Search Results (8)

Background and Clinical Significance: Sarcina ventriculi is a rare Gram-positive coccus that thrives in acidic environments such as the human stomach. It has been increasingly identified in individuals with delayed gastric emptying and has been reported in association with various gastric disorders. However, its exact pathogenic role is not fully understood and remains controversial. Case Presentation: We present two cases of patients, one with a small bowel obstruction and the other with epigastric pain, both diagnosed with Sarcina ventriculi infection by histological examination of gastric biopsies. The patients were managed with a combination of antibiotics and a proton pump inhibitor, resulting in symptom resolution and clearance of Sarcina ventriculi upon follow-up examinations. Conclusions: This report explores the pathogenicity of Sarcina ventriculi by documenting its presence in symptomatic patients without other identifiable pathogens and demonstrating complete symptom resolution following targeted therapy. These findings raise the possibility of Sarcina ventriculi’s pathogenic potential under specific clinical conditions, suggesting it may act as more than a benign colonizer. Full article

Background and Clinical Significance: Orofacial granulomatosis is a rare but often disabling condition potentially associated with inflammatory bowel disease (IBD). Pathogenesis is not well understood, and no disease-specific approved treatment exists to date. Case Presentation: A 26-year-old woman with pan-enteric Crohn’s disease developed buccal swelling and deep oral ulcers histologically confirmed as associated orofacial granulomatosis. Multiple therapies were attempted during her life, including systemic steroids and immunomodulator drugs as Thalidomide, Adalimumab, and Ustekinumab in combination with topical steroid injections and Cyclosporin application, with no or minimal benefit. Only Infliximab showed good efficacy, but it was suspended due to side effects. Following secondary loss of response to Ustekinumab, compassionate treatment with Upadacitinib, a recently developed oral Jak-1 selective inhibitor, resulted in the complete resolution of the oral ulcers. Moreover, after the 12-week induction phase and the transition to 30 mg/daily maintenance dosage, the oral disease remained controlled. Due to the clinical recurrence of Crohn’s disease, Vedolizumab was added as associated treatment, resulting in complete clinical benefit after six months of follow-up. Conclusions: This is a unique case of orofacial granulomatosis associated with pan-enteric Crohn’s disease successfully treated with Upadacitinib. More data are needed to explore its potential benefits in this clinical condition. Full article

Background and Clinical Significance: Upper gastrointestinal (GI) bleeding is a common emergency, typically requiring prompt intervention. This case report presents a unique situation where apparent GI bleeding was ultimately identified as anaphylaxis triggered by accidental wasp ingestion. Such cases are rare, underscoring the need for a broad differential diagnosis in atypical presentations. Case Presentation: A 53-year-old male with a history of heavy alcohol use presented with presumed acute hematemesis, hypotension, and tachycardia. An initial examination revealed mild anemia and elevated liver enzymes. An urgent upper GI endoscopy showed severe esophagitis with no signs of active or stigmata of recent bleeding; instead, two dead wasps were found in the gastric antrum. Further inquiry revealed that the patient had recently consumed a home-brewed alcoholic beverage, likely contaminated with the wasps. The patient’s symptoms were then attributed to anaphylaxis from venom exposure rather than hemorrhagic shock. The patient’s condition improved with antihistaminic therapy, and he was discharged with follow-up recommendations. Conclusions: This case highlights the importance of considering rare but critical diagnoses, such as insect-induced anaphylaxis, in patients presenting with presumed GI bleeding. It reinforces the value of thorough history taking, prompt endoscopy, and systematic management in assessing and treating atypical emergency presentations. Full article

Background and Clinical Significance: Acute esophageal necrosis (AEN), or black esophagus, is an extraordinary rare source of acute upper gastrointestinal bleeding. Its pathogenesis is still poorly understood, whereas etiology seems to be multifactorial, mainly involving esophageal ischemia, increased acid reflux, and reduced mucosal defenses. Although alcohol abuse has been reported to be a common trigger factor, only one case of AEN due to severe alcoholic lactic acidosis has been described up to date. Case Presentation: Herein, we describe a case of a non-cirrhotic 61-year-old lady with a history of chronic alcohol abuse, who was admitted to the Emergency Room due to upper gastrointestinal (GI) bleeding. AEN caused by severe alcoholic lactic acidosis was promptly diagnosed by subsequent investigations, including blood test, urinalysis, computed tomography, and upper GI endoscopy. The treatment involved a multidisciplinary, aggressive medical approach, which included one hemodialysis session. Conclusions: This is the second documented case of AEN secondary to alcoholic lactic acidosis, successfully treated with a previously unreported aggressive multidisciplinary approach, involving one hemodialysis session. It highlights the value of a multidisciplinary approach in managing such complex and rare conditions. Full article

