scholarly journals Factitious Disorder Presenting with Refractory Enterocutaneous Fistula that Underwent 7 Surgeries

2020 ◽  
Vol 14 (2) ◽  
pp. 291-298
Author(s):  
Di Zhao ◽  
Qiyi Chen ◽  
Ning Li
Keyword(s):  
Inflammatory Bowel Disease ◽  
Enterocutaneous Fistula ◽  
Surgical Excision ◽  
Young Female ◽  
Factitious Disorder ◽  
Test Results ◽  
Distal Obstruction ◽  
Appendiceal Stump ◽  
Inflammatory Bowel ◽  
Antibiotic Coverage

The formation of a post-appendicectomy fistula is rare but devastating. Major etiological factors include leakage from the appendiceal stump, neoplasm of the appendix and/or cecum, infection, inflammatory bowel disease, and distal obstruction. The management of enterocutaneous fistula involves enteral nutrition, drainage, antibiotic coverage, as well as surgical excision and segmental resection of the involved bowel. Here we present a case where a young female suffered from refractory enterocutaneous fistula after appendicectomy. Despite extensive treatments, her symptoms persisted and contradicted with objective test results. Therefore, a diagnosis of factitious disorder was suspected. After questioning, she finally admitted to having applied feces to her wound to fake fistula. It was estimated that the lifetime prevalence of factitious disorder in the general population was 0.1%, which warrants the awareness of clinicians.

scholarly journals Frequency of Positive Conversion of Interferon-Gamma Release Assay Results Among Patients With Inflammatory Bowel Disease Treated With Non-tumor Necrosis Factor Inhibitors

2021 ◽  
Vol 8 ◽  
Author(s):  
Kyuwon Kim ◽  
Kyung-Wook Jo ◽  
Tae Sun Shim ◽  
Jin Hwa Park ◽  
Sung Wook Hwang ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Tumor Necrosis ◽  
Inhibitor Therapy ◽  
Interferon Gamma Release Assay ◽  
Tnf Inhibitor ◽  
Tumor Necrosis Factor Inhibitors ◽  
Test Results ◽  
Release Assay ◽  
Inflammatory Bowel ◽  
Necrosis Factor

Considering the risk of reactivation of latent tuberculosis infection (LTBI), not only before starting tumor necrosis factor inhibitors but also before non-TNF inhibitor therapy, LTBI screening is routinely recommended for patients with inflammatory bowel disease (IBD). However, data on the positive conversion of LTBI test results during non-TNF inhibitor therapy are scarce. Among IBD patients treated with vedolizumab and/or ustekinumab, a total of 91 patients who had negative baseline interferon-gamma release assay (IGRA) results, assessed by QuantiFERON®-TB Gold In-tube or QuantiFERON®-TB Gold Plus, were enrolled. Serial LTBI test results after starting non-TNF inhibitor therapy were collected, and patients' clinical characteristics were analyzed. Positive IGRA conversion was observed in six of 91 patients (6.6%). The cumulative IGRA conversion–free survival rates after starting therapy were 97.7% after 1 year and 86.7% after 2 years. Ulcerative colitis was more common among converters compared with non-converters (66.7 vs. 23.5%, P = 0.040). Among six converters, four had been treated with vedolizumab, one with ustekinumab, and the other with vedolizumab followed by ustekinumab. All six patients had been previously exposed to TNF inhibitors before non-TNF inhibitor therapy: five to infliximab and one to both infliximab and adalimumab. After positive IGRA conversion, none of the six converters developed active tuberculosis while maintaining non-TNF inhibitor therapy (median 6.8 months, range 0.4–32.1 months). Positive IGRA conversion among IBD patients treated with vedolizumab and/or ustekinumab appears to occur somewhat frequently, but its clinical implications remain to be elucidated.

scholarly journals A comparison of diagnostic performance between two quantitative rapid fecal calprotectin assays in detecting active inflammatory bowel disease

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255974
Author(s):  
Jong-Mi Lee ◽  
Joo Hee Jang ◽  
Ji Hyeong Ryu ◽  
Jaeeun Yoo ◽  
Bo-In Lee ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Diagnostic Performance ◽  
Area Under The Curve ◽  
Fecal Calprotectin ◽  
Test Results ◽  
Rapid Assays ◽  
Endoscopic Score ◽  
Inflammatory Bowel

