Doxycycline-induced large esophageal ulcer resembling esophageal cancer

More than 100 medications are reported to cause pill-induced esophagitis (PIE). Doxycycline is the most common cause. Common symptoms are chest pain, odynophagia, dysphagia and heartburn.The authors report a young female internist presenting with a large esophageal ulcer resembling esophagealcancer caused by doxycycline. She was successfully treated with sucralfate and xylocaine viscous. Her symptoms improved within 1 week. Thus, medical personnel and patients should be aware of PIE

A Case of Colorectal Liver Metastasis with Central Scar Mimicking Focal Nodular Hyperplasia

The authors report a case of colorectal liver metastasis which is one of the uncommon causes of liver tumor with central scar in a young female. Our patient presented with right upper abdominal discomfort and palpable liver mass for about 2 months. She did not have underlying disease. She had used oral contraceptive pills for 14 years. Physical examination revealed only liver span 16 centimeters (cm). Multidetector-row computed tomography demonstrated 3 masses and the largest one measured 10.7x 8.3x 7 cm in diameter with lobulated contour, hypodensity enhancing pattern, and a central scar at segment II and IVa of liver. Magnetic resonance imaging (MRI) of the largest mass showed hyposignal intensity on T1-weighted and slightly hypersignal intensity in T2-weighted MRI. This mass also had a large central scar which was hyposignal intensity on T1-weighted and hypersignal intensity in T2-weighted MRI. Liver biopsy showed scattered infiltration of atypical epithelium with glandular formation. Immunohistochemical analysis was compatible with colorectal cancer. Colonoscopy was performed and revealed large mass at distal part of sigmoid colon. The patient was scheduled to undergo surgical operation and receive chemotherapy. To our knowledge, colorectal metastasis of liver should be considered as a cause of liver tumor with central scar

Comparison of nutritional screening and assessment tools for predicting the composite outcome of mortality and complication in cirrhosis

Summary: Background & Aim: Malnutrition is a common problem among cirrhotic patients. There is currently no gold standard of nutritional assessment tools. The purpose of present study was to compare various nutritional screening and assessment tools for predicting the composite outcome of mortality and complications in cirrhotic patients. Methods: A total of 94 patients with cirrhosis underwent nutritional screening by Royal Free Hospital-Nutritional Prioritizing tool (RFH-NPT), Liver Disease Undernutrition Screening Tool (LDUST), Malnutrition Universal Screening Tool (MUST), Prognostic Nutritional Index (PNI–O), Nutritional Risk Index (NRI), Spanish Society of Parenteral and Enteral Nutrition (SENPE) and Controlling Nutritional Status (CONUT). Nutritional assessment was performed using body mass index (BMI), triceps skinfold (TSF), midarm circumference (MAC), midarm muscle circumference (MAMC), six-minute walk test (6MWT), Subjective Global Assessment (SGA), and Royal Free Hospital Subjective Global Assessment (RFH-SGA). Patients were followed up for 1 year. Result: When compared with other nutrition screening tools, NRI and CONUT had the highest sensitivity (83.3%). NRI also demonstrated the highest negative predictive value (90.7%) and accuracy, reflected by an area under the curve of 0.800, in predicting the composite outcome of mortality and complications of cirrhosis. LDUST and PNI–O showed the highest specificity (89.1%) and positive predictive value (74.1%). In the realm of nutritional assessment, RFH-SGA had the highest sensitivity (73.3%) and negative predictive value (86.4%). BMI demonstrated the highest specificity (98.5%) and positive predictive value (83.3%). SGA showed the highest accuracy, as indicated by an area under the curve of 0.794. Conclusions: NRI and SGA exhibited the highest accuracy in predicting the composite outcome of mortality and complications among cirrhotic patients

Clinical characteristics and diagnosis of intestinal tuberculosis in clinical practice at Thailand’s largest national tertiary referral center: An 11-year retrospective review