Background and Clinical Significance: Venous thromboembolism (VTE) is a severe extra-intestinal manifestation that can complicate the course of inflammatory bowel disease (IBD). Among pediatric patients, cerebral thrombosis (CT) is the most common form of VTE associated with IBD. Magnetic resonance imaging (MRI) remains the gold standard for diagnosing cerebral venous thrombosis, allowing visualization of flow absence and intraluminal thrombus. Prompt initiation of treatment with low-molecular-weight heparin (LMWH) is crucial to prevent complications. Follow-up imaging is essential to evaluate venous recanalization and guide therapy duration. However, data on cerebral thrombosis in pediatric patient with IBD remain scarce. Case Presentation: We report the case of a 12-year-old boy with a known history of ulcerative colitis who presented to the emergency room (ER) with a two-day history of headache and vomiting. One month prior to the ER visit, he experienced an IBD flare confirmed through clinical, biochemical, and endoscopic evaluation and was subsequently started on oral corticosteroids. Neurological examination was unremarkable; however, given the persistence of severe headache, a brain MRI was performed, leading to a diagnosis of cerebral venous thrombosis. Anticoagulation therapy with LMWH was initiated immediately. Follow-up imaging with contrast-enhanced MR venography four months later revealed partial resolution of the thrombosis. The patient continued long-term anticoagulation therapy for a total duration of 12 months. Conclusions: Cerebral venous thrombosis is a serious complication of IBD, particularly in pediatric patients. Clinicians should consider this diagnosis in any child with IBD presenting with persistent headache, even in the absence of focal neurological signs. Early diagnosis and prompt anticoagulation therapy are key to improving outcomes in these patients. Full article

Background and Clinical Significance: Ectopic variceal bleeding is a rare, but regrettably life-threatening, complication of hepatic cirrhosis. There is no standardized approach to this life-threatening event due to the absence of randomized controlled trials. Prompt identification of the bleeding site is crucial for timely hemostasis using endoscopic, radiologic or surgical methods. Case presentation: Throughout this paper, we present the case of a 52-year-old patient with decompensated alcoholic cirrhosis, who was admitted for melena. Upper and lower endoscopy failed to identify the source of bleeding. Ultimately, an evaluation with endoscopic capsule identified ileal varices. The patient was referred to surgery and the outcome was successful. We approached the diagnostic and therapeutic arsenals in managing ectopic varices. Conclusions: Although ectopic variceal bleeding has a substantial potential for fatal outcomes, prompt intervention in a multidisciplinary team could be the key for patient salvation. Full article

Background and Clinical Significance: Mexiletine is a class 1B antiarrhythmic drug commonly prescribed for ventricular arrhythmias and neuropathic pain. It works as a blocker of the sodium channel that modulates cardiac conduction and reduces aberrant nerve signaling. While it is generally well tolerated, gastrointestinal side effects, such as nausea, vomiting, and abdominal pain, are relatively common. Esophagitis and esophageal ulcerations have been described as rare side effects; however, they are poorly documented in the literature. Esophageal ulceration induced by oral medications, termed pill esophagitis, occurs due to prolonged contact between the medication and the esophageal mucosa. Factors contributing to this phenomenon include improper administration, such as swallowing without sufficient water, taking medication before lying down, or inherent irritant properties of the drug itself. Mexiletine-induced esophageal ulceration has not been extensively reported, making such cases clinically significant and worth investigating. In particular, the prompt diagnosis of mexiletine-induced esophageal injury is essential for timely treatment initiation or the discontinuation of the drug, preventing complications such as bleeding, strictures, or perforation. Altogether, these actions are important to prevent the onset of potentially serious complications, such as bleeding, strictures, and the perforation of the esophagus. Case Presentation: Two different patients were included in this case report on mexiletine-induced esophageal ulceration: a 78-year-old woman affected by primary dilated cardiomyopathy and atrial fibrillation with high ventricular response and a 19-year-old man affected by dilated cardiomyopathy and systemic sclerosis. Conclusions: This case report underscores the importance of recognizing mexiletine-induced esophageal ulceration, and it advocates for timely diagnosis and management to optimize patient outcomes. Full article

Background and Clinical Significance: The treatment for pediatric Crohn’s disease (CD) has shifted over the years from steroids and immunomodulators to biologics with the goal of histological and clinical remission. Endoscopic balloon dilation (EBD) has been utilized for stricturing disease, even in the pediatric population. EBD has been shown to be effective and minimally invasive, though historically, has been performed on patients with persistent mucosal inflammation. As such, intralesional corticosteroid (ILC) injections have been traditionally utilized during EBD. However, intralesional corticosteroid efficacy among pediatrics patients in deep endoscopic remission is unknown. Case Presentation: We report four patients that demonstrated at least initial successful dilations without intralesional steroid injections. Conclusions: The use of ILC injections during routine EBDs in pediatric patients should be further explored in randomized control trials. Full article