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Hafner S, Seufferlein T, Kleger A, Müller M. Symptoms and Management of Aseptic Liver Abscesses. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:208-217. [PMID: 37827501 DOI: 10.1055/a-2075-5082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Aseptic liver abscesses occur very rarely. Clinical guidelines on the management of the disease do not exist, and the diagnosis is challenging.We screen MEDLINE and PUBMED databases for relevant case reports from inception to November 2022. Information on patient age, sex, initial symptoms, the extent of abscess formation, further diagnoses, treatment, and course of the disease is analyzed.Thirty cases with sterile hepatic abscess formation are identified. In most patients (n=18), the spleen is affected as well. Patients typically present with fever, abdominal pain, and increased inflammatory values. Comorbidity with inflammatory bowel disease is very common (n=18) and is associated with a significantly younger age at the time of hepatic abscess development. In addition, many patients show autoimmune-mediated cutaneous, ocular, or arthritic rheumatoid manifestations. Histological examination of abscess material reveals neutrophilic infiltration. The majority of patients initially receive corticosteroid therapy. Furthermore, response to azathioprine, anti-TNF-α antibodies, and other immunomodulatory drugs is reported. Ten out of fourteen patients with a long-term follow-up (≥ 36 months) have at least one relapse of hepatic abscess formation.Aseptic hepatic abscesses should be considered in the case of sterile punctures and non-response to antibiotics. Patients with aseptic liver abscesses have a high risk of recurrence warranting immunomodulatory maintenance therapy.
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Affiliation(s)
- Susanne Hafner
- Institute of Experimental and Clinical Pharmacology, Toxicology and Pharmacology of Natural Products, University Ulm Medical Centre, Ulm, Germany
| | | | - Alexander Kleger
- Internal Medicine I, University Ulm Medical Centre, Ulm, Germany
| | - Martin Müller
- Internal Medicine I, University Ulm Medical Centre, Ulm, Germany
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Jazeer M, Antony D, Pakkiyaretnam M. Aseptic Abscess of the Spleen as an Antecedent Manifestation of Behçet's Disease. Cureus 2023; 15:e38375. [PMID: 37265896 PMCID: PMC10230598 DOI: 10.7759/cureus.38375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 06/03/2023] Open
Abstract
Behçet's disease (BD) is a multisystem autoimmune vasculitis that manifests as oral and genital ulcers with varying degrees of dermatological and ocular involvement. Aseptic splenic abscesses are a rare entity commonly occurring in autoinflammatory diseases and are rarely associated with BD. Here, we present the case of a 16-year-old male with BD who presented with prolonged fever and constitutional symptoms and was found to have an aseptic splenic abscess. Rapid resolution of the symptoms along with radiological evidence of abscess shrinkage was achieved with corticosteroid therapy.
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Affiliation(s)
- Mohamed Jazeer
- Internal Medicine, Teaching Hospital Batticaloa, Batticaloa, LKA
| | - Diroji Antony
- University Medical Unit, Teaching Hospital Batticaloa, Batticaloa, LKA
| | - Mayurathan Pakkiyaretnam
- University Medical Unit, Teaching Hospital Batticaloa, Batticaloa, LKA
- Department of Clinical Sciences, Faculty of Health-Care Sciences, Eastern University of Sri Lanka, Batticaloa, LKA
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Pylephlebitis: A Systematic Review on Etiology, Diagnosis, and Treatment of Infective Portal Vein Thrombosis. Diagnostics (Basel) 2023; 13:diagnostics13030429. [PMID: 36766534 PMCID: PMC9914785 DOI: 10.3390/diagnostics13030429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/20/2022] [Accepted: 01/21/2023] [Indexed: 01/27/2023] Open
Abstract
Pylephlebitis, defined as infective thrombophlebitis of the portal vein, is a rare condition with an incidence of 0.37-2.7 cases per 100,000 person-years, which can virtually complicate any intra-abdominal or pelvic infections that develop within areas drained by the portal venous circulation. The current systematic review aimed to investigate the etiology behind pylephlebitis in terms of pathogens involved and causative infective processes, and to report the most common symptoms at clinical presentation. We included 220 individuals derived from published cases between 1971 and 2022. Of these, 155 (70.5%) were male with a median age of 50 years. There were 27 (12.3%) patients under 18 years of age, 6 (2.7%) individuals younger than one year, and the youngest reported case was only 20 days old. The most frequently reported symptoms on admission were fever (75.5%) and abdominal pain (66.4%), with diverticulitis (26.5%) and acute appendicitis (22%) being the two most common causes. Pylephlebitis was caused by a single pathogen in 94 (42.8%) cases and polymicrobial in 60 (27.2%) cases. However, the responsible pathogen was not identified or not reported in 30% of the included patients. The most frequently isolated bacteria were Escherichia coli (25%), Bacteroides spp. (17%), and Streptococcus spp. (15%). The treatment of pylephlebitis consists initially of broad-spectrum antibiotics that should be tailored upon bacterial identification and continued for at least four to six weeks after symptom presentation. There is no recommendation for prescribing anticoagulants to all patients with pylephlebitis. However, they should be administered in patients with thrombosis progression on repeat imaging or persistent fever despite proper antibiotic therapy to increase the rates of thrombus resolution or decrease the overall mortality, which is approximately 14%.
