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Chronic Hepatitis and Hemophagocytic Lymphohistiocytosis Associated With Systemic Chronic Active Epstein-Barr Virus Disease.
IF 0.6
ACG Case Reports Journal Pub Date : 2025-03-20 eCollection Date: 2025-03-01 DOI: 10.14309/crj.0000000000001649
Emmanuel Palomera-Tejeda, Lauren Shaffer, Michael Shi, Nagasri Shankar, Roshan Raza, George Cholankeril
{"title":"Chronic Hepatitis and Hemophagocytic Lymphohistiocytosis Associated With Systemic Chronic Active Epstein-Barr Virus Disease.","authors":"Emmanuel Palomera-Tejeda, Lauren Shaffer, Michael Shi, Nagasri Shankar, Roshan Raza, George Cholankeril","doi":"10.14309/crj.0000000000001649","DOIUrl":"10.14309/crj.0000000000001649","url":null,"abstract":"<p><p>Systemic chronic active Epstein-Barr virus (EBV) disease is a rare, delayed, and life-threatening complication of EBV infection. It is characterized by persistent viremia and a mononucleosis-like syndrome with multisystemic involvement because of lymphocytic tissue infiltration. We present the case of an 82-year-old woman without known immunodeficiency who presented with abnormal liver enzymes and interstitial pneumonia. Investigations revealed hyperferritinemia, elevated soluble interleukin-2 receptor levels, hypofibrinogenemia, and hepatosplenomegaly, consistent with hemophagocytic lymphohistiocytosis, as well as a high EBV viral load. Liver biopsy demonstrated portal chronic lymphocytic inflammation and positive EBV in situ hybridization, suggesting systemic chronic active Epstein-Barr virus disease as the underlying etiology.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 3","pages":"e01649"},"PeriodicalIF":0.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668627","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
Sclerosing Mesenteritis Presenting as Hilar Cholangiocarcinoma Causing Recurrent Chylous Ascites and Gastric Outlet Obstruction.
IF 0.6
ACG Case Reports Journal Pub Date : 2025-03-19 eCollection Date: 2025-03-01 DOI: 10.14309/crj.0000000000001637
Thomas Hoang, Adnan Karavelic, Aswathy Sunil, Timothy Murray, Jennifer Telford, Elizabeth Clement, Anthony Gador
{"title":"Sclerosing Mesenteritis Presenting as Hilar Cholangiocarcinoma Causing Recurrent Chylous Ascites and Gastric Outlet Obstruction.","authors":"Thomas Hoang, Adnan Karavelic, Aswathy Sunil, Timothy Murray, Jennifer Telford, Elizabeth Clement, Anthony Gador","doi":"10.14309/crj.0000000000001637","DOIUrl":"10.14309/crj.0000000000001637","url":null,"abstract":"<p><p>Sclerosing mesenteritis is a rare spectrum of disease that results in chronic inflammation and fibrosis of the abdominal mesentery. Its heterogeneous presentation, nondiagnostic imaging, and pathology findings make diagnosis challenging. In this study, we present the first reported case of hilar sclerosing mesenteritis resulting in chylous ascites, gastric outlet obstruction, and duodenal perforation. Diagnosis was made after extensive investigations including computed tomography imaging, magnetic resonance cholangiopancreatography, positron emission tomography scan, bidirectional endoscopy, endoscopic ultrasound, and diagnostic laparoscopy. While initially mistaken for hilar cholangiocarcinoma, the patient has significant clinical improvement with corticosteroids and now remains in symptomatic and radiographic remission on low-dose prednisone and tamoxifen.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 3","pages":"e01637"},"PeriodicalIF":0.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661900","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
Transcolonic Necrosectomy: A Rarely-Used Pancreatic Debridement Strategy.
