A psoas abscess in a patient with Crohn's disease]

We report a case of Crohn's disease diagnosed 13 years ago, complicated by a psoas abscess. The main symptoms were flexion deformity of the hip, pain and fever. Diagnosis was made by CT-scan. Surgical and CT-guided percutaneous drainage was ineffective and the abscess relapsed. Surgical resection of the affected bowel with abscess drainage, provided patient's healing.     

A case of Crohn's disease with broncho-bronchiolitis]

A 41-year old man was hospitalized for abdominal pain and melena. Two years before, he had contracted Crohn's disease, which was brought into remission by using mesalazine and oral corticosteroids. When Crohn's disease appeared to flare up again, the dose of corticosteroids was increased. Afterwards, when a gradual decrease in this dose was initiated, melena developed once again, along with a dry cough. Chest radiography revealed diffuse patchy shadows. A significant increase of lymphocytes was observed in the bronchoalveolar lavage fluid. Mesalazine was suspended and steroid pulse therapy was initiated in combination with azathioprine. Although the symptoms were alleviated and the patchy shadows disappeared, the bronchiectatic shadows remained. A broncho-bronchiolitis associated with Crohn's disease was finally diagnosed despite the need for a differential diagnosis of mesalazine-induced disease due to the long-term administration of mesalazine before the onset of the pulmonary lesion. Also, the pathological findings were inconsistent with many other reported cases, the onset of the pulmonary lesion coincided with the flare-up of an intestinal disease, and the pulmonary shadows remained long after the suspension of mesalazine.     

Non-Hodgkin's lymphoma with Toxoplasma encephalitis]

A 62-year-old man was admitted to our hospital due to fever and systemic lymph-node swelling on June 9, 1998. He was given a diagnosis of non-Hodgkin's lymphoma (diffuse mixed T cell lymphoma) with involvement of mediastinum and para-aortic lymph nodes, pleura, peritoneum, and bone marrow. After diagnosis, combined chemotherapy (CHOP regimen) was started. On day 11, the patient's consciusness level suddenly deteriorated. A brain computed tomographic scan showed no abnormal findings. A cytospin smear of cerebrospinal fluid disclosed tachyzoides (Toxoplasmic bodies), thus yielding a diagnosis of Toxoplasma encephalitis. Oral sulfadoxine pyrimethamine rapidly alleviated the patient's consciousness disturbance. One month later, a cytospin smear and RT-PCR analysis of cerebrospinal fluid detected no tachyzoides. Complete remission of lymphoma was achieved after 2 courses of CHOP therapy. Toxoplasma encephalitis should be considered a potential cause of consciousness disturbance in immunocompromised hosts, such as patients with malignant lymphoma. Cytospin smears of cerebrospinal fluid are a useful tool for the early diagnosis of Toxoplasma encephalitis.     

非霍奇金淋巴瘤并IgM—KAP型单克隆免疫球蛋白血症一例

患者 ,男性 ,52岁。全身多处肿大包块 3个月余。患者 3个月前发现右腋下可触及一绿豆大结节 ,活动 ,无痛 ,1个月后自觉双腋下及锁骨上多个大小不等包块 ,蚕豆至鸽蛋大 ,无痛 ,不伴有发热及骨关节疼痛。入院查体 :Ｔ 36 .5℃ ,Ｐ 80次 /ｍｉｎ ,Ｒ 2 0次 /ｍｉｎ ,ＢＰ 1 1 0 /6 0ｍｍＨｇ ,贫血貌 ,皮肤巩膜无黄染 ,全身浅表淋巴结均可触及肿大 ,蚕豆至鸽蛋大 ,部分融合 ,质地中等 ,表面光滑 ,活动可 ,无触痛 ,心肺听诊无异常 ,肝右肋下未及 ,脾左肋下 2ｃｍ ,移动性浊音 (± )。实验室检查 :①血常规 :ＷＢＣ 6 .79× 1 0 9/Ｌ ,Ｈｂ 93ｇ/…     

A case of therapy-related myeloid neoplasm in a patient with Crohn's disease treated with azathioprine

The aim of the present study was to determine serum levels of neutrophil gelatinase-associated lipocalin (NGAL) and leptin in patients with chronic myeloid leukemia (CML) at diagnosis and after imatinib therapy when patients achieved a complete molecular remission. The study was conducted on 22 patients with CML in the chronic phase and 10 healthy subjects. The median serum NGAL levels in CML patients at diagnosis were significantly higher compared to age-matched controls. After imatinib therapy, all patients achieved complete molecular remission and NGAL levels decreased and were found significantly lower with respect to the baseline. No significant correlations were found between NGAL levels and other disease parameters. Before imatinib therapy, the median blood leptin levels were not significantly different from those of controls. After therapy with imatinib, all patients in molecular remission presented an increase in leptin levels. Future research is eagerly awaited as it may demonstrate the real role of NGAL and leptin in the onset and progression of CML.     

