Volume 76 - 2013 - Fasc.3 - Case series
A review of the literature on three extraintestinal complications of ulcerative colitis: an ulcerative colitis flare complicated by Budd-Chiari syndrome, cerebral venous thrombosis and idiopathic thrombocytopenia
Extraintestinal manifestations are well described and recognized in association with ulcerative colitis. Immunologically mediated and thrombotic events are among the more rare manifestations -associated- with- flares.- These- manifestations- include- Budd-Chiari syndrome, idiopathic thrombocytopenia, and cerebral venous thrombosis. A 22year-old male with a three-year history of ulcerative colitis presented with worsening hematochezia, fatigue, headache and upper respiratory symptoms. Laboratory evaluation demonstrated a platelet count of 24 × 109/L (normal baseline plate- let count noted 3 months prior) and hemoglobin of 8.6 × 109/L. Imaging demonstrated hepatic venous thrombosis consistent with Budd-Chiari syndrome and cerebral venous thrombosis. Based on peripheral smear analysis and eventual marked response to steroids, a diagnosis of idiopathic thrombocytopenia was made. He was started on prednisone 40mg daily with brisk improvement in both- his- ulcerative- colitis- flare- and- his- platelet- count- increasing above 100 × 109/L. He was therapeutically anticoagulated for the cerebral venous thrombosis. He continued to do well and was discharged on therapeutic enoxaparin and a 40 mg prednisone -taper-without-recurrent-flare-or-idiopathic-thrombocytopenia-two weeks- post-hospitalization.- To- our- knowledge,- this- is- the- first report of all three known but rare complications diagnosed concur- rently-in-the-same-patient.-This-review-examines-three-extraintesti- nal complications of ulcerative colitis, including the presentation, diagnosis, and treatment. (Acta gastroenterol. belg., 2013, 76, 311- 316).
Alveolar Echinococcosis in a Belgian Urban Dweller
Human alveolar echinococcosis is a rare parasitic disease caused by larvae of the tapeworm E. multilocularis that colonizes the intes- tines of foxes. The disease predominantly affects the liver and mimics slow growing liver cancer. With a mere 13 reports coming mostly from southern rural regions Belgium has so far been spared from the disease. However alveolar echinococcosis appears to be slowly spreading to non-endemic European countries like Belgium and to urban centres. We report the first autochthonous case involving a patient having lived exclusively in downtown Brussels.
Heightened awareness by the medical community is necessary to detect this lethal disease at an early curable stage. In patients with an undetermined focal liver lesion - especially if calcified - and no firm evidence of malignancy, serological screening should be per- formed to exclude alveolar echinococcosis. (Acta gastroenterol. belg., 2013, 76, 317-321).
The use of fecal calprotectin and lactoferrin in patients with IBD. Review
Endoscopy has been the gold standard for diagnosing and fol- lowing patients with inflammatory bowel disease. However, ileoco- lonoscopy is still an expensive and invasive method. Secondly we do know that clinical scores for ulcerative colitis and Crohn's disease are subjective which creates several problems. And thirdly, when using the known serological markers such as C-reactive protein, white blood cell count en albumin, one should take into account that these markers are not perfect or superior to the current diag- nostic techniques given their low sensitivity and specificity.
Fecal markers may prove to have a greater specificity. Calpro- tectin can differentiate between active and inactive inflammatory bowel disease and between inflammatory bowel disease and irrita- ble bowel syndrome. It correlates with the severity of symptoms and it may predict relapse especially in ulcerative colitis. Finally it can be used as a surrogate marker for the endoscopic response dur- ing treatment given a normal value of calprotectin is a reliable marker for mucosal healing. Lactoferrin also seems to be a sensi- tive and specific marker for the detection of chronic inflammation and for predicting relapse. The relationship with the endoscopic activity is significant and lactoferrin values are significantly higher in active endoscopic disease as compared to inactive disease. Finally, given the significant correlation with endoscopic activity, lactoferrin can function as an adequate marker for the monitoring of therapy. (Acta gastroenterol. belg., 2013, 76, 322-328).