Volume 88 - 2025 - Fasc.4 - Case reports
Tuberculosis presenting as dysphagia in an immunocompetent patient: a case report
Extra-pulmonary tuberculosis can affect any part of
the digestive system, including the esophagus. Esophageal
involvement in tuberculosis is considered rare and its atypical
manifestation can lead to delayed or misdiagnosis. Primary
esophageal tuberculosis (ET) occurs when the esophagus is
directly affected by tuberculosis while secondary ET arises from
infiltration by surrounding structures. We report the case of a
44-year-old immunocompetent Tibetan patient who presented
with dysphagia, in whom gastroscopy revealed a subepithelial
lesion (SEL). The patient was diagnosed with secondary
esophageal tuberculosis by tissue acquisition with endoscopic
ultrasound (EUS) and successfully treated with tuberculostatic
drugs. Esophageal tuberculosis must be considered when a
subepithelial lesion of the esophagus is found, especially in
patients originating from endemic areas
SBP: Always peritonitis in decompensated cirrhosis? Case report and review of the literature
We report a case of a 56-year-old male with alcohol-associated
liver cirrhosis presenting with septic and obstructive shock
due to spontaneous bacterial peritonitis and pericarditis with
tamponade. Imaging revealed ascites, pleural and pericardial
effusion requiring drainage. Escherichia coli with identical
resistance patterns was cultured from all drained fluids.
Scintigraphy confirmed a peritoneal-pericardial connection.
After initial treatment, fluid recurrences prompted evaluation for
transjugular intrahepatic portosystemic shunt (TIPS) placement,
which was unfortunately complicated by severe bleeding,
ultimately leading to multi-organ failure and death.
This case highlights the exceptional occurrence of pericardial
effusion and spontaneous bacterial pericarditis as well as peritonitis
as a complication of decompensated cirrhosis, with confirmed
connection between the pericardium and the abdominal cavity by
nuclear tracer study, as well as microbiological evidence. Based on
an overview of all published cases management includes diuretics,
paracentesis and in refractory cases, TIPS. Liver transplantation
remains the definitive treatment.
Endotipsitis in a liver transplant patient: the role of positron emission tomography in a challenging diagnosis
Endotipsitis is a rare but serious infection of TIPSS, with
no established diagnostic criteria or treatment guidelines.
It presents significant diagnostic challenges, particularly in
immunocompromised patients such as liver transplant recipients.
We report the case of a patient who underwent liver
transplantation followed shortly thereafter by TIPSS placement
due to refractory ascites (PSVD of the liver graft). He presented
10 years after with decompensation of cirrhosis and fever.
Despite negative blood cultures, FDG PET-CT revealed intense
hypermetabolism along the TIPSS suggesting endotipsitis. He was
treated initially with antibiotics and required ultimately a liver
retransplantation.
This case is notable for its occurrence in a transplant recipient,
the absence of bacteremia, and the extremely delayed onset after
TIPSS placement, the longest interval reported to date. Diagnosis
was made through PET-CT, highlighting its critical role when
conventional investigations are inconclusive. (
Auto-Immune Pancreatitis with Pseudo-Tumoral Mass Induced by Pembrolizumab in a Woman suffering from Metastatic Urothelial Carcinoma: Case Report and Literature survey
Immune checkpoint inhibitors (ICIs) have revolutionized
cancer therapy but may induce rare immune-related adverse
events including pancreatitis (ICI-PI-), which occurs in 2–4% of
cases. Such ICI-PI may necessitate treatment discontinuation.
We report the rare case of a 51-year-old female with Lynch
syndrome treated with pembrolizumab for metastatic urothelial
carcinoma. A pancreatic mass was identified during follow-up by
PET/CT. Pathology from endoscopic ultrasound-guided fine-needle
aspiration (EUS-FNA) could not exclude adenocarcinoma. Surgical
resection revealed pathology consistent with type II autoimmune
pancreatitis (AIP) in a case which represent by definition , a type
III ICI-PI. We explore diagnostic criteria focusing on clinical,
serological, histological as well as medical imaging features and
management