Case Rep Gastroenterol
· 2025 · PMID 40556638
·
Full text
INTRODUCTION: Trichobezoar is an aggregation of swallowed hair strands that entangle in the stomach. It presents with abdominal pain, vomiting, and diarrhea. Diagnosis is usually made by imaging and endoscopy. Surgical r...INTRODUCTION: Trichobezoar is an aggregation of swallowed hair strands that entangle in the stomach. It presents with abdominal pain, vomiting, and diarrhea. Diagnosis is usually made by imaging and endoscopy. Surgical removal is typically required, but endoscopic retrieval has been successful. Fecal calprotectin is a biomarker of inflammation that is typically elevated in inflammatory bowel disease (IBD) but is also elevated in other gastrointestinal (GI) disorders such as infections. Trichobezoar is not known to precipitate GI inflammation and has never been reported among the etiologies of elevated fecal calprotectin. Herein is a case presenting with vague abdominal pain and elevated fecal calprotectin that was attributed solely to a trichobezoar. CASE PRESENTATION: A 7-year-old girl presented with abdominal pain for 6 months associated with occasional vomiting and diarrhea. Family history was positive for ulcerative colitis. Physical examination was unremarkable including normal growth. Diagnostic workup revealed elevated fecal calprotectin at 433.9 mg/kg. Upper and lower endoscopies were performed. A trichobezoar with Rapunzel syndrome was incidentally found in the stomach extending into the duodenum without frank obstruction. Histology showed reactive gastropathy in a few areas of mechanical rubbing by hair strands; otherwise, it was completely unremarkable in both upper and lower GI biopsies. Endoscopic retrieval of piecemeal hair locks was done. Surgical removal was subsequently done due to the generous size of the mass. CONCLUSION: Fecal calprotectin is an important biomarker for IBD, as well as other unusual GI pathologies, and clinical context is crucial when interpreting its value.
Case Rep Gastroenterol
· 2025 · PMID 40546296
·
Full text
INTRODUCTION: Vesico-peritoneal fistula (VPF) is an uncommon type of fistula in the urogenital tract and a rare cause of ascites. CASE PRESENTATION: Although VPF mainly occurs as an early postoperative complication of gy...INTRODUCTION: Vesico-peritoneal fistula (VPF) is an uncommon type of fistula in the urogenital tract and a rare cause of ascites. CASE PRESENTATION: Although VPF mainly occurs as an early postoperative complication of gynecological surgery, we report a case of a 71-year-old female patient who presented with ascites, pseudo-renal failure, and peritonitis caused by a VPF as a delayed complication of radiotherapy. CONCLUSION: In this case report, we discuss treatment strategies based on previously published case studies and our experience. We provide a diagnostic overview of commonly available imaging techniques, such as computed tomography scans and magnetic resonance imagings. Despite their widespread use, these imaging modalities have not led to any shift in the diagnostic process, with the definitive diagnosis being confirmed only by retrograde cystography.
Kreidieh M, Mobarakai N, Andrawes S
… +4 more, Colef R, Kreidieh L, Al Moussawi H, Chalhoub JM
Case Rep Gastroenterol
· 2025 · PMID 40546295
·
Full text
INTRODUCTION: The Strongyloidae family includes at least fifty species of intestinal nematode worms, and is the most prevalent one among humans. As a result of this parasite's complex lifecycle, it can either remain loc...INTRODUCTION: The Strongyloidae family includes at least fifty species of intestinal nematode worms, and is the most prevalent one among humans. As a result of this parasite's complex lifecycle, it can either remain localized in the intestines or disseminate to different organs throughout the body, culminating in hyperinfection in case of immunosuppression. Strongyloidiasis is rarely encountered in the USA, and an associated gastric involvement is uncommon. CASE PRESENTATION: In this case report, we describe the case of an asymptomatic and immunocompetent Liberian patient with gastroduodenal strongyloidiasis whose diagnosis was based on histologic findings during endoscopic evaluation for iron deficiency anemia. CONCLUSION: This case sheds light on the importance of suspecting the diagnosis of disseminated strongyloidiasis in high-risk individuals with iron deficiency anemia in combination with peripheral eosinophilia.
