Introduction: Collagenous colitis (CC) is a rare condition that is known to complicate inflammatory bowel diseases, but its relationship with celiac disease (CD) is more controversial. Aims: To report a case of CC that developed in a patient with CD and was manifested by rectal erosions at onset. Case report: A 46-year-old woman was diagnosed with CD and placed on a gluten-free diet. After an initial phase of improvement, her diarrhea resumed, and she began to lose weight. Despite strict adherence to the diet, the patient's diarrhea worsened. One year after diagnosis, colonoscopy was performed and mucosal biopsies were collected, but the findings were inconclusive. Two months later, the previously watery diarrhea became bloody, and a second colonoscopy was performed. Histological examination of the biopsy specimens revealed rectal erosions and CC. The patient was treated with oral prednisone plus mesalazine for 6 weeks, and her symptoms immediately disappeared. Mesalazine was continued, and the prednisone was then gradually replaced with budesonide. Six months after the CC diagnosis, the patient was asymptomatic, and a second colonoscopy revealed no macroscopic or microscopic signs of CC. She continues to take mesalazine and budesonide. An attempt to taper the dosage of the latter drug from 6 to 3 mg/day caused the reappearance of the diarrhea. Conclusion: CC is rarely associated to CD and can cause bloody diarrhea. Excellent results were obtained in this case with prednisone plus mesalazine followed by maintenance therapy with budesonide plus mesalazine.
Budd-Chiari syndrome may be defined as a heterogeneous group of vascular disorders characterized by obstruction of hepatic venous return to the level of hepatic venules, supra-hepatic veins, inferior vena cava or right atrium. The main cause of this syndrome is represented by myeloproliferative diseases and, in particular, by polycythemia vera. The latter may cause multiple splanchnic thrombosis, including portal vein thrombosis, particularly important for its clinical outcomes (ascites, collateral vessels genesis, etc.). We report 2 cases of a Budd-Chiari syndrome induced by polycythemia vera characterized by an abnormal clinical onset, both as regards subjects’ age (29 and 39 years old, respectively) and set of symptoms, signs and laboratory data. After a complete clinical, instrumental and genetic diagnosis, the patients were treated with combined therapy, using acetylsalicylic acid and hydroxyurea. The therapy proved successful and patients are still in follow up in our institution. Polycythemia vera should be suspected in patients affected with portal vein thrombosis and Budd-Chiari syndrome even if its clinical onset might be unusual. Every effort should be made to make a correct and early diagnosis in order to start appropriate therapy as soon as possible and to prevent patients from useless diagnostic and therapeutic treatments.
Mediterranean spotted fever (MSF) is an infectious disease endemic in the southern regions of Italy, with an incidence of about 400 cases/year. The bacteria responsible of the disease is Rickettsia conorii, transmitted to humans by Rhipicephalus sanguineus, the common dog tick. The infection usually manifests with a characteristic symptomatologic triad: fever, exanthema and the so called tache noire, which is the typical eschar at the site of the tick bite. Immunoglobulin M (IgM) and IgG enzymelinked immunosorbent assay and the gold standard micro-immunofluorescent assay, allow serological diagnosis. We report the case of a man suffering from MSF, whose atypical presentation and false-negative diagnostic tests delayed consistently diagnosis and therapy. Afterwards we review the literature about this topic. Contributions: PM and AS studied the case, reviewed literature and wrote the paper; AB, TC and GP studied the case; AD'A and CC studied the case and reviewed literature; AC coordinated the study group, reviewed literature and wrote the paper.Conflict of interest: the authors declare no potential conflict of interest.
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