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More Than Just a Gut Feeling: Unmasking Systemic Mastocytosis Behind Chronic Gastrointestinal Symptoms in a 2-Patient Case Series. 不仅仅是一种直觉：揭示慢性胃肠道症状背后的系统性肥大细胞增多症的2例病例系列。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-09-28 eCollection Date: 2026-10-01 DOI: 10.14309/crj.0000000000002310
Grace Ramirez, Antoine Khoudari, Yesenia Gonzalez, Ashley H Davis-Yadley
{"title":"More Than Just a Gut Feeling: Unmasking Systemic Mastocytosis Behind Chronic Gastrointestinal Symptoms in a 2-Patient Case Series.","authors":"Grace Ramirez, Antoine Khoudari, Yesenia Gonzalez, Ashley H Davis-Yadley","doi":"10.14309/crj.0000000000002310","DOIUrl":"10.14309/crj.0000000000002310","url":null,"abstract":"<p><p>Systemic mastocytosis is a rare clonal mast-cell disorder whose gastrointestinal manifestations may mimic common diseases and delay diagnosis. We present 2 women with longstanding gastrointestinal symptoms, including 1 treated for Crohn's disease for more than 15 years. Gastrointestinal biopsies demonstrated mast-cell infiltrates consistent with systemic mastocytosis, supported by elevated serum tryptase and KIT proto-oncogene, receptor tyrosine kinase (KIT) D816V mutations. Both received mast cell-directed therapy, with differing response and tolerability. These cases highlight the importance of considering systemic mastocytosis in refractory or atypical gastrointestinal disease, particularly when accompanied by skin or skeletal findings.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 10","pages":"e02310"},"PeriodicalIF":0.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073317","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
Acute Liver Failure During Thyroid Storm With Autoimmune Hepatitis Overlap: A Rare Immunoendocrine-Hepatic Intersection. 急性肝功能衰竭甲状腺风暴与自身免疫性肝炎重叠：罕见的免疫内分泌-肝脏交叉。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-09-28 eCollection Date: 2026-10-01 DOI: 10.14309/crj.0000000000002311
Jorge Guillermo Pacheco Oliva, Ninoska Meléndez Rodríguez, Allen Jerus Castellanos, Abel Alberto Sánchez, María de la Asunción Sánchez
{"title":"Acute Liver Failure During Thyroid Storm With Autoimmune Hepatitis Overlap: A Rare Immunoendocrine-Hepatic Intersection.","authors":"Jorge Guillermo Pacheco Oliva, Ninoska Meléndez Rodríguez, Allen Jerus Castellanos, Abel Alberto Sánchez, María de la Asunción Sánchez","doi":"10.14309/crj.0000000000002311","DOIUrl":"10.14309/crj.0000000000002311","url":null,"abstract":"<p><p>A previously healthy 24-year-old woman presented with jaundice, diarrhea, tachycardia, fever, and altered mental status. Laboratory evaluation revealed severe hyperbilirubinemia, mixed hepatocellular-cholestatic injury, international normalized ratio 4.99, hypofibrinogenemia, and encephalopathy, fulfilling criteria for acute liver failure (ALF). Thyroid studies demonstrated suppressed thyroid-stimulating hormone, elevated free thyroxine and triiodothyronine, and strongly positive anti-thyroid peroxidase and anti-thyroid‑stimulating hormone receptor antibodies, confirming thyroid storm. Profound hypergammaglobulinemia (immunoglobulin G 9,079 mg/dL), anti-smooth muscle antibody positivity (1:40), and antinuclear antibody positivity (1:80) suggested autoimmune hepatitis (AIH) overlap. Immunoglobulin M levels were not available. AIH frequently coexists with other autoimmune disorders, occurring in up to 20%-30% of cases, and may exacerbate liver injury during endocrine crises. Despite corticosteroids, iodine therapy, and supportive care, the patient deteriorated and died. This case highlights the rare intersection between thyroid storm, ALF, and AIH overlap, emphasizing the importance of early recognition of autoimmune markers in endocrine emergencies.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 10","pages":"e02311"},"PeriodicalIF":0.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073194","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