Case Rep Gastroenterol
· 2025 · PMID 40535309
·
Full text
INTRODUCTION: Spinal cord stimulation (SCS) for chronic abdominal pain is not novel. However, this has been explored only when the pain has a clear dermatomal association such as the right upper quadrant for sphincter of...INTRODUCTION: Spinal cord stimulation (SCS) for chronic abdominal pain is not novel. However, this has been explored only when the pain has a clear dermatomal association such as the right upper quadrant for sphincter of Oddi dysfunction or the left upper quadrant for post-traumatic splenectomy. The present report thereby discusses the utility of SCS when the visceral pain is diffusely distributed across all four quadrants of the abdomen. CASE PRESENTATION: A patient in their 70s presented with a 30-year history of chronic abdominal pain diffusely located in all four quadrants. The patient had a pancreatic cyst removed via pancreaticoduodenectomy in 1991 complicated by chronic pancreatitis and visceral hyperalgesia. After failed pharmacological management and various outpatient nerve blocks and trigger point injections, the patient underwent SCS placement via five 4-contact paddle leads at the mid- to superior thoracic 7 level. At 1-month follow-up, the patient's visual analog scale score decreased from 8/10 (prior to implantation) to 0/10. The patient also discontinued his chronic opioid regimen post-SCS placement but continued duloxetine. Device settings remained the same throughout the postoperative period: pulse width of 500 microseconds (inter-burst) and 1,000 microseconds, frequency of 40 Hertz, and current of 1.7 milliamperes. At 12-month follow-up, the patient continued to report >90% pain relief at nearly the same SCS settings as the initial programming. CONCLUSION: SCS may be a reliable treatment option for chronic abdominal, visceral hyperalgesia when the pain is diffusely located in all 4 quadrants and without a clear dermatomal pattern.
Case Rep Gastroenterol
· 2025 · PMID 40529631
·
Full text
INTRODUCTION: The purpose of this single subject study was to describe the dysphagia presentation, treatment course, and post-treatment swallowing function in a patient with chronic dysphagia after anterior cervical disc...INTRODUCTION: The purpose of this single subject study was to describe the dysphagia presentation, treatment course, and post-treatment swallowing function in a patient with chronic dysphagia after anterior cervical discectomy and fusion (ACDF) surgery. CASE PRESENTATION: An 83-year-old male experienced dysphagia >2 months post-ACDF. The patient presented with a narrowed pharyngoesophageal segment due to cervical hardware and reduced epiglottic inversion due to pharyngeal narrowing on videofluoroscopic swallow study (VFSS). He completed dysphagia therapy using neuromuscular electrical stimulation (NMES). Structural alterations and a complicated medical course after treatment impacted therapeutic outcomes. Reductions in penetration or aspiration and improved hyoid excursion were found post-treatment, though impairment persisted. The patient ended therapy after the post-treatment VFSS and began to experience odynophagia and submental pain. The patient experienced a complicated post-treatment course including bilateral cancerous masses at the base of tongue with subsequent surgery and chemoradiation. CONCLUSIONS: While considered rare, these findings present a post-operative course of chronic dysphagia post-ACDF surgery where morphological changes to the pharynx significantly altered swallowing function. Swallowing function should be tracked routinely and longitudinally in post-ACDF surgery patients. NMES may be a potential dysphagia therapy modality to explore.
