Cases reported "Duodenal Diseases"

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1/13. Pseudomelanosis duodeni: case report.

    Pseudomelanosis duodeni is a rare benign condition. It manifests endoscopically as discrete, flat, small brown-black spots in the duodenal mucosa. It produces no symptoms and may be reversible. The cause and natural history of the pigmentation have not been clarified, although it is associated with a variety of systemic illnesses and medications. With electron microscopy and electron-probe energy dispersive X-ray analysis, the pigment corresponds principally to an accumulation of ferrous sulfide (FeS) in macrophages within the lamina propria. We report the case of a 56-year-old female patient with a past history of diabetes mellitus and hypertension. She was admitted because of nausea, vomiting, and diarrhea and underwent esophagogastroduodenoscopy because of stool occult blood test results of 3 . endoscopy revealed diffusely scattered black spots in the bulb and second portion of the duodenum. Histological examination showed numerous pigment-laden macrophages in the lamina propria of mucosal villi. The diagnosis requires further confirmation by electron microscopy and electron-probe energy dispersive X-ray microanalysis. No special therapy is indicated for this rare lesion.
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2/13. A microsporidian previously undescribed in humans, infecting enterocytes and macrophages, and associated with diarrhea in an acquired immunodeficiency syndrome patient.

    To date, the only microsporidian that has been associated with diarrhea and weight loss in acquired immunodeficiency syndrome patients is the newly identified enterocytozoon bieneusi. A second species is now described that was associated with intestinal symptoms in a 32-year-old, human immunodeficiency virus- seropositive, Native American male homosexual. Stool studies and routine light microscopy of multiple small intestinal biopsies that showed atrophy with acute and chronic inflammation were without apparent pathogens. light microscopy of semi-thin plastic sections, cytochemical stains of paraffin sections, and ultrastructural studies revealed extensive microsporidial infection of enterocytes and submucosal macrophages. No other pathogens were identified. Unlike E bieneusi, this microsporidian appeared to develop within septated parasitophorous vacuoles, and lacked polar disks and clear clefts. It most closely resembled, but was distinguishable from, members of the genus encephalitozoon. awareness of the microsporidia as potential opportunists in acquired immunodeficiency syndrome patients is increasing the incidence of identification of these organisms.
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3/13. Unusual duodenal presentation of leishmaniasis.

    This case report describes an atypical case of duodenal leishmaniasis in an elderly patient not infected with human immunodeficiency virus. Investigation of this 84 year old woman with a constitutional syndrome and dysphagia revealed anaemia of chronic disorder, a high erythrocyte sedimentation rate, and polyclonal hypergammaglobulinaemia. Abdominal ultrasonography revealed thickening of the stomach wall, which was seen to be inflamed during gastroscopy. Duodenal histology revealed numerous leishmania amastigotes within macrophages. This was confirmed by bone marrow biopsy and leishmania serology. This case report stresses the importance of atypical symptoms and the unusual location of visceral leishmaniasis, not only in immunodepressed patients, but also in elderly immunocompetent patients.
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4/13. Pseudomelanosis duodeni: a case report with electron-probe X-ray analysis.

    Pseudomelanosis of the duodenum is rare. Only 17 cases have been documented in the world literature. A 59-year-old man presented to Bankstown Hospital, new south wales with dysphagia. On endoscopy, he was found to have melanosis of the duodenum in addition to oesophageal ulceration. It has been previously suggested that the pigment ferrous sulphide is derived from gastro-intestinal bleeding and lodged in the macrophages. A detailed examination of the pigment, including X-ray probe micro-analysis at various levels of the intestinal epithelium as well as in macrophages is presented.
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5/13. clofazimine induced enteropathy--a case highlighting the importance of drug induced disease in differential diagnosis.

