The role of multimodality imaging in diagnosing acute perimyocarditis secondary to Crohn’s disease

Abstract Background Acute perimyocarditis is a rare extra-intestinal manifestation in Crohn’s disease which required multimodality imaging to confirm the diagnosis. Here we present a case of acute perimyocarditis as the first presentation of Crohn’s disease. To date, this is the first case presentation reporting the use of 18F-FDG PET/CT Scan for diagnosing such condition. Case presentation A 25-year-old male presented to our hospital with severe persistent pleuritic sharp left-sided chest pain. This was his second hospital admission in the past 4 months for chest pain and diarrhea. At the first hospitalization, he was diagnosed with viral perimyocarditis and irritable bowel syndrome. Laboratory findings, electrocardiogram, and cardiac magnetic resonance imaging results confirm the diagnostic of perimyocarditis. Virology, bacteriology, parasitology, and autoimmune evaluations were unremarkable. Colonoscopy, colorectal biopsy, and 18FGD PET findings confirmed manifestation of perimyocarditis, Crohn’s disease, and negative for sarcoidosis. Conclusions Looking at the overall clinical picture and investigation results of colonoscopy, colorectal biopsy findings, as well as multi-modality imaging with echocardiography, 18FDG PET—scan and CMRI, the patient was diagnosed to have perimyocarditis attending Chron’s disease flare up as a rare extra-intestinal manifestation.

Download Full-text

Fistula-Related Cancer in Crohn’s Disease: A Systematic Review

Cancers ◽

10.3390/cancers13061445 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1445

Author(s):

Andromachi Kotsafti ◽

Melania Scarpa ◽

Imerio Angriman ◽

Ignazio Castagliuolo ◽

Antonino Caruso

Keyword(s):

Systematic Review ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Hpv Vaccination ◽

Perianal Fistula ◽

Hpv Infection ◽

Poor Quality ◽

Colorectal Disease ◽

Small Series ◽

Chron's Disease

Perianal fistulizing Crohn’s disease is a very disabling condition with poor quality of life. Patients with perianal fistulizing Crohn’s disease are also at risk of perianal fistula-related squamous cell carcinoma (SCC). Cancer arising at the site of a chronic perianal fistula is rare in patients with Crohn’s disease and there is a paucity of data regarding its incidence, diagnosis and management. A systematic review of the literature was undertaken using Medline, Embase, Pubmed, Cochrane and Web of Science. Several small series have described sporadic cases with perianal cancer in Crohn’s disease. The incidence rate of SCC related to perianal fistula was very low (<1%). Prognosis was poor. Colorectal disease, chronic perianal disease and HPV infection were possible risk factors. Fistula-related carcinoma in CD (Chron’s disease) can be very difficult to diagnose. Examination may be limited by pain, strictures and induration of the perianal tissues. HPV is an important risk factor with a particular carcinogenesis mechanism. MRI can help clinicians in diagnosis. Examination under anesthesia is highly recommended when findings, a change in symptoms, or simply long-standing disease in the perineum are present. Future studies are needed to understand the role of HPV vaccination in preventing fistula-related cancer.

Download Full-text

Transperineal total mesorectal excision for rectal cancer on the residual rectum after multiple abdominal surgeries in a patient with Crohn’s disease: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01206-7 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Shin Emoto ◽

Shigenori Homma ◽

Tadashi Yoshida ◽

Nobuki Ichikawa ◽

Yoichi Miyaoka ◽

...

Keyword(s):

Rectal Cancer ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Intraoperative Complications ◽

Rectal Stump ◽

Stage I ◽

Colonoscopic Examination ◽

Case Presentation ◽

History Of ◽

Blood Loss Volume

Abstract Background The improved prognosis of Crohn’s disease may increase the opportunities of surgical treatment for patients with Crohn’s disease and the risk of development of colorectal cancer. We herein describe a patient with Crohn’s disease and a history of multiple surgeries who developed rectal stump carcinoma that was treated laparoscopically and transperineally. Case presentation A 51-year-old man had been diagnosed with Crohn’s disease 35 years earlier and had undergone several operations for treatment of Crohn’s colitis. Colonoscopic examination was performed and revealed rectal cancer at the residual rectum. The patient was then referred to our department. The tumor was diagnosed as clinical T2N0M0, Stage I. We treated the tumor by combination of laparoscopic surgery and concomitant transperineal resection of the rectum. While the intra-abdominal adhesion was dissected laparoscopically, rectal dissection in the correct plane progressed by the transperineal approach. The rectal cancer was resected without involvement of the resection margin. The duration of the operation was 3 h 48 min, the blood loss volume was 50 mL, and no intraoperative complications occurred. The pathological diagnosis of the tumor was type 5 well- and moderately differentiated adenocarcinoma, pT2N0, Stage I. No recurrence was evident 3 months after the operation, and no adjuvant chemotherapy was performed. Conclusion The transperineal approach might be useful in patients with Crohn’s disease who develop rectal cancer after multiple abdominal surgeries.

