scholarly journals Fungal Infections Masquerading as Gastrointestinal Tract Malignancies – A Series of Three Cases

2021 ◽  
Vol 8 (8) ◽  
pp. C108-114
Author(s):  
Rachana Amit Chaturvedi ◽  
Balaji D Baste ◽  
Manjusha M Karegar ◽  
Prajakta A Gupte ◽  
Amita S Joshi
Keyword(s):  
Gastrointestinal Tract ◽  
Surgical Resection ◽  
Clinical Features ◽  
Antifungal Therapy ◽  
Radical Surgery ◽  
Fungal Infections ◽  
Clinical Suspicion ◽  
Uncommon Presentation ◽  
High Index Of Suspicion ◽  
Timely Treatment

Fungal infections of the gastrointestinal tract (GIT) are not rare, but get missed due to their misleading clinical features. Here we report three GIT fungal infections at different locations with varied symptoms. We received surgical resection specimens with the clinical suspicion of malignancy for all. The first was a case of Aspergillosis, at an uncommon site, esophageal, in a 60year diabetic male with a suspicion of carcinoma in view of presence of dysphagia and a stricture on CT. The second was a 60-year male, a case of stomach Zygomycosis with no definite immunosuppression, who presented with an intra-operative suspicion of malignancy, and showed fungal angio-invasion and ischemic perforation. Third was a 32year immunocompetent male, a case of GI histoplasmosis with an uncommon presentation, showing obstructive symptoms due to an ileocaecal mass with a clinical suspicion of TB/malignancy. Thus, a high index of suspicion for fungal a etiology in GIT is essential, because misdiagnosis can lead to a radical surgery. Timely treatment with appropriate antifungal therapy is crucial as high mortality is associated with certain fungi.

scholarly journals COVID-19 and Gastrointestinal Symptoms—A Case Report

Geriatrics ◽  
2020 ◽  
Vol 5 (2) ◽  
pp. 31
Author(s):  
Alistair J. Mackett ◽  
Victoria L. Keevil
Keyword(s):  
Case Report ◽  
Older People ◽  
Clinical Features ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
High Index ◽  
Uncommon Presentation ◽  
Novel Coronavirus ◽  
High Index Of Suspicion

COVID-19, a new illness secondary to a novel Coronavirus emerged in December 2019 in China. Our early understanding of the clinical features of COVID-19 has been based on case series emerging from the first outbreak in Wuhan. These features included fever, a dry cough, myalgia and dyspnea. Gastrointestinal symptoms were rarely reported as a key feature. We present a case report of a 74-year-old male who presented with symptoms of gastroenteritis and subsequently tested positive for COVID-19. This article aims to highlight an uncommon presentation of COVID-19 and that a high index of suspicion is required for COVID-19 in older people given their greater likelihood of presenting atypically.

Reconsidering NMIHBA Core Features: Macrocephaly Is Not a So Unusual Sign in PRUNE1-Related Encephalopathy

2020 ◽  
Author(s):  
Roberta Battini ◽  
Enrico Bertini ◽  
Roberta Milone ◽  
Chiara Aiello ◽  
Rosa Pasquariello ◽  
...  
Keyword(s):  
Nervous System ◽  
Differential Diagnosis ◽  
Clinical Features ◽  
Neurodevelopmental Disorder ◽  
Recurrent Mutation ◽  
Clinical Suspicion ◽  
Alexander Disease ◽  
Brain Anomalies ◽  
Progressive Encephalopathy ◽  
Core Features

Abstract PRUNE1-related disorders manifest as severe neurodevelopmental conditions associated with neurodegeneration, implying a differential diagnosis at birth with static encephalopathies, and later with those manifesting progressive brain damage with the involvement of both the central and the peripheral nervous system.Here we report on another patient with PRUNE1 (p.Asp106Asn) recurrent mutation, whose leukodystrophy, inferior olives hyperintensity, and macrocephaly led to the misleading clinical suspicion of Alexander disease. Clinical features, together with other recent descriptions, suggest avoiding the term “microcephaly” in defining this disorder that could be renamed “neurodevelopmental disorder with progressive encephalopathy, hypotonia, and variable brain anomalies” (NPEHBA).

scholarly journals A long-term survivor of clear cell sarcoma-like tumor of the gastrointestinal tract with liver metastasis: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Takuhisa Okada ◽  
Yasumitsu Hirano ◽  
Shintaro Ishikawa ◽  
Hiroka Kondo ◽  
Toshimasa Ishii ◽  
...  
Keyword(s):  
Small Intestine ◽  
Lymph Node ◽  
Gastrointestinal Tract ◽  
Liver Metastasis ◽  
Surgical Resection ◽  
Clear Cell ◽  
Clear Cell Sarcoma ◽  
Cell Sarcoma

