Cases reported "Enterocolitis"

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1/30. CD4/CD8 double-positive adult T cell leukemia with preceding cytomegaloviral gastroenterocolitis.

    We present a rare case of adult T cell leukemia (ATL) in which leukemic T cells simultaneously expressed CD4 and CD8 surface antigens and refractory cytomegalovirus (CMV)-induced gastroenterocolitis preceded its clinical onset. A 40-year-old male was admitted to our hospital with abdominal pain and bloody stool. biopsy specimens of the gastric and rectal mucosa indicated CMV-induced gastroenterocolitis. The patient also proved to be seropositive for human T lymphotropic virus type I (HTLV-I). While being administered gancyclovir for CMV infection, he presented hepatomegaly and systemic lymphadenopathy. Monoclonal expansion of lymphoid cells integrated with HTLV-I genome was observed. He underwent a LSG15 regimen and hepatomegaly and lymphadenopathy improved markedly. Gastroenterocolitis also improved, but the symptoms did not disappear completely. CMV-induced diseases are prevalent among immunosuppressed patients. Although there was no evidence that this patient had ATL on admission, it is likely that he was severely immunodeficient. CMV can easily infect damaged mucosa. ATL cells often infiltrate gastrointestinal mucosa and may have triggered CMV gastroenterocolitis in this case.
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2/30. A plea for incidental appendectomy in pediatric patients with malignancy.

    The evaluation of right lower quadrant (RLQ) abdominal pain in pediatric patients with malignancy can be difficult. However, since the mortality rate from peritoneal infections in these patients is very high, the differential diagnosis of RLQ peritoneal irritation, mainly of acute appendicitis (AA) versus neutropenic enterocolitis (NE), is crucial. Three cases of pediatric patients with malignancy demonstrating these difficulties are represented to enlighten this problem. The first patient died of multiorgan failure after operation for perforated appendicitis without generalized peritonitis. The second had a severe life-threatening postoperative complication because of delayed diagnosis of acute appendicitis. The third patient with malignant pelvic spread, underwent an unnecessary abdominal exploration for suspected AA. In all these cases and probably in many others, the clinical outcome could have been different if a previous incidental appendectomy had been performed during the primary abdominal operation. Incidental appendectomy in oncologic patients is recommended to facilitate the differential diagnosis of RLQ pain and to exclude the diagnosis of AA.
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3/30. enterocolitis with pathogenic escherichia coli infection in renal transplant recipients: case reports.

    PURPOSE: We report three cases of enterocolitis associated with pathogenic escherichia coli infection in renal transplant recipients. methods/RESULTS: patients presented with abdominal pain and diarrhea at 1, 3 and 7 years after living-related renal transplantation. Pathogens of enterocolitis were identified by stool culture as verotoxin-2-producing O157:H7 E. coli, non-verotoxin-producing E. coli 06 and 0125. All patients were basically treated with fluid replacement with additional fosfomycin administration in the patient with O157:H7 E. coli infection. Immunosuppressive drugs were kept at maintenance doses throughout the treatment. CONCLUSION: All patients recovered uneventfully within 10 days after the onset of enterocolitis without severe complications.
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4/30. Florid computed tomographic appearance of acute Campylobacter enterocolitis.

    A 28-year-old male presented with severe abdominal pain and bloody diarrhoea. Computed tomographic scan showed marked swelling of the distal ileum and entire colorectum. The patient recovered and campylobacter jejuni was subsequently grown from his faeces.
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5/30. Successful conservative treatment of neutropenic enterocolitis complicating taxane-based chemotherapy: a report of five cases.

    Five cases of acute neutropenic enterocolitis complicating taxane-based chemotherapy are described. During a 34-month period, our department administered 4,600 courses of taxane-based (paclitaxel and docetaxel) chemotherapy to 800 cancer patients. Seven to 10 days postchemotherapy in five patients (0.1% of the given courses), neutropenic fever, abdominal pain, rebound tenderness, and grade II-IV diarrhea (bloody in two cases) developed. Two patients had oral candidiasis, and in two others septic shock developed. Computed tomography scans of the abdomen revealed in all patients thickening of the colon wall and pericolic edema, and a pericolic abscess was revealed in three of them. Both clinical and radiologic findings supported the diagnosis of acute neutropenic enterocolitis. All patients were successfully treated with broad-spectrum antibiotics and recombinant human granulocyte colony-stimulating factor. In conclusion, acute neutropenic enterocolitis is a severe complication of taxane-based chemotherapy. early diagnosis and appropriate conservative treatment leads to complete recovery. Although rare, this infection is less often associated with other chemotherapeutic regimens.
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6/30. Idiopathic enterocolic lymphocytic phlebitis: a rare cause of ischemic colitis.