Download Full-text

Outcomes of surgical treatment in patients with anorectal fistula cancer

Surgical Case Reports ◽

10.1186/s40792-021-01118-6 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Katsuya Osone ◽

Hiroomi Ogawa ◽

Chika Katayama ◽

Yuta Shibasaki ◽

Kunihiko Suga ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Mucinous Adenocarcinoma ◽

Fdg Pet ◽

R0 Resection ◽

Anorectal Fistula ◽

Patients With Cancer ◽

Pet Ct ◽

Fdg Pet Ct ◽

Fdg Accumulation

Abstract Background No standard treatment for anorectal fistula cancer, such as multidisciplinary therapy, has been established due to the rarity of the disease. Herein, we investigated patients with cancer associated with anorectal fistula who underwent surgery to clarify the clinicopathological characteristics and to propose future perspectives for treatment strategies. Case presentation Seven patients with cancer associated with anorectal fistula who underwent rectal amputation in our institute were analyzed with regard to clinical characteristics, pathological findings, surgical results, and prognosis. Four cases had Crohn's disease as an underlying cause. All seven cases were diagnosed as advanced stage. Preoperative [18F]-fluoro-2-deoxy-d-glucose (FDG)-positron emission tomography/computed tomography (FDG-PET/CT) showed abnormal FDG accumulation in six cases including four mucinous adenocarcinomas. Three cases that received preoperative hyperthermo-chemoradiotherapy achieved pathological R0 resection. Postoperative recurrence was observed in four cases including three with Crohn's disease and one resulting in death. Conclusions Anorectal fistula cancer is rare and difficult to be diagnosed at early stages. Mucinous adenocarcinoma associated with anorectal fistula tends to exhibit abnormal FDG accumulation by FDG-PET/CT unlike common colorectal mucinous adenocarcinoma. Preoperative hyperthermo-chemoradiotherapy may be effective in obtaining pathological complete resection.

Download Full-text

Two for One: Coexisting Ulcerative Colitis and Crohn’s Disease

Canadian Journal of Gastroenterology ◽

10.1155/2002/219187 ◽

2002 ◽

Vol 16 (1) ◽

pp. 29-34 ◽

Cited By ~ 5

Author(s):

Grant I Chen ◽

Fred Saibil ◽

Izabella Morava-Protzner

Keyword(s):

Ulcerative Colitis ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Ulcerative Proctitis ◽

Crohn’S Colitis ◽

Crohn's Colitis ◽

First Case ◽

History Of

Three cases of coexisting ulcerative colitis and Crohn’s disease are presented. In the first case, the patient had a long-standing history of ulcerative proctitis before developing Crohn’s colitis. In the two remaining cases, the patients presented initially with Crohn’s disease of the ileum and, subsequent to resection, developed ulcerative colitis. Well-documented cases of patients diagnosed with both ulcerative colitis and Crohn’s disease are rare. The literature on such cases is reviewed, and the controversy over whether ulcerative colitis and Crohn’s disease are two distinct diseases is explored.

Download Full-text

Case report: a 5-year-old with new onset nephrotic syndrome in the setting of COVID-19 infection

BMC Nephrology ◽

10.1186/s12882-021-02520-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Kelsi M. Morgan ◽

Peace D. Imani

Keyword(s):

Nephrotic Syndrome ◽

Case Report ◽

Pediatric Patient ◽

Corticosteroid Therapy ◽

Clinical Remission ◽

Laboratory Findings ◽

Case Presentation ◽

The Third ◽

First Case ◽

New Onset

Abstract Background This is a case report of an asymptomatic SARS-CoV-2 infection associated with new-onset nephrotic syndrome in a pediatric patient. This is the third case of new-onset nephrotic syndrome in children associated with SARS-CoV-2 infection, but is the first case report describing a new-onset nephrotic syndrome presentation in a patient who had asymptomatic COVID-19 infection. Case presentation This is a case of a previously healthy 5 year old female who presented with new-onset nephrotic syndrome in the setting of an asymptomatic COVID-19 infection. She presented with progressive edema, and laboratory findings were significant for proteinuria and hypercholesterolemia. She was treated with albumin, diuretics, and corticosteroid therapy, and achieved clinical remission of her nephrotic syndrome within 3 weeks of treatment. Though she was at risk of hypercoagulability due to her COVID-19 infection and nephrotic syndrome, she was not treated with anticoagulation, and did not develop any thrombotic events. Conclusions Our case report indicates that SARS-CoV-2 infection could be a trigger for nephrotic syndrome, even in the absence of overt COVID-19 symptoms.