Mixed Neuroendocrine Carcinoma and Adenocarcinoma in a Patient With Ileal Pouch-Anal Anastomosis. 回肠袋肛吻合术并发神经内分泌癌和腺癌1例。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-09-28 eCollection Date: 2026-10-01 DOI: 10.14309/crj.0000000000002342
Prajith Raj Ramesh, Victor Chedid, Siri A Urquhart
{"title":"Mixed Neuroendocrine Carcinoma and Adenocarcinoma in a Patient With Ileal Pouch-Anal Anastomosis.","authors":"Prajith Raj Ramesh, Victor Chedid, Siri A Urquhart","doi":"10.14309/crj.0000000000002342","DOIUrl":"10.14309/crj.0000000000002342","url":null,"abstract":"<p><p>Neoplasia of the ileoanal pouch is uncommon, occurring in fewer than 1% of patients. Neuroendocrine carcinoma (NEC) is a rare neoplastic complication and can be difficult to diagnose due to symptoms overlapping with inflammatory pouch disorders. We describe a 36-year-old man with ileal pouch-anal anastomosis complicated by Crohn's-like disease of the pouch who underwent pouch excision for refractory disease. Histopathology revealed mixed poorly differentiated adenocarcinoma and NEC. Management may involve surgical resection for localized disease and systemic therapy for advanced stages. This case highlights the need to consider neoplastic processes, including NECs, in patients with persistent or atypical pouch symptoms.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 10","pages":"e02342"},"PeriodicalIF":0.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073335","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
Dual-Targeted Therapy With Upadacitinib and Ustekinumab in Pediatric Refractory Perianal Crohn's Disease. Upadacitinib和Ustekinumab双靶向治疗小儿难治性肛周克罗恩病
IF 0.6
ACG Case Reports Journal Pub Date : 2026-09-28 eCollection Date: 2026-10-01 DOI: 10.14309/crj.0000000000002331
Neha Sathe, Meredith Kline, Amelia Kellar, David Choi, Ranjana Gokhale
{"title":"Dual-Targeted Therapy With Upadacitinib and Ustekinumab in Pediatric Refractory Perianal Crohn's Disease.","authors":"Neha Sathe, Meredith Kline, Amelia Kellar, David Choi, Ranjana Gokhale","doi":"10.14309/crj.0000000000002331","DOIUrl":"10.14309/crj.0000000000002331","url":null,"abstract":"<p><p>Perianal Crohn's disease (pCD) is a challenging manifestation of CD. We present the case of a 17-year-old adolescent girl with severe, refractory pCD, complicated by a rectovaginal fistula, who failed multiple lines of therapy and required a temporary ileostomy. While on upadacitinib (UPA) monotherapy, she experienced a flare with magnetic resonance imaging (MRI)-confirmed perianal abscesses. The addition of ustekinumab (UST) to UPA resulted in marked improvement in clinical symptoms and radiographic resolution of perianal disease on follow-up MRI. No adverse events occurred. This case highlights dual UPA/UST therapy as a promising strategy for severe, refractory pCD in an adolescent.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 10","pages":"e02331"},"PeriodicalIF":0.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073169","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
Refractory Intrahepatic Bile Leak in a Young Patient After Blunt Abdominal Trauma: Technique of Endoscopic Management Using Cyanoacrylate Glue-Lipiodol Combination. 钝性腹部创伤后顽固性肝内胆汁漏一例：氰基丙烯酸酯胶-脂醇联合应用的内镜治疗技术。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-09-28 eCollection Date: 2026-10-01 DOI: 10.14309/crj.0000000000002304
Jahnvi Dhar, Chhagan Lal Birda, Antriksh Kumar, Pardhu Bharath Neelam, Ujjwal Gorsi, Cherring Tandup, Rakesh Kochhar, Jayanta Samanta
{"title":"Refractory Intrahepatic Bile Leak in a Young Patient After Blunt Abdominal Trauma: Technique of Endoscopic Management Using Cyanoacrylate Glue-Lipiodol Combination.","authors":"Jahnvi Dhar, Chhagan Lal Birda, Antriksh Kumar, Pardhu Bharath Neelam, Ujjwal Gorsi, Cherring Tandup, Rakesh Kochhar, Jayanta Samanta","doi":"10.14309/crj.0000000000002304","DOIUrl":"10.14309/crj.0000000000002304","url":null,"abstract":"<p><p>Bile leaks are commonly managed endoscopically with either sphincterotomy and/or biliary stenting. Historically, if these procedures failed, surgery was inevitable, carrying high morbidity. Data are sparse on the management of persistent or refractory bile leaks after failed endoscopic retrograde cholangiopancreatography. We report a young patient, following blunt abdominal trauma, managed with percutaneous catheter drains for bilomas. Ongoing bilious output in the perihepatic drain persisted, despite 3 sessions of biliary stenting and subsequent stent upgradations. Definitive management was achieved by endoscopic injection of glue-lipiodol (1:1) at the leak site under real-time fluoroscopic guidance, highlighting a minimally invasive alternative to surgery.