Altork N, Fischer MP, Cheraghvandi L
… +1 more, Thomas AM
Case Rep Gastroenterol
· 2025 · PMID 40529630
·
Full text
INTRODUCTION: Hepatitis E virus (HEV) is a global cause of acute viral hepatitis, for which there is currently no FDA-approved medication. This case report describes a unique instance of a healthy US female presenting wi...INTRODUCTION: Hepatitis E virus (HEV) is a global cause of acute viral hepatitis, for which there is currently no FDA-approved medication. This case report describes a unique instance of a healthy US female presenting with acute HEV, who was treated with ribavirin to address her acute liver injury. CASE PRESENTATION: A 36-year-old US female, nonpregnant, without liver disease, developed nonspecific symptoms post-travel to Indonesia, leading to acute liver injury with concern for failure. Liver biopsy showed severe hepatocellular necrosis (>50%) with mixed infiltrate; HEV PCR was positive (93,700,000 IU/mL) [Am J Gastroenterol. 2024;119(10S):S2872-3]. After risk-benefit analysis, ribavirin treatment resolved symptoms and normalized biomarkers in a month, avoiding emergency transplantation. CONCLUSION: HEV infection should be considered in acute liver injury cases in the US, especially with exposure risks. Ribavirin's role in acute cases warrants further study, potentially averting major morbidity and mortality.
Case Rep Gastroenterol
· 2025 · PMID 40529629
·
Full text
INTRODUCTION: Splenic artery aneurysm (SAA) is a rare but potentially life-threatening condition. SAA can occur following an acute or chronic pancreatitis as a pseudoaneurysm, iatrogenic (post-pancreatic/splenic surgery)...INTRODUCTION: Splenic artery aneurysm (SAA) is a rare but potentially life-threatening condition. SAA can occur following an acute or chronic pancreatitis as a pseudoaneurysm, iatrogenic (post-pancreatic/splenic surgery) or post-traumatic. If symptomatic, it needs to be treated urgently as it has a high risk of rupture. CASE PRESENTATION: Here is a case where a ruptured aneurysm presented in an unusual manner: first as an acute abdomen and second, delayed, as hemorrhagic shock. Only emergency laparotomy and splenectomy saved the patient's life. CONCLUSION: If a splenic artery pseudoaneurysm is detected on CT scan, there is an increased risk of rupture irrespective of the size and the patient that should be proactively managed. Concomitant abdominal findings and diseases can delay diagnosis and underestimate the risk.
Case Rep Gastroenterol
· 2025 · PMID 40519994
·
Full text
INTRODUCTION: There is an increased incidence of opioid use disorder (OUD) originating from prescription misuse. Diagnosing OUD remains challenging, particularly in patients with multiple medical comorbidities where othe...INTRODUCTION: There is an increased incidence of opioid use disorder (OUD) originating from prescription misuse. Diagnosing OUD remains challenging, particularly in patients with multiple medical comorbidities where other potential etiologies may cause overlapping symptoms. CASE PRESENTATION: This report highlights a 28-year-old male with Crohn's disease (CD) with recurrent hospitalizations of abdominal pain, hematuria, nausea, vomiting, and diarrhea. An extensive workup was negative for a Crohn's flare; however, the patient's symptoms improved within 48 h of admission, coinciding with opioid administration for pain management. Subsequently, the patient was diagnosed with opioid withdrawal and discharged with a buprenorphine clinic appointment to initiate medications for OUD. CONCLUSION: This case highlights the complexity of diagnosing opioid withdrawal in a patient with CD and the persistent stigma in the healthcare community regarding persons who use opioids.
Alexander RG, Cheville JC, Thompson GB
… +1 more, Alexander GL
Case Rep Gastroenterol
· 2025 · PMID 40503451
·
Full text
INTRODUCTION: Hypergastrinemia in a patient with refractory reflux, steatorrhea, or peptic ulcer disease with a gastric pH <4 is concerning for Zollinger-Ellison syndrome (ZES), but antral G-cell hyperplasia can also pre...INTRODUCTION: Hypergastrinemia in a patient with refractory reflux, steatorrhea, or peptic ulcer disease with a gastric pH <4 is concerning for Zollinger-Ellison syndrome (ZES), but antral G-cell hyperplasia can also present in this manner and is distinguished from ZES based on negative radiographic studies and secretory stimulation testing with a typical gastrin response to a standardized test meal. CASE PRESENTATION: A 51-year-old female with a history of a Nissen fundoplication for refractory reflux presented with a 3-month history of heartburn, diarrhea, and 55-pound weight loss. Evaluation included negative upper and lower endoscopies with biopsies and negative MR enterography. A 48-h fecal fat study revealed 501 g of stool and 51 g of fat per 24 h. A serum gastrin level off PPI was elevated at 589 pg/mL with a gastric pH of 2 on gastric aspirate. An EUS, DOTATATE PET scan, and secretin stimulation test were negative for ZE. A standardized test meal with serial gastrin monitoring demonstrated an 8-fold increase in serum gastrin. Open abdominal exploration and intraoperative ultrasound showed no evidence of a gastrinoma and an antrectomy and Billroth II anastomosis was performed in treatment of G-cell hyperplasia. Pathology demonstrated a moderately increased G-cell population. Postoperatively, her hypergastrinemia and steatorrhea resolved and she regained 60 pounds. CONCLUSION: Antral G-cell hyperplasia should be considered in patients with symptoms suggestive of gastrinoma with negative secretin stimulation testing and imaging studies. A standardized test meal demonstrates a substantial increase in serum gastrin levels and antrectomy is the treatment of choice for refractory symptoms.
