{"title":"Neoadjuvant Chemotherapy after Plasmapheresis in Borderline Resectable Pancreatic Cancer: A Case Report.","authors":"Yoshihiro Uehara, Tatsunori Satoh, Shinya Kawaguchi, Eri Asahina, Shinya Endo, Kazuya Ohno","doi":"10.1159/000553338","DOIUrl":"10.1159/000553338","url":null,"abstract":"<p><strong>Introduction: </strong>Persistent jaundice may occasionally occur even after technically successful biliary drainage, posing a considerable challenge in patients requiring early systemic therapy. In borderline resectable pancreatic cancer (BR-PC), timely initiation of neoadjuvant chemotherapy (NAC) is critical for optimizing treatment outcomes, but hyperbilirubinemia often delays therapy. Although plasmapheresis has been reported as a potential option for refractory hyperbilirubinemia, its use for facilitating initiation of NAC in BR-PC has not been well described.</p><p><strong>Case presentation: </strong>We present a case of a 65-year-old man with BR-PC who underwent endoscopic biliary drainage with metallic stent placement. Despite successful drainage, his serum bilirubin concentrations remained markedly elevated, preventing initiation of NAC. Plasmapheresis was performed, which resulted in a steady decline in bilirubin concentrations and allowed NAC with gemcitabine plus nab-paclitaxel to begin 21 days after plasmapheresis. There was no recurrence of jaundice during treatment, NAC was completed without interruption, and pancreaticoduodenectomy was subsequently performed.</p><p><strong>Conclusion: </strong>This case highlights the potential role of plasmapheresis as an adjunctive strategy in managing persistent jaundice following biliary drainage, particularly when early induction of chemotherapy is required in patients with BR-PC.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"342-350"},"PeriodicalIF":0.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811971","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":"Transient Right Temporal Visual Field Loss Temporally Associated with Maintenance Infliximab in Crohn's Disease: A Case Report with Focused Literature Review.","authors":"Asad Shahbaz, Suliman AlMohtasib, Fatima Sajjadi, Fadel Alqatati, Nagham Dhiaa Sadik","doi":"10.1159/crg/abwag002","DOIUrl":"https://doi.org/10.1159/crg/abwag002","url":null,"abstract":"<p><strong>Introduction: </strong>Infliximab is an established therapy for Crohn's disease, but uncommon neuro-ophthalmic adverse events have been reported. Most published infliximab-associated visual complications have involved optic neuritis or optic neuropathy rather than transient, structurally unexplained visual field symptoms. We report a 32-year-old man with ileocolonic Crohn's disease in remission on maintenance infliximab who developed sudden right temporal visual field loss approximately 2 days after infusion.</p><p><strong>Case presentation: </strong>The episode of sudden right temporal visual field loss after infliximab infusion lasted 15-30 min and was followed by blurred vision in the same field for about 6 h, with mild periorbital pain and headache. Ophthalmologic examination, including funduscopy, was unremarkable. Computed tomography of the head and magnetic resonance imaging of the brain and orbits with contrast were also unremarkable. Electrocardiography showed normal sinus rhythm, and transthoracic echocardiography demonstrated normal biventricular function without evidence of patent foramen ovale. Symptoms resolved spontaneously. The patient also described a prior episode of transient right-sided limb weakness occurring after a previous infliximab exposure, suggesting a recurrent transient neurological pattern.</p><p><strong>Conclusion: </strong>Although causality cannot be established from a single case, this presentation appears to represent a recurrent, transient, imaging-negative neuro-ophthalmic syndrome temporally associated with maintenance infliximab exposure. The case underscores the need to exclude vascular, inflammatory, demyelinating, and migrainous causes while remaining alert to uncommon transient neurological events in patients receiving anti-tumor necrosis factor therapy.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"361-369"},"PeriodicalIF":0.7,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263084","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 Case Suggestive of Intrathoracic Rupture of a Nonparasitic Hepatic Cyst in Polycystic Liver Disease: A Case Report.","authors":"Minoru Shimizu, Tomoaki Fujikawa, Shogo Iwabuchi, Yasuhiro Nakazaki, Hiroyuki Tanemura","doi":"10.1159/000553232","DOIUrl":"10.1159/000553232","url":null,"abstract":"<p><strong>Introduction: </strong>Rupture of nonparasitic hepatic cysts is rare and usually occurs into the peritoneal cavity, whereas intrathoracic rupture has only rarely been described.