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 10","pages":"e02304"},"PeriodicalIF":0.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073434","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 Interval Growth of a Presumed Simple Hepatic Cyst Revealing a Mucinous Cystic Neoplasm in a Rare Male Presentation. 单纯性肝囊肿快速间期生长表现为粘液囊性肿瘤，罕见男性病例。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-09-22 eCollection Date: 2026-09-01 DOI: 10.14309/crj.0000000000002306
Jorge Guillermo Pacheco Oliva, Ninoska Meléndez Rodríguez, Abel Sánchez, Juan Pablo De León, Melanie Figueroa, Brandom Lobos, Vinicio Roquel
{"title":"Rapid Interval Growth of a Presumed Simple Hepatic Cyst Revealing a Mucinous Cystic Neoplasm in a Rare Male Presentation.","authors":"Jorge Guillermo Pacheco Oliva, Ninoska Meléndez Rodríguez, Abel Sánchez, Juan Pablo De León, Melanie Figueroa, Brandom Lobos, Vinicio Roquel","doi":"10.14309/crj.0000000000002306","DOIUrl":"10.14309/crj.0000000000002306","url":null,"abstract":"<p><p>Hepatic mucinous cystic neoplasms are rare biliary cystic tumors with malignant potential and are particularly uncommon in men. We report a case of a long-standing presumed simple hepatic cyst that demonstrated rapid interval growth and development of complex features, ultimately diagnosed as mucinous cystic neoplasms. Magnetic resonance imaging (MRI) revealed multiloculation, capsular septations, and mild septal enhancement. Histopathology showed mucinous epithelium and specialized mesenchymal stroma supported by immunohistochemistry. Surgical marsupialization was performed due to extensive adhesions from previous cholecystectomy. This case highlights the importance of reevaluating hepatic cysts that enlarge or develop complex features, as timely MRI characterization and surgical assessment are essential.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 9","pages":"e02306"},"PeriodicalIF":0.6,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023761","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 Hidden Stalk: The Giant Pedunculated Brunner Gland Hamartoma Presenting as a Duodenal Subepithelial Mass. 隐藏的茎：巨大带梗的布伦纳腺错构瘤表现为十二指肠上皮下肿块。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-09-22 eCollection Date: 2026-09-01 DOI: 10.14309/crj.0000000000002323
Said Al Alawi, Talat Bessissow, Victoria Marcus, Miryam Al Nasir, Asma Ouakaa, Yen-I Chen
{"title":"A Hidden Stalk: The Giant Pedunculated Brunner Gland Hamartoma Presenting as a Duodenal Subepithelial Mass.","authors":"Said Al Alawi, Talat Bessissow, Victoria Marcus, Miryam Al Nasir, Asma Ouakaa, Yen-I Chen","doi":"10.14309/crj.0000000000002323","DOIUrl":"https://doi.org/10.14309/crj.0000000000002323","url":null,"abstract":"","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 9","pages":"e02323"},"PeriodicalIF":0.6,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023728","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
Gastric Involvement With Disseminated Histoplasmosis in an Immunocompetent Patient From a Nonendemic Region. 来自非流行地区的免疫功能正常患者的弥散性组织胞浆菌病累及胃。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-09-22 eCollection Date: 2026-09-01 DOI: 10.14309/crj.0000000000002315
Mahmoud Yousef, Sharifeh Almasaid, Abdelkader Chaar, Oleksandr Kravtsov, Idan Goren, Ganesh Aswath
