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Volume 73 - 2010 - Fasc.3 - Case reports

Seroconversion of acute hepatitis B by antiretroviral therapy in an HIV-1 infected patient

A 33-year-old man with human immunodeficiency virus type1 (HIV-1) infection was admitted because of acute hepatitis B. His serum alanine aminotransferase level was 1200 IU/mL and CD4 cells count was 268/mm3. Antiretroviral therapy including teno- fovir and emtricitabine, which suppresses both HIV and hepatitis B virus (HBV) replication, was initiated. The liver enzymes decreased dramatically. The viral loads of both HIV-1 and HBV were suppressed below detectable limits. Seroconversion from hepatitis B surface antigen to hepatitis B surface antibody was acquired 19 weeks later. In this case, the initiation of antiretrovi- ral therapy with anti-HBV activity during the acute phase of hepatitis B had a favourable effect on HBV serostatus. (Acta gas- troenterol. belg., 2010, 73, 389-391).


Whipple's disease - A classic case report and review of the literature

We report the case of a 43-year old carpenter with abdominal complaints and progressive weight loss. The HLA-B27 positive male had been suffering migratory arthropathy for five years, only partially under control with corticosteroids and methotrexate therapy. Endoscopic investigation showed dark staining of the duodenal mucosa and the ileal mucosa had an erythematous aspect with multiple white spots. Abundant periodic acid Schiff - positive macrophages were seen on histologic examination of biop- sy samples. This is a classic presentation of Whipple's disease, a rare multisystemic disease caused by the Tropheryma whipplei. Typical symptoms are arthropathy, weight loss, abdominal pain and diarrhea, but also systemic and neurological manifestations may occur. The otherwise lethal disease can be treated with long term antibiotics. (Acta gastroenterol. belg., 2010, 73, 392-396).


Second primary malignancies in patients with a gastrointestinal neuroendocrine tumour : a case report and review of the literature

A second primary malignancy (SPM) is frequently reported in patients with a gastrointestinal neuroendocrine tumour (NET). The majority of SPM are located in the gastrointestinal tract, but malignancies at other sites are described as well. This phenome- non might just be coincidental due to high incidence rates of asymptomatic NET lesions in patients who are operated or who undergo autopsy for another primary malignancy. However, other theories have been developed since the observed incidence rates seem to be double as high as expected. Some authors suggest a common genetic predisposition, while others report tumourigenic properties of various neuroendocrine peptides, including secretin, gastrin and cholecystokinin. This review is illustrated by a case report of a patient in whom the radiological diagnosis of a diffuse liver metastasized adenocarcinoma of the rectum changed dra- matically after positron emission tomography and explorative laparoscopy to a curable adenocarcinoma of the rectum with a simultaneous well-differentiated neuroendocrine carcinoma. (Acta gastroenterol. belg., 2010, 73, 397-402).


Daily cannabis use and the digestive tract : an underrecognized relationship

A 33 year old man presented with recurrent episodes of hyper- emesis with symptom-free intervals since eight years. The diagno- sis of cyclic vomiting syndrome due to longstanding and daily cannabis use was retained, after exclusion of any organic cause of vomiting. Although the patient was informed that the clinical response after cessation of smoking is proven to be spectacular, he continued the use of cannabis and kept on presenting with cyclic symptoms of hyperemesis. (Acta gastroenterol. belg., 2010, 73, 403- 405).


Endoscopic removal of a bleeding colonic polypoid angiodysplasia : case report

Arteriovenous malformations are common causes of lower gas- trointestinal bleeding in the elderly. Among them, angiodysplasia is one subtype that appears on endoscopy as red, flat superficial lesions, and sometimes slightly elevated. Colonic angiodysplasia is very rarely seen as a polypoid lesion. The present case describes a bleeding large polypoid colonic angiodysplasia in a 60 year-old man. It was removed endoscopically using a PolyLoop® ligature device without complications. (Acta gastroenterol. belg., 2010, 73, 406-408).