Colitis, Ulcerative ; complications ; drug therapy ; Humans ; Male ; Middle Aged ; Psoriasis ; complications ; drug therapy ; Pyoderma Gangrenosum ; drug therapy ; etiology

Eosinophilic colitis is a relatively rare complication of hypereosinophilic syndrome which is characterized by abdominal pain and bloody diarrhea and is usually treated with steroids and hydroxyurea. However, no standard regimen exists in cases of intractable disease despite several treatment attempts with Interferon- alpha, cyclosporin, etoposide, and vincristine, etc. We here report a case of a 43-year-old woman with recurrent eosinophilic colitis as a complication of hypereosinophilic syndrome who was successfully treated with cyclophosphamide.
Adult ; Case Report ; Colitis/*complications/*drug therapy/pathology ; Cyclophosphamide/*therapeutic use ; Eosinophilia/*complications/*drug therapy/pathology ; Female ; Human ; Hypereosinophilic Syndrome/*complications ; Recurrence

Kaposi's sarcoma is a rare and slowly progressive disease that primarily affects the skin but has an associated visceral involvement. It can occur in the HIV-positive patients or patients treated with immunosuppressants. However, it is extremely rare in the patients receiving the treatment for inflammatory bowel disease. We used corticosteroid for the treatment of ulcerative colitis in 60-year-old woman. Then, Kaposis's sarcoma occured in the skin and colon of the patient. Since she was HIV-negative, we believed that it was developed from the condition of corticosteroid-induced immunosuppression. We present a case of skin and colonic Kaposi's sarcoma in a HIV-negative woman following treatment with corticosteroid for ulcerative colitis.
Aged ; Colitis, Ulcerative/*complications/drug therapy ; Colonic Neoplasms/*complications/diagnosis ; English Abstract ; Female ; Humans ; Sarcoma, Kaposi/*complications/diagnosis ; Skin Neoplasms/*complications/diagnosis

BACKGROUND/AIMS: The prevalence of Helicobacter pylori (H. pylori) infection has been reported to be lower in individuals with inflammatory bowel disease (IBD) in some Western countries. We investigated H. pylori infection in Korean patients with IBD and any possible associations of H. pylori infection with drug therapy for IBD and the phenotype of Crohn's disease (CD). METHODS: We studied 316 unselected patients with IBD, including 169 ulcerative colitis (UC) patients and 147 with CD, and the control group consisted of 316 age- and gender-matched healthy people who received a comprehensive medical examination for a regular checkup purpose. Infection rates of H. pylori as detected by the urea breath test were compared between the IBD patients and the controls. RESULTS: A statistically significant difference in H. pylori infection rate was noticed between the IBD patients (25.3%) and the controls (52.5%; p<0.001), and between UC (32.0%) and CD patients (17.7%; p=0.04). Among the IBD patients, the age group of <60 and individuals with a history of taking metronidazole (13.0%; p=0.038) or ciprofloxacin (6.7%; p=0.001) were found to have a meaningfully lower infection rate, but those who did not take antibiotics still showed H. pylori infection rate significantly lower than the controls (CD 22.0% vs. UC 33.8% vs. Control 52.5%, p<0.001). With an exception of age, phenotypic characteristics showed no significant relations with H. pylori infection rate in CD patients. CONCLUSIONS: Korean patients with IBD, particularly CD, were found to have a significantly lower H. pylori infection rate than the controls. This association was more evident in those <60 years old, which suggested that H. pylori infection might be deemed to lower possible risks of IBD in younger adults.
Adolescent ; Adult ; Age Factors ; Aged ; Colitis, Ulcerative/complications/diagnosis/drug therapy ; Crohn Disease/complications/diagnosis/drug therapy ; Female ; Helicobacter Infections/complications/diagnosis/*epidemiology ; *Helicobacter pylori ; Humans ; Inflammatory Bowel Diseases/*complications/diagnosis/drug therapy ; Korea ; Male ; Middle Aged ; Phenotype ; Prevalence

