have esophageal involvement from SSc, and more likely to need prolonged TPN. Mortality tended to be higher in male patients and patients who did not have SSc-related esophageal involvement, and also in patients who had low hemoglobin and serum albumin at presentation. The need for a nasogastric tube for decompression and a surgical intervention correlated with a more prolonged hospital stay. CONCLUSION: To the best of our knowledge, ours is the largest study looking at this rare manifestation of SSc.

Severe eosinophilic syndrome associated with the use of probiotic supplements: a new entity?

Severe eosinophilic syndromes related to the administration or use of unsuspected immunogenic substances have been described previously. Many of these diseases presented initially as clusters or isolated cases. The spanish toxic oil syndrome, the eosinophilia myalgia syndrome, and nephrogenic systemic fibrosis are examples of such diseases. We describe 2 cases of a severe eosinophilic syndrome characterized by marked peripheral blood eosinophilia (>15,000 cells/ml), mononeuritis multiplex, and necrotizing vasculitis which developed in a close temporal association with the recent onset use of nonprescription probiotics. There was no history of a prior autoimmune disease. Although both cases had prompt response to immunosuppression with rapid resolution of peripheral blood eosinophilia and accompanying constitutional symptoms, they remained with permanent neurological deficits.