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Sato N, Yamaide F, Shibata R, Nakano T, Yamaide A, Saito T, Shimojo N. Successful management of a case of intestinal Behçet's disease with a splenic abscess by intensified immunosuppressive therapy without splenectomy. Mod Rheumatol Case Rep 2022; 6:266-269. [PMID: 35274694 DOI: 10.1093/mrcr/rxac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/12/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
Behçet's disease (BD) is often associated with neutrophilic dermatosis. However, BD is rarely associated with aseptic abscesses in the spleen or liver. A 2-year-old girl presented to our hospital with a 2-week history of fever, abdominal pain, and a skin ulcer on her leg. Each time her skin was punctured with a needle for a blood test or spinal fluid test, she developed intractable aseptic abscesses on her skin. She was diagnosed with intestinal BD based on gastrointestinal endoscopy findings and was treated with prednisolone, mesalazine, and elemental diet therapy. Although these were effective for her colon ulcers, low-grade fever and mild abdominal pain persisted. Abdominal computed tomography revealed a low-density area in the spleen. Although it is recommended to check the contents with puncture drainage, it was difficult due to the risk of bleeding and pathergy. The abscess expanded despite antimicrobial therapy. We discontinued antimicrobial therapy and switched to intensified immunosuppressive therapy for BD [intravenous infliximab (IFX)]. After administration of IFX, the splenic abscess gradually disappeared, and all her symptoms improved. In cases of BD with splenic abscesses resistant to antimicrobial therapy, intensifying immunosuppressive therapy can be expected to shrink the abscesses and avoid splenectomy.
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Affiliation(s)
- Noriko Sato
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Fumiya Yamaide
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryohei Shibata
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Taiji Nakano
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akiko Yamaide
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Allergy and Rheumatology, Chiba Children's Hospital, Chiba, Japan
| | - Takeshi Saito
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoki Shimojo
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
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Wang B, Li R, Zhang S, Zhao Q, Wang Q, Yang J, Zhang A. A Case of Behçet's Disease With Hepatic Lesions Misdiagnosed as Crohn's Disease. Inflamm Bowel Dis 2022; 28:e86-e87. [PMID: 34971380 DOI: 10.1093/ibd/izab322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Baihui Wang
- From the ∗Department of Gastroenterology, Qilu Hospital(Qingdao), Cheeloo College of Medicine, Shangdong University, 758 Hefei Road, Qingdao, Shangdong, China
| | - Ruyuan Li
- From the ∗Department of Gastroenterology, Qilu Hospital(Qingdao), Cheeloo College of Medicine, Shangdong University, 758 Hefei Road, Qingdao, Shangdong, China
| | - Shuaiqing Zhang
- From the ∗Department of Gastroenterology, Qilu Hospital(Qingdao), Cheeloo College of Medicine, Shangdong University, 758 Hefei Road, Qingdao, Shangdong, China
| | - Qianqian Zhao
- Department of Pathology, Qilu Hospital(Qingdao), Cheeloo College of Medicine, Shangdong University, 758 Hefei Road, Qingdao, Shangdong, China
| | - Qing Wang
- From the ∗Department of Gastroenterology, Qilu Hospital(Qingdao), Cheeloo College of Medicine, Shangdong University, 758 Hefei Road, Qingdao, Shangdong, China
| | - Jie Yang
- From the ∗Department of Gastroenterology, Qilu Hospital(Qingdao), Cheeloo College of Medicine, Shangdong University, 758 Hefei Road, Qingdao, Shangdong, China
| | - Aijun Zhang