</p><p><strong>Case presentation: </strong>We report the case of a 61-year-old woman with polycystic liver disease (PCLD) who presented with right-sided chest pain and dyspnea, suggesting intrathoracic rupture of a hepatic cyst. Computed tomography revealed unilateral pleural effusion and reduction with deformation of a large subdiaphragmatic hepatic cyst compared with prior imaging. Thoracentesis revealed transudative pleural fluid without evidence of infection or malignancy but markedly elevated levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9). Based on these findings, intrathoracic rupture of a nonparasitic hepatic cyst was considered the most likely etiology. The patient subsequently underwent surgical deroofing because of cyst enlargement and symptoms; however, no definitive rupture site was identified intraoperatively, and the diagnosis therefore remained presumptive. To our knowledge, this represents a very rare presentation of intrathoracic rupture of a nonparasitic hepatic cyst in PCLD.</p><p><strong>Conclusion: </strong>This case highlights the importance of comparison with prior imaging and suggests that measurement of pleural CEA and CA19-9 levels may provide limited adjunctive information when intrathoracic rupture of a hepatic cyst is suspected, although these markers are nonspecific.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"288-296"},"PeriodicalIF":0.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13450990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697142","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":"Prolonged Retention of a Spontaneously Dislodging Pancreatic Duct Stent in a Patient with Surgically Altered Anatomy: A Case Report.","authors":"Toji Murabayashi, Hirofumi Okuda, Shinya Sugimoto","doi":"10.1159/000553188","DOIUrl":"10.1159/000553188","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneously dislodging pancreatic duct stents are generally expected to pass within several days. We report a rare case of markedly prolonged retention of such a stent in a patient with surgically altered anatomy.</p><p><strong>Case presentation: </strong>A 78-year-old man with a history of distal gastrectomy with Roux-en-Y reconstruction underwent single-balloon enteroscopy-assisted ERCP for choledocholithiasis. After successful biliary cannulation using pancreatic guidewire assistance, stone extraction was performed following a small sphincterotomy and papillary balloon dilation. A 5-Fr × 5-cm spontaneously dislodging pancreatic duct stent without an internal flange was prophylactically placed. The postoperative course was uneventful; however, spontaneous stent dislodgement was not observed on follow-up imaging. Because of the technical burden of repeat endoscopy in surgically altered anatomy, careful observation was initially selected. The stent remained in place for 104 days and was ultimately removed endoscopically using a single-balloon enteroscope without adverse events.</p><p><strong>Conclusion: </strong>This case illustrates that markedly prolonged retention of a spontaneously dislodging pancreatic duct stent may occur in patients with surgically altered anatomy. Careful follow-up, including imaging to confirm spontaneous stent passage, is important, and endoscopic removal should be considered when the stent remains in place, even if repeat endoscopy is technically challenging.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"276-281"},"PeriodicalIF":0.7,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673066","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}
Sameera Hajijama, Abdullatif Sheikh Ibrahim, Hawa Ali Jama, Hamza Shikh, Nagoud Ali, Abdulrahman Rafat A Samman, Abdulahi M Aden, Melmed Y Gil, Nezar Y Albar
{"title":"Severe Pancolitis Presenting with Sacroiliitis: A Case Report Highlighting the Gut-Joint Axis in Ulcerative Colitis.","authors":"Sameera Hajijama, Abdullatif Sheikh Ibrahim, Hawa Ali Jama, Hamza Shikh, Nagoud Ali, Abdulrahman Rafat A Samman, Abdulahi M Aden, Melmed Y Gil, Nezar Y Albar","doi":"10.1159/000553611","DOIUrl":"10.1159/000553611","url":null,"abstract":"<p><strong>Introduction: </strong>Ulcerative colitis (UC) has a complex multifocal etiology that includes immune dysregulation of the gut microbiome leading to pro-inflammatory cytokine release. UC may present initially through subclinical manifestations such as sacroiliitis due to underlying inflammation, known as the gut-joint axis. JAK inhibition provides an effective treatment method for overlapping intestinal and articular inflammation.