scholarly journals Metastatic Hepatocellular Carcinoma in a Patient with Crohn’s Disease Treated with Azathioprine and Infliximab: A Case Report and Literature Review

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Kyle J. Fortinsky ◽  
Ali Alali ◽  
Khursheed Jeejeebhoy ◽  
Sandra Fischer ◽  
Morris Sherman ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Crohn’S Disease ◽  
Liver Disease ◽  
Crohn's Disease ◽  
Case Reports ◽  
Future Research ◽  
Azathioprine Therapy ◽  
Additional Risk ◽  
Early Imaging ◽  
History Of

Hepatocellular carcinoma most commonly occurs in patients with underlying liver disease or cirrhosis. We describe a case of hepatocellular carcinoma in a 34-year-old man with Crohn’s disease treated with azathioprine and infliximab. The patient had no history of liver disease and a complete autoimmune and viral workup was unremarkable. Unfortunately, the patient developed widespread metastatic disease and passed away 5 months after his initial diagnosis. The mechanism of hepatocellular carcinoma in patients’ with Crohn’s disease is poorly understood and may include both autoimmunity and treatment-related complications. Previous case reports suggest the possibility of a concerning association between azathioprine therapy and the development of hepatocellular carcinoma in patients with Crohn’s disease. Clinicians may consider early imaging in patients with Crohn’s disease presenting with concerning symptomatology or abnormal liver enzymes, especially in those being treated with azathioprine alone or in combination with infliximab. Future research may help to uncover additional risk factors for this exceedingly rare diagnosis in this patient population.

scholarly journals Resected Hepatocellular Carcinoma in a Patient with Crohn’s Disease on Azathioprine

2016 ◽  
Vol 10 (1) ◽  
pp. 54-60 ◽  
Author(s):  
Valérie Heron ◽  
Kyle Joshua Fortinsky ◽  
Gillian Spiegle ◽  
Nir Hilzenrat ◽  
Andrew Szilagyi
Keyword(s):  
Hepatocellular Carcinoma ◽  
Crohn’S Disease ◽  
Liver Disease ◽  
Crohn's Disease ◽  
Liver Enzymes ◽  
Case Reports ◽  
Azathioprine Therapy ◽  
Elevated Liver Enzymes ◽  
Resection Specimen ◽  
High Degree

Hepatocellular carcinoma rarely occurs in patients without underlying cirrhosis or liver disease. While inflammatory bowel disease has been linked to certain forms of liver disease, hepatocellular carcinoma is exceedingly rare in these patients. We report the twelfth case of hepatocellular carcinoma in a patient with Crohn’s disease. The patient is a 61-year-old with longstanding Crohn’s disease who was treated with azathioprine and was found to have elevated liver enzymes and a new 3-cm liver mass on ultrasound. A complete workup for underlying liver disease was unremarkable and liver biopsy revealed hepatocellular carcinoma. The patient underwent a hepatic resection, and there is no evidence of recurrence at the 11-month follow-up. The resection specimen showed no evidence of cancer despite the initial biopsy revealing hepatocellular carcinoma. This case represents the third biopsy-proven complete spontaneous regression of hepatocellular carcinoma. Although large studies have failed to show a definite link between azathioprine and hepatocellular carcinoma, the relationship remains concerning given the multiple case reports suggesting a possible association. Clinicians should exercise a high degree of suspicion in patients with Crohn’s disease who present with elevated liver enzymes, especially those on azathioprine therapy.

scholarly journals Recurrent Hepatocellular Carcinoma in Patient with Crohn’s Disease: Incidental or Expected Outcome of Azathioprine?

