Massive gastrointestinal tubercolsis in a young patient without immunosupression

Although the lung is the major site for Mycobacterium tuberculosis infection, gastrointestinal involvement can be present as part of multiorgan disease process or, less commenly, can be seen as primary gastrointestinal tuberculosis. In the cases where the culture is negative, it can be difficult to differantiate tuberculosis from Crohn's disease based on both the clinical and histological features.When side effects of classic antimycobacteria are encountered,we can initially add ciprofloxacin to the treatment of tuberculosis. We reported a case of 19-yr-old patient, who was treated as Crohn's disease and worsen. We began to tuberculosis treatment, and the patient improved clinically and histologically. The main point in this case is that widespread involvement of gastrointestinal tract can be brought about by non resistant strains of Mycobacterium tuberculosis even in immunocompetent patients.     

Massive gastrointestinal bleeding in a patient with COVID-19

Despite the emerging data about the thrombophilic effect of the novel coronavirus [1] , the relation between coagulation disorders and the COVID-19 pandemic is still not well understood. Various studies pointed to the significant role of the COVID-19 induced cytokine storm in development of the hypercoagulable state which leads to serious thromboembolic complications [2], [3] . Some studies report the development of severe immune thrombocytopenia induced by the novel coronavirus [4] . Other studies found a correlation between COVID-19 disease and the development of disseminated intravascular coagulation (DIC) [5].Patients with severe COVID-19 disease have an increased risk for development of gastrointestinal bleeding (GI) which may be related to stress [6] , critical illness or mechanical ventilation [7] . Further studies showed the ability of the novel coronavirus to infect the epithelial cells of the GI tract [8] . Moreover, some data pointed to the ability of the virus even to infect the endothelium of blood vessels [9]. The relation between the COVID-19 pandemic and GI bleeding deserves more studies [10]. We present a case of GI bleeding in a patient with severe COVID-19 disease. We assume that COVID-19 disease can be a predominant factor for the development of DIC and GI bleeding.     

Massive gastrointestinal bleeding due to gastric ulcer in a patient with amyloidosis

Gastrointestinal amyloidosis may occur as part of the systemic manifestations of primary amyloidosis or in a localized form. The symptoms and signs that may occur are numerous and nonspecific, hampering clinical suspicion when this disease has not already been diagnosed. Gastric ulcers presenting as massive bleeding are an uncommon manifestation of this disease. We report the case of a patient with primary amyloidosis who developed massive gastrointestinal bleeding complicated by an amyloid gastric ulcer. Emergency surgery was required to control the bleeding.     

Massive gastrointestinal hemorrhage

Summary The poor prognostic factors in massive gastrointestinal hemorrhage have been enumerated. The accuracy, complications, and value of early diagnostic studies have been discussed. The management of massive gastrointestinal hemorrhage based upon these considerations has been outlined.     

Isolated liver tuberculosis abscess in a patient without immunodeficiency: A case report

Although hepatic tuberculosis is not a rare disease entity, tubercular liver abscess (TLA) is extremely rare. It is usually associated with foci of infection either in the lung and/or gastrointestinal tract or with an immunocompromised state. An isolated or primary TLA with no evidence of tuberculosis elsewhere is even rarer. We report on a 28 year old man who developed an isolated tuberculous liver abscess not associated with lung involvement. Ultrasonography and computed tomography of the abdomen showed the abscess lesions in the liver but the diagnosis of tuberculosis was confirmed by histological examination of the wall of the abscess after surgical drainage. Although tuberculous liver abscess is very rare, it should be included in the differential diagnosis of abscess and unknown hepatic mass lesions.     

Massive gastrointestinal bleeding due to aneurysmal rupture of ileo-colic artery in a patient with Behcet's disease]

Behcet's disease has been recognized as a systemic vasculitis characterized by the involvement of multiple organs such as orogenital ulcers, eye lesions including uveitis and optic neuritis, and skin lesions including folliculitis and erythema nodosum. Vascular involvement occurs occasionally and is classified into thrombosis and aneurysm. However, massive gastrointestinal bleeding from arterial aneurysm is a rare manifestation of intestinal Behcet's disease. Recently, we experienced a case of intestinal Behcet's disease presenting with massive gastrointestinal bleeding due to aneurysmal rupture of ileo-colic artery. A 30-year-old male with Behcet's disease was admitted because of massive gastrointestinal bleeding. A large ileo-cecal ulcer was revealed as a bleeding focus on colonoscopic examination. Celiac angiography showed aneurysm and stenosis of ileo-colic artery. After the failure of hemostasis with arterial embolization, ileocecectomy was performed. After the resection hematochezia was completely stopped.     

