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Biopsy-Proven Hepatic Extramedullary Hematopoiesis With Chronic Portal Vein Thrombosis in JAK2 V617F-Positive Prefibrotic Myelofibrosis: Contributors to Noncirrhotic Portal Hypertension. 活组织检查证实肝髓外造血伴慢性门静脉血栓JAK2 v617f阳性纤维化前骨髓纤维化：非肝硬化门静脉高压的诱因。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-10-16 eCollection Date: 2026-10-01 DOI: 10.14309/crj.0000000000002354
Rowan Bandaranaike, Beth Rutland, Travis Rutland
{"title":"Biopsy-Proven Hepatic Extramedullary Hematopoiesis With Chronic Portal Vein Thrombosis in JAK2 V617F-Positive Prefibrotic Myelofibrosis: Contributors to Noncirrhotic Portal Hypertension.","authors":"Rowan Bandaranaike, Beth Rutland, Travis Rutland","doi":"10.14309/crj.0000000000002354","DOIUrl":"10.14309/crj.0000000000002354","url":null,"abstract":"<p><p>Noncirrhotic portal hypertension warrants evaluation for vascular and infiltrative etiologies when hepatic fibrosis is absent. We describe a 48-year-old man with JAK2 V617F-positive prefibrotic primary myelofibrosis who developed chronic portal vein thrombosis with cavernous transformation and gastroesophageal varices despite preserved liver stiffness (4.2 kPa). Endoscopic ultrasound-guided liver biopsy demonstrated grade 2 hepatic extramedullary hematopoiesis (4 foci across 10 high-power fields) without fibrosis. Chronic portal vein thrombosis was the principal driver of portal hypertension. This case demonstrates that appreciable hepatic extramedullary hematopoiesis can occur in prefibrotic primary myelofibrosis despite minimal marrow fibrosis, representing a possible intrahepatic contributor to noncirrhotic portal hypertension.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 10","pages":"e02354"},"PeriodicalIF":0.6,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214863","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}
引用次数: 0
Hidden in Plain Sight: Gastric Adenocarcinoma in Endoscopically Normal Mucosa in a CDH1 Mutation Carrier. 隐藏在视线中：内镜下正常黏膜中CDH1突变携带者的胃腺癌。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-10-15 eCollection Date: 2026-10-01 DOI: 10.14309/crj.0000000000002355
Seth Mills, Abinash Subedi
{"title":"Hidden in Plain Sight: Gastric Adenocarcinoma in Endoscopically Normal Mucosa in a CDH1 Mutation Carrier.","authors":"Seth Mills, Abinash Subedi","doi":"10.14309/crj.0000000000002355","DOIUrl":"10.14309/crj.0000000000002355","url":null,"abstract":"<p><p>Hereditary diffuse gastric cancer associated with cadherin 1 (CDH1) mutations poses diagnostic challenges because of its subepithelial and multifocal nature. We report a 71-year-old woman with a germline CDH1 mutation and complex breast cancer history who chose endoscopic surveillance over prophylactic gastrectomy. Despite a grossly normal esophagogastroduodenoscopy, random biopsies revealed signet ring cell adenocarcinoma. Staging imaging was negative. She underwent total gastrectomy, and final pathology showed multifocal intramucosal carcinoma (pT1a) without nodal involvement. This case highlights the limitations of endoscopic surveillance and underscores the importance of risk-reducing surgery in CDH1 mutation carriers.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 10","pages":"e02355"},"PeriodicalIF":0.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214908","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}
引用次数: 0
Invasive Cryptococcal Meningitis: A Sequelae of Primary Intestinal Lymphangiectasia. 侵袭性隐球菌脑膜炎：原发性肠淋巴管扩张的后遗症。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-10-14 eCollection Date: 2026-10-01 DOI: 10.14309/crj.0000000000002360
Jeemin Kwon, Hanlin L Wang, Guy A Weiss, Anthony Myint
