The American Journal of Case Reports最新文献

{"title":"Peripherally Inserted Central Catheter-Related Infectious Myositis: A Case Report.","authors":"Shingo Kurahashi,&nbsp;Shinsuke Takeda,&nbsp;Yutaro Suzuki,&nbsp;Yoshifumi Arai,&nbsp;Shingo Kurahashi,&nbsp;Ken-Ichi Yamauchi","doi":"10.12659/AJCR.937215","DOIUrl":"https://doi.org/10.12659/AJCR.937215","url":null,"abstract":"<p><p>BACKGROUND Peripherally inserted central catheters (PICCs) are commonly used by clinicians in daily practice as a safe and reliable alternative to central venous catheters. While there are advantages to the use of PICCs, such as a low insertion-related complication rate and cost-effectiveness, using PICCs may expose patients to life-threatening severe complications such as a central line-associated bloodstream infection and deep venous thrombosis (DVT). There have been no reports of infectious myositis associated with PICC insertion. CASE REPORT We report a case of infectious myositis related to PICC insertion complicated by brachial DVT in a 43-year-old immunocompromised patient with myelodysplastic syndrome. Despite the administration of broad-spectrum antibiotics, the patient's condition did not improve. He developed septic shock and required emergency excision of the infected and necrotic muscles. Although the pathogen responsible for the infection was unknown, infectious myositis and myonecrosis were observed intraoperatively. Furthermore, histopathological examination revealed evidence of infectious myositis in the biceps brachii and brachial muscles. The septic shock resolved with treatment and the patient survived with residual elbow joint dysfunction. CONCLUSIONS We present a case of infectious myositis related to PICC insertion. We believe that urgent resection of infected and necrotic tissues, rather than broad-spectrum antimicrobial therapy alone, was essential to save the patient's life.</p>","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e937215"},"PeriodicalIF":1.2,"publicationDate":"2022-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/59/3f/amjcaserep-23-e937215.PMC9552856.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33490312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demodicosis as a Skin Complication in Organ Transplant Recipients: A Case Series.","authors":"Adriana Marquardt-Feszler,&nbsp;Maria Alicja Dębska-Ślizień,&nbsp;Beata Imko-Walczuk","doi":"10.12659/AJCR.936467","DOIUrl":"https://doi.org/10.12659/AJCR.936467","url":null,"abstract":"<p><p>BACKGROUND Patients after organ transplantation are, due to chronic immunosuppression, prone to have many cutaneous adverse events, both infections and neoplasms. Studies show that some groups of patients under chronic immunosuppression are prone to develop demodicosis. The significance of demodicosis in the population of organ transplant recipients has not been established yet. CASE REPORT We present 4 cases of patients with multiply dermatological complications of immunosuppression, in which one of them is demodicosis. The presented symptoms were itch, pustules, papules, and/or telangiectasias. Age of patients varied from 64 to 79 years old. Time between transplantation and diagnosis of demodicosis varied from 6 to 10 years. Other dermatological problems that appeared were basal cell carcinoma, actinic keratosis, and seborrheic keratosis. Patients showed complete resolution after treatment with topical ivermectin 10 mg/g and topical permethrin 50 mg/g. However, the medications were prolonged to 16 weeks in 1 case to reduce persistent papules and telangiectasias. The therapy did not cause any complications or disruptions in function of transplanted kidneys in any of reported patients. CONCLUSIONS Demodicosis may have a significant role in the group of infections that organ transplant recipients are prone to, and may co-exist with other dermatological diseases, including neoplasms. However, larger studies in the field are needed.</p>","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e936467"},"PeriodicalIF":1.2,"publicationDate":"2022-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e1/94/amjcaserep-23-e936467.PMC9552859.