Abstract Background Clear cell sarcoma-like tumor of the gastrointestinal tract (CCSLTGT) is extremely rare. It is a mesenchymal neoplasm that usually forms in the small intestine of adolescents and young adults, is prone to local recurrence and metastasis, and has a high mortality rate. We report a patient with CCSLTGT with lymph node- and liver metastases, who continues to survive 6 years after initial surgical resection. Case presentation A 38-year-old woman presented with lightheadedness. Laboratory analysis revealed anemia (hemoglobin, 6.7 g/dL), and enhanced computed tomography (CT) demonstrated a mass in the small intestine, about 6 cm in diameter, with swelling of 2 regional lymph nodes. Double-balloon small intestine endoscopic examination revealed a tumor accompanied by an ulcer; the biopsy findings suggested a primary cancer of the small intestine. She was admitted, and we then performed a laparotomy for partial resection of the small intestine with lymph node dissection. Pathologic examination revealed CCSLTGT with regional lymph node metastases. About 3 years later, follow-up CT revealed a single liver metastasis. Consequently, she underwent a laparoscopic partial liver resection. Histopathologic examination confirmed that the liver metastasis was consistent with CCSLTGT. It has now been 3 years without a recurrence. Conclusion Repeated radical surgical resection with close follow-up may be the only way to achieve long-term survival in patients with CCLSTGT.

scholarly journals Clinical features and prognostic analysis of patients with Aspergillus isolation during acute exacerbation of chronic obstructive pulmonary disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yu Gu ◽  
Xianping Ye ◽  
Yu Wang ◽  
Kunlu Shen ◽  
Jinjin Zhong ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Clinical Features ◽  
Antifungal Therapy ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Positive Culture ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Background Lower respiratory tract (LRT) specimen culture is widely performed for the identification of Aspergillus. We investigated the clinical features and prognosis of patients with Aspergillus isolation from LRT specimens during acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods This is a 6-year single-center, real-world study. 75 cases out of 1131 hospitalized AECOPD patients were positive for Aspergillus. These patients were carefully evaluated and finally diagnosed of pulmonary aspergillosis (PA, 60 cases, 80%) or colonization (15 cases, 20%). Comparisons of clinical data were performed between these two groups. A cox regression model was used to confirm prognostic factors of Aspergillus infection. Results The PA group had worse lung function and higher rates of systemic corticosteroid use and broad-spectrum antibiotic use before admission than the colonization group. The PA group had significantly higher in-hospital mortality and 180-day mortality than the colonization group (45% (27/60) vs. 0% (0/15), p = 0.001, and 52.5% (31/59) vs. 6.7% (1/15), p < 0.001, respectively). By multivariable analysis among Aspergillus infection patients, antifungal therapy (HR 0.383, 95% CI 0.163–0.899, p = 0.027) was associated with improved survival, whereas accumulated dose of systemic steroids > 700 mg (HR 2.452, 95% CI 1.134–5.300, p = 0.023) and respiratory failure at admission (HR 5.983, 95% CI 2.487–14.397, p < 0.001) were independently associated with increased mortality. Significant survival differential was observed among PA patients without antifungals and antifungals initiated before and after Aspergillus positive culture (p = 0.001). Conclusions Aspergillus isolation in hospitalized AECOPD patients largely indicated PA. AECOPD patients with PA had worse prognosis than those with Aspergillus colonization. Empirical antifungal therapy is warranted to improve the prognosis for Aspergillus infection.

scholarly journals Challenging Presentations of Seven Cases of Gastrointestinal Basidiobolomycosis in Sudan: Clinical Features, Histology, Imaging, and Recommendations

2020 ◽  
Vol 12 (04) ◽  
pp. 281-284
Author(s):  
Sawsan A. Mohammed ◽  
Azza A. Abdelsatir ◽  
Mohamed Abdellatif ◽  
Suliman Hussein Suliman ◽  
Omer Mohammed Ibrahim Elbasheer ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Fungal Infection ◽  
Clinical Features ◽  
Subcutaneous Tissue ◽  
Case Series ◽  
First Case

AbstractsBasidiobolomycosis is a fungal infection caused by Basidiobolus ranarum which affects the skin and subcutaneous tissue and rarely the gastrointestinal tract. We report seven cases of gastrointestinal basidiobolomycosis with interesting clinical, radiological, and histological presentations. To our knowledge, this is the first case series of abdominal basidiobolomycosis to be reported from Sudan.

scholarly journals Eosinophilic Gastrointestinal Diseases: Review and Update

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Mahreema Jawairia ◽  
Ghulamullah Shahzad ◽  
Paul Mustacchia
Keyword(s):  
Gastrointestinal Tract ◽  
Clinical Features ◽  
Gastrointestinal Symptoms ◽  
Gastrointestinal Diseases ◽  
Gastrointestinal Disorders ◽  
Diverse Group ◽  
Intestinal Diseases ◽  
Gastrointestinal Inflammation ◽  
Eosinophilic Gastrointestinal Disorders

Eosinophilic gastrointestinal disorders (EGIDs) are a progressively more frequent diverse group of intestinal diseases. The intention of this paper is to present the newest developments in the care of patients with EGIDs and to sum up a rising literature defining the clinical features and mechanistic elements of eosinophils and their intricate associations with the gastrointestinal tract. Clinicians ought to stay sensitive to EGIDs as a diagnostic likelihood for patients with general gastrointestinal symptoms. Further research is warranted to establish various methods leading to dysfunction coupled with eosinophilic gastrointestinal inflammation.