    A patient on treatment for multibacillary leprosy for the past three years, presented with episodes of abdominal pain. Since the patient improved with conservative management, clofazimine induced enteropathy was considered as a remote possibility. A review of the mucosal biopsies showed macrophages with crystal-storing spaces consistent with clofazimine deposition in the duodenum. This case highlights the need to consider and investigate drug-induced disease as part of the differential diagnosis.
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6/13. endoscopy in the diagnosis of gastrointestinal mycobacterium avium-intracellulare infection.

    Two cases of mycobacterium avium-intracellulare (MAI) infection in association with acquired immunodeficiency syndrome (AIDS) are presented to highlight the distinctive upper gastrointestinal endoscopic appearances: 2 X 4 mm diameter, white nodules with intervening erythema and hemorrhagic erosions covered the mucosa of the second part of the duodenum. Histological evaluation of these nodules revealed diffuse expansion of the lamina propria by macrophages that contained numerous intracellular and extracellular acid-fast organisms. We conclude that endoscopy with endoscopic biopsy may represent the most rapid and sensitive diagnostic tool available in this disease.
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7/13. Pseudomelanosis of the duodenum. Endoscopic, histologic, and ultrastructural study of a case.

    We present the endoscopic, microscopic, and histochemical studies of a patient with pseudomelanosis of the duodenum. The pigment was located mainly in the lysosomes of macrophages in the lamina propria and was heterogeneous, showing features of melanin, pseudomelanin, and hemosiderin. The origin of this pigment remains unknown, but antihypertensive medication may have played a role.
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8/13. Intestinal infection with Mycobacterium avium in acquired immune deficiency syndrome (AIDS). Histological and clinical comparison with Whipple's disease.

    At endoscopy, a 30-year-old man with acquired immune deficiency syndrome (AIDS), Kaposi's sarcoma, diarrhea, and unexplained malabsorption showed erythematous macular duodenal lesions consistent with Whipple's disease by histology and electron microscopy. Symptoms did not respond to tetracycline. Subsequent cultures revealed systemic Mycobacterium avium (M. avium) infection. Tissue from this patient, from patients with Whipple's disease and from a macaque with M. avium were compared. All contained PAS-positive macrophages but M. avium could be distinguished by positive acid-fast stains and a difference in pattern of indirect immunofluorescence staining with bacterial typing antisera. PAS-positive macrophages in the intestinal lamina propria are no longer pathognomonic of Whipple's disease. Ultrastructural and histological similarities between Whipple's disease and M. avium infection suggest that both are manifestations of immune deficits limiting macrophage destruction of particular bacteria after phagocytosis. M. avium must be considered in the differential diagnosis of diarrhea in patients with AIDS and other immunosuppressed conditions.
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9/13. Further characterization of the pigment in pseudomelanosis duodeni in three patients.

    Pseudomelanosis duodeni is a rare condition in which dark pigment accumulates in macrophages located in the lamina propria of the duodenal mucosa. Three cases are reported here and the literature is reviewed. No clinical association can be found that points clearly to the underlying etiology. Electron probe x-ray microanalysis was used to study the pigment in macrophage granules in 2 of our patients and demonstrated high iron and sulfur content. iron accumulation in ferritinlike particles was detected in absorptive cell lysosomes. A possible mechanism for the accumulation of absorbed iron by macrophages is considered.
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10/13. Ultrastructure and electron-probe x-ray analysis of the pigment in melanosis duodeni.

    A patient with peptic ulceration developed melanosis duodeni, which was studied by light microscopy, histochemistry, electron microscopy and electron-probe x-ray analysis. Our studies show that the pigment in melanosis duodeni resides in the lysosomes of macrophages in the lamina propria. The pigment is not melanin or a melanin-like compound as has been claimed by previous workers. On the basis of electron-probe x-ray analytical findings we have concluded that the pigment is essentially FeS. On the basis of the history of this patient and cases reported in the literature we think that the Fe in this pigment is derived from haemorrhage in the gastrointestinal tract. We also found small amounts of Ca, K, Al, Mg, Si, and Ag. It would appear that Al, Mg and Si were probably derived from the biological milieu and/or other drugs and/or food and/or specimen contamination.
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