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1.
A rectal neuroendocrine tumor in a patient with Crohn's disease: a case report and literature review.
Suzuki, K, Yamamoto, M, Suzuki, Y, Kawamura, T, Kamishima, M, Sakata, M, Harada, T, Kagami, T, Tani, S, Yamade, M, et al
Clinical journal of gastroenterology. 2020;(3):320-327
Abstract
Crohn's disease is recognized to increase the risk of gastrointestinal malignances. Adenocarcinoma is the most common malignancy in these patients. Association between Crohn's disease and adenocarcinoma in the small intestine has already been established, however, the association between neuroendocrine tumor and Crohn's disease remains uncertain. We report a 39-year-old man with Crohn's disease, who was diagnosed with NET in the rectum. He had suffered from fever and anal pain due to the anal fistula and abscess. The disease state was considered to be resistant to medical treatment. He underwent total proctocolectomy, small bowel resection, anal fistula drainage with ileostomy. Postoperative histology revealed a neuroendocrine tumor in the rectum. His postoperative course was uneventful, and he followed a good course under treatment with infliximab and mercaptopurine hydrate. This case highlights the need of careful observation of resected specimens in light of the possibility of NET, especially those with anal disorders.
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2.
IgG4-Related Disease Mimicking Crohn's Disease: A Case Report and Review of Literature.
Ciccone, F, Ciccone, A, Di Ruscio, M, Vernia, F, Cipolloni, G, Coletti, G, Calvisi, G, Frieri, G, Latella, G
Digestive diseases and sciences. 2018;(4):1072-1086
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3.
Fetal death in utero and miscarriage in a patient with Crohn's disease under therapy with ustekinumab: case-report and review of the literature.
Venturin, C, Nancey, S, Danion, P, Uzzan, M, Chauvenet, M, Bergoin, C, Roblin, X, Flourié, B, Boschetti, G
BMC gastroenterology. 2017;(1):80
Abstract
BACKGROUND Ustekinumab is a fully human monoclonal antibody against the p40 subunit of interleukin (IL) 12 and 23 which is involved in the pathogenesis of several inflammatory diseases. Ustekinumab is approved for psoriasis and psoriatic arthritis treatment and has been successfully evaluated in phase II and III trials for patients with Crohn's disease (CD). CASE PRESENTATION We report here the case of a patient who became pregnant during treatment with ustekinumab for a refractory CD and which ended in miscarriage. CONCLUSION Ustekinumab is a relatively new pharmacotherapy and in addition to this clinical case, we reviewed the published literature concerning the use of this treatment during pregnancy and its consequences on pregnancy and fetus outcome.
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4.
[Tracheobronchitis as an extraintestinal manifestation of Crohn's disease].
Sakemi, R, So, S, Morimitsu, Y, Noda, T, Ohtsu, K, Karashima, Y, Imamura, K, Terabe, H, Chojin, Y, Kato, T
Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology. 2017;(12):2125-2133
Abstract
A 27-year-old woman with Crohn's disease, who had sustained clinical remission for two years following treatment with mesalazine and nutrition therapy, was admitted to our hospital complaining of dry cough, mild dysphagia, and slight fever. A computed tomography of the chest demonstrated an increase in the thickness of the tracheal wall. Bronchoscopy showed a diffusely erythematous and edematous mucosa with whitish granular lesions in the trachea and main carina. Bronchial biopsy specimens showed epithelioid cell granuloma. We diagnosed tracheobronchitis as an extraintestinal manifestation of Crohn's disease. She was treated with 40mg/day prednisolone. Her symptoms improved immediately. However, dry cough recurred two months after prednisolone treatment, and further treatment with inhaled steroids was prescribed. Tracheobronchial involvement in Crohn's disease is rare, with only 13 cases having been reported. Tracheal involvement should be considered in Crohn's disease patients with respiratory symptoms.
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5.
Oral immunoglobulin treatment improved intestinal permeability in children with active Crohn's disease.
Sundqvist, T, Stenhammar, L, Tjellström, B, Magnusson, KE, Forslund, T, Högberg, L
Acta paediatrica (Oslo, Norway : 1992). 2017;(4):647-653
Abstract
AIM: Crohn's disease (CD) is a chronic mucosal inflammation that affects the intestinal barrier function, for example, by altering the intestinal permeability. This pilot clinical study investigated the impact of oral human immunoglobulin (OHIG) treatment on permeability characteristics in children with active luminal Crohn's disease. METHODS The study was performed at the Department of Paediatrics, Norrköping Hospital, Sweden. Intestinal permeability was studied in three boys aged 13, 15 and 18 years with active CD, before and after a six-week treatment programme with OHIG, using different-sized polyethylene glycols as the test molecules. Three age- and sex-matched children with active CD treated with exclusive enteral nutrition (EEN) were also studied. RESULTS OHIG and EEN resulted in virtually similar reductions in the signs and symptoms of mucosal inflammation. However, OHIG, unlike EEN, appeared to normalise mucosal transfer leading to a normalisation of the maximum permeation of the small PEG molecules, as well as less restrictions of the larger PEG molecules. CONCLUSION Our study found that OHIG appeared to normalise the mucosal barrier. This suggests that it could offer a new additional and versatile treatment for paediatric CD patients, with a minimal risk of adverse effects.