- From the ∗Department of Gastroenterology, Qilu Hospital(Qingdao), Cheeloo College of Medicine, Shangdong University, 758 Hefei Road, Qingdao, Shangdong, China
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Nguyen A, Upadhyay S, Javaid MA, Qureshi AM, Haseeb S, Javed N, Cormier C, Farooq A, Sheikh AB. Behcet's Disease: An In-Depth Review about Pathogenesis, Gastrointestinal Manifestations, and Management. Inflamm Intest Dis 2022; 6:175-185. [PMID: 35083283 DOI: 10.1159/000520696] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Behcet's disease (BD) is a complex inflammatory vascular disorder that follows a relapsing-remitting course with diverse clinical manifestations. The prevalence of the disease varies throughout the globe and targets different age-groups. There are many variations of BD; however, intestinal BD is not only more common but has many signs and symptoms. Summary BD is a relapsing-remitting inflammatory vascular disorder with multiple system involvement, affecting vessels of all types and sizes that targets young adults. The etiology of BD is unknown but many factors including genetic mechanisms, vascular changes, hypercoagulability, and dysregulation of immune function are believed to be responsible. BD usually presents with signs and symptoms of ulcerative disease of the small intestine; endoscopy being consistent with the clinical manifestations. The mainstay of treatment depends upon the severity of the disease. Corticosteroids are recommended for severe forms of the disease and aminosalicylic acids are used in maintaining remission in mild to moderate forms of the disease. Key Messages In this review, we have tried to summarize in the present review the clinical manifestations, differential diagnoses, and management of intestinal BD. Hopefully, this review will enable health policymakers to ponder over establishing clear endpoints for treatment, surveillance investigations, and creating robust algorithms.
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Affiliation(s)
- Anthony Nguyen
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Shubhra Upadhyay
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | | | - Abdul Moiz Qureshi
- Department of Internal Medicine, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Shahan Haseeb
- Department of Internal Medicine, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Nismat Javed
- Department of Internal Medicine, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Christopher Cormier
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Asif Farooq
- Department of Family and Community Medicine, Texas Tech Health Sciences Center, Lubbock, Texas, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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Yamaguchi Y, Nakagawa M, Nakagawa S, Nagao K, Inoue S, Sugiyama T, Izawa S, Hijikata Y, Ebi M, Funaki Y, Ogasawara N, Sasaki M, Kasugai K. Rapidly Progressing Aseptic Abscesses in a Patient with Ulcerative Colitis. Intern Med 2021; 60:725-730. [PMID: 32999240 PMCID: PMC7990631 DOI: 10.2169/internalmedicine.5733-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Aseptic abscesses (AAs) are extraintestinal manifestations of inflammatory bowel disease (IBD). IBD-associated AAs are rare in Japan. We treated a 45-year-old man with ulcerative colitis (UC)-associated AAs. During remission, multiple progressive abscesses were detected in the spleen; he underwent splenectomy because an infectious disease was suspected. Although his condition improved temporarily after splenectomy, a large liver abscess was noted, and a diagnosis of UC-associated AAs was made. Granulocytapheresis (GCAP) and infliximab (IFX) administration resolved the abscess. This is the first reported case of UC-associated AAs in a Japanese patient treated by splenectomy, GCAP, and IFX.
