Collagenous sprue(CS) is a pattern of small-bowel injury characterized histologically by marked villous blunting,intraepithelial lymphocytes,and thickened sub-epithelial collagen table. Clinically,patients present wit...Collagenous sprue(CS) is a pattern of small-bowel injury characterized histologically by marked villous blunting,intraepithelial lymphocytes,and thickened sub-epithelial collagen table. Clinically,patients present with diarrhea,abdominal pain,malabsorption,and weight loss. Gluten intolerance is the most common cause of villous blunting in the duodenum; however,in a recent case series by the Mayo Clinic,it has been reported that olmesartan can have a similar effect. In this case report,a 62-year-old female with a history of hypothyroidism and hypertension managed for several years with olmesartan presented with abdominal pain,weight loss,and nausea. Despite compliance to a gluten-free diet,the patient's symptoms worsened,losing 20 pounds in 3 wk. Endoscopy showed thickening,scalloping,and mosaiform changes of the duodenal mucosa. The biopsy showed CS characterized by complete villous atrophy,lymphocytosis,and thickened sub-epithelial collagen table. After 2 mo cessation of olmesartan,the patient's symptoms improved,and follow-up endoscopy was normal with complete villous regeneration. These findings suggest that olmesartan was a contributing factor in the etiology of this patient's CS.Clinicians should be aware of the possibility of druginduced CS and potential reversibility after discontinuation of medication.展开更多
Esophageal involvement by lichen planus(ELP),previously thought to be quite rare,is a disease much more common in women and frequently the initial manifestation of mucocutaneous lichen planus(LP).Considering that the ...Esophageal involvement by lichen planus(ELP),previously thought to be quite rare,is a disease much more common in women and frequently the initial manifestation of mucocutaneous lichen planus(LP).Considering that the symptoms of ELP do not present in a predictable manner,ELP is perhaps more under-recognized than rare.To date,four cases of squamous cell carcinoma in association with ELP have been reported,suggesting that timely and accurate diagnosis of ELP is of importance for appropriate follow-up.In this case report,a 69-year-old female presented with dysphagia and odynophagia.She reported a history of oral LP but had no active oral or skin lesions.Endoscopic examination revealed severe strictures and web-like areas in the esophagus.Histologic examination demonstratedextensive denudation of the squamous epithelium,scattered intraepithelial lymphocytes,rare eosinophils and dyskeratotic cells.Direct immunofluorescence showed rare cytoid bodies and was used to exclude other primary immunobullous disorders.By using clinical,endoscopic,and histologic data,a broad list of differential diagnoses can be narrowed,and the accurate diagnosis of ELP can be made,which is essential for proper treatment and subsequent follow-up.展开更多
文摘Collagenous sprue(CS) is a pattern of small-bowel injury characterized histologically by marked villous blunting,intraepithelial lymphocytes,and thickened sub-epithelial collagen table. Clinically,patients present with diarrhea,abdominal pain,malabsorption,and weight loss. Gluten intolerance is the most common cause of villous blunting in the duodenum; however,in a recent case series by the Mayo Clinic,it has been reported that olmesartan can have a similar effect. In this case report,a 62-year-old female with a history of hypothyroidism and hypertension managed for several years with olmesartan presented with abdominal pain,weight loss,and nausea. Despite compliance to a gluten-free diet,the patient's symptoms worsened,losing 20 pounds in 3 wk. Endoscopy showed thickening,scalloping,and mosaiform changes of the duodenal mucosa. The biopsy showed CS characterized by complete villous atrophy,lymphocytosis,and thickened sub-epithelial collagen table. After 2 mo cessation of olmesartan,the patient's symptoms improved,and follow-up endoscopy was normal with complete villous regeneration. These findings suggest that olmesartan was a contributing factor in the etiology of this patient's CS.Clinicians should be aware of the possibility of druginduced CS and potential reversibility after discontinuation of medication.
文摘Esophageal involvement by lichen planus(ELP),previously thought to be quite rare,is a disease much more common in women and frequently the initial manifestation of mucocutaneous lichen planus(LP).Considering that the symptoms of ELP do not present in a predictable manner,ELP is perhaps more under-recognized than rare.To date,four cases of squamous cell carcinoma in association with ELP have been reported,suggesting that timely and accurate diagnosis of ELP is of importance for appropriate follow-up.In this case report,a 69-year-old female presented with dysphagia and odynophagia.She reported a history of oral LP but had no active oral or skin lesions.Endoscopic examination revealed severe strictures and web-like areas in the esophagus.Histologic examination demonstratedextensive denudation of the squamous epithelium,scattered intraepithelial lymphocytes,rare eosinophils and dyskeratotic cells.Direct immunofluorescence showed rare cytoid bodies and was used to exclude other primary immunobullous disorders.By using clinical,endoscopic,and histologic data,a broad list of differential diagnoses can be narrowed,and the accurate diagnosis of ELP can be made,which is essential for proper treatment and subsequent follow-up.
