ACG Case Reports JournalPub Date : 2025-04-16eCollection Date: 2025-04-01DOI: 10.14309/crj.0000000000001675
Caleb Glover, Ali Rida, Eric Nguyen, Edward Cay, Gisela Ocasio-Cortes, Summer Stefanko, Arman Fotouhi, Albert Ross
{"title":"Unveiling the Uncommon: Pyoderma Gangrenosum as an Extraintestinal Complication of Ulcerative Colitis.","authors":"Caleb Glover, Ali Rida, Eric Nguyen, Edward Cay, Gisela Ocasio-Cortes, Summer Stefanko, Arman Fotouhi, Albert Ross","doi":"10.14309/crj.0000000000001675","DOIUrl":"https://doi.org/10.14309/crj.0000000000001675","url":null,"abstract":"<p><p>Pyoderma gangrenosum (PG) is a rare inflammatory skin disorder characterized by neutrophil accumulation, commonly appearing as erythematous papules or pustules that can coalesce into extensive ulcers. It is the second most common dermatologic manifestation of inflammatory bowel disease, though it affects <1% of patients with inflammatory bowel disease. We present a case of a 66-year-old woman with a history of hypothyroidism and hypertension who developed nonhealing abdominal wounds following a small pustule. Despite multiple debridements and antibiotics, her condition worsened, alongside a history of bloody diarrhea for 2.5 years. Investigations led to a diagnosis of ulcerative colitis and PG. The patient was treated with high-dose steroids and infliximab. This case highlights the rarity of abdominal PG as an extraintestinal manifestation of ulcerative colitis and emphasizes the importance of early diagnosis and treatment in improving outcomes for affected patients.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 4","pages":"e01675"},"PeriodicalIF":0.6,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958553","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}
ACG Case Reports JournalPub Date : 2025-04-16eCollection Date: 2025-04-01DOI: 10.14309/crj.0000000000001677
Jinye Liu, Abdulazeez Swaiti, Saeed Graham, Alessandra Martorella, Sha Yi, Kim Geisinger, Zarak Hassan Khan, Kara Regan
{"title":"An Exophytic Pancreatic Mass Diagnosed as Ganglioneuroma.","authors":"Jinye Liu, Abdulazeez Swaiti, Saeed Graham, Alessandra Martorella, Sha Yi, Kim Geisinger, Zarak Hassan Khan, Kara Regan","doi":"10.14309/crj.0000000000001677","DOIUrl":"https://doi.org/10.14309/crj.0000000000001677","url":null,"abstract":"<p><p>Ganglioneuromas are rare neuroendocrine tumors affecting around one in a million, mostly young adults. These slow-growing, well-differentiated neuroepithelial tumors originate from the neural crest and involve the sympathetic nervous system. We present an unusual case of a 47-year-old African American man with mildly elevated liver enzymes who was incidentally found to have a suspected pancreatic mass. Endoscopic ultrasound and fine-needle biopsies confirmed the diagnosis of a ganglioneuroma, inseparable and exophytic in the body of the pancreas extending into the tail.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 4","pages":"e01677"},"PeriodicalIF":0.6,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956588","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}
ACG Case Reports JournalPub Date : 2025-04-16eCollection Date: 2025-04-01DOI: 10.14309/crj.0000000000001673
Mark Chatto, Vipul Jairath
{"title":"Upadacitinib Monotherapy After Tofacitinib Failure Was Successful for Induction But Not Maintenance of Remission in Medically Refractory Ulcerative Colitis.","authors":"Mark Chatto, Vipul Jairath","doi":"10.14309/crj.0000000000001673","DOIUrl":"https://doi.org/10.14309/crj.0000000000001673","url":null,"abstract":"<p><p>This small case series represents real-world experience of the efficacy of upadacitinib after prior tofacitinib failure in medically refractory ulcerative colitis and challenges current observations that upadacitinib is effective after tofacitinib exposure. Although all patients had a clinical or partial response after upadacitinib induction, 4/4 (100%) patients relapsed or required rescue therapy during maintenance, in contrast to previous publications.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 4","pages":"e01673"},"PeriodicalIF":0.6,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959506","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}
ACG Case Reports JournalPub Date : 2025-04-16eCollection Date: 2025-04-01DOI: 10.14309/crj.0000000000001672
