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ACG Case Reports Journal

Davinia Suárez-Flores, Paulina Moctezuma-Velázquez, Héctor Adrián Díaz-Hernández, Armando Gamboa-Domínguez, Mario Vilatobá-Chapa, Aldo Torre
No abstract text is available yet for this article.
2018: ACG Case Reports Journal
Sridhar Sundaram, Kiran S, Srijan Mazumdar, Akash Shukla
Overlap syndrome indicates the coexistence of 2 or more autoimmune liver diseases in the same individual, occurring simultaneously or sequentially. Cases of overlap of autoimmune hepatitis (AIH) with primary biliary cholangitis (PBC) and of AIH with primary sclerosing cholangitis (PSC) are known and have defined criteria for diagnosis. Overlap between PBC and PSC has been reported in only a few case reports. The cause for the rarity of this entity compared to other overlap syndromes is unclear. We present a case of an overlap syndrome of PBC with PSC in a 35-year-old woman...
2018: ACG Case Reports Journal
Natascha Silva Sandy, Elizete Aparecida Lomazi
Distal intestinal obstruction syndrome (DIOS) is a relatively common intestinal complication in cystic fibrosis (CF), and it can eventually lead to intussusception, a less frequent complication in CF. Intussusception is classically associated with gastrointestinal symptoms that overlap those of DIOS. We describe a young woman with oligosymptomatic intussusception diagnosed after resolution of DIOS symptoms.
2018: ACG Case Reports Journal
Alexander M Sy, Alla Joutovsky, David Friedel
No abstract text is available yet for this article.
2018: ACG Case Reports Journal
Debdeep Banerjee, Saikiran Raghavapuram, Nayana E George, Soheila Korourian, Faysal A Fedda, Abhilash Perisetti, Benjamin Tharian
Cholangiocarcinoma offers poor prognosis. Infrequent sites of metastasis are poorly described and often diagnostically delayed or missed. Bile duct brush cytologies provide poor diagnostic sensitivity/specificity. We present an unusual case of cholangiocarcinoma in a 34-year-old woman with rare distant metastasis to the psoas muscle and urinary bladder. It is the first case of metastatic cholangiocarcinoma presenting as linitis plastica, and our patient is the youngest to be described with metastatic cholangiocarcinoma to the psoas muscle leading to diagnosis...
2018: ACG Case Reports Journal
Debdeep Banerjee, Abhilash Perisetti, Saikiran Raghavapuram, Nayana George, Benjamin Tharian
No abstract text is available yet for this article.
2018: ACG Case Reports Journal
Matthew Woo, Michael Curley
Stercoral ulceration, an uncommon complication of constipation and fecal impaction, can present as a significant lower gastrointestinal bleed. Endoscopic management of this complication is rarely described in the literature. We describe the first documented case of an individual with massive hematochezia in the setting of stercoral ulceration being managed with Hemospray (Cook Medical, Bloomington, Indiana).
2018: ACG Case Reports Journal
Zachary Junga, Brett Theeler, Manish Singla
Infliximab is an anti-tumor necrosis factor α (TNFα) monoclonal antibody that treats moderate-to-severe Crohn's disease. In rare cases, infliximab has been associated with drug-induced aseptic meningitis. We present a 46-year-old woman with migraines and inflammatory Crohn's colitis treated with intravenous infliximab and methotrexate. She developed nuchal rigidity, photophobia, and headache 2 days after each of her infliximab infusions, with symptom resolution 1 week post-infusion. Her exam, imaging, and cerebrospinal fluid analysis were consistent with drug-induced aseptic meningitis...
2018: ACG Case Reports Journal
Evan Darwin, Amar Deshpande, Hadar Lev-Tov
Crohn's disease is difficult to manage and often requires multiple medications. While these drugs vastly improve quality of life, physicians must monitor for adverse events. We report a case of a flare of inverse psoriasis after 15 months of treatment with ustekinumab. This is the third reported case of a flare of drug-induced psoriasis with ustekinumab, and it is the first reported case with an inverse presentation; however, the clinical picture is confounded by concomitant use of hydroxychloroquine. Inverse psoriasis is a rare variant of drug-induced psoriasis of which physicians must be cognizant while treating patients with Crohn's disease...
2018: ACG Case Reports Journal
Valentine Ongeri Millien, Ashish Sharma, Shilpa Jain, Robert J Sealock
Malignancies of the gallbladder are uncommon in the developed world. Collision tumors are also extremely rare neoplastic phenomena. Given their scarcity, there are no guidelines for treatment, and prognosis is based on the more aggressive tumor type. We present a patient with a collision tumor consisting of signet-ring cholangiocarcinoma and large-cell neuroendocrine gallbladder carcinoma of the biliary tract, and we review the literature pertaining to biliary tract collision tumors and their management.
2018: ACG Case Reports Journal
Adam Daniel Gerrard, Gagandeep Thind, Ravindra Date
Primary bile duct perforation is rare in adults. It commonly results in biliary peritonitis and high morbidity and mortality. We present a 72-year-old man who was initially admitted with biochemically diagnosed pancreatitis who was found to have a bile duct perforation and bile collection limited to the lesser sac. This presented a diagnostic challenge and, due to its containment, did not result in generalized biliary peritonitis, which is usually associated with this condition. His condition was managed with stenting with endoscopic retrograde cholangiopancreatography...
