Case Study

This article considers the case of a 19-year-old white woman who presented with a 6-month history of progressively worsening dysphagia. Eosinophilic esophagitis was diagnosed and a PPI and fluticasone propionate prescribed; fluticasone propionate was tapered, but the PPI maintained. When dysphagia returned, fluticasone propionate was restarted, but rapidly progressive dysphagia with severe chest pain and odynophagia developed. A diagnosis of herpes esophagitis with concurrent eosinophilic esophagitis was made, fluticasone propionate treatment immediately discontinued and fluconazole and valaciclovir prescribed.

This article considers the case of a 62-year-old white woman who presented with a 2-month history of progressive, painless, left supraclavicular and axillary lymph node enlargement. Her history was significant for chronic HCV infection, for which she had just completed a 48-week course of treatment with pegylated interferon [alpha] plus ribavirin. Granulomatous lymphadenitis with sarcoid and tuberculoid granulomas was diagnosed and anti-tuberculosis treatment initiated with a successful outcome.

This article considers the case of a 54-year-old male with a history of coronary artery disease, diabetes mellitus and tobacco abuse who presented with right upper quadrant abdominal pain, decreased appetite and jaundice. After admission, the patient's clinical status declined rapidly, with the development of confusion, respiratory failure, hypotension, renal failure and worsening lactic acidosis. The patient developed asystole and was pronounced dead on hospital day 4.

This Case Study considers a 56-year-old female with a 2-week history of fevers, chills and right upper quadrant pain. Her medical history was significant only for hypertension. She denied high-risk sexual behavior, the use of tobacco, alcohol or illicit drugs, had no sick contacts and had not traveled recently, but she had adopted a stray cat 1 month before presentation.

This Case Study describes a female with ileocolic Crohn's disease who was taking immunosuppressive therapy who presented with a 1-month history of bloody diarrhea, decreased caliber of stools, a broad indurated perianal fissure as well as a deep palmar space abscess. The patient was diagnosed with disseminated histoplasmosis. The authors of this article discuss the diagnosis and management of this patient and the importance of considering histoplasmosis in patients on immunosuppressive therapy who develop atypical symptoms.

This Case Study considers a 20-year-old female with a history of Crohn's colitis, perirectal abscesses and fistulizing disease who developed painful erythematous nodules in her pretibial region. She was on no medications for her Crohn's disease because of medication side effects and intolerance. Active Crohn's disease with perianal fistula and sigmoid colitis and erythema nodosum were diagnosed and treatment with adalimumab initiated.

This Case Study discusses a 57-year-old male diagnosed with an aortoenteric fistula secondary to aortic graft surgery. The case highlights the importance of performing multidetector CT as soon as possible in patients who are suspected to have this condition so a quick diagnosis can be made.

This article considers the case of a 22-year-old female with congenital disorder of glycosylation type Ib and a history of congenital hepatic fibrosis, portal hypertension and esophageal varices, who presented with edema, diarrhea, hypoalbuminemia and pancytopenia. Protein-losing enteropathy was diagnosed. As previous mannose therapy was associated with diarrhea and abdominal pain, albumin was infused followed by intravenous and subcutaneous therapy with unfractionated heparin.

This Case Study describes a 40-year-old female laboratory technician who accidentally came into contact with water containing snails infected withSchistosoma mansoni. Cercarial dermatitis occurred in the areas exposed to the contaminated water, but a unique treatment approach involving a single oral dose of oxamniquine (50 mg/kg) on the day of exposure resulted in cure during the early stages of disease. No further symptoms were observed throughout follow-up.

This Case Study describes a 72-year-old male who had an unresectable adenocarcinoma of the pancreas and enrolled in a clinical trial of endoscopic ultrasound-guided neoadjuvant therapy to downstage the tumor. The tumor was surgically removed with a complete pathologic response and showed no signs of recurrence at the 12-month follow-up, although the patient went on to develop bilateral pulmonary nodules and a liver mass, consistent with metastatic disease.

This Case Study describes a 47-year-old woman who was treated with indomethacin for osteoarthritis-related hip pain. Soon after beginning treatment she developed nausea, vomiting, abdominal pain, dark urine and jaundice. Despite discontinuing all medications, her symptoms worsened. Treatment with prednisone 40 mg/day was initially successful, but after tapering (over 18 months) and then discontinuing prednisone her liver chemistry test results worsened and a liver biopsy showed evidence of chronic hepatitis.

This Case Study describes a 45-year-old white female who was admitted to hospital with a 1-week history of right upper quadrant abdominal pain, progressive tiredness and jaundice. Test results raised concerns that the she had a concomitant acute onset of HCV and autoimmune hepatitis, necessitating liver biopsy. The patient was diagnosed with acute symptomatic infection with HCV genotype 1a with no evidence of autoimmune hepatitis.

This Case Study discusses a 39-year-old man who initially presented with a 2-month history of abdominal pain, jaundice, non-bloody diarrhea, weakness and weight loss. Vanishing bile duct syndrome and IBD, type unclassified, were diagnosed. Budesonide therapy improved the patient's symptoms, but they worsened several months later. Repeat evaluation revealed extensive lymphadenopathy and an elevated white blood cell count, and Hodgkin's lymphoma was diagnosed.

This Case Study describes a 17-year-old boy who presented with sudden onset of visual impairment, identified as bilateral anterior uveitis by an ophthalmologist. The patient was diagnosed with multifocal Crohn's disease, involving the terminal ileum, cecum, stomach and duodenum. The authors discuss the importance of rapid evaluation of extraintestinal manifestations of Crohn's disease.

This Case Study describes a 24-year-old white male with Crohn's disease that was in remission who presented with cholestasis and hyperbilirubinemia. The patient had normal alanine aminotrasferase and γ-globulin levels, and the results of serological tests for an infectious cause of hepatopathia were negative. The patient was diagnosed with autoimmune hepatitis–primary sclerosing cholangitis overlap syndrome on the background of primary sclerosing cholangitis.