Treatment of primary nasal tuberculosis with anti-tumor necrosis factor immunotherapy:A case report

BACKGROUND Primary nasal tuberculosis(TB)is a rare form of extrapulmonary TB,particularly in patients receiving anti-tumor necrosis factor(TNF)immunotherapy.As a result,its diagnosis remains challenging.CASE SUMMARY A 58-year-old male patient presented to the ear,nose,and throat department with right-sided nasal obstruction and bloody discharge for 1 month.He was diagnosed with psoriatic arthritis and received anti-TNF immunotherapy for 3 years prior to presentation.Biopsy findings revealed chronic granulomatous inammation and a few acid-fast bacilli,suggestive of primary nasal TB.He was referred to our TB management department for treatment with oral anti-TB agents.After 9 months,the nasal lesions had disappeared.No recurrence was noted during follow-up.CONCLUSION The diagnosis of primary nasal TB should be considered in patients receiving TNF antagonists who exhibit thickening and crusting of the nasal septum mucosa or inferior turbinate,particularly when pathological findings suggest granulomatous inflammation.

Burril-Bernard Crohn(1884-1983)and the disease which bears his name

Background:Crohn’s disease,described by Dr.Burrill Crohn and his colleagues in 1932,continues to be of great research and clinical interest.It was initially perceived as a distinct condition and it has evolved since into a complex disease,with debates still going regarding its classification and etiology.Even though more that 80 years of research have passed,numerous significant questions regarding the disease’s causes and best possible treatment strategies still remain.Methods:This article reviews both historical and contemporary perspectives on Crohn’s disease,including its initial description,the research developments that happened in the years to follow,as well as the way it is regarded nowadays.It refers to notable contributions from medical figures,such as Dr.Crohn and his colleagues,examines related advances made in medical research and mentions the challenges and the treatment strategies that are still being discussed.Results:This article highlights the evolution of Crohn’s disease from a distinct condition to a more heterogeneous one.Furthermore,it refers to advancements made in medical research,such as the identification of CARD15(NOD2)gene mutations and the role of dysbiosis,and it examines current therapeutic approaches.Conclusion:Even though significant progress has been made since the initial description of Chron’s disease,there is no definitive cure,even though it has been determined that genetic and environmental factors are of great importance.The ongoing research could possibly lead to future discoveries and therefore aid in the discovery of efficient management and treatment of Crohn’s disease.

Efficacy of additional treatment with azathioprine in a patient with prednisolone-dependent gastric sarcoidosis

Gastric sarcoidosis with noncaseating granuloma is rare. Although corticosteroid produces a dramatic clinical response, it is unknown whether azathioprine show efficacy in prednisolone-dependent cases. Here, we report a case of gastric sarcoidosis in a 25-year-old man with severe epigastlargia. Gastroendoscopy revealed multiple map-like ulcerations. Histological examination showed multiple noncaseating granulomatous lesions in gastric mucosa, which were incompatible with diagnoses of Crohn's disease or tuberculosis. He was started on prednisolone at 30 mg/d, and his symptoms improved within 7-d. The prednisolone was gradually tapered by 5 mg every 2-wk, but oral azathioprine at 50 mg was added after symptoms recurred at tapered dose of 10 mg. Endoscopy 4-wk later showed healing ulcers, and, lymphocytic infiltration was absent. The efficacy of additional azathioprine in gastric sarcoidosis is not well defined. Here, we report a case of prednisolone-dependent gastric sarcoidosis that improved after additional azathioprine, and also review the literature concerning the treatment, especially for prednisolone-dependent cases.

Long-term natural history of Crohn’s disease

Crohn’s disease is a chronic inflammatory granulomatous process that usually involves different sites in the intestinal tract. Genetic and environmental factors are thought to play a role in its etiology and pathogenesis. The disorder has a heterogeneous clinical expression and data from tertiary care settings have documented its female predominance, occasional familial nature, and high rate of stricture formation and penetrating disease. It may appear from early childhood to late adulthood, although over 80% are currently diagnosed before age 40 years, usually with terminal ileal and colonic involvement. Several studies have now shown differences in phenotypic clinical expression depending on the initial age at diagnosis, with pediatric-onset disease being more severe and more extensive with more involvement of the upper gastrointestinal tract compared to adult-onset disease. In addition, long- term studies from these tertiary care settings have documented that the disorder may evolve with time into a more complex disease with stricture formation and penetrating disease complications (i.e. fistula and abscess). Although prolonged remission with no evidence of inflammatory disease may occur, discrete periods of symptomatic and active granulomatous inflammatory disease may re-appear over many decades. Long-term studies on the natural history have also suggested that discrete events (or agents) may precipitate this granulomatous inflammatory process.

Vogt-Koyanagi-Harada syndrome and Crohn’s disease:an exceptional association

Vogt-Koyanagi-Harada disease(VKH)is a rare,multisystem disease of melanocyte-containing organs.It is characterized by diffuse,granulomatous inflammation involving various organs.It has been reported to occur in association with other autoimmune disorders.We report the case of a female patient who was diagnosed with VKH at the age of 4 years and who was treated with corticosteroids until the age of 16.Twenty years later,Crohn’s disease was diagnosed,with a severe flare-up.Three cases of VKH associated with ulcerative colitis have previously been reported anecdotally but,to our knowledge,this is the first case occurring in association to Crohn’s disease.