Hemophagocytic syndrome (HPS) is an uncommon hematological disorder that manifests as fever, splenomegaly, and jaundice, with hemophagocytosis in the bone marrow and other tissues pathologically. Secondary HPS is associated with malignancy and infection, especially viral infection. The prevalence of cytomegalovirus (CMV) infection in ulcerative colitis (UC) patients is approximately 16%. Nevertheless, HPS in UC superinfected by CMV is very rare. A 52-year-old female visited the hospital complaining of abdominal pain and hematochezia for 6 days. She was diagnosed with UC 3 years earlier and had been treated with sulfasalazine, but had stopped her medication 4 months earlier. On admission, her spleen was enlarged. The peripheral blood count revealed pancytopenia and bone marrow aspiration smears showed hemophagocytosis. Viral studies revealed CMV infection. She was treated successfully with ganciclovir. We report this case with a review of the related literature.
Antiviral Agents/therapeutic use ; Colitis, Ulcerative/*complications/drug therapy ; Cytomegalovirus Infections/*complications/drug therapy ; Female ; Ganciclovir/therapeutic use ; Gastrointestinal Agents/therapeutic use ; Gastrointestinal Hemorrhage/etiology ; Humans ; Lymphohistiocytosis, Hemophagocytic/drug therapy/*virology ; Middle Aged ; Sulfasalazine/therapeutic use ; Superinfection/*complications

BACKGROUND/AIMS: Many studies on infliximab have confirmed its efficacy in the remission induction and even maintenance in refractory and fistulizing Crohn's disease. We report the treatment efficacy of infliximab in Crohn's disease and ulcerative colitis refractory to steroid treatment and the complications of infliximab treatment. METHODS: We performed infliximab administration in 5 cases (3 Crohn's disease, 2 ulcerative colitis) refractory to systemic steroid treatment and 5 cases of Crohn's disease with fistula. Patients received an intravenous infusion of infliximab at 3-5 mg/kg body weight. RESULTS: In 3 cases of refractory Crohn's patients, clinical response and remission induction were obtained in 2 (67%) and 1 cases (33%). After infusion of infliximab, the occlusion of internal fistula could be found in all 2 cases. Two out of 3 cases of anal fistula were completely healed. In two cases of refractory ulcerative colitis, one case who showed clinical manifestation of toxic megacolon had improved and avoided the colectomy, but the other case did not respond to the infusion of infliximab and underwent colon resection. CONCLUSIONS: We found that administration of infliximab is an effective alternative for refractory and fistulizing Crohn's disease but further studies are necessary for refractory ulcerative colitis.
Adolescent ; Adult ; Antibodies, Monoclonal/*therapeutic use ; Colitis, Ulcerative/complications/*drug therapy ; Crohn Disease/complications/*drug therapy ; English Abstract ; Female ; Gastrointestinal Agents/*therapeutic use ; Humans ; Intestinal Fistula/complications ; Male ; Middle Aged ; Tumor Necrosis Factor-alpha

Autoimmunity is thought to play a central role in the pathogenesis of inflammatory bowel disease and associated extraintestinal manifestations. Autoimmune hemolytic anemia associated with ulcerative colitis is a rare occurrence. No more than 50 cases have been described in the international literatures, and only 2 cases reported in Korea. A 29-year-old woman who was diagnosed as ulcerative colitis two years ago was complicated with autoimmune hemolytic anemia, and did not respond to steroid therapy. Ultimately, total colectomy and splenectomy were carried out for the treatment of ulcerative colitis and hemolytic anemia. After the operation, anemia was resolved. We present the case with a review of literature.
Adult ; Anemia, Hemolytic, Autoimmune/*diagnosis/drug therapy/etiology ; Colectomy ; Colitis, Ulcerative/complications/*diagnosis/pathology ; Drug Resistance ; Female ; Humans ; Splenectomy ; Steroids/therapeutic use

