Casal’s Necklace: Extraintestinal Manifestation of Tropical Sprue

While the association of immune thrombocytopenic purpura (ITP) and inflammatory bowel disease (IBD) has been described in a few case reports, management of ITP as an extraintestinal manifestation of Crohn’s disease (CD) is less studied. There are approximately a dozen cases describing the management of patients dually diagnosed with CD/ITP. Previous reports postulated that the mechanism of ITP in CD was through the presence of circulating immune complexes in the serum and antigenic mimicry due to increased mucosal permeability in active colitis, versus increased mucosal production of TH1-type proinflammatory cytokines during CD flares, which may account for remission of ITP with surgery for CD. We present a case of a 27-year-old man who presented with medically refractory CD and ITP who responded to surgical management with colectomy and splenectomy, along with a systematic review of the literature. These cases suggest that colectomy should be considered in the treatment of medically refractory ITP among patients with concomitant CD.

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Recurrent myocarditis in a patient with active ulcerative colitis: a case report and review of the literature

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2020-000587 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000587

Author(s):

Giacomo Caio ◽

Lisa Lungaro ◽

Fabio Caputo ◽

Maria Muccinelli ◽

Maria Caterina Marcello ◽

...

Keyword(s):

Ulcerative Colitis ◽

Case Report ◽

Inflammatory Bowel Diseases ◽

Drug Toxicity ◽

Active Ulcerative Colitis ◽

Extraintestinal Manifestations ◽

Review Of The Literature ◽

Extraintestinal Manifestation ◽

Bowel Diseases ◽

Inflammatory Bowel

Inflammatory bowel diseases such as ulcerative colitis (UC) may be complicated by several extraintestinal manifestations. These involve joints, skin, eyes and less commonly lungs and heart. Myocarditis may result from the toxic effect of drugs (ie, mesalazine) commonly used for the treatment of UC or due to infections (eg, Coxsackieviruses, enteroviruses, adenovirus). Here, we report a case of a 26-year old man affected by UC and complicated by two episodes of myocarditis. Both episodes occurred during two severe exacerbations of UC. However, in both cases the aetiology of myocarditis remains uncertain being ascribable to extraintestinal manifestation, drug toxicity or both.

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