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Youssef Botros ◽  
Mary Mathews ◽  
Hiren Patel ◽  
Nihar Shah ◽  
Walid Baddoura ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Case Reports ◽  
Disease Patient ◽  
Aminosalicylic Acid ◽  
Immune Mediated ◽  
Increased Risk ◽  
History Of

Hepatocellular carcinoma (HCC) usually occurs in patients with underlying risk factors such as liver cirrhosis and chronic hepatitis B. Although patients with Crohn’s disease (CD) are at an increased risk to develop malignancies such as colon cancer, the incidence of HCC in this population is extremely rare. We report a case of 62-year-old male with long history of CD treated with azathioprine (AZA) and aminosalicylic acid (ASA) who was incidentally diagnosed with HCC, for which left hepatectomy was done. Four years later during routine follow-up, patient had another hepatic lesion and underwent resection of the mass. The mechanism of occurrence of HCC in patient with CD is still controversial and may include immune mediated changes and medication related complications. AZA was reported in all case reports of CD that developed HCC. Through this report we hope to explore the complex pathophysiological mechanisms contributing to the development of HCC in the Crohn’s disease patient population.

Profuse Diarrhea after Misoprostol Use in a Patient with a History of Crohn's Disease

1992 ◽  
Vol 26 (9) ◽  
pp. 1092-1093 ◽  
Author(s):  
Julie S. Johnson ◽  
James A. Karboski ◽  
Glenys O. Williams
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Case Reports ◽  
Data Extraction ◽  
Gastrointestinal Symptoms ◽  
Personal Communication ◽  
Watery Diarrhea ◽  
Synthetic Analog ◽  
Ulcer Disease ◽  
History Of

OBJECTIVE: To report a case of profuse diarrhea after misoprostol use in a patient with a history of Crohn's disease and to discuss the role of eicosanoids in Crohn's disease. DATA SOURCES: Patient medical records, case reports, review articles identified by MEDLINE, and personal communication with the physician, patient, and manufacturer. DATA EXTRACTION: From interviews, the manufacturer, and pertinent published sources by one author and reviewed by the others. DATA SYNTHESIS: A 55-year-old woman presented to clinic complaining of multiple joint pains. Her medical history was significant for peptic ulcer disease, hypertension, and Crohn's disease in remission since May 1989. Her joint pains were treated with ibuprofen 600 mg po qid and misoprostol 200 μg po qid (after meals and at bedtime). Following the administration of three doses of ibuprofen and misoprostol, the patient experienced abdominal cramps, pain, and voluminous, watery diarrhea for two days. Upon discontinuation of the ibuprofen and misoprostol, all of her gastrointestinal symptoms resolved within 12 hours. Rechallenge with ibuprofen alone failed to produce a recurrence of symptoms. Enhanced synthesis of intestinal eicosanoids has been demonstrated in Crohn's disease. Misoprostol, a synthetic analog of one of the eicosanoids, could induce a flare-up of Crohn's disease as suggested in this patient. CONCLUSIONS: Misoprostol should be used with caution in patients with known inflammatory bowel disease.

Interesting case of dual pathology: Crohn’s disease and Peutz-Jeghers syndrome

2020 ◽  
Vol 13 (10) ◽  
pp. e234513
Author(s):  
Mantej Sehmbhi ◽  
Penelope Sellers ◽  
Jonathan Segal ◽  
Susan Clark
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Case Reports ◽  
Interesting Case ◽  
Night Sweats ◽  
History Of ◽  
Progressive Weight Loss ◽  
Inflammatory Bowel ◽  
Peutz Jeghers Syndrome ◽  
The Uk

An 18-year-old man presented with fever, night sweats and progressive weight loss over 2 months. He had a history of Peutz-Jeghers syndrome (PJS) complicated by previous intussusception requiring left hemicolectomy. Colonoscopy revealed deep punched out ulceration throughout the colon with multiple polyps. He was investigated for tuberculosis based on his occupation as dairy farmer. Following a negative QuantiFERON test, he was started on infliximab as emergency therapy and made a good recovery at 6 months follow-up. We describe a case of newly diagnosed Crohn’s disease (CD) in an adolescent with a background diagnosis of PJS. While inflammatory bowel disease, such as CD, is common in the UK, the association with PJS is very rare, with only two existing case reports in the literature.

scholarly journals Severe Erosive Pill Esophagitis Induced by Crizotinib Therapy: A Case Report and Literature Review

