Necrolytic erythema migrans in celiac disease

Erythema migrans necrolytica is a red, blistering rash that spreads over the skin. It particularly affects the skin around the mouth and distal extremities, but can also be found on the lower abdomen, buttocks, perineum and groin. It is strongly associated with glucagonoma, a glucagon-producing tumor of the pancreas, but is also seen in a number of other conditions, including liver disease and intestinal malabsorption such as celiac disease. We present a case of a patient with a history of poorly followed celiac disease presenting with a clinical picture of ENM. This rare case adds to our understanding of the clinical presentation of NME, as well as highlights the importance of acting in a timely manner to avoid the most redoubtful complications.

Altered Plasma Fatty Acids Associate with Gut Microbial Composition in Common Variable Immunodeficiency

Purpose: Fatty acid (FA) abnormalities have been found in various inflammatory disorders and have been related to disturbed gut microbiota. Patients with Common variable immunodeficiency (CVID) have inflammatory complications associated with altered gut microbial composition. We hypothesized that there is an altered FA profile in CVID patients, related to gut microbial dysbiosis. Methods: Plasma FAs were measured in 39 CVID patients and 30 healthy controls. Gut microbial profile, a food frequency questionnaire and the effect of the oral antibiotic rifaximin, were investigated in CVID patients. Results: The n-3 PUFAs, EPA (1.4 [1.0-1.8] vs 1.9 [1.2-2.5], median [IQR], P<0.05) and DHA (3.2 [2.4-3.9] vs 3.5 [2.9- 4.3], P<0.05) were reduced in CVID compared to controls. Also, n-6 PUFAs (34.3 ± 3.4, vs 37.1 ± 2.8, mean ± SD, P< 0.001) and linoleic acid (LA) (24.5 ± 3.3, vs 28.1 ± 2.7, P< 0.0001), and the FA anti-inflammatory index (98.9, [82.1-119.4], vs 117.0, [88.7-153.1], median [IQR]), P<0.05) were reduced in CVID. The microbial alpha diversity was positively associated with plasma n-6 PUFAs, (r=0.41, P<0.001) and LA (r=0.51, P<0.001), but not n-3 PUFAs (P= 0.78). Moreover, a 2-week course of rifaximin significantly reduced the proportion of n-6 PUFAs (P=0.04, UNIANOVA). Overall, the altered proportions of n-3 and n-6 PUFAs did not seem to be related to dietary intake, intestinal malabsorption or presence of CVID enteropathy.Conclusion: We found a potentially unfavourable FA profile in CVID, where plasma proportion of n-6 PUFAs was related to gut microbial diversity and altered by microbial therapy.

Management of pulmonary tuberculosis on the background of intestinal malabsorption syndrome

OBJECTIVE. To investigate the frequency of malabsorption in newly diagnosed sensitive pulmonary tuberculosis (TB) and to establish the effectiveness of treatment correction in these patients. MATERIALS AND METHODS. In the first stage of the study, 73 patients with new drug-susceptible TB underwent lactulose-mannitol test. Individuals with intestinal permeability index <3 were selected and divided into main group which received injectable forms of isoniazid, rifampicin, ethambutol and oral pyrazinamide and control group which received standard treatment orally. RESULTS. Bacterial excretion stopped in 88.2 % of patients in the main group and in only 61.5 % of patients in the control group. In 46.1 % of cases in the control group treatment failure was diagnosed. The frequency of positive radiological dynamics at the end of the intensive phase of treatment was 64.7 % in the main group versus 30.8 % in the control group. The total efficacy of treatment at the end of the main course of chemotherapy was 88.2 % in the main group against 53.9 % in the control group (p <0.05). CONCLUSIONS. Malabsorption, which requires correction of treatment, occurs in about one-fifth of patients with new TB. Usage of injectable anti-TB drugs in such patients increases the effectiveness of treatment by 34 % (p <0.05).

Cystic fibrosis and coeliac disease: a case report of an unusual association

ABSTRACT Coeliac disease (CD) and cystic fibrosis (CF) are well known as the most common causes of chronic intestinal malabsorption in childhood. The coexistence of coeliac disease with cystic fibrosis is uncommon. Here, we describe the case of cystic fibrosis in a patient diagnosed with coeliac disease who failed to respond clinically to a gluten-free diet and had persistent steatorrhea and failure to thrive.

Diarrhoea And Intestinal Microbiota

We carry out a review of the world literature, regarding the role played by the Intestinal Microbiota (IM), -when transplanted- in the decrease and disappearance of diarrhoea, in many conditions. Some acute and most chronic. Also, we show our little experience regarding the effect of Intestinal Microbiota Transplant (IMT), also known as Fecal Microbiota Transplant (FMT). We refer how patients with Irritable Bowel Syndrome, Diarrhoea variety, Anxiety, Systemic Lupus Erythematosus, Pseudomembranous Colitis, Intestinal Malabsorption Syndrome, Amyotrophic Lateral Sclerosis and Retroperitoneal Cancer operated on 4 occasions, secondary to left seminoma and right testicular teratoma (excised). We show that in all of them, the diarrhoea was reduced substantially and that the complications that appeared were minimal; without relevance or significant effect.

The Phenotype of Celiac Disease Has Low Concordance between Siblings, Despite a Similar Distribution of HLA Haplotypes

The factors determining the presentation of celiac disease are unclear. We investigated the phenotypic concordance and the distribution of human leukocyte antigen (HLA) risk haplotypes in affected siblings. One hundred sibling pairs were included. Clinical and histological parameters and HLA haplotypes were compared between the first diagnosed indexes and their siblings. The phenotype was categorized into gastrointestinal, extra-intestinal, malabsorption/anemia, and asymptomatic. The phenotype was fully concordant in 21 pairs. The most common concordant phenotype was gastrointestinal (14 pairs). Indexes had more anemia/malabsorption and extra-intestinal symptoms than siblings (45% vs. 20%, p < 0.001 and 33% vs. 12%, p < 0.001, respectively). Twenty siblings and none of the indexes were asymptomatic. The indexes were more often women (81% vs. 63%, p = 0.008). They were also more often seronegative (11% vs. 0%, p = 0.03) and younger (37 vs. 43 year, p < 0.001), and had more severe histopathology (total/subtotal atrophy 79% vs. 58%, p = 0.047) at diagnosis. The indexes and siblings were comparable in other disease features. Pairs with discordant presentation had similar HLA haplotypes more often than the concordant pairs. The phenotype was observed to vary markedly between siblings, with the indexes generally having a more severe presentation. HLA did not explain the differences, suggesting that non-HLA genes and environmental factors play significant roles.