Background Diagnosing intestinal tuberculosis (ITB) is challenging due to the low diagnostic sensitivity of current methods. This study aimed to assess the clinical characteristics and diagnosis of ITB at our tertiary referral center, and to explore improved methods of ITB diagnosis. Methods This retrospective study included 177 patients diagnosed with ITB at Siriraj Hospital (Bangkok, Thailand) during 2009–2020. Results The mean age was 49 years, 55.4% were male, and 42.9% were immunocompromised. Most diagnoses (108/177) were made via colonoscopy; 12 patients required more than one colonoscopy. Among those, the sensitivity of tissue acid-fast bacilli (AFB), presence of caseous necrosis, polymerase chain reaction (PCR), and culture was 40.7%, 13.9%, 25.7%, and 53.4%, respectively. Among patients with negative tissue histopathology, 4 (3.7%) and 13 (12.0%) were ITB positive on tissue PCR and culture, respectively. The overall sensitivity when all diagnostic methods were used was 63%. Seventy-six patients had stool tests for mycobacteria. The overall sensitivity of stool tests was 75.0%. However, when analyzing the 31 patients who underwent both endoscopy and stool testing, the sensitivity of stool testing when using tissue biopsy as a reference was 45.8%. Combining stool testing and tissue biopsy did not significantly increase the sensitivity compared to tissue biopsy alone (83.9% vs. 77.4%, respectively). Conclusion Despite the availability of PCR and culture for TB, the overall diagnostic sensitivity was found to be low. The sensitivity increased when the tests were used in combination. Repeated colonoscopy may be beneficial. Adding stool mycobacteria tests did not significantly increase the diagnostic yield if endoscopy was performed, but it could be beneficial if endoscopy is unfeasible

Stool test results compared to tissue biopsy results in patients who underwent both stool testing for mycobacteria and evaluation of tissue biopsies obtained during colonoscopy to diagnose intestinal tuberculosis (N = 31).

Stool test results compared to tissue biopsy results in patients who underwent both stool testing for mycobacteria and evaluation of tissue biopsies obtained during colonoscopy to diagnose intestinal tuberculosis (N = 31).</p

Fig 1 -

Endoscopic (A and B), computed tomography (C), and pathological findings (D) from the patient with intestinal tuberculosis. A and B showed a large ulcer involving the IC valve. C was an axial contrast-enhanced CT scan showing moderate segmental wall thickening with increased mucosal and mural enhancement at the terminal ileum with associated increasing IC valve thickness. D showed ulcerated ileal mucosa with dense chronic inflammatory cell infiltration and aggregates of epithelioid histiocytes (granuloma) with central necrosis (arrow).</p

S1 Data -

BackgroundDiagnosing intestinal tuberculosis (ITB) is challenging due to the low diagnostic sensitivity of current methods. This study aimed to assess the clinical characteristics and diagnosis of ITB at our tertiary referral center, and to explore improved methods of ITB diagnosis.MethodsThis retrospective study included 177 patients diagnosed with ITB at Siriraj Hospital (Bangkok, Thailand) during 2009–2020.ResultsThe mean age was 49 years, 55.4% were male, and 42.9% were immunocompromised. Most diagnoses (108/177) were made via colonoscopy; 12 patients required more than one colonoscopy. Among those, the sensitivity of tissue acid-fast bacilli (AFB), presence of caseous necrosis, polymerase chain reaction (PCR), and culture was 40.7%, 13.9%, 25.7%, and 53.4%, respectively. Among patients with negative tissue histopathology, 4 (3.7%) and 13 (12.0%) were ITB positive on tissue PCR and culture, respectively. The overall sensitivity when all diagnostic methods were used was 63%. Seventy-six patients had stool tests for mycobacteria. The overall sensitivity of stool tests was 75.0%. However, when analyzing the 31 patients who underwent both endoscopy and stool testing, the sensitivity of stool testing when using tissue biopsy as a reference was 45.8%. Combining stool testing and tissue biopsy did not significantly increase the sensitivity compared to tissue biopsy alone (83.9% vs. 77.4%, respectively).ConclusionDespite the availability of PCR and culture for TB, the overall diagnostic sensitivity was found to be low. The sensitivity increased when the tests were used in combination. Repeated colonoscopy may be beneficial. Adding stool mycobacteria tests did not significantly increase the diagnostic yield if endoscopy was performed, but it could be beneficial if endoscopy is unfeasible.</div