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6.
Urogenital Manifestations of Metastatic Crohn's Disease in Children: Case Series and Review of the Literature.
Rani, U, Russell, A, Tanaka, S, Correa, H, Nicholson, MR
Urology. 2016;:117-21
Abstract
Although cutaneous manifestations are the most common extraintestinal manifestation of inflammatory bowel disease, metastatic Crohn's disease (MCD) is rare. MCD is defined as the presence of noncaseating granulomatous inflammation and perivascular infiltrate in the cutaneous tissue that is noncontiguous to the gastrointestinal tract. MCD rarely involves the genitourinary tract in children. When it does, it can present as external genitalia swelling, erythema, plaques, or ulcerations. Here we present three pediatric cases of MCD involving the genitourinary tract. In addition to discussion of the presented cases, we have reviewed the literature on the genitourinary presentation of MCD in the pediatric population.
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7.
Observations on the effects of odours on the homeopathic response.
McGuigan, M
Homeopathy : the journal of the Faculty of Homeopathy. 2014;(3):198-202
Abstract
Samuel Hahnemann described incidences where the homeopathic response was disrupted by noxious smells in the environment. An earlier paper proposed that homeopathic medicines may be sensed by vomeronasal cells (VNCs) i.e. microvillus or brush cells in the vomeronasal organ (VNO), the taste buds and associated with the trigeminal nerve and nervus terminalis. This paper proposes an extension to the theory and suggests that a subset of solitary chemosensory cells (SCCs) in the diffuse chemosensory system (DCS) that is morphologically similar to VNCs might also be receptive to homeopathic medicines. The types of odours that may interfere with this process are described. Two clinical cases of disruption of the homeopathic response are given as examples, showing that successful re-establishment of remedy action can be produced by timely repetition of the medicine. The ramifications on clinical homeopathic practice are discussed.
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8.
A rare case of free bowel perforation associated with infliximab treatment for stricturing Crohn's disease.
Lim, CS, Moon, W, Park, SJ, Park, MI, Kim, HH, Kim, JB, Choi, JM, Chang, HK, Lee, SH
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi. 2013;(3):169-73
Abstract
Crohn's disease is characterized by chronic transmural inflammation of the bowel and is associated with serious complications, such as bowel strictures, abscesses, fistula formation, and perforation. As neither medical nor surgical therapy provides a cure for Crohn's disease, the primary goals of therapy are to induce and maintain remission and prevent complications. As a biologic agent, infliximab, a monoclonal antibody to tumor necrosis factor, is indicated for refractory luminal and fistulizing Crohn's disease that does not respond to other medical therapies or surgery. Infliximab has proven to be very effective for inducing and maintaining remission in Crohn's disease; however, infliximab treatment has several potential complications. Here, we report a case of free perforation following a therapeutic response after an initial dose of infliximab for Crohn's disease. This is the first case report describing a free perforation in a Crohn's disease patient after an initial dose of infliximab.
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9.
Amicrobial pustulosis-like rash in a patient with Crohn's disease under anti-TNF-alpha blocker.
Lee, HY, Pelivani, N, Beltraminelli, H, Hegyi, I, Yawalkar, N, Borradori, L
Dermatology (Basel, Switzerland). 2011;(4):304-10
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Abstract
Amicrobial pustulosis of the folds (APF) is a recently described entity characterized by relapsing pustular lesions predominantly involving the cutaneous flexures and scalp. This disease typically occurs in association with systemic lupus erythematosus and a variety of other autoimmune diseases. We here describe an APF-like pustular eruption predominantly affecting the scalp, face and trunk, occurring during long-term infliximab treatment for Crohn's disease. Immunohistochemical staining of skin biopsy specimens for myxovirus resistance protein A, a marker for type 1 interferon-inducible proteins, showed increased staining in the epidermis and dermal mononuclear inflammatory infiltrate. Our observation further extends the spectrum of cutaneous adverse reactions potentially related to anti-tumor necrosis factor-α, the clinical context in which APF can occur as well as its clinical presentations.
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10.
Assessment of non-cirrhotic portal hypertension associated with thiopurine therapy in inflammatory bowel disease.
Calabrese, E, Hanauer, SB
Journal of Crohn's & colitis. 2011;(1):48-53
Abstract
Thiopurines represent an effective and widely used immunosuppressant in the therapeutic armamentarium of inflammatory bowel disease. However up to 25% of patients may be unable to continue the drug due to side effects. The incidence of hepatotoxicity associated with thiopurine use is reported between 0% and 32%. Veno-occlusive disease, peliosis hepatis, perisinusoidal fibrosis and nodular regenerative hyperplasia have all been described with thiopurines. Recent trials of 6-tioguanine, although successful in patients with allergies to azathioprine or mercaptopurine, have been compromised by increased hepatotoxicity, either veno-occlusive disease or nodular regenerative hyperplasia. We describe a report of nodular regenerative hyperplasia in a Crohn's disease patient associated with 6-mercaptopurine therapy and have reviewed the management and the literature regarding this complication. Our report strengthens the importance of further safety studies to evaluate the etiology, prevalence, risk factors and screening modalities for hepatotoxicity, in particular of nodular regenerative hyperplasia, in patients treated with thiopurines for inflammatory bowel disease.