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33493188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 60-Year-Old Man with Gingivitis and Poorly Controlled Diabetes Developing Low Back Pain 1 Week Following Recovery from COVID-19 Diagnosed with Spinal Abscess Due to Streptococcus oralis.","authors":"Eric Chun-Pu Chu,&nbsp;Robert J Trager,&nbsp;Alan Te Chang Chen,&nbsp;John Sing Fai Shum","doi":"10.12659/AJCR.937517","DOIUrl":"https://doi.org/10.12659/AJCR.937517","url":null,"abstract":"<p><p>BACKGROUND Streptococcus oralis (S. oralis) is a gram-positive bacterium and component of the oral microbiota that can rarely cause opportunistic infection in the immunosuppressed. This report presents a 60-year-old man from Hong Kong with gingivitis and poorly controlled diabetes who visited his chiropractor with low back pain 2 weeks following mild COVID-19 and was diagnosed with paraspinal, psoas, and epidural abscess due to S. oralis. CASE REPORT The patient tested positive for COVID-19 when asymptomatic, then had a mild 10-day course of the illness, followed by low back pain 1 week later, prompting him to visit his primary care provider, who diagnosed sciatica and treated him with opioid analgesics. He presented to a chiropractor the following week, noting severe low back pain with radiation into the gluteal regions and posterior thighs, difficulty with ambulation, and mild neck pain. Considering the patient's diabetes, widespread symptoms, and weakness, the chiropractor ordered whole-spine magnetic resonance imaging, which suggested possible multifocal spinal abscess and referred him urgently to a spine surgeon. The surgeon conducted testing consistent with bacterial infection, and referred to an infectious disease specialist, who confirmed S. oralis spinal infection via lumbar paraspinal needle biopsy and culture. The patient was first treated with oral antibiotics, then intravenous antibiotics in a hospital. Over 4 weeks, his spinal pain improved, and laboratory markers of infection normalized. CONCLUSIONS This case illustrates an opportunistic pyogenic spinal infection including paraspinal, psoas, and epidural abscesses caused by S. oralis in an immunocompromised patient following COVID-19 illness.</p>","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e937517"},"PeriodicalIF":1.2,"publicationDate":"2022-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a1/9c/amjcaserep-23-e937517.PMC9552857.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33506521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathogenic Novel Heterozygous Variant c.1076c>T p. (Ser359Phe) chr1: 120512166 in NOTCH2 Gene, Type 2 Alagille Syndrome Causing Neonatal Cholestasis: A Case Report.","authors":"Mohammed Shahab Uddin,&nbsp;Saleh Al Fulayyih,&nbsp;Fatin Fahad Al Denaini,&nbsp;Maher Mohammed Al Hatlani","doi":"10.12659/AJCR.935840","DOIUrl":"https://doi.org/10.12659/AJCR.935840","url":null,"abstract":"<p><p>BACKGROUND Alagille syndrome (ALGS) is a multisystem hereditary illness with a dominant pattern and partial penetrance. Multiple organ abnormalities can be caused by mutations in the Jagged canonical Notch ligand 1 (JAG1) gene. Notch receptor 2 (NOTCH2) gene mutations are also uncommon. ALGS is also characterized by deformed or narrowed bile ducts and is notoriously difficult to diagnose due to the wide range of symptoms and absence of unambiguous genotype-phenotype connections. Little is known about ALGS patients who have NOTCH2 mutations. We present a patient who developed progressive liver failure due to a unique pathogenic heterozygous variation of the NOTCH2 gene, c.1076c>T p. (Ser359Phe) chr1: 120512166, resulting in type 2 ALGS. CASE REPORT A Saudi Arabian newborn with bilateral hazy eyes, ectropion, dry ichthyic skin, normal male genitalia, and bilateral undescended testes was born at 31 weeks. Previous miscarriages, pregnancy-induced maternal cholestasis, fatty liver, or neonatal jaundice were not reported in the family history. He had developed worsening cholestatic jaundice by the third week of hospitalization. The extensive work-up for metabolic, infectious, and other relevant etiologies was negative. Following gram-negative sepsis, he died of multiorgan failure. A NOTCH2 gene mutation explained the phenotypic difference in our situation. Another intriguing observation was the presence of ichthysis and craniosynostosis in ALGS with a NOTCH2 mutation. CONCLUSIONS Cholestasis in newborns can be difficult to diagnose. Next-generation sequencing detects 112 copy number variants in the cholestasis gene panel blood test. More research is needed to understand why NOTCH2 mutations are relatively rare in ALGS.</p>","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e935840"},"PeriodicalIF":1.2,"publicationDate":"2022-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8e/77/amjcaserep-23-e935840.PMC9552858.