Cases reported "Gastrointestinal Diseases"

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1/18. Unusual cytomegalovirus complications after autologous stem cell transplantation for large B cell lymphoma: massive gastrointestinal hemorrhage followed by a communicating hydrocephalus.

    Unusual cytomegalovirus (CMV)-related complications were seen after autologous stem cell transplantation (SCT) in a 50-year-old patient with diffuse large B cell lymphoma. One month after SCT, the patient developed life-threatening upper gastrointestinal tract (GIT) bleeding with several episodes of hemorrhagic shock. endoscopy and subsequent explorative laparotomy revealed deep-seated bleeding ulcers containing intracellular CMV inclusion bodies distributed extensively in the GIT, from the lower esophagus to the small bowel. Later, she developed gradual loss of consciousness with communicating hydrocephalus which was possibly secondary to CMV-induced ventriculitis. She recovered completely after insertion of a ventriculostomy and subsequent V-P shunt.
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2/18. GI anthrax: report of one case confirmed with autopsy.

    BACKGROUND: bacillus Anthraces is a non-motile, rod like, gram-positive and aerobic bacillus that produces central oval-shaped spores and characterized by rough, irregular and often comma-shaped colonies in blood agar. About 95% of human anthrax is cutaneous and 5% respiratory. GI anthrax, a very rare type, has been reported in less than 1% of all cases. We thus report a case of GI anthrax with autopsy findings. CASE REPORT: A 15-year-old young adult man was admitted to our hospital with history of fever, abdominal pain and bloody diarrhea from 48 hours after ingestion of half-cooked sheep's meat. In endoscopic exam of upper GI tract, the esophagus had been filled with fresh blood without any varices, stomach showed evidence of hemorrhage and had multiple erosion but no ulceration of duodenum. penicillin g 24,000,000 U/day IV was started but unfortunately severe upper and lower GI hemorrhage developed, leading to hypotension and death. In autopsy, ascites, paraaortic and mesenteric lymphadenopathy was accident with some of them being hemorrhagic. The spleen was slightly enlarged with hemorrhagic congestion in some parts of it. In the blood sample drawn from the spleen, the filamentous bacillus was successfully found. CONCLUSIONS: Because of the fatal nature of the disease and the similarity of the signs and symptoms to the other gastrointestinal diseases, we should consider it as one of the probable differential diagnosis in the patients with upper and lower gastrointestinal bleeding with fever esp. in the endemic areas.
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3/18. Mitochondrial neurogastrointestinal encephalomyopathy: evidence of mitochondrial dna depletion in the small intestine.

    BACKGROUND & AIMS: Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive disease clinically defined by gastrointestinal dysmotility, cachexia, ptosis, ophthalmoparesis, peripheral neuropathy, white-matter changes in brain magnetic resonance imaging, and mitochondrial abnormalities. Loss-of-function mutations in thymidine phosphorylase gene induce pathologic accumulations of thymidine and deoxyuridine that in turn cause mitochondrial dna (mtDNA) defects (depletion, multiple deletions, and point mutations). Our study is aimed to define the molecular basis of gastrointestinal dysmotility in a case of MNGIE. methods: By using laser capture microdissection techniques, we correlated histologic features with mtDNA abnormalities in different tissue components of the gastrointestinal wall in a MNGIE patient and ten controls. RESULTS: The patient's small intestine showed marked atrophy and mitochondrial proliferation of the external layer of muscularis propria. Genetic analysis revealed selective depletion of mtDNA in the small intestine compared with esophagus, stomach, and colon, and microdissection analysis revealed that mtDNA depletion was confined to the external layer of muscularis propria. Multiple deletions were detected in the upper esophagus and skeletal muscle. Site-specific somatic point mutations were detected only at low abundance both in the muscle and nervous tissue of the gastrointestinal tract. Analysis of the gastrointestinal tract from 10 controls revealed a non-homogeneous distribution of mtDNA content; the small intestine had the lowest levels of mtDNA. CONCLUSION: atrophy, mitochondrial proliferation, and mtDNA depletion in the external layer of muscularis propria of small intestine indicate that visceral myopathy is responsible for gastrointestinal dysmotility in this MNGIE patient.
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4/18. Gastrointestinal cryptococcosis.

    Cryptococcal infection of the gastrointestinal (GI) tract is rarely reported, either in disseminated disease or as an isolated finding. We report a case of gastric cryptococcal infection diagnosed by endoscopic biopsy as the initial presentation of the acquired immunodeficiency syndrome (AIDS), and an additional seven cases found by reviewing 23 other autopsy cases of disseminated or pulmonary cryptococcal infection. The patient with gastric cryptococcosis was a 38-year-old man who presented with symptoms of gastroesophageal reflux including odynophagia. Upper GI endoscopy showed candida esophagitis and gastric nodules. biopsy of the nodules revealed cryptococcal infection and granulomatous inflammation of the fundic mucosa and submucosa. The patient died 3 weeks later despite anti-fungal therapy. autopsy revealed widespread cryptococcal infection involving the cecum but not the stomach, suggesting that the gastric lesions resolved with therapy. The sites of infection in the seven other cases were esophagus (three), stomach (one), terminal ileum (one), colon (three), gallbladder (one), and in a focus of Kaposi's sarcoma in the wall of the small bowel (one). Esophageal candidiasis was also present in two of the cases of esophageal cryptococcal infection. Predisposing factors were AIDS (3), hematologic malignancy (3), and corticosteroid therapy (1). In summary, we report a case of gastric cryptococcosis and conclude that cryptococcal infection involves the GI tract more commonly than has been previously reported, with 8/24 (33%) cases positive in our autopsy series. Of clinical significance is the observation that GI cryptococcal infection may be the initial presentation of disseminated disease in the immunocompromised patient, and cryptococcal infection of the esophagus may be found in the setting of esophageal candidiasis.
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5/18. Tardive dyskinesia presenting as gastrointestinal disorder.

