Yersinia enterocolitica Prosthetic Joint Septic Arthritis Successfully Treated with Ceftriaxone

Yersinia enterocolitica is a Gram-negative coccobacillus that is known to cause gastroenteritis and symptoms mimicking appendicitis or terminal ileitis. It is also one of the culprit infections implicated in causing reactive arthritis. Rarely, it can cause musculoskeletal infections including osteomyelitis, septic arthritis, and discitis. We describe the case of a 70-year-old female with multiple comorbidities who presented with left knee pain and swelling after recent gastroenteritis. She was found to have Yersinia enterocolitica septic arthritis in her left knee prosthetic joint. The patient underwent an exchange of her prosthetic material and was successfully treated with a six-week course of ceftriaxone. Our article aims to highlight a rare manifestation of Yersinia enterocolitica infection and to point out an important differential for reactive arthritis after Yersinia enterocolitica infection.

Severe ileum bleeding following adjuvant capecitabine chemotherapy for locally advanced colon cancer: a case report and review of the literature

Background Capecitabine is a prodrug that is enzymatically converted to its active form, fluorouracil (also called 5-fluorouracil), which is commonly used as adjuvant chemotherapy in colorectal cancer patients. Severe gastrointestinal bleeding induced by capecitabine is rare. Here, we are presenting the first case report of surgery specimen assisted diagnosis of this uncommon condition. Case presentation A 63-year-old Chinese male with a history of colon adenocarcinoma and right hemicolectomy presented with severe lower gastrointestinal bleeding 2 days after finishing capecitabine administration during the first cycle of XELOX adjuvant chemotherapy. Because of the negative findings of active bleeding points by digital subtraction angiography (DSA) or colonoscopy, emergency laparotomy and partial enterectomy were performed. The bloody diarrhea had resolved after surgery and a terminal ileitis was diagnosed after pathological examination of the surgical specimen. Conclusions Terminal ileitis induced by capecitabine is likely to be underreported. It should be considered more often as a cause of severe gastrointestinal bleeding during or after treatment with capecitabine agents. Emergency surgery may achieve satisfactory outcomes if endoscopic hemostasis is ineffective. Highlights of this case 1. Gastrointestinal bleeding following capecitabine treatment in colorectal cancer patients might be life-threatening. 2. Terminal ileitis induced by capecitabine should always be considered in the differential diagnosis of severe gastrointestinal bleeding. 3. Awareness of the risk factors such as deficiency of dihydropyrimidine dehydrogenase, advanced age, or right colectomy may aid in reducing capecitabine-related morbidity. 4. When severe bleeding occurs, emergency surgery may achieve satisfactory outcomes if medical and endoscopic interventions are ineffective.

Tuberculosis reactivation at ileum following immune checkpoint inhibition with pembrolizumab for metastatic nasopharyngeal carcinoma: a case report

Background Tuberculosis (TB) reactivation has been increasingly identified following immune checkpoint inhibitor (ICI) therapy for cancer patients. However there has been no report on TB reactivation in the gastrointestinal tract. In the report, we describe a patient who developed TB ileitis after pembrolizumab for her metastatic nasopharyngeal carcinoma (NPC). Rechallenge with pembrolizumab after its temporary interruption together with anti-TB therapy produced continuous tumor response but without further TB reactivation. Case presentation A 29-year-old lady with metastatic NPC involving the cervical nodes, lungs and bones started pembrolizumab after failure to multiple lines of chemotherapy. She complained of sudden onset of abdominal pain, vomiting and bloody diarrhea with mucus 21 months after pembrolizumab. Colonoscopy revealed terminal ileitis with multiple caseating granulomas with Langerhan cells. Serum interferon gamma release assay was strongly positive. She was treated with anti-TB medication and was later rechallenged with pembrolizumab for her progressive lung metastases without further TB relapse while her lung metastases were brought under control again. Conclusion To date, this is the first gastrointestinal TB reactivation after ICI therapy for cancer. Guidelines to screen for TB before initiation of ICIs in endemic areas should be established.

