N. Bel Hadj

Nodular Hyperplasia of the Gastrointestinal Tract After Liver Transplantation: Role of Immunosuppressive Therapy? A Case Report

Nodular lymphoid hyperplasia (NLH) of the gastrointestinal tract is a rare disease usually reported in patients with congenital or acquired immunodeficiency and chronic gastrointestinal infections. However, no case of NLH in a patient receiving immunosuppressive therapy has been reported to date. We describe the case of a woman who developed chronic diarrhea related to NLH 9 years after liver transplantation. Other causes of diarrhea and NLH were excluded. Her immunosuppressive regimen consisted on mycophenolate mofetil (MMF) and tacrolimus. Reduction of MMF dose improved symptoms but led to a rising aminotransferase level. Given the risk of graft rejection, MMF at full dose was resumed and she was started on symptomatic treatment for diarrhea. The role of immunosuppressive drugs in the pathogenesis of NLH may be related to the reduction of T- and B-lymphocyte proliferation and decreasing antibody production. NLH will further develop to compensate functionally inadequate lymphoid tissue, as reported in congenital immunodeficiency states.

Colite kystique profonde localisée : une cause inhabituelle de formation polypoïde pectinéale

RésuméLa colite kystique profonde est une affection bénigne et rare siégeant préférentiellement dans le rectosigmoïde. Dans sa forme focale, elle peut prendre l’aspect d’une masse polypoïde mimant une formation tumorale. D’autre part, une association colite kystique profonde, dysplasie et adénocarcinome au sein de la même formation est possible.Nous rapportons le cas d’une colite kystique profonde simulant un pseudopolype pectinéal ou papille hypertrophique chez un patient ayant des antécédents d’adénocarcinome colique et de thrombose hémorroïdaire.Devant ces constatations, la résection complète de toute formation polypoïde, même sus-pectinéale, avec un examen anatomopathologique précis, devient indispensable. La réalisation d’une rétrovision rectale à chaque coloscopie est encore controversée, mais dans notre cas, elle a été utile car la formation n’était pas visible en vision directe.AbstractColitis cystica profunda is a rare and benign condition mainly localized in the recto-sigmoid. It can present in a localized form with a polypoid lesion, mimicking tumor. Moreover, single polypoid colitis cystic profunda lesion in association with dysplasia and adenocarcinoma is possible.We report the case of colitis cystic profunda presenting as a polyp above the dentate line and mimicking a sequella of hemorroïdal thrombosis in a patient with a personal history of colorectal cancer. The lesion was visible only on rectal retroflexion.Therefore, the resection and pathologic examination of all polypoïd lesion, even above the dental line, seems mandatory. Performing rectal retroflexion at the end of each coloscopy is still controversial, however, in our case, it was useful because the lesion was missed by antegrade viewing.