{"title":"Invasive Cryptococcal Meningitis: A Sequelae of Primary Intestinal Lymphangiectasia.","authors":"Jeemin Kwon, Hanlin L Wang, Guy A Weiss, Anthony Myint","doi":"10.14309/crj.0000000000002360","DOIUrl":"10.14309/crj.0000000000002360","url":null,"abstract":"<p><p>Primary intestinal lymphangiectasia (PIL) is a protein-losing enteropathy causing enteric loss of albumin, immunoglobulins, and lymphocytes. Untreated or inadequately monitored PIL may result in secondary immunodeficiency and opportunistic infections. We report a 30-year-old man with a childhood diagnosis of PIL who developed cryptococcal meningoencephalitis. Evaluation revealed secondary immunodeficiency with lymphopenia and hypogammaglobulinemia which was attributed to ongoing protein-losing enteropathy despite absence of gastrointestinal symptoms, supported by hypoalbuminemia and fat-soluble vitamin deficiencies. This is the third reported case of PIL-associated cryptococcal meningitis and the first in a patient with a previously established diagnosis, highlighting consequences of lapsed subspecialty follow-up in adulthood.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 10","pages":"e02360"},"PeriodicalIF":0.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190711","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}
引用次数: 0
Transplant-Free Recovery in Wilson Disease-Associated Acute Liver Failure. 肝豆状核病相关急性肝衰竭的无移植恢复。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-10-14 eCollection Date: 2026-10-01 DOI: 10.14309/crj.0000000000002358
Hakan Demiröz, Yusuf Bünyamin Ketenci, Mehmet Akca, Ufuk Avcıoğlu, Ahmet Bektaş
{"title":"Transplant-Free Recovery in Wilson Disease-Associated Acute Liver Failure.","authors":"Hakan Demiröz, Yusuf Bünyamin Ketenci, Mehmet Akca, Ufuk Avcıoğlu, Ahmet Bektaş","doi":"10.14309/crj.0000000000002358","DOIUrl":"10.14309/crj.0000000000002358","url":null,"abstract":"<p><p>Wilson disease-associated acute liver failure carries high mortality without urgent liver transplantation. Diagnosis is challenging when classical signs like Kayser-Fleischer rings are absent. We report a 28-year-old woman presenting with Wilson disease-associated acute liver failure characterized by Coombs-negative hemolytic anemia, profound hyperbilirubinemia, low alkaline phosphatase, and a New Wilson Index score of 14. Despite predicting poor transplant-free survival, she achieved complete clinical and biochemical recovery following aggressive copper-removal therapy using chelation, zinc, therapeutic plasma exchange, and continuous renal replacement therapy. This case demonstrates that early combined extracorporeal liver support can successfully bridge patients to recovery, potentially obviating liver transplantation.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 10","pages":"e02358"},"PeriodicalIF":0.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190723","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}
引用次数: 0
Severe Transaminitis Without Rhabdomyolysis: An Unusual Presentation of Daptomycin-Induced Liver Injury. 无横纹肌溶解的严重转氨炎：达托霉素引起的肝损伤的一种不寻常的表现。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-10-13 eCollection Date: 2026-10-01 DOI: 10.14309/crj.0000000000002352
Imran Khokhar, Khaled Elsokary, Muhammad Haris Latif, Navanita Biswas, Ayesha Kang
{"title":"Severe Transaminitis Without Rhabdomyolysis: An Unusual Presentation of Daptomycin-Induced Liver Injury.","authors":"Imran Khokhar, Khaled Elsokary, Muhammad Haris Latif, Navanita Biswas, Ayesha Kang","doi":"10.14309/crj.0000000000002352","DOIUrl":"https://doi.org/10.14309/crj.0000000000002352","url":null,"abstract":"<p><p>Daptomycin is a lipopeptide antibiotic commonly used for methicillin-resistant <i>Staphylococcus aureus</i> infections. Abnormal liver function tests occur in approximately 3% of patients receiving daptomycin; severe isolated transaminitis is exceptionally rare. We report a 43-year-old man with methicillin-resistant <i>Staphylococcus aureus</i> bacteremia and multiple abscesses who developed marked transaminitis with aspartate aminotransferase and alanine aminotransferase levels peaking at 1,965 U/L and 2,253 U/L, respectively, within 6 days of initiating daptomycin therapy (8 mg/kg daily). Notably, the patient had no evidence of rhabdomyolysis, hyperbilirubinemia, or acute kidney injury. After excluding alternative etiologies and discontinuing daptomycin on hospital day 10, liver enzymes normalized within 13 days without additional intervention. This case highlights the importance of monitoring hepatic function in patients receiving daptomycin and recognizing isolated hepatotoxicity as a rare but significant adverse effect.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 10","pages":"e02352"},"PeriodicalIF":0.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178470","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}