Massive rectal bleeding in a malingering patient

Summary In this case report attention is drawn to malingering as a possible cause for recurrent, and at times profuse, rectal bleeding. The bleeding lesions were, characteristically, limited to the distal part of the rectum and the adjacent mucosa was perfectly normal. In the case described this syndrome occurred in a woman with a hysterical personality and conversion reactions.     

Massive ST-segment elevation without myocardial injury in a patient with fulminant hepatic failure and cerebral edema

A 49-year-old woman presented in fulminant hepatic failure. The ECG showed dramatic ST-segment elevation, suggesting diffuse myocardial injury. However, echocardiography, creatine phosphokinase enzyme determinations, and examination of the heart at autopsy (six days later) failed to demonstrate any physiologic, anatomic, or histologic evidence of abnormality. The appearance of ST-segment elevation in this setting should not prompt treatment for cardiac disease or limit the candidacy for liver transplantation of such critically ill patients.     

Pneumoperitoneum without perforation of the gastrointestinal tract in a patient with systemic lupus erythematosus

Pneumoperitoneum often occurs after the perforation of the gastrointestinal tract. However, pneumoperitoneum without the perforation has been reported as one of the complications of collagen diseases, the cause of which is usually the rupture of pneumatosis cystoides intestinalis (PCI). PCI is sometimes observed in the patients with scleroderma and mixed connective tissue disease but rarely in the patients with systemic lupus erythematosus. We reported here a case of systemic lupus erythematosus developed the pneumoperitoneum without the perforation of gastrointestinal tract. A 51-year-old female who had been diagnosed as systemic lupus erythematosus and taken steroid for 12 years, visited our hospital because of general malaise. She had no abdominal symptoms but the roentgenographic examinations revealed the pneumoperitoneum. The laparotomy was performed and there were no findings of the perforation of the gastrointestinal tract. Because PCI is hardly recognized macroscopically after the rupture and the pneumoperitoneum due to PCI is often asymptomatic, we considered the cause of the pneumoperitoneum in this case was the rupture of PCI. The mechanisms of the formation of PCI in patients with collagen diseases were also discussed in this paper.     

Catastrophic gastrointestinal complication of systemic immunosuppression

We present a case of acute upper gastrointestinal haemorrhage in a patient with systemic vasculitis immunosuppressed on cyclophosphamide and prednisolone.The patient presented with a diffuse haemorrhagic oesophagitis and a non-specific duodenitis.Biopsies taken from the oesophagus and duodenum demonstrated infection with herpes simplex virus(HSV)and cytomegalovirus(CMV)respectively.Viral infection of the upper gastrointestinal tract is a recognised complication of immunosuppression and HSV is one of the most common pathogens.CMV on the other hand most commonly causes a colitis or less commonly oesophagitis.CMV enteritis is rare as is the synchronous infection with two viral agents in an immunocompromised patient having being described in a few case series only.Viral infection of the gastrointestinal tract in immunocompromised patients should be treated with systemic anti-viral medication and consideration to withdrawal of the immunosuppressive therapy if possible and appropriate.The authors highlight the need for a high suspicion of viral infection in immunosuppressed patients presenting with upper gastrointestinal bleeding.     

Pseudogout in a young patient

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is conventionally classified into cases that are hereditary, idiopathic (sporadic) or associated with other disorders. In the idiopathic form, the disease usually occurs in middle-aged or elderly patients. An earlier age of disease onset is observed in the hereditary form and the form associated with other disorders. Therefore, the occurrence of CPPD crystal deposition disease in a young patient merits thorough investigation for an underlying cause such as haemochromatosis, hyperparathyroidism, Wilson's disease, hypophosphatasia or hypomagnesaemia and requires a family study to investigate a possible hereditary cause. We report a case of a young female patient who presented with pseudogout at the age of 24 years; no associated diseases or familial occurrence were found despite a follow-up of more than 12 years.     

免疫功能低下与老年人肺结核

免疫功能是机体防御性反应，是机体识别并消除外来损害以保持体内环境的平衡和稳定的重要功能。结核病的发生和发展取决于很多因素，其中最重要的是感染的菌量及其毒力的大小和机体的反应性（免疫反应或变态反应）。如果机体的免疫功能低下，感染菌株的毒力较强且数量较多时，将导致结核病的发生和发展；反之机体的免疫功能较好，感染菌株的毒力不强且数量不多时，则导致临床痊愈，感染免疫的建立。结核病的免疫反应以细胞免疫为主，即T细胞起主要作用。成人型及内源性肺结核的发病与否及发病类型与人体的免疫功能关系密切。近年来由于恶性…