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Affiliation(s)
- Yoshiharu Yamaguchi
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Marie Nakagawa
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Shoko Nakagawa
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Kazuhiro Nagao
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Satoshi Inoue
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Tomoya Sugiyama
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Shinya Izawa
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Yasutaka Hijikata
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Masahide Ebi
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Yasushi Funaki
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Naotaka Ogasawara
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Makoto Sasaki
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
| | - Kunio Kasugai
- Department of Gastroenterology, Aichi Medical University School of Medicine, Japan
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Mathapathi S, Preziosi M. Multiple Hepatic Micro-Hypodensities as a Presenting Sign in Systemic Lupus Erythematosus- A Case Report. Open Rheumatol J 2020. [DOI: 10.2174/1874312902014010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Systemic Lupus Erythematosus (SLE) is a chronic multisystemic inflammatory disorder that can present with a wide array of signs and symptoms. Hepatic involvement is commonly limited to a subclinical biochemical transaminitis while clinically significant liver disease is rare. A case of a 22-year-old female who presented with abdominal pain, fevers, arthralgia, and several hepatic hypodense lesions with normal liver function tests is reported in this study. She failed to improve with antibiotics and infectious workup was largely unrevealing. She was found to have a positive ANA, high titers of anti-double-stranded DNA antibody, and was ultimately diagnosed with new-onset SLE with hepatic aseptic micro-abscesses. Her symptoms were self-limiting, and she was later started on a low-dose prednisone taper and hydroxychloroquine. This case demonstrates that hepatic involvement, despite normal liver function tests, should be considered in SLE patients presenting with abdominal pain.
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Liverani E, Colecchia A, Mazzella G. Persistent Fever and Abdominal Pain in a Young Woman With Budd-Chiari Syndrome. Gastroenterology 2018; 154:495-497. [PMID: 29352960 DOI: 10.1053/j.gastro.2017.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 12/02/2022]
Affiliation(s)
- Elisa Liverani
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Antonio Colecchia
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy; UOC Gastroenterologia, Azienda Ospedaliera Universitaria Integrata Verona, Italy
| | - Giuseppe Mazzella
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy
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Yildiz H, Munting A, Komuta M, Danse E, Lefebvre C. Aseptic lung and liver abscesses: a diagnostic challenge. Acta Clin Belg 2017; 72:259-263. [PMID: 27498958 DOI: 10.1080/17843286.2016.1215888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A 67-year-old man known with systemic sarcoidosis was admitted to the department of internal medicine because of cough and chest pain for several weeks. Thoracic tomodensitometry demonstrated multiple pulmonary nodules. Biopsies revealed features compatible with abscesses. Cultures and serologic tests were negative and the patient was successfully treated with prednisone. Three years later, a thoraco-abdominal tomodensitometry showed a relapse in the lung and also the apparition of similar lesions in the liver. Blood test revealed elevated CRP level at 40 mg/L and mild cholestasis. Biopsies of the liver excluded neoplastic or infectious diseases and showed inflammatory granulation tissue with abscess formation. A diagnosis of sarcoidosis-associated aseptic abscesses syndrome was then made, which was successfully treated with corticosteroids.
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Affiliation(s)
- Halil Yildiz
- Department of Internal Medicine, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Aline Munting
- Department of Internal Medicine, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Mina Komuta
- Department of pathology, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Etienne Danse
- Department of Radiology, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Chantal Lefebvre
- Department of Internal Medicine, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
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Lim KI, Yang DH, Ryoo E. Behçet's disease with multiple splenic abscesses in a child. Intest Res 2017; 15:422-428. [PMID: 28670241 PMCID: PMC5478769 DOI: 10.5217/ir.2017.15.3.422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/31/2016] [Accepted: 09/12/2016] [Indexed: 01/30/2023] Open
Abstract
We report the case of a 5-year-old male patient with multiple aseptic splenic abscesses associated with Behçet's disease. The patient visited Gachon University Gil Hospital with fever, abdominal pain, and acute watery and bloody diarrhea, and reported a 2-year history of chronic abdominal pain and intermittent watery diarrhea. He was treated with antibiotics at a local clinic for fever and cervical lymph node swelling. Additionally, he had recurrent stomatitis. A colonoscopy showed multiple well-demarcated ulcerations throughout the colon, and abdominal computed tomography showed multiple splenic abscesses. Pathergy and HLA-B51 tests were positive. Investigations did not reveal any infectious organisms in the aspirate obtained via ultrasound-guided fine needle aspiration. After steroid treatment, all symptoms and multiple aseptic splenic abscesses resolved. However, oral ulcers, genital ulcers, and abdominal pain recurred after tapering the steroids. Infliximab treatment improved the patient's symptoms. However, 5 months after the treatment, the symptoms recurred. The treatment was changed to include adalimumab. Subsequently, the patient's symptoms resolved and colonoscopic findings improved. No recurrence was noted after 3 months of follow-up.
