Nadim El-Majzoub

Celiac Crisis in a 64-Year-Old Woman: An Unusual Cause of Severe Diarrhea, Acidosis, and Malabsorption.

Celiac disease (CD) rarely presents with life-threatening complications in older individuals. We report a 64-year-old woman who presented with profuse diarrhea, weight loss, hemodynamic instability, hypokalemia, hypoproteinemia, acidosis, and vitamin and iron deficiency. Pathologic and serologic studies confirmed CD presenting with celiac crisis with extensive and severe intestinal disease. Although celiac crisis occurs mostly in childhood and early adulthood, it should be considered in adults presenting with acute severe diarrheal illness, electrolyte abnormalities, and malabsorption.

Successful treatment of hydroxyurea-associated chronic leg ulcers associated with squamous cell carcinoma.

Hydroxyurea (HU) is an antineoplastic drug used in the treatment of chronic myeloproliferative neoplasms (MPNs). HU is associated with cutaneous adverse effects, whereas severe complications such as leg ulcers and non-melanoma skin cancers (NMSCs) are rare and only observed after long-term treatment. We herein report a patient with essential thrombocythemia (ET) treated chronically with HU, and who developed refractory bilateral leg ulcers complicated by squamous cell carcinoma (SCC) over both heels. The patient was successfully managed by multiple debridement stages and skin grafting surgeries.

Propafenone hepatotoxicity: report of a new case and review of the literature.

Propafenone is a class Ic antiarrhythmic drug. It is a beta-adrenergic blocker that causes bradycardia and bronchospasm. It is metabolized primarily in the liver. Its bioavailability and plasma concentration differ among patients under long-term therapy. They are genetically determined by the hepatic cytochrome P-450 2D6. Hepatic toxicity is highly uncommon. To date, only eight patients were reported in the reviewed world literature. In this article, one new case will be reported emphasizing the importance of medication history taking in patients presenting with new-onset liver enzymes abnormalities.

Simultaneous occurrence of a CD30 positive/ALK-negative high grade T-cell lymphoma and plasma cell myeloma: Report of a case

Simultaneous occurrences of T-cell and B-cell neoplasms are rare, and etiological relationships between these two malignancies are poorly understood. We report the case of a 76-year-old man who presented with hypercalcemia, multiple skin nodular lesions, fatigue, episodic fever, and night sweats. PET/CT scan showed diffuse skin and subcutaneous fat plane active lesions, supra- and infra- diaphragmatic active lymph nodes, liver and spleen involvement, bone marrow infiltration, and nonspecific bilateral lung nodules. A skin biopsy showed a high grade CD30-positive/ALK-negative T-cell lymphoma. A bone marrow biopsy showed involvement by the same neoplastic cells. Additionally, a monoclonal lambda restricted plasma cell population (15% of marrow elements) was identified, which, in view of an IgA lambda spike in the serum, was consistent with plasma cell myeloma. To the best of our knowledge, this case is the first reported case of a plasma cell neoplasm associated with an aggressive CD30-positive ALK-negative systemic T-cell lymphoma with skin involvement. Reporting such cases is important as it adds to the pool of rare cases of concomitant T-cell neoplasms and plasma cell myelomas, and might help in determining an etiological relationship, if any, between these two hematological malignancies.

Laparoscopy rather than colonoscopy for the diagnosis and treatment of fulminant ischemic colitis.

Brandt LJ, 2000, GASTROENTEROLOGY, V118, P954, DOI 10.1016-S0016-5085(00)70183-1; Higgins PDR, 2004, ALIMENT PHARM THERAP, V19, P729, DOI 10.1111-j.1365-2036.2004.01903.x; Jin Nam-Chul, 2011, Clin Endosc, V44, P38, DOI 10.5946-ce.2011.44.1.38; Kang H, 2012, INT J COLORECTAL DIS, V27, P125, DOI 10.1007-s00384-011-1204-x