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Patrick Jung ◽  
Kyle J. Fortinsky ◽  
Zane R. Gallinger ◽  
Piero Tartaro
Keyword(s):  
Kinase Inhibitor ◽  
Chemotherapeutic Agent ◽  
Case Reports ◽  
Medication Administration ◽  
Future Research ◽  
Additional Risk ◽  
Anaplastic Lymphoma ◽  
Early Imaging ◽  
Alk Positive ◽  
Rare Diagnosis

Previous case reports have described esophagitis thought to be secondary to crizotinib, an oral tyrosine-kinase inhibitor used in the treatment of anaplastic lymphoma kinase- (ALK-) positive non-small cell lung cancer (NSCLC). In those reports, the interval development of esophagitis was between two days and three months after initiating or reinitiating crizotinib therapy. We present a woman who developed ulcerative esophagitis ten months after beginning crizotinib therapy, which is highly unusual. We believe the provoking factor was a change in her medication administration routine, done to accommodate religious practices during the period of Ramadan. This case illustrates the mechanism of pill esophagitis and reinforces the importance of patient education when it comes to medication administration. Clinicians may consider early imaging or investigations in patients with concerning symptomatology in the context of crizotinib therapy or other offending medications. Future research may help to uncover additional risk factors for this exceedingly rare diagnosis in this patient population. Most importantly, this case highlights nonpharmacologic ways to improve tolerability and decrease adverse effects of a highly effective chemotherapeutic agent.

scholarly journals Myopericarditis as an Extra-Intestinal Manifestation of Crohn’s Disease: A Case Report

2022 ◽  
Vol 5 (1) ◽  
pp. 01-05
Author(s):  
Rohan Prasad ◽  
Surya Chennupati ◽  
Tyler Kemnic ◽  
Abdullah Al-abcha ◽  
Manel Boumegouas ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Case Reports ◽  
Case Presentation ◽  
Reactive Protein ◽  
History Of ◽  
St Elevation ◽  
Inflammatory Bowel ◽  
Small Pericardial Effusion

Introduction: Myopericarditis is an uncommon manifestation of Crohn’s disease. Interestingly enough, it can present in a patient without any acute bowel symptoms. Case Presentation: A 21-year-old male with a medical history of Crohn’s disease and eosinophilic esophagitis presented to the hospital with chest pain and fever. Blood work revealed elevated troponin, C-reactive protein, and sedimentation rate levels. Electrocardiogram (EKG) showed diffuse ST elevation in all leads. Transthoracic echocardiogram (TTE) demonstrated a small pericardial effusion without valvular abnormalities. The patient was diagnosed with myopericarditis. Extensive etiological workup was negative, in the absence of other explanations, it was attributed to his Crohn’s disease. The patient was started on colchicine and ibuprofen. Out-patient follow-up revealed resolution of symptoms. Conclusion: This case reports the rare occurrence of myopericarditis and Crohn’s disease. Inflammatory bowel disease as a cause of myopericarditis has been reported in some cases within the literature; however, there is no definitive mechanism known.

Crohn's disease as a differential diagnostic problem in the elderly (case reports)

2006 ◽  
Vol 44 (05) ◽  
Author(s):  
Z Czeglédi ◽  
K Rábai ◽  
T Szamosi ◽  
B Nádas ◽  
J Banai
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Case Reports ◽  
The Elderly ◽  
Diagnostic Problem

scholarly journals Immune Thrombocytopenic Purpura (ITP) as an Uncommon Extraintestinal Complication of Crohn’s Disease: Case Vignette and Systematic Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Raisa Epistola ◽  
Tiffanie Do ◽  
Ritika Vankina ◽  
Daniel Wu ◽  
James Yeh ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Immune Thrombocytopenic Purpura ◽  
Case Reports ◽  
Case Vignette ◽  
Mucosal Permeability ◽  
Extraintestinal Manifestation ◽  
Thrombocytopenic Purpura ◽  
Disease Case ◽  
Inflammatory Bowel

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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