Hatice Unverdi

Ileocolonic involvement in Behçet's disease: endoscopic and histological evaluation.

Background: Our aim was to document the frequency of gastrointestinal (GI) involvement of Behçet’s disease (BD) at endoscopic examination. Also, we aimed to analyze whether GI lesions were correlated with other systemic components of BD. Methods: Fifty patients with BD were enrolled in the study. Patients in whom optimal colonoscopic examination of both the colon and terminal ileum could be performed were included. An ileum biopsy was taken from all cases. Upper GI endoscopy findings, presence of genital ulcers, uveitis, dermatological lesions, pathergy test, neurological involvement and peripheral vasculitis, and laboratory findings were recorded. Thirty age- and sex-matched persons who had perfect bowel cleansing and had a macroscopically normal colon and terminal ileum at colonoscopy without any systemic diseases were enrolled as the control group. Results: Nine patients and 1 case had macroscopic ileum and colon lesions, respectively. Microscopic examination of BD patients with normal colon and terminal ileum at colonoscopy revealed 61% abnormal ileum histologies. That ratio was 30% for the control group (p < 0.001). None of the patients had any lesions suggesting BD at upper GI endoscopy. There was no correlation between macro- or microscopic GI involvement and other components of BD. Conclusions: Lower GI tract, especially ileum involvement, is frequent in BD. Most of the patients have inflammation in the ileum even in the absence of macroscopic lesions.

Unusual cause of acute gastrointestinal bleeding: gastric pyogenic granuloma.

Pyogenic granuloma (PG) is a benign, polypoid type of lobular capillary hemangioma that presents as a polypoid red mass. The lesion is found most commonly on the skin and in the oral cavity. It is extremely rare in the alimentary tract, other than in the oral cavity. Here, we report a case of PG identified in the stomach associated with acute bleeding. A 64-year-old man was admitted to our emergency room with a complaint of hematemesis and melena. Physical examination revealed no remarkable abnormalities other than conjunctival paleness.At the time of admission his laboratory findings were as follows: hemoglobin 10 g/dL, hematocrit 28.5%. An upper gastrointestinal endoscopy revealed a pedunculated reddish lesion approximately 8 mm in diameter with an irregular surface in the cardia of the stomach. Blood was leaking from the surface of the lesion (Fig. 1). The lesion was resected using a polypectomy snare. Histological examination of the resected specimen revealed many capillaries of various sizes, lined with plump endothelial cells, accompanied by acute and chronic inflammatory infiltrates. The endothelial cells proved to be immunohistochemically positive for CD34 (Fig. 2).The histological features were consistent with those of a PG. No bleeding was noted following endoscopic resection of the lesion. Anemia was resolved by treating with iron. PG is an acquired benign tumor arising from the blood vessels of the skin or mucosa, polypoid form of capillary hemangioma.To date, a few cases of PG of the digestive tract have been reported, particularly in the colon, ileum, and esophagus. Only two cases have been described in the stomach. To our knowledge, this is the second case report of gastric PG presenting with acute gastrointestinal bleeding. In conclusion, PG should be considered in the differential diagnosis of acute gastrointestinal bleeding.

Is colchicine therapy effective in all patients with secondary amyloidosis

Abstract Objective: Although colchicine is effective on prevention and regression of amyloidosis in many cases, rate of unresponsiveness to colchicine therapy is not too low. However, there is no sufficient data about which factors effect to response of colchicine therapy on regression of amyloidosis. Materials and methods: 24 patients with renal amyloidosis were enrolled into the study. The patients were divided in two groups according to urinary protein excretions: non-nephrotic stage (14/24) and nephrotic stage (10/24). The patients were also categorized according to the etiology of amyloidosis; familial Mediterranean fever (FMF)-associated amyloidosis (15/24) versus rheumatoid disorders (RD)-associated amyloidosis (9/24). The changes of amount of proteinuria and estimated glomerular filtration rates were investigated after colchicine treatment started in these groups. Results: The mean follow-up period was 27.7 ± 19.2 months. After initiating colchicine therapy, the degree of proteinuria was decreased higher than 50% in 11/14 (78%) of non-nephrotic patients and elevated only in three (22%) patients. In nephrotic group, proteinuria was increased in 5/10 (50%) of patients. Glomerular filtration rates were stable in nephrotic and non-nephrotic groups. Presenting with nephrotic syndrome was higher in RD-associated amyloidosis (RD_A) group (5/9) than FMF-associated amyloidosis (FMF_A) group (5/15) without statistical significance (p > 0.05). After colchicine treatment, proteinuria was decreased in 12/15 patients in FMF_A group, however, the significant decreasing of proteinuria was not observed in RD_A group (p = 0.05 vs. p > 0.05). Conclusion: Colchicine therapy was found more effective in low proteinuric stage of amyloidosis. The beneficial effect of colchicine therapy was not observed in patients with RD- associated amyloidosis.

Multiple sub-epidermal calcified nodule mimicking eruptive xanthoma: a case report and review of the literature.

