Cases reported "Crohn Disease"

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1/140. Generalized AA-amyloidosis in a 58-year-old Caucasian woman with an 18-month history of gastrointestinal tuberculosis.

    We report on a 58-year-old Caucasian woman who went to a general practitioner about recurrent abdominal pain, night sweats and weight loss of a few weeks' duration. Once gynaecological disease had been ruled out, the patient was admitted to hospital with severe abdominal pain and intestinal obstruction and a right-sided hemicolectomy was performed. Following the investigation of osteolytic lumbar vertebrae, 18 months after visiting the general practitioner the patient was finally found to be suffering from generalized AA-amyloidosis secondary to gastrointestinal tuberculosis. This had been misinterpreted as Crohn's disease. Re-examination of the specimens from the right-sided hemicolectomy demonstrated that scanty deposits of AA-amyloid were present 9 months after the first presentation. AA-amyloid can thus be present in serious inflammatory disease even during the first 9 months after the initial clinical presentation.
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2/140. Massive T wave changes following a combined kidney and liver transplant in a young female with cirrhosis.

    We report the case of a young female with PSC-associated cirrhosis and chronic renal failure who developed clinical and electrocardiographic signs consistent with acute myocardial infarction after a combined kidney and liver transplant. Cardiac investigations at that time were negative and she is currently asymptomatic one year post-transplant with resolution of most of her ECG abnormalities. Although the cause of her symptoms and ECG abnormalities is not immediately apparent, this case illustrates the difficulties in interpreting abnormal cardiac investigations in transplanted patients with liver cirrhosis who may have a background of subclinical cardiac disease.
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3/140. Recurrent buccal space abscesses: a complication of Crohn's disease.

    Oral features of Crohn's disease include ulcerations, lip fissuring, cobblestone plaques, and mucosal tags. We report the case of a 16-year old male patient with a 3-month history of abdominal pain, diarrhea, and oral ulceration. Clinical examinations revealed established intestinal lesions, a marked cobblestone appearance in the oral cavity, and an unusual pattern of presentation not previously reported in the literature: persistent, recurrent buccal space abscesses.
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4/140. Yersinia enterocolitis mimicking Crohn's disease in a toddler.

    A 31/2-year-old girl presented with persistent abdominal pain, fever, vomiting, and diarrhea accompanied by rash, oral ulceration, anemia, and an elevated sedimentation rate. Initial evaluation revealed no pathogens and was extended to include abdominal ultrasound and computed tomography showing marked ileocecal edema and mesenteric adenopathy. colonoscopy revealed focal ulceration from rectum to cecum with histology of severe active colitis with mild chronic changes. Enteroclysis demonstrated a nodular, edematous terminal ileum. Because of the patient's clinical deterioration despite antibiotics, these features were construed consistent with Crohn's disease, and glucocorticoid therapy was begun. By the ninth hospital day, admission cultures grew yersinia enterocolitica, and trimethoprim/sulfamethoxazole was begun followed by prompt clinical improvement. The delay in diagnosis afforded an unusually comprehensive clinical description of the presentation and diagnosis of Yersinia enterocolitis in childhood.
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5/140. Crohn's disease mimicking sarcoidosis in bronchoalveolar lavage.

    Granulomatous disorders like sarcoidosis or Crohn's disease are commonly associated with extrapulmonary or extraintestinal manifestations which occasionally may represent the only symptoms. We describe a 28-year-old female patient suffering from atypical erythema nodosum and arthritis. Although the chest x-ray was unremarkable bronchoalveolar lavage revealed lymphocytic alveolitis with an elevated CD4/CD8 ratio of 8 and 11.4 at repeated examinations suggesting a diagnosis of sarcoidosis. Further diagnostic workup included endoscopy of the bowel. The macroscopic aspect and histology of the terminal small bowel and colon ascendens indicated Crohn's disease. The patient recovered on steroids and sulfasalazine. Six months later she developed a perianal abscess for which she needed surgery supporting the diagnosis of Crohn's disease. This is the first case of a significantly (>6) elevated CD4/CD8 ratio in Crohn's disease previously regarded as highly specific for sarcoidosis.
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keywords = chest
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6/140. Treatment of severe esophageal Crohn's disease with infliximab.

