Confusing untypical intestinal Behcet's disease:Skip ulcers with severe lower gastrointestinal hemorrhage

Behcet's disease(BD) is a rare and life-long disorder characterized by inflammation of blood vessels throughout the body. BD was originally described in 1937 as a syndrome involving oral and genital ulceration in addition to ocular inflammation. Intestinal BD refers to colonic ulcerative lesions documented by objective measures in patients with BD. Many studies have shown that over 40% of BD patients have gastrointestinal complaints. Symptoms include abdominal pain, diarrhea, nausea, anorexia and abdominal distension. Although gastrointestinal symptoms are common, the demonstration of gastrointestinal ulcers is rare. This so-called intestinal BD accounts for approximately 1% of cases. There is no specific test for BD, and the diagnosis is based on clinical criteria. The manifestations of intestinal BD are similar to those of other colitis conditions such as Crohn's disease or intestinal tuberculosis, thus, it is challenging for gastroenterologists to accurately diagnose intestinal BD in patients with ileocolonic ulcers. However, giant ulcers distributed in the esophagus and ileocecal junction with gastrointestinal hemorrhage are rare in intestinal BD. Here, we present a case of untypical intestinal BD. The patient had recurrent aphthous ulceration of the oral mucosa, and esophageal and ileo-colonic ulceration, but no typical extra-intestinal symptoms. During examination, the patient had massive acute lower gastrointestinal bleeding. The patient underwent ileostomy after an emergency right hemicolectomy and partial ileectomy, and was subsequently diagnosed with incomplete-type intestinal BD by pathology. The literature on the evaluation and management of this condition is reviewed.

Synthesis of C—N Axial Chirality N-Arylindoles via Pd(II)-Catalyzed Free Amine-Directed Atroposelective C—H Olefination

Axially chiral N-arylindoles bearing a stereogenic C—N axis are unique important scaffolds in natural products,advance materials,pharmaceuticals and privileged chiral ligands or catalysts.Herein,we report the direct synthesis of C—N axially chiral N-arylindoles through a Pd-catalyzed free amine-directed atroposelective C—H olefination enabled by a spiro phosphoric acid(SPA)ligand.A wide range of enantioenriched N-aromatic amine indoles were obtained in high yields with good enantioselectivities(35 examples,up to 91%yield and up to 96%ee).The chiral products with free amine group offer an effective functional handle for down-stream diversity-oriented synthesis.