PROBLEMS OF ACUTE APPENDICITIS DIAGNOSTICS AND SURGICAL TREATMENT

Acute appendicitis is a "chameleon disease" that requires in many cases a complex differential diagnosis. Inflammation of the appendix is one of the most common surgical diseases. Difficulties in the verification of acute appendicitis, the severity of complications associated with late diagnosis indicate that the problems of diagnosis and treatment of this pathology has not lost its relevance. The most difficult question for the surgeon is to diagnose acute appendicitis in time and carry out surgical treatment, prevent all possible complications and minimize the frequency of removal of the unaltered appendix. The aim of the study to determine and systematize the causes of difficulties in diagnosing acute appendicitis at the preoperative stage. A retrospective analysis of 586 medical records of inpatients who were treated in the surgical department was performed. Among the operated 511 (87.2%) patients, the diagnosis of acute appendicitis before and after surgery coincided, which was confirmed morphologically. In 75 cases, which is 12.8%, the diagnosis of acute appendicitis had atypical symptoms or was masked by the clinic of another pathology. Observations of atypical cases of acute appendicitis in combination with other pathologies were the following diseases that occurred under the clinic signs, or combined with them: perforation of the small intestine with fish bone - 4 cases; perforation of Meckel's diverticulum - 2. In one case perforation by a fish bone, in another inflammation with its perforation. - terminal ileitis - 1; torsion and necrosis of the fatty suspension of the elongated sigmoid colon - 2; perforation of the diverticulum of the elongated sigmoid colon - 1, rupture of the ovarian cyst - 9 cases, including two children 13 and 17 years; piosalpinx - 2, 1 case of combination of acute calculous cholecystitis with gangrenous appendicitis, which was detected during the audit of the abdominal cavity; inflammatory infiltrate of the omentum - 3; torsion and gangrene of the omentum - 2, a combination of acute appendicitis with omentitis - 8 cases; combination of acute appendicitis with mesoadenitis - 39 cases; rupture of the spleen - 1. Conclusions: Under the clinic of acute appendicitis or in combination with it other acute diseases of the abdominal cavity can mask, up to 12.8%, which are difficult or in some cases impossible to diagnose in the preoperative period. One of the reasons for the difficulties of diagnosis is the omission by patients of anamnesis data regarding the onset and course of the disease, as well as alcohol consumption. Difficulties in diagnosis occur in children, especially young people, which is 61.3% of cases. The combination of acute appendicitis with mesoadenitis was observed in 6.6%. Among these patients, acetonemic syndrome was observed in 87.2% of cases. This group of patients is dominated by children. Gynecological diseases are disguised under the clinic of acute appendicitis in 1.9%, which requires a joint examination by a surgeon and obstetrician-gynecologist of patients with suspected acute appendicitis in the preoperative period. Deciding on surgical treatment for suspected acute appendicitis is a clinic of acute peritonitis, which was observed in 63.3%, requires proper clinical thinking of the surgeon combined with experience, laboratory and instrumental examination.

IgA vasculitis with terminal ileitis and giant duodenum ulceration and review of the literatures

BackgroundImmunoglobulin A vasculitis (IgA V), formerly Henoch–Schönlein purpura, is one of the most common self-limiting vasculitis in children. In 15-20% IgA V cases, gastrointestinal symptoms precede the rashes,they no specific gastrointestinal symptoms and often present as acute abdomen, making the diagnosis difficult.Case presentationWe present two female patients, ages 8 years old and 5 years old, who presented to vomiting and abdominal pain, rashes appeared on the lower limbs a few days later, they were subsequently diagnosed with IgA V. Both patients were given IV methylprednisolone, achieved benign clinical results.ConclusionsWhen gastrointestinal symptoms precede the rashes, it is difficult to diagnose IgA vasculitis, resulting in unnecessary surgery. Early recognition and treatment will promote the remission of the children and avoid unnecessary surgery.

Novel Presentation of Terminal Ileitis Associated with Secukinumab Therapy

Inflammatory bowel disease (IBD) and psoriasis are chronic inflammatory immune-mediated diseases. The interleukin-23- (IL23-) T helper (Th)17 pathway has been implicated in their pathogenesis, with multiple biologic therapies targeting this pathway. IL-17, the main proinflammatory cytokine produced by (TH)17, has been targeted by antibodies and IL-17 receptor blockers with favorable outcomes in treating psoriasis and psoriatic arthritis. However, their role in IBD is unpredictable as studies reported worsening of IBD with agents targeting IL-17 and rare case reports with new-onset IBD. We present a case of Crohn's-like severe terminal ileitis and worsening diverticulitis complicated by intestinal perforation requiring total parenteral nutrition shortly after being started on secukinumab.