Ujwala Pamidimukkala, Gabriella Aitcheson, Hala Fatima, Itegbemie Obaitan
{"title":"Successful Use of a Novel High-Dose Mycophenolate Mofetil and Rituximab Regimen for Progressive IgG4 Sclerosing Cholangitis With Multisystemic Involvement.","authors":"Ujwala Pamidimukkala, Gabriella Aitcheson, Hala Fatima, Itegbemie Obaitan","doi":"10.14309/crj.0000000000001672","DOIUrl":"https://doi.org/10.14309/crj.0000000000001672","url":null,"abstract":"<p><p>Immunoglobulin G4 (IgG4) sclerosing cholangitis is an immune-mediated fibroinflammatory disease of the biliary tree. It may be asymptomatic or cause abdominal pain, jaundice, or pruritus on presentation. While glucocorticoids and rituximab are regarded as initial treatment options, there is little guidance on the management of patients who either cannot tolerate these agents or are refractory to them. We discuss a case of IgG4 sclerosing cholangitis that required a novel treatment strategy of 1,000 mg oral mycophenolate mofetil twice daily and 375 mg/m<sup>2</sup> rituximab infusions every 3 months to achieve disease control and limit adverse effects.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 4","pages":"e01672"},"PeriodicalIF":0.6,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958126","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}
ACG Case Reports JournalPub Date : 2025-04-10eCollection Date: 2025-04-01DOI: 10.14309/crj.0000000000001658
Akash Patel, Sujata Bhushan
{"title":"Recurrent Diverticulitis Complicated by <i>Actinomyces turicensis</i> Abscess.","authors":"Akash Patel, Sujata Bhushan","doi":"10.14309/crj.0000000000001658","DOIUrl":"https://doi.org/10.14309/crj.0000000000001658","url":null,"abstract":"<p><p><i>Actinomyces turicensis</i> is an uncommon cause of intra-abdominal infection. We present a patient with diverticulitis complicated by <i>A. turicensis</i> abscess formation. Our patient required multiple admissions and a prolonged course of antibiotics. To our knowledge, this case represents the first instance of <i>A. turicensis</i> complicating diverticular disease. This case highlights the challenges in managing <i>Actinomycotic</i> infections and will hopefully prompt clinicians to consider atypical pathogens in other cases of refractory diverticulitis.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 4","pages":"e01658"},"PeriodicalIF":0.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11984757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953095","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}
ACG Case Reports JournalPub Date : 2025-04-10eCollection Date: 2025-04-01DOI: 10.14309/crj.0000000000001661
Meagan Phox, John Thesing, W Ransom Kilgore, Joel Alderson
{"title":"Tirzepatide-Induced Liver Injury: A Rare Medication Side Effect.","authors":"Meagan Phox, John Thesing, W Ransom Kilgore, Joel Alderson","doi":"10.14309/crj.0000000000001661","DOIUrl":"https://doi.org/10.14309/crj.0000000000001661","url":null,"abstract":"<p><p>Tirzepatide, an injectable agonist of glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide receptors, is used to treat type 2 diabetes mellitus and obesity. To our knowledge, there have been few reported cases of drug-induced liver injury (DILI) secondary to tirzepatide use. We report the experience of a 76-year-old woman who developed acute hepatitis following 8 weeks of tirzepatide use and a sixteen-pound weight loss. She was found to have elevated liver enzymes, and liver biopsy confirmed DILI. Though the mechanism underlying this DILI remains unknown, physicians should be aware of this rare side effect.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 4","pages":"e01661"},"PeriodicalIF":0.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11984778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955021","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}
ACG Case Reports JournalPub Date : 2025-04-10eCollection Date: 2025-04-01DOI: 10.14309/crj.0000000000001668
Michael B Andrews, Mary Stevenson, Puneet Puri