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33489794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pushing the Boundaries: Drug-Coated Balloons to Treat a Calcified and Thrombotic Lesion in Acute Coronary Syndrome.","authors":"Giacomo Maria Cioffi,&nbsp;Mehdi Madanchi,&nbsp;Adrian Attinger-Toller,&nbsp;Matthias Bossard,&nbsp;Florim Cuculi","doi":"10.12659/AJCR.936950","DOIUrl":"https://doi.org/10.12659/AJCR.936950","url":null,"abstract":"<p><p>BACKGROUND Use of drug-coated balloons (DCB) is an important research topic. Many companies are quickly developing new, cutting-edge technologies and means to deliver drugs. Moreover, interest is growing in use of sirolimus-coated balloons, a promising technology in the \"leaving nothing behind\" era. This, in combination with interest in lesion preparation and intravascular imaging, creates a promising future for DCB for years to come. CASE REPORT A 72-year-old patient presented with NSTEMI. Coronary angiography showed a subtotal stenosis of the right coronary artery (RCA). PCI was performed on the native RCA and, given the patient's failure to adhere to the drug regimen, he was treated with a metal-free PCI strategy. After using a novel lesion preparation technique with cutting balloon and high-pressure non-compliant balloon, a novel Sirolimus DCB was used. Final angiography and OCT run showed good luminal gain despite diffuse dissections. To assess vascular healing, we performed coronary angiography 5 weeks later, which demonstrated an excellent result, with absence of residual dissection and further luminal gain compared to the index procedure. CONCLUSIONS The use of a novel lesion preparation technique (cutting balloon and high-pressure highly non-compliant balloon) in combination with guidance by intravascular imaging and the use of a new sirolimus-coated balloon may attract attention in the interventional cardiology community and stimulate discussion on lesion preparation and use of drug-coated balloons.</p>","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e936950"},"PeriodicalIF":1.2,"publicationDate":"2022-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/74/fb/amjcaserep-23-e936950.PMC9552860.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33487712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Lingual Nerve Injury Following Endotracheal Intubation: Risk Factors and Diagnostic Considerations.","authors":"Abdallah Khashan,&nbsp;Michael Carson,&nbsp;Vanil Pandya,&nbsp;Abram R Wahba,&nbsp;Doha Mohamed Ahmed Khashan,&nbsp;Emad Noor","doi":"10.12659/AJCR.937192","DOIUrl":"https://doi.org/10.12659/AJCR.937192","url":null,"abstract":"<p><p>BACKGROUND Endotracheal intubation is an essential procedure to protect the airway. However, immediate complications like voice hoarseness, cervical spine injury, and tooth trauma are common. One of the rarest complications is lingual nerve palsy. Risk factors include small airway instruments, non-supine position, nitrous oxide use, and difficult intubation. Only 15 cases of lingual nerve injury were identified worldwide, and only 2 of them were bilateral. This case report describes the third case of bilateral lingual nerve palsy after intubation. CASE REPORT We present a 52-year-old woman admitted for a total abdominal hysterectomy. Postoperatively, the patient noted voice hoarseness, left tongue numbness, and loss of taste on both sides of the tongue. MRI brain revealed no new masses or lesions, and a diagnosis of bilateral lingual nerve palsy was made. She was treated conservatively with symptom observation for 14 weeks. On follow-up, she remained with only a patch of numbness and dryness, and loss of taste on the top middle area of the tongue. CONCLUSIONS Lingual nerve palsy is a very rare but devastating adverse effect of airway manipulation. Symptoms can include dryness, loss of sensation, and loss of taste of the anterior two-thirds of the tongue on the ipsilateral side. Salivary function assessment is important to determine the location of peripheral nerve injury. All possible causes like stroke, hemorrhage, and nerve impingement should be evaluated. MRI is advised to exclude central etiologies. Steroids may be used to decrease tissue edema and inflammation.</p>","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e937192"},"PeriodicalIF":1.2,"publicationDate":"2022-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/99/3f/amjcaserep-23-e937192.PMC9552861.