Case Rep Gastroenterol
· 2025 · PMID 40503450
·
Full text
INTRODUCTION: Curcumin and QingDai (QD, indigo) are two herbal extracts used in traditional medicine. A combination of curcumin with QD (CurQD) was reported to be effective in ulcerative colitis, but its effectiveness in...INTRODUCTION: Curcumin and QingDai (QD, indigo) are two herbal extracts used in traditional medicine. A combination of curcumin with QD (CurQD) was reported to be effective in ulcerative colitis, but its effectiveness in Crohn's disease (CD) is unknown. We report on the use of CurQD for the treatment of CD. CASE PRESENTATION: The patient was a 35-year-old male with colonic and perianal CD responsive to infliximab therapy, who had to discontinue therapy due to a concomitant cardiomyopathy diagnosis. After cessation of infliximab treatment, he experienced clinical and endoscopic relapse which responded to initiation of CurQD therapy with regained clinical and endoscopic remission. CONCLUSION: In summary, the present case report describes, for the first time, a possible benefit of CurQD nutraceutical in the induction and maintenance of remission in a Crohn's patient. However, more data, preferably from adequately powered randomized controlled trials, are needed to corroborate these observations.
Li WB, Xue Z, Shi W
… +8 more, Wang LB, He XJ, Wang C, Zhao G, Kong LH, Pu M, Liu CL, Kong YL
Case Rep Gastroenterol
· 2025 · PMID 40492176
·
Full text
INTRODUCTION: For aviation personnel, calculous cholecystitis often requires surgical treatment because of the potential risks to flight safety whether symptomatic or asymptomatic. Although much effort has been put on th...INTRODUCTION: For aviation personnel, calculous cholecystitis often requires surgical treatment because of the potential risks to flight safety whether symptomatic or asymptomatic. Although much effort has been put on the precaution of gallstone formation, the incidence of long-term post-cholecystectomy syndrome (PCS) seems more apparent in the limited number of cases undergoing cholecystectomy. The purpose of article was to elucidate the possible mechanism of gallstone formation and the development of long-term PCS caused by variations of bile duct, as well as choice of surgical treatments, just in this particular group of aviation personnel. CASE PRESENTATION: Seven aviation pilots who underwent laparoscopic cholecystectomy in recent 5 years were reviewed, and 3 cases who developed long-term PCS because of variations of bile duct were presented. Variations of bile duct included existence of accessory extrahepatic bile, absence of common bile duct, and absence of cystic duct. Long-term PCS was characterized as epigastric dull pain and diarrhea or sparse stool, and became aggravated when resuming trainings of flight stimulations. Dietary adjustment and oral antispasmodic or cholagogic drug therapy, combined with relieving apprehensions after surgery, helped them recover well and resume flight. CONCLUSION: Variation of bile duct may be an important potential risk for gallstone formation and development of long-term PCS with the cause of probable decrement of bile drainage under the physiological environment of aviation.