{"title":"Thyrotoxicosis-Induced Myopathic Dysphagia Treated With Plasmapheresis.","authors":"Michael B Andrews, Mary Stevenson, Puneet Puri","doi":"10.14309/crj.0000000000001668","DOIUrl":"https://doi.org/10.14309/crj.0000000000001668","url":null,"abstract":"<p><p>Thyrotoxicosis is a rare cause of dysphagia. Plasmapheresis is a reserved treatment option for cases of thyrotoxicosis with severe symptoms refractory to or with contraindications to standard medical therapy. This is a case of a woman with newly diagnosed Graves' disease and rapidly reversible severe thyrotoxicosis-induced myopathic dysphagia successfully treated with plasmapheresis after failed treatment attempts with standard medical therapy. Symptoms improved after 1 treatment session followed by improvement in thyroid biochemical markers.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 4","pages":"e01668"},"PeriodicalIF":0.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11984784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955739","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":"Endoscopic Submucosal Resection With a Ligation Device for Pediatric Rectal Neuroendocrine Tumor.","authors":"Ryosuke Miyamoto, Hitoshi Honma, Yu Masuda, Tomoya Sugiyama, Satoshi Ono, Akihisa Okumura","doi":"10.14309/crj.0000000000001669","DOIUrl":"https://doi.org/10.14309/crj.0000000000001669","url":null,"abstract":"<p><p>A 13-year-old boy with a 3-month history of diarrhea was successfully treated for a rectal neuroendocrine tumor (NET) using endoscopic submucosal resection with ligation (ESMR-L). Rectoscopy revealed a submucosal tumor in the lower rectum, diagnosed as a rectal NET upon pathological examination. ESMR-L resulted in complete tumor resection without complications. Pathological examination confirmed a 6-mm low-grade NET with no vascular invasion or positive tumor margins. The patient was discharged without complications. This case study indicates that ESMR-L can be applied to rectal NET in children, necessitating further investigation on its efficacy and safety in more patients.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 4","pages":"e01669"},"PeriodicalIF":0.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11984764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959505","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}
ACG Case Reports JournalPub Date : 2025-04-07eCollection Date: 2025-04-01DOI: 10.14309/crj.0000000000001656
Lily Kaufman, Hannah Chi, Luke Bushrow, Martha Yearsley, Khalid Mumtaz
{"title":"B-Cell Lymphoma Diagnosed in an Explanted Liver of a Patient With Metabolic Dysfunction-Associated Steatohepatitis Cirrhosis.","authors":"Lily Kaufman, Hannah Chi, Luke Bushrow, Martha Yearsley, Khalid Mumtaz","doi":"10.14309/crj.0000000000001656","DOIUrl":"10.14309/crj.0000000000001656","url":null,"abstract":"<p><p>Hepatic malignancies in explanted livers are not uncommon; however, finding primary nonhepatic malignancies in explanted livers of any etiology is very rare. Given its rarity, we present a case of low-grade B-cell lymphoma in the liver explant of a patient with metabolic dysfunction-associated steatohepatitis cirrhosis after orthotopic liver transplantation. Preorthotopic liver transplantation workup was notable for periportal lymphadenopathy that was negative for malignancy per ultrasound-guided biopsy, so this finding was surprising. This unexpected diagnosis of lymphoma despite negative workup during pretransplant evaluation underscores the importance for liver transplant centers to conduct thorough investigations for malignancies before transplantation.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 4","pages":"e01656"},"PeriodicalIF":0.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810285","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}
ACG Case Reports JournalPub Date : 2025-04-07eCollection Date: 2025-04-01DOI: 10.14309/crj.0000000000001667
Sarpong Boateng, Gabriel Heymann, Frances Mejia, Benjamin A Lerner, Caroline Loeser
{"title":"Annular Pancreas Causing Gastric Diverticulum in a 29-Year-Old Man: A Rare Complication of an Uncommon Condition.","authors":"Sarpong Boateng, Gabriel Heymann, Frances Mejia, Benjamin A Lerner, Caroline Loeser","doi":"10.14309/crj.0000000000001667","DOIUrl":"10.14309/crj.0000000000001667","url":null,"abstract":"","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 4","pages":"e01667"},"PeriodicalIF":0.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810282","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}