    We report on a 74-year-old female patient who was admitted to the hospital because of abdominal pain. She underwent a colonoscopy and a stenosing mass was found in the cecum. Histologic findings in the biopsy specimens were consistent with ischemic colitis. Due to clinical symptoms and the endoscopic and radiologic findings that roused the suspicion that the patient was suffering from a malignant tumor, a right hemicolectomy was performed. histology of the resection specimen disclosed an inflammation of the veins. It was characterized by a predominantly lymphocytic infiltration of the vessels affecting the veins of the colonic wall and the mesentery. Furthermore, secondary thrombosis with focal venous occlusion was observed. The colon showed extensive ischemic colitis with focal transmural coagulation necrosis. The disease was considered to be idiopathic lymphocytic phlebitis, which is a rare disease of unknown origin. Our patient is well and alive after more than 1 year, supporting the notion that the disease shows a benign course after surgery.
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7/30. Intestinal bleeding and occlusion associated with shiga toxin-producing escherichia coli O127:H21.

    We report a case of a nine-year old boy with vomiting, abdominal pain and fever, who underwent surgery with a diagnosis of appendicitis in Mendoza and from whom a shiga toxin-producing escherichia coli (STEC) O127:H21 strain was recovered. Forty-eight hours after surgery he presented bilious vomiting and two episodes of intestinal bleeding. Laboratory findings included: hematocrit, 35%; blood urea nitrogen, 0.22 g/L. The urinary output was normal. The following day physical examination showed an alert mildly hydrated child, without fever but with distended and painful abdomen. The patient was again submitted to surgery with a diagnosis of intestinal occlusion. Bleeding and multiple adhesions in jejunum and ileum were found. The patient still had tense and painful abdomen and presented two bowel movements with blood; hematocrit fell to 29% and blood urea nitrogen rose to 0.32 g/L. STEC O127:H21 eae(-)/Stx2/Stx2vh-b( )/E-Hly( ) was isolated from a stool sample. He was discharged after 10 days of hospitalization and no long-term complications such as HUS or TTP were observed. This is the first report, to our knowledge, on the isolation of E. coli O127:H21, carrying the virulence factors that characterize STEC strains, associated to an enterohemorrhagic colitis case. This serotype was previously characterized as a non-classic enteropathogenic E. coli (EPEC). STEC infections can mimic infectious or noninfectious pathologies. Therefore an important aspect of clinical management is making the diagnosis using different criteria thereby avoiding misdiagnoses which have occasionally led to invasive diagnostic and therapeutic procedures or the inappropriate use of antibiotics.
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8/30. Neutropenic enterocolitis: a rare presenting complication of acute leukemia.

    Neutropenic enterocolitis is a necrotizing inflammatory process with intramural infection that occurs predominantly in neutropenic patients. This syndrome is most frequently observed after chemotherapy for hematologic and solid tissue malignancies, but it can also be observed in a number of other clinical settings as well. Neutropenic enterocolitis can be a rare presenting complication of acute leukemia. We report a case of acute lymphoblastic leukemia that presented with abdominal pain due to neutropenic enterocolitis. The diagnostic and treatment challenges associated with this manner of presentation are discussed.
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9/30. cytomegalovirus enterocolitis in an immunocompetent individual.

    We report a rare case of cytomegalovirus (CMV) enterocolitis in a healthy 57-year-old woman. In March 1999, she developed hematochezia, diarrhea, and abdominal pain. Total colonoscopy on March 17th showed multiple aphthoid lesions and friable mucosa from the terminal ileum to the rectum and a shallow ulcer on the ileocecal valve. Repeat total colonoscopy on April 19th showed faded aphthoid lesions in the terminal ileum, and biopsy specimen revealed CMV inclusion bodies. Symptoms and endoscopic findings improved without any specific medication. In previous reports, the definition of "immunocompetent individual" varied. Here, we define immunocompetent individual as one who has no associated diseases, is not under immunosuppressive therapy, has no recent history of operation, is negative for human immunodeficiency virus antibody, is not pregnant, has no obvious infectious course, and is less than 70 years of age. This is the ninth report of CMV enterocolitis in an immunocompetent individual in the world literature.
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10/30. Gastrointestinal toxicity associated with weekly docetaxel treatment.

    Previous studies have demonstrated a marked reduction of haematological and non-haematological toxicity if weekly doses of docetaxel <40 mg/m2 were used. Reviewing the literature, neutropenic enterocolitis is uncommon but not unknown in patients treated with taxane-based chemotherapy. Although this complication occurs rarely, here we report on two patients, one with metastatic breast cancer and one with non-small-cell lung cancer, treated on a weekly schedule with single-agent docetaxel. Both patients developed excessive and fatal haemorrhragic gastroduodenitis and enterocolitis associated with grade 2 and 3 neutropenia. We would like to stress the importance of symptoms such as abdominal pain and tenderness, fever, diarrhoea and mucositis, with or without neutropenic fever, in patients treated with docetaxel-based chemotherapy. These symptoms should alert the physician and supportive care management should be started aggressively and immediately.
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