Stoeckli L, Koster M, Tuerkmen-Uthayanan T
… +2 more, Cogliatti S, Brand S
Case Rep Gastroenterol
· 2025 · PMID 40487080
·
Full text
INTRODUCTION: Sartan-induced enteropathy is an uncommon side effect of treatment with angiotensin II receptor antagonists (ARBs), which has predominantly been described for olmesartan. CASE PRESENTATION: For the first ti...INTRODUCTION: Sartan-induced enteropathy is an uncommon side effect of treatment with angiotensin II receptor antagonists (ARBs), which has predominantly been described for olmesartan. CASE PRESENTATION: For the first time, we describe sartan-induced enteropathy as an adverse drug reaction associated with azilsartan in a 74-year-old male patient who was admitted to the hospital twice within 5 months because of excessive non-bloody diarrhea and weight loss. In this case, histopathological findings of intraepithelial lymphocytosis and intestinal villous atrophy resembled celiac disease; however, celiac disease-specific antibodies remained negative, and a gluten-free diet did not result in significant clinical recovery, while symptoms stopped rapidly after stopping azilsartan. When the patient was seen 5 months later, he was free of clinical symptoms, and histological changes disappeared after stopping azilsartan. CONCLUSION: This case illustrates sprue-like enteropathy as a potential side effect of azilsartan, emphasizing to consider this differential diagnosis in ARB-treated patients with chronic diarrhea. The causality of our findings was confirmed by drug de-challenge and re-challenge resulting in typical histological changes.
Noda K, Ohno H, Naito K
… +3 more, Shirakabe K, Muramatsu H, Funakoshi H
Case Rep Gastroenterol
· 2025 · PMID 40476148
·
Full text
INTRODUCTION: Gallstone ileus is rare but with high mortality. Although gallstone ileus usually requires urgent enterolithotomy, cholecystectomy, and fistula closure, we present a case of recurrent gallstone ileus treate...INTRODUCTION: Gallstone ileus is rare but with high mortality. Although gallstone ileus usually requires urgent enterolithotomy, cholecystectomy, and fistula closure, we present a case of recurrent gallstone ileus treated with enterolithotomy alone. CASE PRESENTATION: A 69-year-old female presented to the emergency department with nausea, emesis, and abdominal pain. After computed tomography revealed the diagnosis of gallstone ileus, enterolithotomy was performed without postoperative complications. Cholecystectomy and fistula closure were not performed due to inaccessibility to the gallbladder and the high surgical invasion required. Four months later, the patient developed gallstone ileus again. A second enterolithotomy was performed immediately, resulting in a favorable outcome without complications. CONCLUSION: In managing gallstone ileus, particularly in cases with surgical limitations, a less invasive strategy could be a reasonable option.
Case Rep Gastroenterol
· 2025 · PMID 40469247
·
Full text
INTRODUCTION: Ulcerative colitis is a chronic inflammatory disease affecting the colon. Anti-tumor necrosis factor-alpha drugs are a cornerstone of management in ulcerative colitis both in induction and maintenance of re...INTRODUCTION: Ulcerative colitis is a chronic inflammatory disease affecting the colon. Anti-tumor necrosis factor-alpha drugs are a cornerstone of management in ulcerative colitis both in induction and maintenance of remission. Thrombocytopenia is a rare side effect of these drugs. CASE PRESENTATION: We present a case of infliximab-induced immune thrombocytopenic purpura in a 34-year-old female ulcerative colitis patient. CONCLUSION: Infliximab can be a cause of drug-induced immune-related thrombocytopenia and patient's platelet counts should be regularly monitored. In patients with severe thrombocytopenia and having been recently commenced on infliximab, prompt referral to hematology specialty is essential.
