Ileana Duca

Steroid-refractory ulcerative colitis and associated primary sclerosing cholangitis treated with infliximab

Primary sclerosing cholangitis is an infrequent extraintestinal manifestation of ulcerative colitis. Damage to bile ducts is irreversible and medical therapies to prevent progression of the disease are usually ineffective. We describe a patient with long-standing ulcerative colitis, which was refractory to corticosteroid therapy who developed primary sclerosing cholangitis (biochemical stage II/IV) in the course of his pancolitis. Treatment with infliximab (5 mg/kg as an induction dose followed by maintenance doses every two months) was indicated because of steroid-dependent disease associated to primary sclerosing cholangitis as well as sacroiliitis and uveitis and previous episode of severe azathioprine-related hepatic toxicity. At present, after two years of follow-up, the patient is asymptomatic with normal liver tests and complete resumption of daily life activities. This case draws attention to the usefulness of anti-tumor necrosis factor-alpha therapy for the management of primary sclerosing cholangitis as extraintestinal manifestation of inflammatory bowel disease.

Combined Liver and Kidney Transplant in a Patient with Budd-Chiari Syndrome Secondary to Autosomal Dominant Polycystic Kidney Disease Associated with Polycystic Liver Disease: Report of a Case with a 9-Year Follow-Up

Polycystic liver disease (PLD) is a hereditary disease inherited by autosomal dominant trait that occurs as a frequent extrarenal manifestation of autosomal dominant polycystic kidney disease (ADPKD). We report a case of a 59-year-old woman diagnosed with ADPKD associated with PLD. End-stage chronic renal failure with a secondary Budd-Chiari syndrome developed during the patients clinical course. She underwent combined liver and kidney transplantation, with a successful response over a 9-year follow-up period.

Síndrome de Budd-Chiari secundario a pseudotumor inflamatorio hepático: seguimiento durante 10 años

Inflammatory pseudotumor (IPT) of the liver is a rare benign tumor of unknown origin, it has the appearance of a malignant tumor but has a benign histology and clinical course. We report a case of a 63-year-old man diagnosed of IPT of the liver and followed for 10 years. During the clinical course, he developed a secondary Budd-Chiari syndrome, with a successful response to a transjugular intrahepatic portosystemic shunt over a 5-year follow-up period.

Methotrexate Pneumonitis in Crohn's Disease: A Rare Case Report and Review of Literature

Methotrexate (MTX) is an analog of folic acid with ntiproliferative and immunomodulating effects.1 Low-dose TX therapy is a well-recognized treatment for various inflammaory diseases, including rheumatoid arthritis, psoriatic arthritis, soriasis, and inflammatory bowel disease.2 More than 20 years go, the clinical efficacy of MTX was also established for steroidependent Crohn’s disease (CD).3 Pulmonary toxicity is a rare ide effect of MTX, which clinically is characterized by the new nset of dyspnea, dry cough, and fever and usually presents adiologically as an acute interstitial pneumonitis.4 Pneumonitis s a serious and unpredictable adverse event of treatment with TX that may become life-threatening.5 Since the first description n 1969,6 Imokawa et al.7 collected 123 cases of MTX-induced neumonitis published in the English language literature and dded the description of 9 further cases. Cancer and leukemia ere the underlying diseases in most patients (64.4%) followed by soriasis (7.6%) and rheumatoid arthritis (6.1%). However, no case f pneumonitis associated with MTX therapy in patients with CD as identified in this clinical series. We here describe the case of woman with ileocecal CD who presented with pneumonitis after 0 months of treatment with MTX. In a review of the literature, we ere able to collect only three cases of MTX-induced pneumonitis n patients with CD,8–10 although one of these cases has been ublished twice.8,11 A review of salient clinical findings of CD atients with MTX-induced pneumonitis is also presented. A 79-year-woman was followed up at the Gastroenterology