    Esophageal ulceration with fistula is an uncommon manifestation of Crohn's disease. Typical presentation of symptomatic esophageal Crohn's disease may include dysphagia, odynophagia, weight loss, and chest discomfort. We present a patient with severe esophageal and skin involvement of Crohn's disease that was progressive despite conventional therapy including prednisone and 6-mercaptopurine. The diagnosis of Crohn's was based on the presence of typical clinical, endoscopic, and pathologic findings, including granulomas in the skin ulcer and the absence of infectious etiologies. The patient had a nearly complete resolution of her esophageal disease with a single infusion of infliximab.
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keywords = chest
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7/140. Intestinal angioedema mimicking Crohn's disease.

    angioedema usually presents as episodic attacks of swelling of the face, airway and extremities, but it may also involve visceral tissues. A 58-year-old woman with repeated episodes of abdominal pain, nausea and vomiting had two laparotomies and was treated for Crohn's disease for two years before a diagnosis of acquired intestinal angioedema was made. This case provides important insights into the presentation of intestinal angioedema.
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8/140. Severe tracheobronchial stenosis in a patient with Crohn's disease.

    Tracheobronchial involvement in Crohn's disease is rare, usually associated with symptoms of tracheobronchitis, and typically responds well to steroids. The authors report a case of a 29-yr old patient with Crohn's disease, who presented with dyspnoea, fever, and a productive cough. Computed tomography of the chest revealed extensive nodular tracheobronchial stenosis, that was accompanied by severe mucosal inflammation at bronchoscopy. High-dose oral steroids diminished the mucosal inflammation, but had limited efficacy on the underlying tracheobronchial stenosis. It is speculated that this relative ineffectiveness of steroids may be due to the persistence of the untreated inflammatory process.
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9/140. Rare complication of intestinal Crohn's disease: giant fibroid polyp.

    A 25-year-old male patient who had a brother with Crohn's disease was referred to our clinic with bloody diarrhea and crampy abdominal pain. After a plain erect abdominal X-ray, enteroclysis was performed, followed by abdominopelvic CT. Besides the radiological features of CD, both enteroclysis and CT revealed a big polypoid filling defect in the small intestine. The patient was surgically treated and the histopathology of the specimen revealed a giant fibroid polyp superimposed on CD, an extremely rare complication heretofore unmentioned in the radiology literature. In this report we discuss the role of enteroclysis in the diagnosis of complicated cases of long-standing CD. In addition, we also shed light on the importance of both enteroclysis and CT, with their complementary findings, in the radiological diagnosis of rare complicated cases of CD.
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10/140. Crohn's disease mimicking as bowel endometriosis. Are the symptoms reduced by nafarelin acetate?

    We report a 27-year-old female with Crohn's disease clinically misdiagnosed with intestinal endometriosis. Her complaints were abdominal pain and fullness, which occurred monthly during her menstrual period. Although we had no histopathological evidence, we diagnosed her as bowel endometriosis on the basis of her clinical course. Since nafarelin acetate therapy started, the symptoms due to mechanical subileus have improved. The transverse colon, a 70 cm segment of the ileum, including the terminal ileum, were resected because of repeated symptoms of bowel obstruction despite prolonged nafarelin therapy. Histopathological findings of the resected specimen revealed Crohn's disease without endometrial tissue. In our patient, an increased cortisol and ACTH secretion, a side effect of nafarelin, was noted during the therapy. This case showed that nafarelin therapy could increase serum concentration of ACTH and cortisol, which was considered to suppress the pathology of Crohn's disease by its anti-inflammatory action. We emphasize that intestinal examination must be performed with Crohn's disease in mind, even if nafarelin acetate is effective.
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