IF 0.6
ACG Case Reports Journal Pub Date : 2025-03-19 eCollection Date: 2025-03-01 DOI: 10.14309/crj.0000000000001634
Thomas Rees Checketts, Ravishankar Madhu, Suhail Sidhu, Evan Daugherty, Ahmed Al-Chalabi
{"title":"Transcolonic Necrosectomy: A Rarely-Used Pancreatic Debridement Strategy.","authors":"Thomas Rees Checketts, Ravishankar Madhu, Suhail Sidhu, Evan Daugherty, Ahmed Al-Chalabi","doi":"10.14309/crj.0000000000001634","DOIUrl":"10.14309/crj.0000000000001634","url":null,"abstract":"<p><p>Necrotizing pancreatitis represents a life-threatening sequela of acute pancreatitis in which rapid necrotization of pancreatic and abdominal tissue leads to inflammation and sometimes infection. Treatment includes debridement of necrotic tissue to prevent inflammation from spreading and antibiotics if infected. Areas of necrosis are accessed through percutaneous drainage, surgical debridement, or upper endoscopy. In this study, we present a case of walled-off necrosis debrided through a fistulous connection to the transverse colon. Transcolonic necrosectomy is a seldom used approach, which could provide treatment options for necrotizing pancreatitis in anatomically amenable patients.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 3","pages":"e01634"},"PeriodicalIF":0.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661903","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
Innovative Endoscopic Management of Recurrent Gastrogastric Fistula Post-Roux-en-Y Gastric Bypass Patient Using Cardiac Septal Occluder and Lumen-Apposing Metal Stent. 使用心脏隔膜封堵器和腔内金属支架对鲁氏-Y 胃旁路术后复发性胃胃瘘进行创新性内窥镜治疗
IF 0.6
ACG Case Reports Journal Pub Date : 2025-03-17 eCollection Date: 2025-03-01 DOI: 10.14309/crj.0000000000001642
Ajay Gade, Kalpit Devani
{"title":"Innovative Endoscopic Management of Recurrent Gastrogastric Fistula Post-Roux-en-Y Gastric Bypass Patient Using Cardiac Septal Occluder and Lumen-Apposing Metal Stent.","authors":"Ajay Gade, Kalpit Devani","doi":"10.14309/crj.0000000000001642","DOIUrl":"10.14309/crj.0000000000001642","url":null,"abstract":"<p><p>Gastrogastric fistula (GGF) is a rare complication of post-Roux-en-Y gastric bypass, often challenging to manage. This case report presents a 63-year-old patient with recurrent GGF and gastrojejunal stricture, refractory to prior endoscopic treatments. Using a minimally invasive approach with atrial septal defect closure device and a lumen-apposing metal stent, the fistula was successfully closed, and stricture relieved. The patient reported complete symptom resolution at follow-up. This innovative approach of combining a cardiac septal occluder and lumen-apposing metal stent for management of complex GGF cases offers a promising alternative to surgical interventions.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 3","pages":"e01642"},"PeriodicalIF":0.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646785","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
A Novel Application of a Through the Scope Fully Covered Esophageal Stent for an Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography Procedure.
IF 0.6
ACG Case Reports Journal Pub Date : 2025-03-14 eCollection Date: 2025-03-01 DOI: 10.14309/crj.0000000000001648
Kareena S Garg, Saad A Haque
{"title":"A Novel Application of a Through the Scope Fully Covered Esophageal Stent for an Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography Procedure.","authors":"Kareena S Garg, Saad A Haque","doi":"10.14309/crj.0000000000001648","DOIUrl":"https://doi.org/10.14309/crj.0000000000001648","url":null,"abstract":"<p><p>Performing traditional endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass anatomy is challenging. The endoscopic ultrasound-directed transgastric ERCP (EDGE) procedure offers a minimally invasive solution. This case describes a 53-year-old woman with a history of Roux-en-Y gastric bypass presenting with cholelithiasis, abnormal liver function tests, and cholecystitis. After initial conservative treatment, a staged EDGE procedure was performed. A lumen-apposing metal stent (LAMS) was placed in the jejunum, but subsequent attempts to cannulate it with the ERCP scope were unsuccessful due to \"bowing\" of the efferent loop. A fully covered esophageal stent was placed through the LAMS creating a \"ramp\" allowing passage of the duodenoscope, enabling successful ERCP and stone removal. This case highlights an effective technique to overcome often encountered challenges accessing LAMS during an EDGE procedure.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 3","pages":"e01648"},"PeriodicalIF":0.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646713","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
Foveolar Gland Metaplasia of the Duodenal Bulb on Retrograde View of the Pylorus.
IF 0.6
ACG Case Reports Journal Pub Date : 2025-03-13 eCollection Date: 2025-03-01 DOI: 10.14309/crj.0000000000001645
Zaid Ansari, Pablo Bejarano, Asad Rahman
{"title":"Foveolar Gland Metaplasia of the Duodenal Bulb on Retrograde View of the Pylorus.","authors":"Zaid Ansari, Pablo Bejarano, Asad Rahman","doi":"10.14309/crj.0000000000001645","DOIUrl":"10.14309/crj.0000000000001645","url":null,"abstract":"","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 3","pages":"e01645"},"PeriodicalIF":0.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623110","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
Rare Presentation of Eosinophilic Cholangitis in a 32-Year-Old Man.
