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Massive gastrointestinal bleeding is rarely caused by infectious etiologies especially with esophageal localization. Even if Cytomegalovirus Infection (CMV) is not often encountered in the clinical practice, it has to be taken into account when the cause of GI hemorrhage is not obvious. We report a case of a 53 years old, male patient, with diabetes who is admitted in the hospital for cellulitis of the left calf and who developed massive hematemesis with no obvious source at the upper GI endoscopy. The patient was treated conservatory with PPI and transfusions of blood but he repeated the hemorrhage after 5 days with severe hypotension and a drop of hemoglobin to 6g/dl.The second endoscopy revealed massive clots in the esophagus with erythema and deep ulcers underneath while the stomach and duodenum were normal. Multiple biopsies were taken from esophageal ulcers and normal mucosa. We suspected viral esophagitis with CMV and we started treatment with Valganciclovir for 21 days with favorable clinical course. The infection was then confirmed by the pathology department and the immunohistochemical studies. The control endoscopy after one month showed healed esophageal ulcers with minimal residual lesions. [ABSTRACT FROM AUTHOR]

Massive gastrointestinal bleeding is rarely caused by infectious etiologies especially with esophageal localization. Even if Cytomegalovirus Infection (CMV) is not often encountered in the clinical practice, it has to be taken into account when the cause of GI hemorrhage is not obvious. We report a case of a 53 years old, male patient, with diabetes who is admitted in the hospital for cellulitis of the left calf and who developed massive hematemesis with no obvious source at the upper GI endoscopy. The patient was treated conservatory with PPI and transfusions of blood but he repeated the hemorrhage after 5 days with severe hypotension and a drop of hemoglobin to 6g/dl.The second endoscopy revealed massive clots in the esophagus with erythema and deep ulcers underneath while the stomach and duodenum were normal. Multiple biopsies were taken from esophageal ulcers and normal mucosa. We suspected viral esophagitis with CMV and we started treatment with Valganciclovir for 21 days with favorable clinical course. The infection was then confi rmed by the pathology department and the immunohistochemical studies. The control endoscopy after one month showed healed esophageal ulcers with minimal residual lesions. [ABSTRACT FROM AUTHOR]

Objectives: Over the past two decades has been a dramatic worldwide increase in both incidence and severity of Clostridium Difficile infection (CDI). Several studies showed worse clinical outcomes in Inflammatory Bowel Disease (IBD) patients with CDI, including longer hospital stay, higher colectomy and mortality rates than in those without CDI. The aim of our study was to evaluate the prevalence of Clostridium difficile infection in IBD patients and to evaluate the particularities of diagnosis and treatment. Methodology: We performed a retrospective study that included 15 patients from a group of 220 IBD patients admitted in the Gastroenterology Department of the Clinical Emergency Hospital Bucharest between 2013- 2016 having also Clostridium Difficile infection. Results: The patients mean age was 44.1 years. The prevalence of CDI in patients with inflammatory bowel disease was 6.81%. Patients with ulcerative colitis were more susceptible to CDI (86.6%), than those with Crohn's disease (13.3%). We studied also the response to treatment. Metronidazole alone was effective in 33.3% of cases. Vancomycin combined with Metronidazole was effective in 60% of cases. Refractory CDI unresponsive to 48 hours of conventional therapy appeared in 6.6% of cases. The eradication was achieved only with Tigecycline and fecal microbiota transplant. Imunosupressive therapy was continued in all cases, concomitant with Metronidazole/Vancomicin. Conclusions: Patients with ulcerative colitis are at higher risk for CDI and have a poor prognosis than those with Crohn's disease. Average age of CDI in IBD patients significantly is lower than in general population. In IBD patients, presenting with diarrhea or a change in bowel habits, practitioners need to test for C. difficile and differentiate CDI symptoms from a disease flare. Special care to rule out C. difficile should be pursued prior to escalating or starting new immunosuppressive agents. Fecal microbiota transplant, probiotics, and newer antibiotics are good alternatives for refractory disease. [ABSTRACT FROM AUTHOR]

Crohn's disease and intestinal tuberculosis (TB) share many clinical, radiological and endoscopic features. A definitive diagnosis in these cases is extremely important, to avoid the toxicity of unnecessary antituberculous therapy in patients with Crohn's disease and potentially fatal immunosuppressive treatment in patients with intestinal TB. A 42-year-old male presented with weight loss, recurrent fever, diarrhea, right iliac fossa pain, night sweats for several months. Abdominal ultrasonography with ileo-cecal wall thickening and retroperitoneal adenopathies and colonoscopy evaluation were thought to be consistent with Crohn's disease. However, the diagnosis was disseminated tuberculosis with lung and colon involvement based on the diffuse, bilateral small nodules seen on Chest X-ray and tuberculoid granulomas revealed on the colon biopsies. [ABSTRACT FROM AUTHOR]

Crohn's disease and intestinal tuberculosis (TB) share many clinical, radiological and endoscopic features. A defi nitive diagnosis in these cases is extremely important, to avoid the toxicity of unnecessary antituberculous therapy in patients with Crohn's disease and potentially fatal immunosuppressive treatment in patients with intestinal TB. A 42-year-old male presented with weight loss, recurrent fever, diarrhea, right iliac fossa pain, night sweats for several months. Abdominal ultrasonography with ileo-cecal wall thickening and retroperitoneal adenopathies and colonoscopy evaluation were thought to be consistent with Crohn's disease. However, the diagnosis was disseminated tuberculosis with lung and colon involvement based on the diffuse, bilateral small nodules seen on Chest X-ray and tuberculoid granulomas revealed on the colon biopsies. [ABSTRACT FROM AUTHOR]

Objectives: Over the past two decades has been a dramatic worldwide increase in both incidence and severity of Clostridium Diffi cile infection (CDI). Several studies showed worse clinical outcomes in Inflammatory Bowel Disease (IBD) patients with CDI, including longer hospital stay, higher colectomy and mortality rates than in those without CDI. The aim of our study was to evaluate the prevalence of Clostridium diffi cile infection in IBD patients and to evaluate the particularities of diagnosis and treatment. Methodology: We performed a retrospective study that included 15 patients from a group of 220 IBD patients admitted in the Gastroenterology Department of the Clinical Emergency Hospital Bucharest between 2013- 2016 having also Clostridium Diffi cile infection. Results: The patients mean age was 44.1 years. The prevalence of CDI in patients with inflammatory bowel disease was 6.81%. Patients with ulcerative colitis were more susceptible to CDI (86.6%), than those with Crohn's disease (13.3%). We studied also the response to treatment. Metronidazole alone was effective in 33.3% of cases. Vancomycin combined with Metronidazole was effective in 60% of cases. Refractory CDI unresponsive to 48 hours of conventional therapy appeared in 6.6% of cases. The eradication was achieved only with Tigecycline and fecal microbiota transplant. Imunosupressive therapy was continued in all cases, concomitant with Metronidazole/Vancomicin. Conclusions: Patients with ulcerative colitis are at higher risk for CDI and have a poor prognosis than those with Crohn's disease. Average age of CDI in IBD patients signifi cantly is lower than in general population. In IBD patients, presenting with diarrhea or a change in bowel habits, practitioners need to test for C. diffi cile and differentiate CDI symptoms from a disease flare. Special care to rule out C. diffi cile should be pursued prior to escalating or starting new immunosuppressive agents. Fecal microbiota transplant, probiotics, and newer antibiotics are good alternatives for refractory disease. [ABSTRACT FROM AUTHOR]