1/8. Tuberculous pleurisy: an unusual complication during treatment of crohn disease with azathioprine.A patient is presented with crohn disease who developed tuberculous pleurisy while treated with azathioprine. The prevalence of opportunistic infections is discussed in patients with inflammatory bowel disease and treated with immunosuppressive regimes.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
2/8. Post-liver transplant Crohn's disease: graft tolerance but not self-tolerance?Inflammatory bowel disease (IBD) rarely occurs de novo after liver transplantation, and when it does usually presents as ulcerative colitis in patients transplanted for primary sclerosing cholangitis. We present two patients who developed de novo Crohn's colitis two and three years after liver transplant for primary biliary cirrhosis (PBC) and chronic hepatitis b infection, respectively. Both were on maintenance immunosuppression with a calcineurin inhibitor and azathioprine with no evidence of allograft rejection. Investigations for enteric and opportunistic infection were negative. In the nontransplant setting, the development of IBD is likely multifactorial with an immune origin. In our cases, the immunosuppression was titrated to minimal levels when IBD developed. Clearly, although a significant degree of allograft tolerance can occur, autoimmune diseases can still develop elsewhere, suggesting selective immune tolerance.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
3/8. Chronic granulomatous disease caused by a deficiency in p47(phox) mimicking Crohn's disease.We describe 2 cases of autosomal recessive chronic granulomatous disease (CGD) in 2 sisters presenting with a picture consistent with inflammatory bowel disease. The index case is a 10-year-old girl with a history of refractory Crohn's colitis treated with aggressive immunosuppressive therapy whose course subsequently was complicated by central nervous system aspergillosis. Additional evaluation showed a diagnosis of CGD, an underlying immunodeficiency in which phagocytes fail to produce microbicidal reactive oxygen intermediates because of inherited defects in the reduced form of nicotinamide-adenine phosphate dinucleotide (NADPH) oxidase. The diagnosis of a typically X-linked inherited disease in our female patient suggested that she had 1 of the 3 less common autosomal recessive forms of the disease. This was confirmed by studies showing the absence of the p47(phox) subunit of nadph oxidase in her neutrophils and the presence of a homozygous dinucleotide deletion in the neutrophil cytosolic factor 1 gene that encodes p47(phox). Additional analyses of members of the patient's immediate family showed the same homozygous mutation in 2 siblings, 1 of whom also developed chronic colitis consistent with a diagnosis of Crohn's disease. These 2 cases emphasize the importance of high clinical suspicion for an alternative diagnosis of immune deficiency in the setting of presumed inflammatory bowel disease and opportunistic infection.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
4/8. Cutaneous nocardiosis complicating management of Crohn's disease with infliximab and prednisone.Infliximab is a chimeric anti-tumour necrosis factor-alpha antibody that is efficacious in treating Crohn's disease. However, its immunomodulatory properties increase susceptibility to opportunistic infections. We present a case of cutaneous nocardia infection in a patient who was taking infliximab for Crohn's disease. The case illustrates the challenges in the diagnosis and management of this disease and serves as a reminder of the complications associated with the use of immunomodulatory agents.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
5/8. Disseminated aspergillosis following infliximab therapy in an immunosuppressed patient with Crohn's disease and chronic hepatitis c: a case study and review of the literature.A 55-year-old white woman with a greater than 25-year history of Crohn's disease developed disseminated aspergillosis following combination therapy with methylprednisolone, azathioprine, and infliximab. The patient was hospitalized 11 days after initiation of infliximab for respiratory symptoms and developed respiratory failure, coma, and died. Postmortem examination revealed disseminated aspergillus fumigatus involving multiple organs. This case demonstrates that combined treatment with infliximab, methylprednisone, and azathioprine may induce severe immunosuppression and depressed cellular immunity, leading to severe opportunistic infections. Given the increasing use of antitumor necrosis factor agents, physicians should be aware of the risk of opportunistic infections and be vigilant about diagnosing and aggressively treating these infections to reduce the risk of disseminated disease.- - - - - - - - - - ranking = 2keywords = opportunistic infection (Clic here for more details about this article) |
6/8. Terminal ileitis associated with cytomegalovirus and the acquired immune deficiency syndrome.A 41-yr-old homosexual male had cytomegalovirus infection localized to the terminal ileum as his initial and sole evident opportunistic infection due to the acquired immune deficiency syndrome. The symptoms, signs, roentgenographic findings, and appearance at surgery were suggestive of Crohn's disease. The pathogen was identified only by microscopic examination of bowel resected during a second laparotomy. The terminal ileum had profound mucosal ulceration and transmural fibrosis without granulomas. This novel report suggests that cytomegalovirus infection should be carefully searched for in immunocompromised patients presenting with clinical features suggesting Crohn's disease.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
7/8. Atypical presentation of childhood acquired immune deficiency syndrome mimicking Crohn's disease: nutritional considerations and management.A child with acquired immune deficiency syndrome became severely malnourished presumably as a result of multiple gastrointestinal infections, with numerous organisms including campylobacter, giardia, and cryptosporidium. These opportunistic infections preceded laboratory evidence of immune deficiency. Despite severe diarrhea and marked weight loss, there was no laboratory evidence of significant malabsorption. By using nasogastric feedings, we were successful in promoting a 60% weight gain, and a rise in serum albumin from 1.2 to 4.3 g/dl. While eventual outcome was not altered, this particular patient's clinical course was improved. We suggest that malnutrition should not be accepted as inevitable and that malabsorption should not be assumed in similar acquired immune deficiency syndrome patients. Appropriate studies for malabsorption should be done, and high caloric enteral feedings should be used whenever feasible.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
8/8. Human immunodeficiency virus infection and Crohn's disease: the role of the CD4 cell in inflammatory bowel disease.Crohn's disease is believed to have an immunologic basis. The importance of the CD4 cell in particular has been supported by several reports of patients whose symptoms of Crohn's disease resolved after a decline in CD4 count associated with human immunodeficiency virus (hiv) infection. A patient with known Crohn's disease, however, who was later infected with hiv, was reported to continue to have symptomatic Crohn's disease despite an eventual decrease in CD4 count to 84/mm3. We report the new onset of Crohn's disease in an hiv-infected patient with a CD4 count of 100/mm3. This report is the first to document the new onset of Crohn's disease in a patient with hiv and a CD4 count in the range commonly associated with various opportunistic infections and neoplasms. In addition, it is the first to confirm the recent finding that Crohn's disease may be active despite the profound immune deficiency associated with advanced hiv infection. Thus this report further challenges the significance of the CD4 cell in the pathogenesis of Crohn's disease.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |