Volume 72 - 2009 - Fasc.2 - Case reports
Fatal mid-gastrointestinal bleeding by cytomegalovirus enteritis in an immuno- competent patient
Cytomegalovirus (CMV) infections are common in immunocom- promised patients but rare in immunocompetent individuals. Gastrointestinal disease is frequent in systemic CMV infections but the small bowel is the least common site of involvement.
We present the case of a 66 years-old man, with no evidence of immunological deficiency, hospitalized for unspecific symptoms of diarrhea, fever and abdominal pain, which developed massive mid-gastrointestinal bleeding during hospitalization. Enteroscopy revealed congestive, oedematous mucosa with multiple ulcers in the small bowel. Cytomegalic cells with intranuclear inclusions were found on histologic examination, allowing the diagnosis of CMV infection. Ganciclovir in full therapeutic dose was started and sur- gery was performed as a last resource treatment, but the patient died.
This case highlights the rare condition of massive gastrointesti- nal bleeding due to CMV disease of the small bowel, the major importance of enteroscopy and pathologic evaluation for diagnosis and the poor prognosis of this situation. (Acta gastroenterol. belg., 2009, 72, 245-248).
Multisystemic sarcoidosis associated with a second therapy for chronic hepatitis C
Hepatitis C virus (HCV) infection is a very common chronic infectious disease. Combined antiviral therapy including pegylated interferon and ribavirine is presently the standard treatment, with sustained viral response rate over 50%.
Interferon induces the development of several autoimmune diseases. Some cases of induced sarcoidosis have been described (affecting mostly lungs, skin and eyes), both with standard and pegylated interferon.
We report the case of an African woman, heterozygote for sickle cell anaemia mutation and for glucose-6-phosphate-deshydroge- nase (G6PD) deficiency, who developed a multisystemic sarcoidosis (skin, lungs, liver, salivary and lachrymal glands, peripheral nerves), confirmed by biopsies, in the course of a second treatment with pegylated interferon and ribavirine for hepatitis C.
The antiviral treatment was discontinued and all symptoms regressed spontaneously within some weeks. (Acta gastroenterol. belg., 2009, 72, 249-251).
Hepatoid adenocarcinoma of the stomach : case report and short notes on immunohistochemical markers
Hepatoid adenocarcinoma of the stomach is a rare type of gas- tric carcinoma with an extremely poor prognosis. We describe a 72- year-old man who underwent esophagogastroduodenoscopy which revealed 50 mm exulcerated lesion with a central necrosis on the lesser curvature and the posterior wall of the body of the stomach. Gastric biopsy revealed a poorly differentiated (anaplastic) adeno- carcinoma. The serum level of alpha-fetoprotein (AFP) was (3220 ng/mL). After diagnosis of AFP-producing gastric adenocar- cinoma, total gastrectomy, with splenectomy, was performed. The tumor showed immunohistochemical positivity for AFP and Hep Par 1. According to these histopathological and immunohistochem- ical findings, the tumor was diagnosed as hepatoid adenocarcino- ma. At 24 months postoperatively the patient is still alive without metastatic disease on repeated abdominal CTs. Because of the poor prognosis for this histological type of tumor, accurate diagnosis of hepatoid adenocarcinoma is important, and long-term follow-up is required. (Acta gastroenterol. belg., 2009, 72, 253-256).
Gastrointestinal stromal tumors of the rectum : report of five cases
We report on five patients (three males and two females), with a median age of 66.2 years (range, 58-73 years) who were admitted in our department from April 1998 until January 2004 with the diag- nosis of rectal gastrointestinal stromal tumor (GIST). Their main symptoms were rectal bleeding, constipation and abdominal discomfort. Two patients were treated by an abdominoperineal resection of the rectum. One patient received palliative surgical treatment and adjuvant therapy with imatinib for metastatic disease. Another patient presented with complete rectal prolapse, and was treated with Delorme's procedure. The subsequent pathological examination of the resected specimen showed positive resection margins and was given adjuvant therapy with imatinib. Finally, one case was considered inoperable. However, after nine months of treatment with imatinib, the magnetic resonance imag- ing (MRI) scan revealed a significant reduction in the tumor size, and the patient was treated with abdominoperineal excision of the rectum. All cases have been proved to be immunohistochemically positive for the CD117 and the CD34 stain. During the follow-up period (mean duration 3.7 years), one patient died of progressive disease while the other four had no sign of recurrence. (Acta gastro- enterol. belg., 2009, 72, 257-261).
Acute hepatitis after treatment for hair loss with oral green tea extracts (Camellia Sinensis)
Nutritional additives based on green tea have been claiming var- ious beneficial health effects. However, several case reports on hepatotoxicity after the intake of green tea derivatives containing Camellia Sinensis have been published. We report a patient with an acute hepatitis after intake of an oral green tea derivative claiming protection against hair loss, showing a histological image compati- ble with drug induced hepatitis. Other important causes of hepati- tis were excluded. After cessation of this nutritional additive there was a rapid and sustained recovery. We raise concern about the safety of nutritional additives with few proven beneficial effects and want to emphasize the importance of accurate and thorough history taking, with attention for over the counter drugs and herbal products. (Acta gastroenterol. belg., 2009, 72, 262-264).