{"title":"Gastric Involvement With Disseminated Histoplasmosis in an Immunocompetent Patient From a Nonendemic Region.","authors":"Mahmoud Yousef, Sharifeh Almasaid, Abdelkader Chaar, Oleksandr Kravtsov, Idan Goren, Ganesh Aswath","doi":"10.14309/crj.0000000000002315","DOIUrl":"10.14309/crj.0000000000002315","url":null,"abstract":"<p><p>Gastric involvement with <i>Histoplasma capsulatum</i> infection is rare but can mimic peptic ulcers or cancer, delaying diagnosis. A 71-year-old man presented with oral ulcer, abdominal pain, and weight loss. The patient had history of tonsillar histoplasmosis treated 8 years before the current presentation with confirmed resolution. The patient had no history of malignancy, autoimmune diseases, or recent travel. Initial laboratory evaluation revealed normocytic anemia. Imaging did not show acute abnormalities that would account for his symptoms. Esophagogastroduodenoscopy revealed multiple gastric ulcers. Biopsies showed chronic gastritis with ulceration and fungal yeasts consistent with <i>H</i>. <i>capsulatum</i>. Similarly, the oral ulcer showed non-necrotizing granulomas with fungal forms. Itraconazole was initiated and follow-up esophagogastroduodenoscopy showed healing ulcers.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 9","pages":"e02315"},"PeriodicalIF":0.6,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023759","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
Refractory Inflammatory Bowel Disease in Pregnancy: Multidisciplinary Management With Timely Surgery and Ultrasound Monitoring. 妊娠难治性炎症性肠病：多学科管理，及时手术和超声监测。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-09-21 eCollection Date: 2026-09-01 DOI: 10.14309/crj.0000000000002322
Leshni Pillay, Maddison Terlato, Dimity Keam, Iniyaval Ini Thevathasan, Fiona Chan, Zaid Ardalan, Aysha Al-Ani, Britt Christensen
{"title":"Refractory Inflammatory Bowel Disease in Pregnancy: Multidisciplinary Management With Timely Surgery and Ultrasound Monitoring.","authors":"Leshni Pillay, Maddison Terlato, Dimity Keam, Iniyaval Ini Thevathasan, Fiona Chan, Zaid Ardalan, Aysha Al-Ani, Britt Christensen","doi":"10.14309/crj.0000000000002322","DOIUrl":"10.14309/crj.0000000000002322","url":null,"abstract":"<p><p>Management of medically refractory inflammatory bowel disease during pregnancy remains challenging due to limited evidence regarding rescue therapy, surgical timing, and fetal safety. We report a case of third-trimester inflammatory bowel disease-unclassified treated with accelerated infliximab rescue therapy and serial intestinal ultrasound monitoring. Persistent clinical, biochemical, and sonographic disease activity despite intensive medical therapy prompted multidisciplinary decision making, culminating in combined lower segment caesarean section and left hemicolectomy at 33+6 weeks gestation. This case highlights the value of multidisciplinary care and serial intestinal ultrasound as an adjunctive objective tool to support therapeutic escalation and surgical decision making in pregnancy.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 9","pages":"e02322"},"PeriodicalIF":0.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015148","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
Memantine-Induced Cholestasis and Acute Hepatitis in an 8-Week-Old Term Infant. 美金刚汀诱发的8周龄足月婴儿胆汁淤积和急性肝炎。
IF 0.6
ACG Case Reports Journal Pub Date : 2026-09-18 eCollection Date: 2026-09-01 DOI: 10.14309/crj.0000000000002301
Briona Thompson, Kadakkal Radhakrishnan
{"title":"Memantine-Induced Cholestasis and Acute Hepatitis in an 8-Week-Old Term Infant.","authors":"Briona Thompson, Kadakkal Radhakrishnan","doi":"10.14309/crj.0000000000002301","DOIUrl":"10.14309/crj.0000000000002301","url":null,"abstract":"<p><p>Cholestasis and hepatitis in infants occur for various reasons and require further evaluation. We present an 8-week-old term male infant with cholestasis secondary to breast milk transference of memantine. To the best of our knowledge, this is the first case associated with cholestasis and acute hepatitis with memantine transference through breast-feeding.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"13 9","pages":"e02301"},"PeriodicalIF":0.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015207","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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