Volume 78 - 2015 - Fasc.4 - Letters
Crohn's Disease treated with azathioprine and basal cell carcinoma : three cases and literature review
Three cases of basal cell carcinoma in Crohn's disease patients treated with azathioprine are described. A review of the literature is conducted concerning this association between the occurrence of basal cell carcinoma and the use of azathioprine. Recently, practi- cal advice on screening and follow-up of these situations have been proposed but there are no validated dermatological recommenda- tions. (Acta gastroenterol. belg., 2015, 78, 436-438).
Eosinophilic colitis under etanercept
Eosinophilic colitis (EC) is a rare manifestation of eosinophilic gastrointestinal disorder. Even though the cut-off value of eosino- phils per HPF for the diagnosis of EC is not clear, histopathological examination is still a cornerstone. Corticosteroids are the main drugs for EC treatment today. Here, we aim to report a woman with EC who showed clinical remission with budesonide and was maintained with adalimumab alone. (Acta gastroenterol. belg., 2015, 78, 439-440).
Metastatic lung adenocarcinoma related a-Fetoprotein elevation in a patient with HBV-related cirrhosis
HCC is the most common type of primary liver tumor. The Prac- tice Guideline, AASLD, for HCC recommended surveillance of HBV carriers at high risk of HCC with US every 6-12 months. Laboratory surveillance option is the measurement of serum a-fetoprotein level which has long been used for the diagnosis of HCC. But, increased serum levels of a-fetoprotein are also seen in acute hepatitis, cirrhosis, and malignancies include yolk sac carci-
noma, neuroblastoma, hepatoblastoma, gastric and lung carcino- ma. Because of elevation a-fetoprotein in these malignancies, liver mass with an elevated a-fetoprotein does not directly indicate HCC. For these reason, clinicians evaluating patient with liver mass and HBV-related cirrhosis should be vigilant for other case of a-fetoprotein elevation. (Acta gastroenterol. belg., 2015, 78, 441- 442).
Hyperferritinemia and splenic iron overload : remember ferroportin
A 34-year old asymptomatic lady was referred to the gastroenterologist with fortuitously discovered hyperfer- ritinemia. There was no history of hematologic disease. She did not consume any alcohol. An uncle of hers had an iron overload.
Physical examination was normal with a BMI of 21 and blood pressure of 135/80 mmHg. Laboratory data showed high level of ferritin (1154 ng/ml) but normal iron level (106 µg /dl) and normal transferrin saturation value (44%). CRP (2 mg/L), blood film, glycemia, lipid profil, liver tests were normal. Ceruloplasmin level was 32 mg/dl (normal range : 20-60 mg/dl). A previously per- formed genetic test for HFE revealed no C282Y muta- tion. Abdominal Magnetic resonance imaging (MRI) without contrast showed light hepatic iron overload, estimated at 40 µmol/gr but also a splenic hyposignal on gradient echo (GE) T2 MRI images. Study of the ferro- portin gene (SLC40A1) showed presence in one allele of a substitution of adenine to guanine at nucleotid 470 (c.470A > G) corresponding to p.Asp157Gly (D157G) at the proteic level. This deleterious mutation confirmed the diagnosis of ferroportin disease, also called type IVa or SLC40A1-related hereditary hemochromatosis. Phle- botomy was initiated with monitoring of hemoglobin. Recommendation was made for performing genotypic screening of relatives.
Eltrombopag : How secure in triple therapy of HCV ?
Triple therapy of hepatitis C usually leads to some hematological and dermatological side effects. Thrombocytopenia is one of the most common side effects that are encountered during triple thera- py. Eltrombopag was approved for the treatment of patients with chronic hepatitis C and thrombocytopenia to allow the initiation and maintenance of interferon based therapies. During eltrom- bopag therapy, some side effects like headache, abdominal pain, and some complications such as portal vein thrombosis, deep vein thrombosis and arterial thrombosis were observed more frequently than placebo. We described here a patient who developing throm- bosis secondary to eltrombopag in receiving triple therapy. (Acta gastroenterol. belg., 2015, 78, 445-446).
Spontaneous fracture of a nasobiliary catheter
A 68-year-old-man was referred to our hospital because of obstructive jaundice and ascites. Laboratory tests showed elevated levels of alkaline phosphatase, ?-glutamyltransferase, and bilirubin (24.8 mg/dL ; normal < 1.2 mg/dL). Magnetic resonance cholangiopancreato- graphy revealed a mass with a diameter of 32 × 24 mm in the junction of the right and left hepatic ducts. Ascitic fluid analysis showed a malignant cytology. Positron emission tomography revealed increased FDG uptake of the mass and celiac, superior mesenteric and preaortic lymph nodes. Tumor antigen CA 19-9 level was 496 U/L (normal < 37 U/L). Based on these findings, a diagnosis of inoperable Klatskin tumor was established.