引用次数: 0
When Imaging is Negative: Endoscopic Diagnosis of a Secondary Aortoduodenal Fistula. 当影像学阴性时：内镜诊断继发性主动脉十二指肠瘘。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-10-13 eCollection Date: 2026-10-01 DOI: 10.14309/crj.0000000000002348
Avneet Kaur, Ayushi Shah, Anand Gupta, Muhammad Nauman Jhandier
{"title":"When Imaging is Negative: Endoscopic Diagnosis of a Secondary Aortoduodenal Fistula.","authors":"Avneet Kaur, Ayushi Shah, Anand Gupta, Muhammad Nauman Jhandier","doi":"10.14309/crj.0000000000002348","DOIUrl":"https://doi.org/10.14309/crj.0000000000002348","url":null,"abstract":"<p><p>Aortoenteric fistula is a life-threatening aortic graft complication with a narrow opportunity for treatment. We present a patient with aortobifemoral bypass who developed recurrent anemia and melena. Despite previous upper endoscopy and colonoscopy, computed tomography angiogram, and tagged red blood cell scan, his symptoms were persistent. Capsule endoscopy showed blood in the duodenum. Push enteroscopy revealed graft erosion in the duodenum, confirming aortoduodenal fistula. He underwent aortobifemoral graft excision, and resection of the third portion of the duodenum with end-to-side duodenojejunostomy, highlighting the importance of endoscopy in timely diagnosis of aortoenteric fistulae.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 10","pages":"e02348"},"PeriodicalIF":0.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178553","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}
引用次数: 0
Mimic of Peritoneal Carcinomatosis: Protein-Losing Enteropathy Revealing HRAS-Driven Generalized Lymphatic Anomaly. 模拟腹膜癌：蛋白质丧失性肠病显示hras驱动的全身性淋巴异常。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-10-12 eCollection Date: 2026-10-01 DOI: 10.14309/crj.0000000000002353
Vijayvardhan Kamalumpundi, Stephanie Saey, Sahil Khanna, Joshua Peterson, Ahmad Al-Huniti, Scott Thompson
{"title":"Mimic of Peritoneal Carcinomatosis: Protein-Losing Enteropathy Revealing HRAS-Driven Generalized Lymphatic Anomaly.","authors":"Vijayvardhan Kamalumpundi, Stephanie Saey, Sahil Khanna, Joshua Peterson, Ahmad Al-Huniti, Scott Thompson","doi":"10.14309/crj.0000000000002353","DOIUrl":"https://doi.org/10.14309/crj.0000000000002353","url":null,"abstract":"<p><p>Complex lymphatic anomalies can present with a protein-losing enteropathy. A 25-year-old woman presented with steatorrhea, weight loss, anasarca, and hypoalbuminemia. Abdominal computed tomography revealed diffuse peritoneal soft tissue lesions concerning for carcinomatosis. Omental biopsies and magnetic resonance lymphangiography established generalized lymphatic anomaly. Targeted genetic sequencing identified a novel postzygotic <i>HRAS</i> insertion mutation. She was started on a low-fat diet, sirolimus, and trametinib monotherapy with modest symptomatic response. However, she continued to have severe malnutrition. Alternating therapy of sirolimus and trametinib is ongoing. This is the first reported case of protein-losing enteropathy as the presenting manifestation of an <i>HRAS</i>-driven generalized lymphatic anomaly.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 10","pages":"e02353"},"PeriodicalIF":0.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178425","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}
引用次数: 0
Endoscopic Ultrasound-Guided Radiofrequency Ablation for Recurrent Metastatic Lesion to the Pancreas From Renal Cell Carcinoma: Long-Term Durable Control With Repeated Ablation Sessions. 内镜超声引导下射频消融治疗肾细胞癌胰腺复发性转移病灶：反复消融治疗的长期持久控制。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-10-09 eCollection Date: 2026-10-01 DOI: 10.14309/crj.0000000000002336
Petko Karagyozov, Yoana Petkova, Nadica Shumka