Sub-epidermal calcified nodule (SCN) is an uncommon form of idiopathic calcinosis. It usually occurs in children, particularly in the head and neck region, presenting as a solitary, painless, yellow-white nodule with papillomatous features. These lesions occur twice as common in males compared with females. The pathogenesis is uncertain, but the clinical and histological features of this lesion are distinctive. We report a case of 22-year-old man with multiple nodules bilaterally located on the dorsum of hands simulating eruptive xanthoma. Histopathological examination of one of the excised lesion confirmed the diagnosis showing epidermal and sub-epidermal deposition of calcium. This paper presents a review of the literature and adds a new case of SCN.

Focal segmental glomerulosclerosis in association with Gitelman syndrome

Gitelman syndrome (GS) is an autosomal recessive disorder characterized by hypokalemia, metabolic alkalosis, hypomagnesemia and hypocalciuria. Glomerulonephritis associated with GS is rarely documented in the literature. We present an adult patient with GS whose renal biopsy revealed focal segmental glomerulosclerosis.

[Melanocytosis of the oesophagus: case report].

Esophageal melanocytosis is a benign clinicopathologic entity characterized by melanocytic proliferation in esophageal squamous epithelium and melanin deposition in the mucosa. Little is known about the etiology and natural course of this condition, although it has been suggested to be a precursor of primary esophageal melanoma by some authors. Following a search of the databases regarding esophageal melanocytosis and melanosis, thirty-four cases of isolated esophageal melanocytosis were found. The histopathologic features of esophageal melanocytosis are reviewed and its differential diagnosis with other pigmented esophageal lesions is discussed.

An unusual cause of acute renal failure in a patient with surgical hypoparathyroidism: nephrocalcinosis

To the Editor, Nephrocalcinosis (NC) is a pattern of renal injury characterized by abundant renal tubular and interstitial deposits of calcium phosphate. Best treatment option for NC depends on the cure of the underlying cause, if possible [1]. During the course of NC, prognosis is highly associated with the severity of renal insufficiency, so early diagnosis has the highest priority. Herein, we present a case of acute renal failure due to NC in a patient with surgical hypoparathyroidism. A 35-year-old woman was referred to our hospital because of acute renal failure of unknown etiology. There was no history of hypertension or diabetes and no family history of renal disease. Her past medical history was remarkable for surgical hypoparathyroidism and hypothyroidism. She had been treated with levothyroxin 50 lg/day, calcitriol 0.5 mcg/day and calcium carbonate 2,500 mg/ day for 15 years. Three months before admission, a routine medical evaluation at a local hospital documented that creatinine level was 0.8 mg/dl. Physical examination did not reveal any pathology. Laboratory tests were as follows: blood urea nitrogen (BUN) 23 mg/dl, creatinine 1.94 mg/dl, total calcium 10.7 mg/dl, urinary calcium excretion 740 mg/day, urinary protein 800 mg/day and parathyroid hormone level 4.2 pg/ml (14–72 pg/ml). Urinalysis, arterial blood gas analysis, serum C3 and C4 complement levels were normal. Antinuclear antibody, antineutrophil cytoplasmic antibody, antistreptolysin O, anti-glomerular basement membrane antibody, hepatitis B surface antigen and anti-hepatitis C antibody were all negative. 1,25(OH)2 vitamin D3 and/or 25-OH Vitamin D levels and renal ultrasonography was normal. A renal biopsy was performed which was showed globally sclerosis in 2 of 9 glomeruli on H&E sections, others were normal in size and cellularity. Degenerative changes were found on the tubules characterized by luminal ectasia, irregularity of the luminal contours, and mild degree of interstitial fibrosis. The tubular degenerative changes were accompanied by intraluminal, interstitial basophilic calcifications, consistent with calcium phosphate. The immunofluorescent studies were negative for neither immunoglobulin nor complement. According to laboratory, radiological and pathological findings, NC was diagnosed. Thereafter calcium preparations and calcitriol doses were gradually reduced to a lower daily dose 0.25 mcg/day for calcitriol and 1,000 mg/day for calcium carbonate. Eight weeks after the initial presentation, the serum calcium level (9.0 mg/dl) and urinary calcium excretion (127 mg/daily) was returned to normal range with improved renal functions. Nephrocalcinosis can involve the renal medulla or, much less often, the cortex. In adults, the most common causes of medullary NC are primary hyperparathyroidism, renal tubular acidosis, medullary sponge kidney and medications such as acetozalamide, amphotericin B, and triamterene [2]. It may cause acute or chronic kidney injury, or be incidentally detected radiographically in a patient with normal renal function. NC is caused by multiple G. Koçak A. Azak Department of Nephrology, Ankara Education and Research Hospital, Ankara, Turkey

Familial Mediterranean fever and membranous glomerulonephritis: report of a case

Familial Mediterranean fever (FMF) is an autosomal recessive genetic disease characterized by recurrent attacks of fever and painful episodes of sterile polyserositis. Kidney involvement may occur as a result of secondary amyloidosis during the course of FMF. Previously, different types of glomerulopathies such as IgM and IgA nephropathy, crescentic glomerulonephritis, diffuse proliferative glomerulonephritis, minimal change disease, and membranoproliferative glomerulonephritis were rarely reported. We herein represent a first case of membranous glomerulonephritis who had complete remission with colchicine treatment in the course of familial Mediterranean fever.