Download Full-text

A review of magnetic resonance enterography-based indices for quantification of Crohn’s disease inflammation

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284818765956 ◽

2018 ◽

Vol 11 ◽

pp. 175628481876595 ◽

Cited By ~ 9

Author(s):

Noa Rozendorn ◽

Marianne Michal Amitai ◽

Rami Abraham Eliakim ◽

Uri Kopylov ◽

Eyal Klang

Keyword(s):

Crohn’S Disease ◽

Magnetic Resonance ◽

Crohn's Disease ◽

Objective Evaluation ◽

Magnetic Resonance Enterography ◽

Laboratory Findings ◽

Disease Response ◽

Reference Guide ◽

Combined Indices ◽

Magnetic Resonance Imaging Mri

Magnetic resonance enterography (MRE) is a leading radiological modality in Crohn’s disease (CD) and is used together with laboratory findings and endoscopic examinations for the evaluation of patients during initial diagnosis and follow up. Over the years, there has been great progress in the understanding of CD and there is a continuous strive to achieve better monitoring of patients and to develop new modalities which will predict disease course and thus help in clinical decisions making. An objective evaluation of CD using a quantification score is not a new concept and there are different clinical, endoscopies, radiological and combined indices which are used in clinical practice. Such scores are a necessity in clinical trials on CD for evaluation of disease response, however, there is no consensus of the preferred MRE score and they are not routinely used. This review presents MRE-based indices in use in the last decade: the Magnetic Resonance Index of Activity (MaRIA), the Clermont score, the Crohn’s Disease Magnetic Resonance Imaging (MRI) Index (CDMI), the Magnetic Resonance Enterography Global Score (MEGS) and the Lemann index. We compare the different indices and evaluate the clinical research that utilized them. The aim of this review is to provide a reference guide for researchers and clinicians who incorporate MRE indices in their work. When devising future indices, accumulated data of the existing indices must be taken into account, as each of the current indices has its own strengths and weakness.

Download Full-text

Crohn’s Disease Presenting with Pyogenic Liver Abscess: A Case Report

Case Reports in Gastrointestinal Medicine ◽

10.1155/2012/762480 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Sharon McGreal ◽

Rupert Sayers ◽

Peter Wurm ◽

Kevin West

Keyword(s):

Computed Tomography ◽

Crohn’S Disease ◽

Case Report ◽

Crohn's Disease ◽

Liver Abscess ◽

Percutaneous Drainage ◽

Severe Disease ◽

Pyogenic Liver Abscess ◽

Initial Manifestation ◽

Laboratory Findings

Pyogenic liver abscess (PLA) is a rare extraintestinal complication of Crohn’s disease (CD), and the clinical and laboratory findings may emulate the reactivation of CD, therefore, delaying diagnosis. In this paper the patient presented with PLA as the initial manifestation of CD and experienced severe disease. The finding of PLA was established by computed tomography and initial treatment involved percutaneous drainage and antibiotics. The diagnosis of CD was made after colonoscopy and histological investigations.

Download Full-text

Crohn's disease presenting as multiple pulmonary nodules in FDG PET/CT scan

The Turkish Journal of Gastroenterology ◽

10.5152/tjg.2015.8030 ◽

2015 ◽

Vol 26 (3) ◽

pp. 279-280

Author(s):

Mevlut Kurt ◽

Emrah Posul ◽

Guray Can ◽

Bulent Yilmaz ◽

Ugur Korkmaz ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Ct Scan ◽

Fdg Pet ◽

Pulmonary Nodules ◽

Multiple Pulmonary Nodules ◽

Pet Ct ◽

Fdg Pet Ct ◽

Pet Ct Scan

Download Full-text

Crohn's Disease Associated with Sweet's Syndrome and Sjögren's Syndrome Treated with Infliximab

Clinical and Developmental Immunology ◽

10.1080/17402520500134254 ◽

2005 ◽

Vol 12 (2) ◽

pp. 145-149 ◽

Cited By ~ 43

Author(s):

Erina N. Foster ◽

Khanh K. Nguyen ◽

Rafiq A. Sheikh ◽

Thomas P. Prindiville

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

Sweet’S Syndrome ◽

Sweet's Syndrome ◽

First Case ◽

Sjögren‘S Syndrome

The association of Crohn's disease (CD) and Sweet's syndrome is rare and the presence of Sjögren's syndrome in Crohn's disease is even rarer, with only three reports found in the literature. We describe two cases of Crohn's disease associated with Sweet's syndrome, one of which is the first case of CD and Sweet's concomitantly associated with Sjögren's syndrome. Both cases responded rapidly to Infliximab therapy with complete resolution of the skin lesions.

Download Full-text