2018: ACG Case Reports Journal
Sakolwan Suchartlikitwong, Pakpoom Tantrachoti, Thammasak Mingbunjerdsuk, Passisd Laoveeravat, Ariwan Rakvit
Light-chain amyloidosis is caused by deposition of immunoglobulin light chains within multiple organs, including the gastrointestinal (GI) tract. Gastrointestinal hemorrhage is a less frequent presentation. Endoscopic findings are nonspecific, and bleeding mucosal polyps are rare. We report a 59-year-old Hispanic woman with a history of gastric polyps who presented with recurrent GI hemorrhage from mucosal polyps. She had periorbital purpura and macroglossia. Biopsy of the gastric polyp confirmed amyloid deposition...
2018: ACG Case Reports Journal
Zahava C Farkas, Lavneet Chawla, Shalom Frager, Edward Esses, Yasmin Yusuf, Brad Dworkin
Cytomegalovirus (CMV)-induced pseudotumors, or mass-like lesions in the colon, are a rare entity. We report a case of CMV-related spindle cell pseudotumor in an immunocompetent patient with a left ventricular assist device. This case highlights the importance of considering CMV-induced inflammatory pseudotumor when evaluating tumorous lesions in the colon, as well as the importance of appropriate diagnostic work-up, including proper biopsy technique and meticulous review of the pathology.
2018: ACG Case Reports Journal
Brian P H Chan, Martin Hyrcza, Jennifer Ramsay, Frances Tse
Gastric duplication cysts are rare congenital anomalies, and malignant transformation has only been reported in 11 cases. A healthy 57-year-old woman presented with abdominal discomfort, and computed tomography revealed a 5.8 × 6.6 × 8.2 cm mass at the gastric fundus. On endoscopic ultrasound, the mass was mostly hypoechoic with anechoic cystic cavities arising from the submucosal layer. Fine-needle aspiration was suspicious for adenocarcinoma. Surgical pathology confirmed high-grade adenocarcinoma, clear cell cytology arising from a foregut duplication cyst...
2018: ACG Case Reports Journal
Manoj Kumar, Gilad Shapira, Alex Wiles, Caitline Marshall, Divya Nadella, Meir Mizrahi
Endoscopic ultrasound (EUS)-guided transluminal drainage of obstructed bile duct with conventional metal and plastic stents has been in practice for several years, but this modality carries its own potential complications and obstacles. Nevertheless, the novel Hot AXIOS stent (Boston Scientific Corp., Marlborough, MA) has been shown to overcome some of those factors, which justifies its application in a variety of clinical indications, such as EUS-guided choledochoduodenostomy (EUS-CDS) for biliary drainage after failed endoscopic retrograde cholangiopancreatography...
2018: ACG Case Reports Journal
Pradeep Kathi, Maher Tama, Vivek Reddy, Shankerdas Kundumadam, Omar Al-Subee, Murray N Ehrinpreis
Common variable immunodeficiency (CVID) is a heterogeneous disorder with decreased production of immunoglobulins that presents with recurrent and serious infections in ∼90% of cases. Review of the literature showed only 12 cases of gastrointestinal infection of cytomegalovirus in patients with CVID. We present an unusual case of a CVID patient presenting with new-onset hematochezia. With proper clinical suspicion and endoscopic evaluation, cytomegalovirus colitis was diagnosed and acute bleeding was successfully treated endoscopically...
2018: ACG Case Reports Journal
Yuchen Wang, Seema Gandhi, Anupam Basu, Anthonia Ijeli, Paula Kovarik, Marin Sekosan, Melchor Demetria
A pancreatic collision tumor is a rare entity that can be challenging to diagnose. We present a very rare case of a pancreatic collision tumor composed of both a neuroendocrine tumor and a ductal adenocarcinoma. Preoperative diagnosis was clinically challenging because both the radiology and fine-needle biopsy were consistent with a typical neuroendocrine mass. However, gross examination of the mass postoperatively revealed neuroendocrine cells with rare foci of ductal adenocarcinoma without a transition zone...
2018: ACG Case Reports Journal
Eiko Okimoto, Norihisa Ishimura, Mayumi Okada, Hironobu Mikami, Hiroki Sonoyama, Nahoko Ishikawa, Asuka Araki, Naoki Oshima, Junko Hirai, Shunji Ishihara, Riruke Maruyama, Yoshikazu Kinoshita
We successfully treated a 22-year-old woman with eosinophilic gastroenteritis (EGE) using a multiple food-elimination diet. The patient was diagnosed with EGE based on histopathological findings and initially treated with oral prednisolone. The symptoms immediately improved, although they recurred when prednisolone was tapered to a low dose. We then treated her with a multiple food-elimination diet, including milk, soy, eggs, wheat, nuts, seafood, and rice. During dietary treatment, we identified dairy products and eggs as causative foods of the symptoms, and we ceased prednisolone...
2018: ACG Case Reports Journal
Arif Ahmad Wani, Mohd Ilyas, Irfan Robbani, Sayar Ahmad Taley
No abstract text is available yet for this article.
2018: ACG Case Reports Journal
Michael W Winter, Amr Dokmak, Zachary Marnoy, Shweta Sinagare, Alexander N Levy
Signet-ring cell carcinoma (SRCC) is an adenocarcinoma characterized by mucin-producing cells and most commonly arises in the stomach. Colonic SRCC can share features of colitis, including long segments of concentric bowel wall thickening and ulcerated mucosa with regions of sparing. We describe a rare case of metastatic gastric SRCC mimicking Crohn's disease. Our patient underwent 2 colonoscopies, and biopsies revealed chronic active inflammation with no evidence of malignancy. The diagnosis of SRCC was only made after colectomy was performed for recurrent bowel obstruction...
2018: ACG Case Reports Journal
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