Background Fecal calprotectin (FC) is widely used for the diagnosis and monitoring disease activity of inflammatory bowel disease (IBD). Quantitative rapid assays can be a reliable alternative to the time-consuming assay. This study aimed to evaluate and compare the diagnostic performance of two quantitative rapid FC assays (Ichroma calprotectin, and Buhlmann Quantum blue). Methods A total of 192 patients were included in this study; 84 patients with IBD (67 ulcerative colitis and 17 Crohn’s disease) and 108 patients with non-IBD. We compared quantitative FC levels in different disease statuses and evaluated the correlation between the FC results of the two FC kits. Diagnostic performances in predicting active IBD were evaluated in reference to different cut-off levels. Results The FC levels in 45 patients with active IBD as defined by endoscopic score were significantly higher compared to the inactive IBD and other diseases (P<0.05). Although the two assays’ results correlated (r = 0.642, P < 0.001), a significant deviation was observed (y (Buhlmannn) = -45.2 +8.9X (Ichroma)). The Diagnostic performances in predicting active IBD were comparable as area under the curve (AUC), 0.812, cut-off, 50, sensitivity, 64.4%, and specificity, 85.0% for iChroma assay and AUC, 0.826, cut-off, 100, sensitivity, 84.4%, and specificity 61.9% for Buhlmann Quantum Blue assay. FC levels using a cut-off of > 250 μg/g confirmed 85.7% (iChroma) and 64.1% (Buhlmann) of active IBD patients. Conclusion The results of the two rapid FC assays iChroma and Buhlmann showed a significant correlation, but the two test results were not interchangeable. With optimized cut-off values, rapid FC tests could be helpful in the diagnosis of IBD and differentiating active IBD from inactive or organic bowel disease.

scholarly journals Clostridium difficile in inflammatory bowel disease

2018 ◽  
Vol 90 (11) ◽  
pp. 32-36
Author(s):  
O V Knyazev ◽  
A V Kagramanova ◽  
M E Chernova ◽  
I A Korneeva ◽  
A I Parfenov
Keyword(s):  
Inflammatory Bowel Disease ◽  
Clostridium Difficile ◽  
Bowel Disease ◽  
Antibiotic Use ◽  
Test Results ◽  
Chi Square ◽  
Medical Institutions ◽  
History Of ◽  
Inflammatory Bowel

Aim. To study epidemiology and risk factors for Clostridium infection (CDI) associated with Clostridium difficile in patients with inflammatory bowel disease (IBD). Materials and methods. 1179 medical records were analyzed in a retrospective study of patients with IBD, of which 764 patients met the inclusion criteria. Patients were divided into 2 groups based on the presence of a preliminary diagnosis of CDI. Statistical analysis was carried out using Pearson Chi-square and two-sample t-test. Results. The incidence of CDI in patients with IBD was 17.3%, with the same prevalence in patients with Crohn's disease (CD) (n=53/40.1%) and ulcerative colitis (UC) (n=79/59.9%). The mean age of occurrence of CDI in patients with IBD was 37.8±12.9, 84.8% of infections were community-acquired and only 4.5% occurred in medical institutions. Only 21.2% of all patients with CDI had a history of antibiotic use, and 24.2% had previously used steroids. Long-term immunosuppressive therapy in patients with IBD has an impact on the development of CDI: among patients with CDI 45.5% long-term received azathioprine/6-mercaptopurine, in patients without IBD - 17.7% (p

COLORECTAL ADENOCARCINOMA DEVELOPING IN A YOUNG FEMALE WITH OVERLAP SYNDROME AND VERY EARLY ONSET-INFLAMMATORY BOWEL DISEASE: A CASE REPORT

2021 ◽  
Vol 160 (3) ◽  
pp. S20
Author(s):  
Prashanthi Kandavel ◽  
Victoria Shakhin ◽  
Mallory Chavannes ◽  
Christopher Gayer ◽  
Hillel Naon ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Case Report ◽  
Bowel Disease ◽  
Early Onset ◽  
Colorectal Adenocarcinoma ◽  
Young Female ◽  
Overlap Syndrome ◽  
Inflammatory Bowel
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