Celiac Artery Vasculitis

Isolated Celiac Artery Vasculitis Presenting as Ileus in a Patient With Ulcerative Colitis

There is a known association between inflammatory bowel disease (IBD) and vasculitis, which can present with mesenteric ischemia or cutaneous manifestations. Infliximab, an anti-tumor necrosis factor (anti-TNF) used to treat IBD, has been implicated as a potential culprit. We present a unique case of a patient with ulcerative colitis who developed isolated celiac artery vasculitis presenting with abdominal pain and ileus after decreasing his dosage of azathioprine. Vasculitis resolved with steroids and increasing azathioprine dosage, while continuing anti-TNF therapy, suggesting that anti-TNF agents are not the only cause of vasculitis in patients with IBD or that thiopurines may be protective.

The Great Masquerader - TB Osteoarthritis

OBJECTIVES

TB arthritis is a rarely reported entity in Western literature and its ability to masquerade as many other diseases makes it difficult to diagnose. We report an interesting case of TB arthritis of the ankle.

METHODS

We present a 44 year-old diabetic Chinese male with a recent history of worsening pain, swelling, and redness in his left foot with an abscess and X-ray findings consistent with Charcot foot.

RESULTS

At first, the presentation was believed to be Charcot's foot with MSSA osteomyelitis but after the wound culture and bone biopsy were both positive for Mycobacterium tuberculosis as well, the diagnosis of tuberculous arthritis was confirmed.

CONCLUSIONS

While the prevalence of TB and other diseases is low in the majority of the United States, we still need to be aware of such diseases in populations with increasing migration and be cognizant of the potential impact of a patient's background on a diagnosis is critical to properly diagnosing and treating patients. Vascular surgeons may be seeing patients with abscesses of the lower extremities and may miss the diagnosis if cultures for TB are not sought.

Noninfectious aortitis: A case report

INTRODUCTION

Noninfectious aortitis has been increasingly reported worldwide with a growing prevalence in western medicine. Attributed to our increasingly diverse population, western surgeons must be vigilant to promptly differentiate these cases from its more common infectious counterpart in order to ensure subsequent appropriate management of these patients.

METHODS

We present a case report of a 71-year-old Indo-Caribbean male who presented with nonspecific abdominal and back pain, found to have aortitis of a noninfectious etiology.Results and conclusion: While our patient's process was ultimately managed without surgical intervention, the varied clinical presentation along with the lack of specific laboratory markers pose a challenge for surgeons to appropriately diagnose and manage aortitis. Appropriate diagnostic imaging, the utilization of a multidisciplinary team, and close patient monitoring are key components for effective management of this increasingly prevalent disease process.