- |||||||||| A Case Report of Partial Small Intestinal Obstruction Secondary to Lupus Enteritis With Bowel Ischemia, Portal Vein Thrombosis and Secondary Antiphospholipid Syndrome (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_3153;
Eventually, anticoagulation with fondaparinux was started and overlapped with warfarin...Figure: Whole abdomen computed tomography scan with triple contrast showing persistent circumferential enhancing mucosal wall thickening (around 1 cm) in the distal jejunum, with associated mesenteric lymphadenopathies and mesenteric reactive changes (Figures A and B). Abdominal aortogram and venogram showing persistent intraluminal filling defect in the main portal vein, prior to the bifurcation of the left and right portal vein, suggestive of portal vein thrombosis (Figures C and D) with note of varices at the gallbladder fossa (Figure E) and peripancreatic region (Figure F)
- |||||||||| Invanz (ertapenem) / Merck (MSD)
Spontaneous Adrenal Insufficiency in a Decompensated Cirrhotic Patient (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_3069;
His home lactulose was uptitrated; he was hydrated with IV fluids and initiated on broad spectrum antibiotics which escalated to Ertapenem...He was pending discharge when he slowly became lethargic, hypotensive despite midodrine, hyponatremic to 124, and hyperkalemic to 6.1...Endocrine was consulted and recommended hydrocortisone and fludrocortisone...Diagnosis occurs through AM cortisol testing with ACT Stimulation tests. Definitive treatment and resolution of symptoms occur through corticosteroids.
- |||||||||| