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We report here the case of a 55-year-old man from Mali, who presented with abdominal pain. Radiological exploration revealed an ileo-colonic mass surrounding the appendix. A biopsy was taken and on histology, transmural granulomatous inflammation of numerous eosinophils, lymphocytes, plasmocytes and giant cells was seen. Tuberculosis was suspected clinically and an antibiotic treatment was initiated. Two months later, the patient died of septic complications. Basidiobolus ranarum was identified by PCR. Pathogens were retrospectively highlighted on biopsies. These elements were between 10 and 15 μm in diameter, occasionally pseudo-septated, and were surrounded by a thick eosinophilic cuff. The thick eosinophilic cuff was identified as the Splendore-Hoeppli phenomenon. Basidiobolomycosis is a well-known infection in the tropical areas. Basidiobolus sp., fungus of the order Entomophtorales are a known cause of chronic subcutaneous mycosis. Gastro-intestinal basidiobolomycosis is rare and presents considerable diagnostic difficulty. This infection needs to be diagnosed because surgical resection and prolonged antifungal treatment are curable in most cases., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Campylobacter jejuni is an enteropathogen with invasive ability which may be responsible for acute colitis. We report the case of a 38-year-old woman who was hospitalized for severe acute colitis. Stool specimen examination revealed Campylobacter jejuni. A laparotomy was performed due to clinical deterioration and toxic megacolon. Colic perforations were observed. The examination of the colectomy specimen revealed ulcerative pancolitis. This is the first published case of Campylobacter jejuni infection complicated by toxic megacolon and perforation.

"Pouchitis" is a well recognised complication of restorative proctocolectomy characterised by acute diarrhoea, sometimes with blood, often complicated by incontinence, malaise, arthritis, erythema nodosum and fever. The ileal mucosa is hyperaemic, there may be shallow ulcers and contact bleeding. Biopsies characteristically show villous atrophy, a poly-morphonuclear infiltrate and chronic inflammatory cells, but the histopathological features are often patchy and may be difficult to differentiate from ischaemic ileitis, colonic metaplasia or Crohn's disease. "Pouchitis" is probably due to an overgrowth of intestinal bacteria secondary to stasis but there is some evidence that there may be an ischaemic factor. Most patients respond rapidly to oral metronidazole.

The authors report the case of a 51-year-old woman who was hospitalized for severe acute colitis. Sub-total colectomy was performed, due to clinical deterioration and resistance to treatment. The examination of the surgery specimen revealed a herpes-virus type 2 as the responsible pathogen agent. Complementary aciclovir treatment cured the patient.

Bacterial translocation is the passage of viable endogenous bacteria from the gastrointestinal tract to mesenteric lymph nodes and other internal organs. The aim of this work was to study bacterial translocation in patients operated on for Crohn's disease. Twenty-eight patients, mean age 29 years, not having received any antibiotics since at least 8 days, presenting with ileal (n = 12), ileo-colonic (n = 14) or colonic (n = 2) Crohn's disease were studied. In 25 out of 28 cases (89%) indication for surgery was strictures inducing an upper small bowel distension in 9 out of 25 patients. Mesenteric lymph nodes and liver biopsies, portal blood samples and peritoneum swabs were harvested after laparotomy and before gut opening. Bacterial translocation, defined as the presence of intestinal bacteria in at least one of the specimens, was present in 8 out of 28 patients. This was found in lymph nodes draining surgical territories in 7 out of 8 cases. Bacterial strains involved in translocation included E. coli (n = 5), Enterococcus (n = 3), Clostridium perfringens (n = 2), Proteus (n = 2), and Bacteroides fragilis (n = 1). The rate of translocation differed neither according to Crohn's disease site nor with perforating or non perforating type of the disease. Five out of 9 patients operated on for strictures with proximal distension had a translocation. In conclusion, bacterial translocation was identified in 29% of patients operated on for Crohn's disease in this series. Distension of the intestine proximal to a digestive stricture could favor the occurrence of bacterial translocation in Crohn's disease.

Sera of 19 patients who had been admitted with an attack of Crohn's disease were tested for agglutinins against Yersinia. The localization and the extent of the disease were highly variable. Only three patients with a subacute obstruction syndrome due to ileitis had a high circulating antibody titer directed against Yersinia pseudotuberculosis type IV (greater than or equal to 1/500). Culture of the stools did not isolate any pathogenic organisms; particularly, Yersinia pseudotuberculosis failed to grow even though specific methods were used. In one case, a strain of Yersinia enterocolitica was identified which did not prove to be pathogenic. Under corticoid and antibiotic treatment, the course was favorable in every patient. Agglutinin titers progressively decreased and serology became negative within seven to ten months. A patient had a relapse of ileitis but agglutinin titers failed to rise again. In these three patients with unquestionable Crohn's disease, it may be concluded that there was serological evidence of superinfection with Yersinia pseudotuberculosis type IV. This organism might be responsible for acute ileitis mimicking an attack of Crohn's disease.