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33488333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open Reduction at 15 Months of Left Hip Dislocation in a Male Infant Diagnosed with Arthrogryposis.","authors":"Fahad Abdullah AlShayhan,&nbsp;Abdulmonem Mohammed Alsiddiky,&nbsp;Motaz Aljohani,&nbsp;Abdulrahman Alomair,&nbsp;Naief Alghnimei","doi":"10.12659/AJCR.936627","DOIUrl":"https://doi.org/10.12659/AJCR.936627","url":null,"abstract":"<p><p>BACKGROUND Arthrogryposis is a congenital condition of multiple contractures of joints associated with hip dislocation. The outcome of open reduction of hip dislocation in arthrogryposis patients is debatable. Open reduction of arthrogryposis is challenging for shallow acetabulum and extensive adhesions and fibrosis. For this reason, a careful extensive release must be carried out to achieve the open reduction of the hip in arthrogryposis patients. The literature lacks surgical recommendations for open reduction of the hip in arthrogryposis patients and how to deal with cases of the extruded bone segment during open reduction. CASE REPORT The patient presented in the first few weeks of life with bilateral clubfoot and left hip dislocation. Clinical diagnosis of arthrogryposis was made after referral to a genetics specialist. The hip was clinically irreducible. The patient underwent open reduction and femoral shortening using the Smith Peterson approach at the age of 15 months, with accidental extrusion of the proximal femur, which was retained immediately. The clinical outcome showed a painless, good range of motion. Radiographically, features of avascular necrosis and healed osteotomy site were evident. CONCLUSIONS A difficult hip reduction was expected in this arthrogryposis patient, which required careful dissection of surrounding fibrosis and appropriate femoral shortening. Careful dissection should be carried out during open reduction to avoid jeopardization of femoral head vascularity or even complete devitalization of the proximal femur.</p>","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e936627"},"PeriodicalIF":1.2,"publicationDate":"2022-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5b/61/amjcaserep-23-e936627.PMC9549526.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33502690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complicated Massive Left Ventricular Thrombus and Surgical Treatment.","authors":"Sedat Pasli,&nbsp;Markus Kamler,&nbsp;Rizwan Malik,&nbsp;Jerry Easo","doi":"10.12659/AJCR.937341","DOIUrl":"https://doi.org/10.12659/AJCR.937341","url":null,"abstract":"<p><p>BACKGROUND Left ventricular thrombus formation is a serious complication of cardiac diseases and may result in acute embolic events. Early diagnosis and prompt treatment are crucial steps in preventing complications. There is a lack of consensus when it comes to therapy recommendations such as treatment with anticoagulation, thrombolysis, or surgical thrombectomy. CASE REPORT A 74-year-old woman presented with acute peripheral ischemia in the left and right lower limbs. After running a diagnostic workup, we found a history of fatigue and dyspnea in the preceding 2 weeks; and an echocardiographic examination revealed a large floating mass in the left ventricle with a severely reduced LV ejection fraction of 10-15%. Coronary heart disease was diagnosed with stenosis of the circumflex artery and posterior branch of the right coronary artery, but not necessitating acute treatment. The decision to operate on our patient was based on the acute situation and mobile form of the thrombi as to prevent further thromboembolic complications, and the surgical procedure was performed via a median sternotomy using a left ventricular apical approach due to the size and deep embedment in the ventricular trabeculae. CONCLUSIONS To date there is no standardized therapy in the guidelines for treatment of LV thrombi. Surgical thrombectomy can be performed in patients with mobile and protruding thrombi. In such cases surgery should be performed immediately due to the high risk of systemic embolism.</p>","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e937341"},"PeriodicalIF":1.2,"publicationDate":"2022-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ef/cb/amjcaserep-23-e937341.PMC9549525.