</p><p><strong>Case presentation: </strong>We describe a 32-year-old man without gastrointestinal symptoms who presented with chronic fatigue and a 2-week history of severe lower back pain. MRI revealed bilateral sacroiliitis, and positive fecal inflammatory markers led to colonoscopy, which showed pancolitis. Further histopathological testing confirmed the diagnosis of UC. He was treated with upadacitinib to address both conditions, resulting in significant improvement in symptoms and inflammatory markers within 2 months.</p><p><strong>Conclusion: </strong>This case emphasizes the importance of considering inflammatory bowel disease in uncommon extraintestinal presentation.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"353-360"},"PeriodicalIF":0.7,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954855","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}
Felix-Antoine Coutu, Hamila Hagh-Doust, Chelsea Rose Maedler-Kron, Jamil Asselah, Talat Bessissow
{"title":"Rectal Metastasis from Breast Cancer: A Case Report and Review of Literature.","authors":"Felix-Antoine Coutu, Hamila Hagh-Doust, Chelsea Rose Maedler-Kron, Jamil Asselah, Talat Bessissow","doi":"10.1159/000550604","DOIUrl":"https://doi.org/10.1159/000550604","url":null,"abstract":"<p><strong>Introduction: </strong>Metastatic spread of breast cancer to the gastrointestinal (GI) tract is very uncommon (<1% of all metastases), but it is disproportionately higher in invasive lobular carcinoma (ILC) compared to invasive ductal carcinoma. Its presentation can mimic primary rectal malignancy, often leading to delayed diagnosis.</p><p><strong>Case presentation: </strong>We describe a 40-year-old woman with metastatic, hormone receptor-positive classic ILC who developed rectal obstruction 2 years after her breast cancer diagnosis. Initial colonoscopy with superficial biopsies was negative. One year later, pelvic magnetic resonance imaging (MRI) demonstrated smooth, concentric thickening of the rectal wall; repeat biopsies confirmed metastatic lobular carcinoma.</p><p><strong>Conclusion: </strong>This case illustrates the diagnostic challenges posed by rectal metastasis from ILC, especially negative superficial rectal biopsies. Endoscopic and radiologic features often mimic primary rectal pathology, underscoring the importance of deep biopsy and imaging in establishing the diagnosis. New lower-GI symptoms in any breast-cancer survivor, especially one with ILC, should prompt pelvic MRI and deep tissue sampling to exclude metastatic disease if superficial biopsies are negative.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"311-328"},"PeriodicalIF":0.7,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13480980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788652","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":"Cytomegalovirus Gastrointestinal Disease Masquerading as Inflammatory Bowel Disease in a Patient with Occult HIV Infection Receiving Biologics: A Case Report.","authors":"Bashar Roumia, Manon Transleau","doi":"10.1159/000553395","DOIUrl":"https://doi.org/10.1159/000553395","url":null,"abstract":"<p><strong>Introduction: </strong>Biologic and targeted synthetic therapies can obscure underlying immunodeficiency and opportunistic infections, leading to diagnostic challenges in patients with presumed autoimmune disease.</p><p><strong>Case presentation: </strong>A 51-year-old man with ankylosing spondylitis and presumed ulcerative colitis experienced progressive systemic decline, including 40 lb. weight loss and encephalopathy, while receiving etanercept and upadacitinib. Clinical deterioration prompted reassessment, revealing advanced HIV/AIDS (CD4 count 21 cells/µL) and biopsy-confirmed cytomegalovirus esophagitis. Discontinuation of Janus kinase inhibition and initiation of antiretroviral therapy resulted in clinical stabilization.</p><p><strong>Conclusion: </strong>This case highlights the dangers of diagnostic momentum and demonstrates how opportunistic infections can mimic autoimmune pathology, emphasizing the need for diagnostic reassessment and objectivity in patients receiving potent immunomodulatory therapies.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"297-303"},"PeriodicalIF":0.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758041","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}
Zehra Naseem, Amala Alenchery, Sarah Yuann Kim, Omar T Sims, Kadakkal Radhakrishnan, Sobia Nasir Laique
