Dhara Chaudhari

Idelalisib: a rare cause of enterocolitis

Idelalisib is an oral, phosphatidylinositol 3-kinase delta (PI3Kδ) inhibitor, approved by FDA since July 2014 for the treatment of relapsed follicular B-cell non-Hodgkin lymphoma. Data from three phases of the study involving idelalisib demonstrate diarrhea (47%) to be the common adverse effect. The other side effects are pyrexia (28%), fatigue (30%), nausea (29%), cough (29%), pneumonia (25%), abdominal pain (26%) and rash (21%). The characteristic histological findings of idelalisib colitis include intraepithelial lymphocytosis, neutrophilic cryptitis and epithelial cell apoptosis within the crypts. Histological findings help differentiate among other causes of diarrhea and entero-colitis. We present a female patient with recurrent follicular lymphoma treated with idelalisib and presented with diarrhea. She was found to have entero-colitis and was treated successfully with drug discontinuation and prednisone.

Obstructive Jaundice as an Initial Manifestation of Non-Hodgkin Lymphoma: Treatment Dilemma and High Mortality

Introduction. Non Hodgkin lymphoma (NHL) presenting with obstructive jaundice is a rare occurrence. Because of rarity of combination, it is seldom considered in differential diagnosis of patients presenting with obstructive jaundice. It is considered treatable due to the chemosensitive nature of the disease and the recent advances in chemotherapy. Case Series. We present a case series of 2 patients with NHL presenting with obstructive jaundice as an initial manifestation. Both patients presented with obstructive jaundice and were diagnosed by CT guided liver biopsy. One patient died of sepsis and multiorgan failure before initiating chemotherapy and the second patient did not choose to undergo chemotherapy. Conclusion. Biliary obstruction is a sign of poor prognosis. The diagnosis of NHL needs to be considered in patients presenting with biliary obstruction. It can be associated with high mortality and poses treatment dilemma.

Hepatic Artery Mycotic Aneurysm Associated with Staphylococcal Endocarditis with Successful Treatment: Case Report with Review of the Literature

Mycotic hepatic artery aneurysm is a vascular pathology associated with bacterial endocarditis. It is rare in occurrence after the introduction of effective antibiotics. We present a young patient with injection drug abuse associated staphylococcal endocarditis which was successfully treated with antibiotics and valve replacement who presented with abdominal pain. He was found to have mycotic aneurysm of hepatic artery which was successfully treated with coil embolization.

Endoscopic Management of Pancreatic Pseudo cyst Complicated with Obstructive Jaundice: Case Report and Literature Review

Obstructive jaundice due to pancreatic pseudocyst is not common. Local Complications of Pancreatic pseudocyst can be managed with Endoscopic drainage, achieved through transmural approach via stomach or duodenal wall into the cyst, or transpapillary/transductal stent placement. Endoscopic drainage of pancreatic pseudocyst is becoming more favorable nowadays because of shorter hospital stay, lower cost, and lower mortality rate. EUSguided drainage is preferred over conventional endoscopic drainage because of higher technical success rate and because of higher success rate, technical feasibility and quick resolution of pancreatic pseudocyst, fully covered fully covered self-expandable metal stents are recently gaining popularity.

Pancreatic Tumor Presenting as Diarrhea.

VIPoma, Verner-Morrison syndrome, is a rare functioning neuroendocrine tumor that secretes vasoactive intestinal polypeptide (VIP). It is also known as pancreatic cholera or WDHA syndrome (watery diarrhea, hypokalemia and hypo or achlorhydria). Verner and Morrison first described the symptoms of VIPoma in 1958 as watery diarrhea, hypokalemia and achlorhydria [1]. Approximately 90 % of cases arise from the pancreas but they may also occur in periganglionic tissue or other locations such as the adrenals, colon, bronchus, liver and sympathetic ganglia. VIPomas are found to be malignant in about 60–80 % cases and are metastatic at the time of diagnosis, with the liver being the most common site of metastasis [2]. Herein, we present a patient with chronic diarrhea who was found to have VIPoma and did well after surgical resection.

Primary Gastric Diffuse Large B Cell Lymphoma Presenting as Gastric Outlet Obstruction: a Call for High Clinical Suspicion

The gastrointestinal tract is the most common extra-nodal site involved by lymphoma accounting for 5–20 % of all extranodal lymphomas [1]. Primary gastrointestinal lymphoma, however, is rare. The stomach is the most commonly involved site (60–75 %) in the gastrointestinal tract followed by small bowel, ileocecal region and rectum [2]. Primary gastric lymphoma is very rare, accounting only for 3 % of cases of gastric malignancy. Gastric outlet obstruction from primary gastric lymphoma could be from intrinsic obstruction or extrinsic compression. We present a case of primary gastric lymphoma initially presenting as gastric outlet obstruction.

Lung Carcinoma Presenting as an Obstructive Jaundice: Case Series with Literature Review

Metastatic lesions of the pancreas are uncommon as compared to primary pancreatic cancer and account for approximately 2 % of all pancreatic malignancies [1]. The clinically evident pancreatic metastasis is rare and mostly found during autopsy. Primary malignancies with the potential to metastasize to pancreas are renal cell cancer, lung cancer, breast cancer, or melanoma. Lung cancer usually spreads to liver, bone, or adrenal glands. Pancreas is an uncommon site for lung metastasis. Obstructive jaundice due to extrahepatic biliary obstruction from synchronous pancreatic metastatic disease from lung cancer has rarely been reported. Here in we report two patients presenting with obstructive jaundice due to pancreatic metastasis from primary lung cancer in absence of pulmonary symptoms. Further work up revealed small cell lung cancer (SCLC) in first patient and lung adenocarcinoma in the second patient.