Search

We present a 20-year-old man with oligosymptomatic Crohn's disease of the terminal ileum complicated by chronic renal insufficiency due to secondary amyloidosis. Definitive diagnosis of Crohn's disease was established 7 years after the onset of the renal disease as a result of symptoms of intestinal obstruction requiring surgery. The affected colonic segment was removed and histopathological examination of the surgical specimen confirmed the diagnosis of Crohn's disease without identifying intestinal amyloidosis. Despite the surgical intervention and the absence of recurrence of inflammatory bowel disease, renal insufficiency steadily progressed, and the patient required kidney transplantation. The patient's subsequent course was excellent and no recurrence of intestinal or renal disease was observed after 8 years of follow-up.

Palmoplantar tylosis is a focal nonepidermolytic palmoplantar hyperkeratosis, which is inherited as an autosomal dominant condition. Two types have been described: an early onset type B tylosis, which occurs in the first year of life and is usually benign, and type A tylosis, which occurs between the ages of 5 and 15 years. Type A tylosis has been associated with a high incidence of oesophageal carcinoma in three families in England, Germany and the USA. This study describes an additional family from Spain with tylosis A, without any known relation to those described before.

A 53-year-old woman with a past medical history of appendectomy and neurinoma on the left side of the neck in 1986 was admitted for asthenia and itching of recent onset, with absence of abdominal pain or any alterations on physical examination. A blood test showed: alkaline phosphatase, 1,499 IU/L, gamma-glutamyl transpeptidase, 1,163 IU/L, total bilirubin, 1.62 mg/dl, and CA-19.9, 533 IU/ml (normal value < 37 IU/ml). Doppler-US and abdominal CT scans were performed, which revealed a mass measuring 6 cm in diameter located in the head of the pancreas, with dilated intraand extra-hepatic bile ducts. The lesion had cystic areas with solid septa and papillary epithelium, some of which stained very brightly (Figs. 1 and 2); no evidence of vascular invasion or adenopathies was observed. With a diagnostic impression of resectable cystic neoplasm of the pancreas with no surgical contraindications a cephalic duodenopancreatectomy was performed. In the surgically removed tissue a solid mass of whitish color and elastic consistency was observed. The mass was located in the head of the pancreas. Although not encapsulated, it showed well-defined borders and was easily removed from the adjacent pancreas. An immunohistochemical study showed that it was positive for vimentin marker, and negative for cytokeratins (AE1-AE3), S-100, chromogranin, CD 34, C-KIT, and actin. Furthermore, a low cell proliferation index (MIB-I) was also observed (Fig. 3). These data from the histological study suggested the presence of a low-malignancy-grade fusocellular sarcoma. After a 2-year follow-up, the patient remained asymptomatic and without recurrent disease.

We present a 20-year-old man with oligosymptomatic Crohn's disease of the terminal ileum complicated by chronic renal insufficiency due to secondary amyloidosis. Definitive diagnosis of Crohn's disease was established 7 years after the onset of the renal disease as a result of symptoms of intestinal obstruction requiring surgery. The affected colonic segment was removed and histopathological examination of the surgical specimen confirmed the diagnosis of Crohn's disease without identifying intestinal amyloidosis. Despite the surgical intervention and the absence of recurrence of inflammatory bowel disease, renal insufficiency steadily progressed, and the patient required kidney transplantation. The patient's subsequent course was excellent and no recurrence of intestinal or renal disease was observed after 8 years of follow-up.

The association of Streptococcus bovis bacteremia and endocarditis with colonic pathology, mainly neoplastic, is well known. Its relationship with liver disease without evidence of gastrointestinal disease has been rarely described. To analyze the association between S. bovis infection and liver disease, positive blood cultures for this microorganism in hospitalized patients in the Internal Medicine and Gastroenterology Departments from December 1993 until October 1995, have been reviewed. Three cases of S. bovis infection (one bacteremia, two endocarditis) were found. Alcoholic liver disease was diagnosed in all three patients, with associated hepatitis C virus in one of them. Colonic pathology was excluded by colonoscopy and/or barium enema. Other gastrointestinal disorders were excluded by means of gastroscopy, barium gastrointestinal study and abdominal ultrasonography. Antibiotic therapy was based in betalactamics, with associated aminoglycoside in two cases. One patient needed aortic and mitral valve replacement and another one needed orthotopic liver transplantation. No new gastrointestinal pathology emerged in the follow-up (5-23 months). Cases of S. bovis bacteremia and endocarditis should be screened not also for colonic pathology, but also for liver disease, particularly in alcoholics.