{"title":"Endoscopic Ultrasound-Guided Radiofrequency Ablation for Recurrent Metastatic Lesion to the Pancreas From Renal Cell Carcinoma: Long-Term Durable Control With Repeated Ablation Sessions.","authors":"Petko Karagyozov, Yoana Petkova, Nadica Shumka","doi":"10.14309/crj.0000000000002336","DOIUrl":"https://doi.org/10.14309/crj.0000000000002336","url":null,"abstract":"<p><p>The pancreas is an uncommon site for metastatic spread, making such cases diagnostically and therapeutically challenging. We report a case of endoscopic ultrasound-guided radiofrequency ablation of pancreatic metastasis from renal cell carcinoma. Follow-up imaging revealed a long-term durable outcome, with a recurrent lesion 3 years after the first session, which was successfully retreated with the same modality. This case underscores the role of minimally invasive endoscopic therapies, combined with targeted therapy, as a multimodal approach for patients not suitable for surgery.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 10","pages":"e02336"},"PeriodicalIF":0.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164779","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}
引用次数: 0
Rapid Radiological Disappearance of Pancreatic Duct Stones Following Oral Trimethadione. 口服甲美沙酮后胰管结石放射学快速消失。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-10-09 eCollection Date: 2026-10-01 DOI: 10.14309/crj.0000000000002359
Kei Yane, Tetsuya Hoshi
{"title":"Rapid Radiological Disappearance of Pancreatic Duct Stones Following Oral Trimethadione.","authors":"Kei Yane, Tetsuya Hoshi","doi":"10.14309/crj.0000000000002359","DOIUrl":"https://doi.org/10.14309/crj.0000000000002359","url":null,"abstract":"<p><p>A 59-year-old man with chronic pancreatitis, surgically altered anatomy, and an implantable cardioverter-defibrillator presented with acute exacerbation caused by cast-like obstructive pancreatic duct stones. Endoscopic therapy was considered technically difficult, and extracorporeal shock wave lithotripsy was avoided. While delayed surgical drainage was being considered, off-label oral trimethadione was started after institutional ethics approval. Computed tomography 2 weeks later showed disappearance of the stones and improvement of ductal dilatation. No adverse events occurred, and surgery was deferred. This case suggests that trimethadione may be a potential salvage option when standard interventions are infeasible.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 10","pages":"e02359"},"PeriodicalIF":0.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164284","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}
引用次数: 0
Isolated Intestinal Ganglioneuroma Completely Resected by Endoscopic Submucosal Dissection. 内镜下粘膜夹层完全切除孤立肠神经节神经瘤。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-10-09 eCollection Date: 2026-10-01 DOI: 10.14309/crj.0000000000002341
Zepeng Wang, Mingjie Chen, Juerong Feng, Guozhen Wang
{"title":"Isolated Intestinal Ganglioneuroma Completely Resected by Endoscopic Submucosal Dissection.","authors":"Zepeng Wang, Mingjie Chen, Juerong Feng, Guozhen Wang","doi":"10.14309/crj.0000000000002341","DOIUrl":"https://doi.org/10.14309/crj.0000000000002341","url":null,"abstract":"<p><p>Intestinal ganglioneuromatosis represents a rare intestinal neuroendocrine disorder, typically identified incidentally during colonoscopy. Isolated ganglioneuromas are clinically rare and generally demonstrate no clear association with hereditary syndromes. Current clinical guidelines offer no specific diagnostic or therapeutic recommendations for solitary polypoid ganglioneuromas. This report details the discovery of an isolated colonic ganglioneuroma during a routine screening colonoscopy. Complete resection of the lesion via colonic endoscopic submucosal dissection resulted in favorable outcomes. This case aimed to offer clinical insights for the management of such lesions.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 10","pages":"e02341"},"PeriodicalIF":0.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164825","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}
引用次数: 0
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