{"title":"Adult-Onset Hyperammonemia: Case Report and Review of Literature.","authors":"Zehra Naseem, Amala Alenchery, Sarah Yuann Kim, Omar T Sims, Kadakkal Radhakrishnan, Sobia Nasir Laique","doi":"10.1159/000553356","DOIUrl":"https://doi.org/10.1159/000553356","url":null,"abstract":"<p><strong>Introduction: </strong>Hyperammonemia is a life-threatening condition most associated with liver disease, though non-cirrhotic causes are increasingly recognized.</p><p><strong>Case presentation: </strong>We report an 18-year-old female presenting with 1 week of progressive confusion, abdominal pain, and nausea. Initial evaluation showed normal routine laboratories but markedly elevated ammonia and respiratory alkalosis. She rapidly deteriorated, requiring intubation and intensive care. Ammonia peaked at 795 µg/dL and improved rapidly after urgent venous hemofiltration and medical therapy, with full neurological recovery by day 3. Further testing revealed late-onset ornithine transcarbamylase deficiency.</p><p><strong>Conclusion: </strong>We present an algorithm for the approach to hyperammonemia and urea cycle disorders through a comprehensive review of current diagnostic and therapeutic strategies pertaining to urea cycle disorders.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"329-341"},"PeriodicalIF":0.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788694","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}
Hussam Almasri, Maram Albandak, Shahem Abbarh, Adnan Humam Hajjar, Ashraf I Ahmed, Abdelrahman A Karen, Yusuf Hallak, Bisher Sawaf, Mohammed Elbadri
{"title":"Neuroendocrine Tumor of Unknown Origin Leading to the Diagnosis of Advanced Celiac Disease: A Case Report Exploring a Possible Association.","authors":"Hussam Almasri, Maram Albandak, Shahem Abbarh, Adnan Humam Hajjar, Ashraf I Ahmed, Abdelrahman A Karen, Yusuf Hallak, Bisher Sawaf, Mohammed Elbadri","doi":"10.1159/000553396","DOIUrl":"https://doi.org/10.1159/000553396","url":null,"abstract":"<p><strong>Introduction: </strong>Celiac disease (CD), if left untreated, can predispose a wide range of intestinal malignancies including enteric lymphoma and adenocarcinoma. On rare occasions, intestinal neuroendocrine tumors (NETs) were reported. We present a case of metastatic NET that led to the diagnosis of CD.</p><p><strong>Case presentation: </strong>A 58-year-old woman presented with a lump in the left axilla without fever or weight loss. Physical examination showed a single tender and rubbery lymph node (LN) of 2.5 cm in size in the left axilla. Laboratories showed mild iron-deficiency anemia. An excisional LN biopsy showed well-differentiated NET, grade 3. A gallium Ga-68 DOTATATE-integrated positron emission tomography (PET)-computed tomography scan showed nonspecific homogenous duodenal and small bowel uptake without apparent signs of fluorodeoxyglucose (FDG)-avid malignancy. Upper endoscopy with push enteroscopy with small bowel biopsies were consistent with CD. The serum tissue transglutaminase-immunoglobulin test was positive. The patient was started on a gluten-free diet and managed with clinical observation. A follow-up FDG-PET scan after 6 months showed no abnormal uptake, and the patient continued to be asymptomatic beyond 1 year of follow-up.</p><p><strong>Conclusion: </strong>This case highlights the possible rare coexistence of CD with an atypical neoplastic process, particularly in patients presenting with unexplained iron-deficiency anemia. While CD is associated with an increased risk of certain rare gastrointestinal malignancies, its relationship with NETs remains poorly defined. Larger studies are needed to further explore any potential association between CD and NETs.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"304-310"},"PeriodicalIF":0.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760015","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}
Alejandra Maria Peñuela-Romero, Peter Studer, Carolin Wagener, Felix Stickel
{"title":"Ascites Decompensation in a Patient without Liver Disease: A Case Report.","authors":"Alejandra Maria Peñuela-Romero, Peter Studer, Carolin Wagener, Felix Stickel","doi":"10.1159/000552879","DOIUrl":"10.1159/000552879","url":null,"abstract":"<p><strong>Introduction: </strong>Ascites in the absence of liver disease poses a diagnostic challenge.</p><p><strong>Case presentation: </strong>We report a previously healthy 50-year-old Swiss man with constitutional symptoms and progressive abdominal distension. Extensive workup excluded hepatic and malignant causes. Peritoneal tuberculosis was confirmed by diagnostic laparoscopy with histopathological and molecular analyses.</p><p><strong>Conclusion: </strong>This case highlights the need to consider rare causes of ascites, even in immunocompetent patients without liver disease.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"282-287"},"PeriodicalIF":0.7,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673038","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}