Rakesh Nanda

Vascular Anomaly of Blue Rubber Bleb Nevus Syndrome.

A 50-year-old man with a constellation of signs and symptoms consistent with blue rubber bleb nevus syndrome presented with a two-day history of melena. Upper endoscopy revealed innumerable purplish blebs throughout the proximal duodenum (left), clustered rubbery blue blebs in the duodenum (right) and a large (10-cm) circumferential vascular lesion with blue and purple coloration in the middle esophagus, with the stigmata of recent bleeding (center). 1Phoenix VA Health Care System, Phoenix, Arizona, USA.

Dysferlin-Deficient Muscular Dystrophy Identified Through Laboratory Testing for Elevated Aminotransferases.

We present a 24-year-old combat veteran who underwent extensive work-up for elevated aminotransferases, including liver biopsy, with no underlying pathology identified. Subsequent investigations showed elevated creatinine kinase and aldolase. The patient was later diagnosed with biopsy-proven dysferlin-deficient muscular dystrophy. Persistent transaminase elevation despite negative liver work-up should prompt clinicians to consider extrahepatic sources of enzyme elevation. Promptly correlating aminotransferase elevation with musculoskeletal pathology may present an opportunity for clinicians to detect myopathies such as muscular dystrophy in their preclinical stages.

Images of the month: Dentures in the cecum.

1Phoenix VA Health Care System, Phoenix, Arizona, USA. A 47-year-old man presented with vague abdominal pain for 1 month. There had been several similar episodes in the past. Contrast-enhanced computed tomography of the abdomen revealed features suggestive of pancreatitis with extrahepatic portal venous obstruction and multiple periportal collaterals. Two gallbladders were identified (arrows; left). Ultrasound examination of the abdomen (center) and magnetic resonance cholangiopancreatography (MRCP; right) confirmed the findings of duplication of gallbladder. Two separate cystic ducts were identified; they drained into the common hepatic duct. Duplication of the gallbladder is an extremely rare, congenital, biliary tract anomaly, and MRCP is the imaging modality of choice for preoperative diagnosis. Differential diagnoses include folded gallbladder, Phrygian cap, diverticulum, vascular band, and pericholecystic fluid.

Palmoplantar Hyperkeratosis and Strong Family History of Esophageal Cancer: Tylosis or Not?

reported in population-based studies, especially in the small bowel location [4]. Additionally, mucinous adenocarcinomas tend to resemble fluid collections due to their mucin content, which produces a markedly T2-hyperintense appearance. Several series have also found new-onset obstructive symptoms to be the most common presenting symptom among CD patients with small bowel adenocarcinoma diagnosed at resection [1, 3]. Our case illustrates that a small bowel malignancy should be included in the differential diagnosis of a change in phenotype of patients with previously well-controlled CD, especially those aged 50 years and older, with earlier consideration for surgery.

Ophthalmologic complications due to treatment with pegylated interferon in patients with chronic hepatitis C

Ophthalmologic complications due to treatment with pegylated interferon in patients with chronic hepatitis C