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Affiliation(s)
- Kyung In Lim
- Department of Pediatrics, Gachon University Gil Hospital, Incheon, Korea
| | - Dong Hwa Yang
- Department of Pediatrics, Gachon University Gil Hospital, Incheon, Korea
| | - Eell Ryoo
- Department of Pediatrics, Gachon University Gil Hospital, Incheon, Korea
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Panos Z, Giannopoulos G, Papangeli E, Antalis E, Pavli A, Spathis A, Poulakou G, Dimitriadis G, Panayiotides I, Boumpas D, Tsiodras S. Aseptic abscess syndrome associated with traveler's diarrhea after a trip to Malaysia. IDCases 2016; 6:23-5. [PMID: 27672562 PMCID: PMC5035335 DOI: 10.1016/j.idcr.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/11/2016] [Indexed: 11/20/2022] Open
Abstract
The first, to our knowledge, case of the aseptic abscesses syndrome as a complication of traveler’s diarrhea after a trip to Malaysia is presented. The patient failed to respond to several antimicrobials. The diagnosis was histologically confirmed and the patient only responded to immunomodulatory therapy with corticosteroids and methotrexate. Travel physicians should be aware of this entity reviewed herein in the context of traveler’s diarrhea.
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Affiliation(s)
- Zois Panos
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - George Giannopoulos
- 2nd Propaideutic Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - Eymorfia Papangeli
- 2nd Propaideutic Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - Emmanouil Antalis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - Androula Pavli
- Travel Medicine Office, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Aris Spathis
- Department of Cytopathology, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - Garyfalia Poulakou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - George Dimitriadis
- 2nd Propaideutic Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - Ioannis Panayiotides
- 2nd Department of Pathology, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - Dimitrios Boumpas
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, University General Hospital “Attikon”, Athens, Greece
- Corresponding author at: 4th Department of Internal Medicine University General Hospital “Attikon”, 1 Rimini street, Chaidari, Athens 12462, Greece.4th Department of Internal MedicineNational and Kapodistrian University of Athens School of MedicineUniversity General Hospital “Attikon”AthensGreece
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Skef W, Hamilton MJ, Arayssi T. Gastrointestinal Behçet's disease: A review. World J Gastroenterol 2015; 21:3801-3812. [PMID: 25852265 PMCID: PMC4385527 DOI: 10.3748/wjg.v21.i13.3801] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/14/2015] [Accepted: 01/30/2015] [Indexed: 02/07/2023] Open
Abstract
Behçet’s disease (BD) is an idiopathic, chronic, relapsing, multi-systemic vasculitis characterized by recurrent oral and genital aphthous ulcers, ocular disease and skin lesions. Prevalence of BD is highest in countries along the ancient silk road from the Mediterranean basin to East Asia. By comparison, the prevalence in North American and Northern European countries is low. Gastrointestinal manifestations of Behçet’s disease are of particular importance as they are associated with significant morbidity and mortality. Although ileocecal involvement is most commonly described, BD may involve any segment of the intestinal tract as well as the various organs within the gastrointestinal system. Diagnosis is based on clinical criteria - there are no pathognomonic laboratory tests. Methods for monitoring disease activity on therapy are available but imperfect. Evidence-based treatment strategies are lacking. Different classes of medications have been successfully used for the treatment of intestinal BD which include 5-aminosalicylic acid, corticosteroids, immunomodulators, and anti-tumor necrosis factor alpha monoclonal antibody therapy. Like inflammatory bowel disease, surgery is reserved for those who are resistant to medical therapy. A subset of patients have a poor disease course. Accurate methods to detect these patients and the optimal strategy for their treatment are not known at this time.
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Abstract
OBJECTIVE The purpose of this article is to review the different cystic hepatic lesions, with an emphasis on the imaging features that help to differentiate them, and to propose a practical algorithm for approaching the diagnosis of these lesions. CONCLUSION The number and morphology of the lesions and determination of whether there is a solid component are key imaging features that are helpful for approaching the diagnosis of cystic hepatic lesions. Familiarity with these features and knowledge of the clinical associations will help the radiologist to establish a definitive diagnosis or provide a reasonable differential diagnosis.
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