    Tardive dyskinesia is an involuntary movement disorder characterized by choreoathetoid movements, tics, grimaces, and dystonia secondary to the prolonged use of neuroleptic medication. The characteristic abnormal movements associated with tardive dyskinesia involve orofacial muscle dyskinesias as well as the limbs and trunk. Involvement of the respiratory musculature and esophagus has rarely been reported. The authors describe a case of tardive dyskinesia presenting with gastrointestinal symptoms. This case illustrates that neuroleptic side effects and the syndrome of tardive dyskinesia need to be considered in the assessment of gastrointestinal complaints in patients with long-term neuroleptic exposure.
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6/18. Gastrointestinal manifestations of mixed connective tissue disease.

    We examined the gastrointestinal tract abnormalities in 61 patients with mixed connective tissue disease. The first 34 were part of a prospective longitudinal study that included manometric and radiographic evaluation of the esophagus. heartburn (48%) and dysphagia (38%) were by far the most common gastrointestinal symptoms. Seventeen percent of patients undergoing manometry had distal esophageal aperistalsis, and 43% low-amplitude peristalsis (less than 30 mmHg). Studies in 10 patients before and after treatment suggested that esophageal dysfunction in mixed connective tissue disease may be responsive to corticosteroids. Upper esophageal sphincter hypotension was also common. One patient had marked upper esophageal sphincter hypotension and recurrent aspiration, which resolved with corticosteroid therapy. Findings on radiographic studies of the stomach and small bowel in 54 patients and barium enemas in 16 patients were reviewed. Our series included one case each of malabsorption, colonic and small bowel perforations due to vasculitis, chronic active hepatitis, and acute pancreatitis. In conclusion, any area of the gastrointestinal tract may be affected by mixed connective tissue disease, although the esophagus is the most common location. The gastrointestinal aspects of mixed connective tissue disease overlap with those of progressive systemic sclerosis, polymyositis, and systemic lupus erythematosus.
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7/18. Alimentary tract lesions in cytomegalovirus infection.

    Ten autopsy and 2 biopsy cases of cytomegalovirus (CMV) infection of the alimentary tract were studied. CMV infection was microscopically determined by the presence of cytomegalic inclusion as well as by the immunofluorescent method. Clinical manifestations such as abdominal pain, diarrhea, hematemesis, bloody stool, perforation, and/or abdominal distension with paralytic ileus were observed in 8 autopsy cases and 1 biopsy case. Disappearance of cytomegalic cells was confirmed by the follow-up study in the biopsy cases. Macroscopically, mucosal hemorrhage or ulceration was found in the gastrointestinal tract from the esophagus to the colon. Ulceration showed a characteristic well-defined punched-out appearance. The esophagus was the most frequently involved organ. However, no cytomegalic cells were found in the squamous epithelium. In the stomach, regenerated epithelial cells were frequently involved in the deeper part of glands. Numerous endothelial cells transformed into cytomegalic cells in the mucosa surrounding the ulcer in the esophagus, stomach, and intestine. ischemia caused by cytomegalic changes of vascular endothelial cells is thought to play an important role in the pathogenesis of the ulcer of the gastrointestinal tract.
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keywords = esophagus
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8/18. A familial visceral myopathy with dilatation of the entire gastrointestinal tract.

    We are reporting a new kindred in which familial visceral myopathy was identified in four siblings. There was no other symptomatic case identified in this 75-member, four-generation family, suggesting an autosomal recessive inheritance. All patients had recurrent symptoms of intestinal obstruction, and 3 died from malnutrition. Gastrointestinal lesions showed marked dilatation of the entire digestive tract from the esophagus to the rectum, which is different from other types of familial visceral myopathies. Microscopic examination of the gastrointestinal smooth muscle showed degeneration and increased fibrosis indistinguishable from other types of familial visceral myopathy.
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keywords = esophagus
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9/18. megacolon in a collagen vascular overlap syndrome.

    mixed connective tissue disease is a syndrome having clinical features of scleroderma, systemic lupus erythematosus, and polymyositis with a unique combination of clinical and laboratory findings. Not all patients with clinical features of more than one connective tissue disease fit the mixed connective disorders category; therefore, the term "overlap syndrome" is applied to patients with features of two or more connective tissue diseases. Gastrointestinal involvement in progressive systemic sclerosis is common, with the esophagus being the usual site, followed by the small bowel, colon, and stomach. Colonic involvement is reported to occur in 10 to 50 percent of cases and is typically manifested radiographically as wide-mouthed diverticular saculations. Symptoms secondary to colonic involvement are rare but occasionally serious, such as impaction of barium or feces. A case is described in which systemic lupus erythematosus coexisted with previously undiagnosed scleroderma involving predominantly the gastrointestinal tract and resulting in megacolon.
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10/18. Effects of radiation on the human gastrointestinal tract.

    radiation therapy directed at the abdomen may damage the digestive tract, the type and extent of injury depending on the dose of the radiation and the radiation sensitivity of the gut. Characteristic early changes are manifest in the mucosa of the gut: for later ulceration, changes in the collagen tissues and particularly in the vascular channels occur. This paper describes and characterizes injuries to the esophagus, stomach, small intestine and colon. It emphasizes the importance of recognizing radiation-induced damage to the gut which may occur early or late after radiation.
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