Cricotracheal separation: a review and a case with bilateral recovery of recurrent laryngeal nerve function

2006 ◽  
Vol 120 (6) ◽  
pp. 497-501 ◽  
Author(s):  
D J McCrystal ◽  
C Bond
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Unusual Case ◽  
Open Repair ◽  
Laryngeal Nerve ◽  
Clinical Suspicion ◽  
Nerve Function ◽  
Short Term ◽  
High Index Of Suspicion ◽  
Type Of Injury

Cricotracheal separation (CTS) is an uncommon injury, with a high index of suspicion required to establish the diagnosis. Computerized tomography (CT) plays a role in diagnosis but cannot necessarily be relied upon. Bilateral recurrent laryngeal nerve (RLN) palsies are usually associated with this type of injury. We recently treated a patient with CTS in whom one RLN was intact from the time of the injury and the other nerve recovered within three months. Computed tomography was inconclusive.Early open repair of the injury and frequent follow-up examinations led to successful decannulation after six weeks and excellent short-term voice and airway outcomes.A detailed discussion of this unusual case is followed by a review of the current literature on CTS, with particular emphasis on significant management dilemmas and controversies.Clinical suspicion remains more sensitive than investigations in diagnosing CTS. Permanent bilateral RLN palsies are not inevitable following these injuries.

Rare cause of paraparesis in a young man: cervico-dorsal neurenteric cysts associated with Klippel-Feil syndrome

2021 ◽  
Vol 14 (3) ◽  
pp. e235327
Author(s):  
Raghav Seth ◽  
Anindita Sinha ◽  
Navneet Singla ◽  
Debajyoti Chatterjee
Keyword(s):  
Cervical Spine ◽  
Gastrointestinal Tract ◽  
Range Of Motion ◽  
Surgical Resection ◽  
Congenital Abnormality ◽  
Neurenteric Cyst ◽  
Short Neck ◽  
Spinal Axis

Klippel-Feil syndrome is an entity presenting with short neck, low hairline and reduced range of motion of cervical spine. Neurenteric cyst is a congenital abnormality, in which mucus-secreting epithelium of the gastrointestinal tract is seen in the spinal axis. The association of a neurenteric cyst with Klippel-Feil syndrome has been reported very rarely. We report the case of a young man, affected by Klippel-Feil syndrome, who presented with bilateral paraplegia. Imaging of the spine revealed features suggestive of cervico-dorsal neurenteric cyst. Subsequently, surgical resection of the cysts was done, which resulted in resolution of the symptoms.

Antifungal therapy with azoles induced the syndrome of acquired apparent mineralocorticoid excess: A literature and database analysis

2021 ◽  
Author(s):  
Huan-huan Ji ◽  
Xue-wen Tang ◽  
Ni Zhang ◽  
Ben-nian Huo ◽  
Ying Liu ◽  
...  
Keyword(s):  
Clinical Features ◽  
Antifungal Therapy ◽  
Adverse Event Reporting System ◽  
Adverse Event Reporting ◽  
Time To Event ◽  
Database Analysis ◽  
Apparent Mineralocorticoid Excess ◽  
Itraconazole Treatment ◽  
Practice Methods ◽  
Dose Dependent

Objective. We aimed to estimate the risk of varied antifungal therapy with azoles causing the syndrome of acquired apparent mineralocorticoid excess (AME) in the real-world practice. Methods. First, we conducted a disproportionality analysis based on data from the FDA Adverse Event Reporting System (FAERS) database to characterize the signal differences of triazoles - related AME. Second, a systematic review was conducted, and to describe clinical features of AME cases reported in clinical practice. Results. In the FAERS database, we identified 27 cases of triazoles - AME, posaconazole [ROR=865.37; 95%CI (464.14; 1613.45)] and itraconazole [ROR=556.21; 95% (303.05; 1020.85)] significantly increased the risk of AME events, while fluconazole, voriconazole and isavuconazole did not affect any of the mineralocorticoid excess targets. 18 studies with 39 cases raised evidence of AME following posaconazole and itraconazole treatment, and another 27 cases were identified by analysis of the description of clinical features in FAERS database. The average age of 66 patients was 55.5 years (6∼87 years). AME mainly occurs in patients with posaconazole concentrations above 3 μg/mL (mean=4.4μg/mL, range 1.8∼9.5μg/mL), and is less likely to occur when levels are below 2 μg/mL (6%). The median time to event onset was 11.5 weeks, and 50% of the adverse events occurred within 3 months for posaconazole. Conclusion. The presented study supports very recent findings that posaconazole and itraconazole but not the other three azole antifungals investigated are associated with AME and the effects were dose-dependent, which allows for a dose de-escalation strategy and for substitution with fluconazole, isavuconazole or voriconazole to resolve the adverse effects.

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