IF 0.6
ACG Case Reports Journal Pub Date : 2025-03-13 eCollection Date: 2025-03-01 DOI: 10.14309/crj.0000000000001641
Himsikhar Khataniar, Hany Habib, Molly Ruiz, Ashni Dharia, Sheena Magoo, Abhijit Kulkarni
{"title":"Rare Presentation of Eosinophilic Cholangitis in a 32-Year-Old Man.","authors":"Himsikhar Khataniar, Hany Habib, Molly Ruiz, Ashni Dharia, Sheena Magoo, Abhijit Kulkarni","doi":"10.14309/crj.0000000000001641","DOIUrl":"10.14309/crj.0000000000001641","url":null,"abstract":"<p><p>Eosinophilic cholangitis (EC) is a rare condition characterized by eosinophilic infiltration of the bile ducts, often mimicking diseases like primary sclerosing cholangitis or cholangiocarcinoma. We report the case of a 32-year-old man with severe epigastric pain and elevated liver function tests. Initial imaging revealed common bile duct dilation and multiple strictures, initially suggestive of primary sclerosing cholangitis. Multiple endoscopic retrograde cholangiopancreatographies with brushings showed benign cytology but revealed polysomy on fluorescence in situ hybridization. A biopsy confirmed EC. High-dose corticosteroids led to significant clinical improvement. This case underscores the importance of considering EC in the differential diagnosis of biliary diseases, as timely diagnosis and treatment can lead to excellent outcomes.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 3","pages":"e01641"},"PeriodicalIF":0.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623192","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
Esophageal Siderosis: An Unusual Complication of Oral Iron Therapy.
IF 0.6
ACG Case Reports Journal Pub Date : 2025-03-12 eCollection Date: 2025-03-01 DOI: 10.14309/crj.0000000000001644
Gianna Stoleru, Meera Jain, Anna Vi Jones, Alexander Podboy
{"title":"Esophageal Siderosis: An Unusual Complication of Oral Iron Therapy.","authors":"Gianna Stoleru, Meera Jain, Anna Vi Jones, Alexander Podboy","doi":"10.14309/crj.0000000000001644","DOIUrl":"10.14309/crj.0000000000001644","url":null,"abstract":"<p><p>Iron is the most common nutritional deficiency encountered in the United States, with over 15% of Americans using some form of daily oral iron supplementation. Although commonly associated with minor gastrointestinal side effects, severe gastrointestinal complications are rare. Direct cytotoxic mucosal damage and subsequent ulcer formation have rarely been reported. Among reported cases, most are found in the stomach with extragastric manifestations of siderosis being less commonly described. We report a rare case of esophageal siderosis related to oral iron supplementation.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 3","pages":"e01644"},"PeriodicalIF":0.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11902948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613032","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 Vacuum Therapy for the Treatment of Atrial Fibrillation Ablation-Induced Esophageal Perforation.
IF 0.6
ACG Case Reports Journal Pub Date : 2025-03-12 eCollection Date: 2025-03-01 DOI: 10.14309/crj.0000000000001650
Larissa Lushniak, Neal Dharmadhikari, Kaveh Zivari, Juan Pablo Reyes Genere, Vladimir Kushnir, Ahmad Najdat Bazarbashi
{"title":"Endoscopic Vacuum Therapy for the Treatment of Atrial Fibrillation Ablation-Induced Esophageal Perforation.","authors":"Larissa Lushniak, Neal Dharmadhikari, Kaveh Zivari, Juan Pablo Reyes Genere, Vladimir Kushnir, Ahmad Najdat Bazarbashi","doi":"10.14309/crj.0000000000001650","DOIUrl":"10.14309/crj.0000000000001650","url":null,"abstract":"<p><p>Esophageal thermal injury from atrial fibrillation ablation is not uncommon; however, full-thickness perforation is rare. Such injuries are often treated with surgical revision, stent placement, or medical management. Endoscopic vacuum therapy is a novel and emerging technique to repair transmural gastrointestinal defects; however, its use in the management of esophageal thermal ulceration and perforation after a cardiac ablation procedure is limited. We present a 52-year-old man who developed a refractory esophageal perforation and leak secondary to atrial fibrillation radiofrequency ablation that was successfully treated with endoscopic vacuum therapy, demonstrating a minimally invasive endoscopic treatment modality when alternative therapies fail.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 3","pages":"e01650"},"PeriodicalIF":0.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11902978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613026","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
Early-Onset Colorectal Cancer: When to Include Cowden Syndrome in Your Differential Diagnosis.
IF 0.6
ACG Case Reports Journal Pub Date : 2025-03-12 eCollection Date: 2025-03-01 DOI: 10.14309/crj.0000000000001643
Joshua Morny, Anna Zakas, Samuel Koebe, Jennifer M Weiss
{"title":"Early-Onset Colorectal Cancer: When to Include Cowden Syndrome in Your Differential Diagnosis.","authors":"Joshua Morny, Anna Zakas, Samuel Koebe, Jennifer M Weiss","doi":"10.14309/crj.0000000000001643","DOIUrl":"10.14309/crj.0000000000001643","url":null,"abstract":"","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 3","pages":"e01643"},"PeriodicalIF":0.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11902970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613000","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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