Segmental colitis associated with diverticular disease (SCAD) is a colonic inflammatory disorder with localized non-granulomatous inflammation at sigmoid colon, and associated with colonic diverticulosis. SCAD is an apparently uncommon disorder in Western. We experienced a rare case of SCAD in a 46-year-old woman who visited the hospital due to abdominal discomfort. Colonoscopic examination showed multiple sigmoid diverticula in association with a segment length colitis. Colonoscopic biopsies of the sigmoid colon demonstrated cryptitis and crypt abscess along with chronic inflammatory cells infiltration. The biopsies of the rectum was histologically normal. The patient was given the diagnosis of SCAD and treated with oral mesalamine. This is the first case of SCAD reported in Korea.
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Colitis/complications/*diagnosis/drug therapy ; Colon, Sigmoid/pathology ; Colonoscopy ; Diverticulitis, Colonic/complications/*diagnosis/drug therapy ; Female ; Humans ; Mesalamine/therapeutic use ; Middle Aged

BACKGROUND/AIMS: Cytomegalovirus (CMV) reactivations are frequently observed in patients with active ulcerative colitis (UC), and ganciclovir therapy is effective in patients with steroid-refractory UC. This study aimed to determine the long-term outcomes of CMV reactivation and the long-term therapeutic efficacy of ganciclovir treatment. METHODS: This retrospective multicenter study included a cohort of 72 patients with moderate-to-severe UC who were evaluated for CMV reactivation at the time of their initial UC flare. Colectomy, disease relapse, and the recurrence rate of CMV reactivation were investigated. RESULTS: The mean duration of follow-up for the 72 patients was 43.16+/-19.78 months (range, 1 to 67 months). The cumulative colectomy (log-rank, p=0.025) and disease flare-up rates (log-rank, p=0.048) were significantly higher in the CMV-positive group. Of the 11 patients who were successfully treated with ganciclovir in the initial treatment, three patients (27.3%) experienced CMV reactivation, and six patients (54.5%) experienced poor outcomes, such as the need for colectomy or a steroid-dependent state. CONCLUSIONS: The patients who had CMV-reactivated UC showed poor outcomes at the long-term follow-up, and the long-term efficacy of ganciclovir therapy was marginal. Careful assessment is necessary for patients who exhibit evidence of CMV reactivation.
Antiviral Agents/*therapeutic use ; Case-Control Studies ; Cohort Studies ; Colectomy/utilization ; Colitis, Ulcerative/complications/*drug therapy ; *Cytomegalovirus ; Cytomegalovirus Infections/complications/*drug therapy ; Ganciclovir/*therapeutic use ; Humans ; Longitudinal Studies ; Remission Induction ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome ; *Virus Activation

Amebic colitis is a disease revealing diverse clinical manifestations and endoscopic gross features and often confused with other types of colitis. In case of misdiagnosis as an idiopathic inflammatory bowel disease or delayed recognition of intestinal amebiasis, an undesirable outcome may occur resulting from erroneous administration of steroids or delayed antiamebic treatment. To demonstrate the pitfalls in the diagnosis and treatment of intestinal amebiasis, 3 cases of amebic colitis with atypical clinical manifestations are presented in this paper. In conclusion, despite the low sensitivities of routine stool examination for parasite and histopathologic confirmation in biopsy specimen, every effort must be made to find amebic trophozoites either in fresh stool or biopsy specimens for prompt and correct diagnosis of amebic colitis when we manage patients with chronic intestinal ulcerations, even though their clinical course and endoscopic findings are not typical of amebiasis. Moreover, following initial successful anti-amebic therapy, more careful clinical, endoscopical, and parasitological follow-up should be done for the early detection of recurrence.
Adult ; Aged ; Aged, 80 and over ; Colitis, Ulcerative/diagnosis ; Diagnosis, Differential ; Diarrhea/etiology ; Dysentery, Amebic/complications/drug therapy/*pathology ; Female ; Humans ; Inflammatory Bowel Diseases/diagnosis ; Male ; Middle Aged