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33487596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Splenectomy of a Wandering Pelvic Splenomegaly in a Young Woman Treated in Childhood with Surgery for Diaphragmatic Hernia and Adhesiolysis for Intestinal Obstruction.","authors":"Eleonora Cartesegna,&nbsp;Pier Carlo Rassu,&nbsp;Valerio Accarpio,&nbsp;Stefano Barbieri,&nbsp;Maria Maurizia Bocchio,&nbsp;Eliana Giaminardi,&nbsp;Antonino Malfitano,&nbsp;Alessandro Montobbio,&nbsp;Sonja Olcese,&nbsp;Denise Palombo,&nbsp;Francesca Ré,&nbsp;Carmine Gianfranco Di Somma","doi":"10.12659/AJCR.936964","DOIUrl":"https://doi.org/10.12659/AJCR.936964","url":null,"abstract":"<p><p>BACKGROUND Wandering spleen (WS) is a rare medical condition in which the spleen migrates from its usual position commonly to the pelvis or lower abdomen assuming an ever-wandering state. The incidence of ectopic spleen is 0.2%, with variable clinical manifestations from asymptomatic to abdominal emergency. Symptoms are most attributed to complications related to torsion, so that a nonoperative management of a WS is not advised. According to the literature, 69.5% of patients with WS need splenectomy and 78.6% need laparotomy. CASE REPORT The patient exhibited vague intermittent lower abdominal pain for 6 months due to progressive torsion of the spleen, which resulted in venous congestion. Abdominal investigation revealed a mobile intra-abdominal mass and parenchymatous consistency in the pelvis. Diagnosis by computed tomography outlined abdominal splenomegaly with abnormal position both of pancreas and stomach. Laparoscopy established a giant spleen, with a lengthened pelvic and twisty vascular pedicle. In its ectopic location, the spleen had dragged the pancreas with it, which had taken a vertical position. The classic splenic ligaments were not recognizable. Spleen was removed with median laparotomic incision. Splenectomy was performed to prevent any traumatic fractures of the spleen, a complete twist of the splenic hilum, and the onset of recurrent acute pancreatitis. CONCLUSIONS Wandering spleen is rare in patients presenting with acute abdominal pain. An approach supported by clinical findings and investigation, even considering splenectomy over splenopexy, and laparoscopy over open surgery, may solve and prevent complications and health risks.</p>","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e936964"},"PeriodicalIF":1.2,"publicationDate":"2022-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8b/a0/amjcaserep-23-e936964.PMC9540513.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40388723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptomatic Gastric Sarcoidosis in a Patient with Pulmonary and Neurosarcoidosis: A Case Report.","authors":"Dana Hassan,&nbsp;Nicholas Weit,&nbsp;Niraj Patel","doi":"10.12659/AJCR.936578","DOIUrl":"https://doi.org/10.12659/AJCR.936578","url":null,"abstract":"<p><p>BACKGROUND Sarcoidosis is an inflammatory condition with multisystem involvement of unknown etiology that is characterized by noncaseating granulomas. Gastrointestinal (GI) involvement of sarcoidosis is not commonly seen in patients with extrapulmonary disease but can result in luminal narrowing, ulceration, and, less commonly, bleeding and obstruction. Patients that present with symptomatic gastric sarcoidosis are extremely rare. Definitive diagnosis can be challenging due to the need for endoscopic biopsy, which may not be performed if the diagnosis is not considered. Biopsy may be falsely negative due to the patchy mucosal involvement of this disease. CASE REPORT This case describes a 38-year-old mixed-race man who presented to the Emergency Department with GI symptoms including nausea, vomiting, and abdominal pain, which persisted after being recently discharged from an outside hospital. The patient had a known history of multisystem sarcoid including pulmonary and neurosarcoidosis, and was maintained on immunosuppressive therapy. The patient underwent upper endoscopy with biopsy confirming a new diagnosis of gastric sarcoidosis. CONCLUSIONS There is an important role for early endoscopy in the diagnosis of patients with symptomatic gastric sarcoidosis to facilitate early treatment initiation and escalation or titration of immunosuppressive therapy, especially in patients with a known history of sarcoidosis with extrapulmonary involvement. The described endoscopic appearance of gastric sarcoidosis is variable in the published literature; endoscopic biopsy is therefore essential to diagnosing this disease. This type of disease progression should be considered in all sarcoid patients with persistent GI symptoms that do not resolve with conservative management, including those who are already on established immunosuppressive therapy.</p>","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e936578"},"PeriodicalIF":1.2,"publicationDate":"2022-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/57/76/amjcaserep-23-e936578.PMC9540506.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40394787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}