The elusive diagnosis of primary esophageal lymphoma

©Copyright 2018 by Turkish Society of Hematology Turkish Journal of Hematology, Published by Galenos Publishing House Received/Geliş tarihi: March 06, 2016 Accepted/Kabul tarihi: December 13, 2016 Address for Correspondence/Yazışma Adresi: Assaad SOWEID, M.D., American University of Beirut Medical Center, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Beirut, Lebanon Phone : +961 135 00 00/5341 E-mail : as25@aub.edu.lb ORCID-ID: orcid.org/0000-0001-7255-8474 A 76-year-old woman presented with a 2-month history of progressive dysphagia that was associated with weight loss. Computed tomography of the neck showed significant circumferential soft tissue thickening involving the upper esophagus with luminal narrowing (Figure 1A). Upper gastrointestinal endoscopy revealed a very tight stricture below the cricopharyngeus muscle. The stricture was traversed using a neonatal endoscope. Endoscopic ultrasonography using a miniprobe revealed marked esophageal wall thickening with diffuse hypoechoic infiltration involving the entire wall (Figure 1B). Biopsy specimens from the esophageal stricture revealed malignant non-Hodgkin lymphoma (diffuse large B-cell type) confirmed by immunohistochemistry (Figure 1C: hematoxylin and eosin staining at 100x magnification of the lymphoid infiltration; Figure 1D: Ki67 (proliferation index) staining at 400x, 40% tumor cells). The patient received 6 cycles of chemotherapy [anti-CD20 monoclonal antibody (rituximab) plus the CVP regimen], followed by positron emission tomography/computed tomography and upper endoscopy with a biopsy that showed no evidence of lymphoma.

Chronic active parietal osteomyelitis due to Salmonella typhi in a patient with Sickle Cell Anemia

Figure 1. Magnetic resonance imaging of the brain demonstrating peripheral enhancement of the scalp abscess alongside noticeable enhancement of the adjacent soft tissues, pathological bone, and underlying pachymeningeal layer enhanced on a coronal T1W slice (left) with a clear intra-osseous edematous edema in keeping with osteomyelitic changes isolating a central bone sequestrum, communicating with a subperiosteal/subgaleal fluid collection on a fluid attenuated inversion recovery weighted slice (right). Chronic Active Parietal Osteomyelitis Due to Salmonella typhi in a Patient with Sickle Cell Anemia Orak Hücreli Anemi Hastasında Salmonella typhi Kaynaklı Kronik Aktif Parietal Osteomiyelit

Thymoma with Concomitant Pure Red Cell Aplasia, Good’s Syndrome and Myasthenia Gravis Responding to Rituximab

Thymomas are often associated with a variety of autoimmune diseases, mostly myasthenia gravis. The association of thymomas with both pure red cell aplasia (PRCA) and Good’s syndrome is exceedingly rare. To the best of our knowledge, the combination of a thymoma with manifestations of myasthenia gravis, PRCA, and Good’s syndrome, as in our case herein, has not been described before in the medical literature. We present a 90-year-old man initially diagnosed with an asymptomatic thymoma. Later, he developed generalized muscle weakness and was found to have severe anemia. He was diagnosed with PRCA, myasthenia gravis and Good’s syndrome. He responded to rituximab with restoration of bone marrow erythroid maturation and stabilization of red blood cell counts.

Pulmonary Embolism in a Sarcoidosis Patient Double Heterozygous for Methylenetetrahydrofolate Reductase Gene Polymorphisms and Factor V Leiden and Homozygous for the D-Allele of Angiotensin Converting Enzyme Gene

Sarcoidosis is a multisystem granulomatous disease of unknown etiology and pathogenesis. It presents in patients younger than 40 years of age. The lungs are the most commonly affected organ. Till the present day, there is no single specific test that will accurately diagnose sarcoidosis; as a result, the diagnosis of sarcoidosis relies on a combination of clinical, radiologic, and histologic findings. Patients with sarcoidosis have been found to have an increased risk of pulmonary embolism compared to the normal population. MTHFR and factor V Leiden mutations have been reported to increase the risk of thrombosis in patients. We hereby present a case of a middle aged man with sarcoidosis who developed a right main pulmonary embolism and was found to be double heterozygous for methylenetetrahydrofolate reductase gene polymorphisms and factor V Leiden and homozygous for the D-allele of the angiotensin converting enzyme gene.

Diagnosis of hydatid cyto-biliary disease by intraductal ultrasound (with video)

Hydatid disease is one of the relatively common infections in the Middle Eastern countries. It is seen in areas where dogs are used to raise livestock. In humans, the majority of Echinococcus cysts tends to develop in the liver (70%) and is asymptomatic. The two most common complications of hydatid cysts are abscess formation and rupture. Furthermore, in 5-25% of patients, rupture occurs into the biliary tract and patients may present with cholangitis, jaundice, abscess, or bilio-cutaneous fistula after surgery. Intraductal ultrasound (IDUS) is reportedly superior to conventional endoscopic ultrasound for the depiction of bile duct obstruction owing to its additional capability of providing higher resolution images due to the use of higher frequency transducers. Unfortunately IDUS is rarely used, possibly due to the limited availability of appropriate IDUS equipment, cost of the procedure and interventional endoscopists trained in its interpretation. IDUS with wire-guided, thin-caliber, high-frequency probes is a promising imaging modality, yet no previous reports discuss its usefulness in hydatid disease investigation. We hereby present the first report of biliary hydatid disease being diagnosed by IDUS.