A case of diffuse endobronchial infiltration in a patient with non-Hodgkin's lymphoma]

A 38-year-old man with diffuse endobronchial infiltration with non-Hodgkin's lymphoma (NHL) is reported. He was admitted to our hospital on November 1990 because of lymph node swelling. Physical examination on admission revealed left axillary, bilateral cervical and inguinal lymph node swelling. Chest and abdominal CT scan showed para-aorta lymph node swelling, mild splenomegaly and heterogeneous density of the liver, although hilar and mediastinal lymphadenopathy were not found. Microscopic examination of the biopsy specimen obtained from the right inguinal lymph node and liver revealed NHL (B cell lymphoma, diffuse, mixed type). After two courses of chemotherapy, a chest roentgenogram showed bilateral hilar lymphadenopathy and reticular shadows. CT scan demonstrated a thickening of the left main bronchus. Bronchoscopic examination revealed a small submucosal nodule in the left main bronchus on February 1991, from which the biopsy specimen revealed NHL infiltration similar to that of the lymph node. At follow-up bronchoscopic examination, in spite of chemotherapy, scattered NHL infiltration was found in the submucosal space of the left vocal cord, carina and the bifurcation between left upper and lower bronchi. In patients with NHL, endobronchial involvement is rare. In this case, diffuse endobronchial infiltration was not thought to be direct invasion from the lymph node but hematogenous or lymphatic spread to the bronchi.     

A case of colon cancer associated with Crohn's disease]

Colon cancer is the most serious intestinal complication in patients with Crohn's disease. Although an association between Crohn's disease and colon cancer has not been clearly defined, a number of studies in western countries reported an increased rate of colon cancer in patients with Crohn's disease. In Korea, Crohn's disease is rare when compared to western countries, and only a single case of colon cancer associated with Crohn's disease has been reported. We recently experienced a 66-year-old women with colon cancer associated with Crohn's disease.     

A case of optic neuritis associated with Crohn's disease]

In Crohn's disease, neurologic complications such as cerebrovascular accident, headache, peripheral neuropathy have been reported sporadically. The pathogenesis of these neurologic complications is still unknown and controversial. We experienced a 22-year-old man, with Crohn's disease accompanied by optic neuritis. Loss of visual acuity was developed during the worsening course of enterocutaneous fistula. After high dose steroid treatment, his visual acuity and neurologic symptoms improved immediately.     

Hypertrophic cardiomyopathy in a patient with Crohn's disease: a case report

Coronary artery dissection after blunt chest trauma has rarely been reported in traumatic cardiac injuries, but it may cause fatal or nonfatal myocardial infarction. We report a case of dissection of the left main coronary artery, which resulted in acute myocardial infarction 5 weeks after blunt chest trauma. Multidetector-row computed tomography performed prior to the onset of infarction depicted intimal flap and dissected cavities.     

Extraintestinal non-Hodgkin's lymphoma presenting as obstructive jaundice in a patient with Crohn's disease

We report the case of a 58-yr-old woman, previously diagnosed with Crohn's disease of the duodenum, who presented with jaundice and an epigastric mass. Diagnostic studies revealed an extraintestinal non-Hodgkin's lymphoma located near the head of the pancreas and causing obstructive jaundice. A review of the literature indicates the rarity of this association. We discuss the etiology, pathogenesis, and management of extraintestinal lymphomas in patients with Crohn's disease.     

Rectal Epstein-Barr virus-positive Hodgkin's lymphoma in a patient with Crohn's disease: case report and review of the literature

We present the case of a 35-year-old man with Crohn's disease diagnosed at the age of 27, several months after an operation for small-bowel adenocarcinoma. Seven years after the adenocarcinoma diagnosis, the patient presented with severe continuous anal pain and diarrhea. In parallel with antibiotic administration, the patient was given treatment with Infliximab, but without clinical symptom amelioration. Sigmoidoscopy and subsequent biopsies from an ulcerated rectal area supported the diagnosis of Epstein-Barr virus-positive (EBV+) primary Hodgkin's lymphoma. Infliximab administration was immediately discontinued and the patient underwent oncological follow-up and began a course of chemotherapy. Only a few cases with primary gastrointestinal Hodgkin's lymphoma in Crohn's disease patients have so far been reported, including a variety of scenarios on the causal relationship including disease duration, presence of EBV, long-term immunosuppressive treatment and, recently, anti-TNFalpha administration.     

A case of rapidly progressive IgA nephropathy in a patient with exacerbation of Crohn's disease

ABSTRACT: BACKGROUND: IgA nephropathy has been reported as a renal involvement in Crohn's disease. Crescentic IgA nephropathy, which accounts for fewer than 5% of cases of IgA nephropathy, has a poorer prognosis than other forms of crescentic glomerulonephritis. We recently experienced a case of rapidly progressive IgA nephropathy concurrent with exacerbation of Crohn's disease. Case Presentation. An 18-year-old male diagnosed with Crohn's disease underwent a hemicolectomy 2 years previously. He had maintained a state of Crohn's disease remission with 5-aminosalicylic acid treatment. Four months prior to referral to the nephrology clinic, he experienced non-bloody diarrhea. He simultaneously developed proteinuria and microscopic hematuria with deterioration of renal function. Based on renal biopsy findings, the patient was diagnosed with crescentic IgA nephropathy. Immunostaining for interkeukin-17 in renal tissue and previous exacerbated colonic ulcers was positive. Steroid pulse therapy was administered, followed by high-dose glucocorticoid and oral cyclophosphamide therapy. The patient's renal function recovered and his gastrointestinal symptoms were alleviated. CONCLUSIONS: We report a case of crescentic IgA nephropathy presenting with exacerbation of Crohn's disease, and present a review of the literature focusing on the pathophysiologic relationship between these two conditions.