Lehner M, Heinrich H, Baumgartner B
… +2 more, Heye T, Zimmerli M
Case Rep Gastroenterol
· 2025 · PMID 40444062
·
Full text
INTRODUCTION: Biliary stenting is commonly used for managing bile duct conditions, with stent migration occurring in up to 21% of cases. Colonic perforation from stent migration is rare, typically managed surgically or w...INTRODUCTION: Biliary stenting is commonly used for managing bile duct conditions, with stent migration occurring in up to 21% of cases. Colonic perforation from stent migration is rare, typically managed surgically or with conventional endoscopic clips. The use of over-the-scope clips (OTSCs) for such perforations is less documented. CASE PRESENTATION: An 89-year-old multimorbid woman presented with abdominal pain and new-onset constipation. Imaging revealed a migrated biliary stent causing sigmoid colon perforation. One year earlier, the stent had been placed for choledocholithiasis. Endoscopic removal of the stent and OTSC closure of the perforations were successfully performed, with no complications on follow-up. CONCLUSION: This case demonstrates the successful use of OTSCs for closing a chronic colonic perforation caused by a migrated biliary stent. OTSCs may be a viable, less invasive alternative to surgery in similar cases.
Case Rep Gastroenterol
· 2025 · PMID 40444061
·
Full text
INTRODUCTION: Gluten-associated disorders, including celiac disease (CeD) and non-celiac gluten sensitivity (NCGS), can present with various extraintestinal neurologic manifestations, including sensory neuropathy, ataxia...INTRODUCTION: Gluten-associated disorders, including celiac disease (CeD) and non-celiac gluten sensitivity (NCGS), can present with various extraintestinal neurologic manifestations, including sensory neuropathy, ataxia, headaches, and seizures. CASE PRESENTATIONS: In this case series, we present 3 interesting patients with gluten-associated neurological disorders (GAND) across a spectrum of gluten-associated disorders severity, from gluten sensitivity, to CeD, to refractory CeD, illustrating variable presentations and treatment approaches for this underdiagnosed population. CONCLUSION: For many patients with neurological presentations who initially lack gastrointestinal symptoms, diagnosis remains challenging. Once diagnosed, while a gluten-free diet has been the mainstay of treating GAND for many years, this approach may only prevent progression of disease without reversal of symptoms. Further studies are needed to help guide the development and standardization of treatments for this patient population.
Weaver MR, Schultz WC, Afzal AR
… +2 more, Oliver KL, Almadhoun OF
Case Rep Gastroenterol
· 2025 · PMID 40421270
·
Full text
INTRODUCTION: Celiac disease (CD) is a systemic, immune-mediated enteropathy that occurs following dietary consumption of gluten in genetically susceptible individuals. The global prevalence of celiac disease is estimate...INTRODUCTION: Celiac disease (CD) is a systemic, immune-mediated enteropathy that occurs following dietary consumption of gluten in genetically susceptible individuals. The global prevalence of celiac disease is estimated to be approximately 1.4%, with variation based on age, sex, and geographic location. CD typically presents early in life with diarrhea, abdominal pain, abdominal distention, weight loss, and impaired growth. In severe cases, patients with CD can present in a state of celiac crisis (CC), classically characterized with profuse diarrhea and life-threatening metabolic derangements. CASE PRESENTATION: In this report, we discuss a 23-month-old girl in a state of CC who presented atypically with hypoalbuminemia, generalized edema, and constipation. CONCLUSION: Even in the presence of atypical symptoms, such as edema or constipation, CD should be considered as a differential diagnosis in pediatric patients with severe gastrointestinal disturbances. Additionally, we propose a revised definition of CC that is specific to the pediatric population.
Lam E, Muteganya R, Nagy N
… +3 more, Arvanitakis M, Covas A, Toussaint E
Case Rep Gastroenterol
· 2025 · PMID 40395485
·
Full text
INTRODUCTION: Dieulafoy's lesion is a rare but severe cause of digestive bleeding and can rarely present as a hemorrhagic shock which is associated with a severe prognosis. MALToma is a B-cell lymphoma of the mucosa-asso...INTRODUCTION: Dieulafoy's lesion is a rare but severe cause of digestive bleeding and can rarely present as a hemorrhagic shock which is associated with a severe prognosis. MALToma is a B-cell lymphoma of the mucosa-associated lymphoid tissue. It was reported that MALToma can be revealed by a Dieulafoy's lesion. Due to the lack of specific endoscopic or clinical characteristics, several endoscopies may be needed to establish the diagnosis of MALToma. CASE PRESENTATION: A 61-year-old male patient presented to the emergency department with melena and hematemesis. The patient was transferred to the intensive care unit due to hemorrhagic shock. The endoscopic work-up showed large gastric folds which were later confirmed as MALToma in anatomo-pathologic analysis. The echoendoscopy showed a vessel going through the entire gastric wall which endoscopically corresponded to a red non-bleeding lesion, confirming Dieulafoy's lesion as the origin of the bleeding. The patient received an endoscopic treatment and was rapidly discharged from the intensive care unit. The evolution was spontaneously favorable, and there was no repeat active bleeding. CONCLUSION: A gastric MALToma was discovered thanks to a hemorrhagic shock on a Dieulafoy's lesion which has not yet been described in the literature.
Buch AC, Dhaliwal S, Londhe M
… +1 more, Shrirao TR
Case Rep Gastroenterol
· 2025 · PMID 40370359
·
Full text
INTRODUCTION: Celiac disease (CD) also called gluten-sensitive enteropathy is a noninfectious and an autoimmune cause of malabsorption. It can be difficult to diagnose because of wide range of gastrointestinal and extrai...INTRODUCTION: Celiac disease (CD) also called gluten-sensitive enteropathy is a noninfectious and an autoimmune cause of malabsorption. It can be difficult to diagnose because of wide range of gastrointestinal and extraintestinal symptoms. CASE PRESENTATION: Here, we present 5 cases of CD out of total 160 patients assessed for malabsorption at a tertiary care facility in western Maharashtra between 2022 and 2023. The male-to-female ratio was 1.5:1, and the age of patients ranged from 2 to 60. Chronic diarrhea was the most prevalent symptom, followed by weight loss and stomach pain. In each case, laboratory results showed elevated tissue transglutaminase IgA (tTG-IgA), along with varied levels of calcium and vitamin D deficiency. Two cases had normal endoscopic findings, one had whitish granular mucosa, while 2 cases had duodenal fold scalloping. Histopathological analysis verified the diagnosis, classifying the cases as Marsh types 3a, 3b, and 3c. There was no relationship between the severity of the histopathology and tTG-IgA levels. CONCLUSION: This case series of 5 cases takes into account the prevalence of CD as a cause of malabsorption in western India. It also emphasizes the significance of taking CD into account in patients with malabsorption and the necessity of following a multidisciplinary approach encompassing nutritional assessment, clinical evaluation, histopathology, and serology for an accurate diagnosis and course of treatment.
Naseem Z, Nadeem A, David AJ
… +5 more, Muhammad A, Shah FZ, Fung BM, Hanauer SB, David J
Case Rep Gastroenterol
· 2025 · PMID 40365555
·
Full text
INTRODUCTION: Cytomegalovirus (CMV) infection is a notable gastrointestinal infection affecting immunocompromised patients. In the gastrointestinal tract, CMV often presents with patchy or diffuse mucosal involvement and...INTRODUCTION: Cytomegalovirus (CMV) infection is a notable gastrointestinal infection affecting immunocompromised patients. In the gastrointestinal tract, CMV often presents with patchy or diffuse mucosal involvement and can cause fulminant colitis. However, polypoid CMV lesions are rare. We present a case of a 49-year-old man with ulcerative colitis (UC) in remission on ozanimod who developed CMV isolated to inflammatory colon polyps. CASE PRESENTATION: A 49-year-old patient with UC in clinical remission on ozanimod underwent routine surveillance colonoscopy, which revealed multiple inflamed polyps with white caps. Biopsy results confirmed inflammatory polyps with positive CMV immunostaining, while adjacent tissues and plasma CMV PCR tests were negative. The patient successfully completed a 3-week course of valganciclovir. Follow-up colonoscopy revealed additional inflammatory polyps but no evidence of CMV. He remained in clinical remission and continued ozanimod therapy. CONCLUSION: The unusual nature of this presentation suggests a clinically silent CMV reactivation or, alternatively, a primary CMV infection in our patient, with an unclear natural history and optimal management. This report emphasizes the importance of considering CMV in UC patients with unusual endoscopic findings and the need for multidisciplinary collaboration to optimize care.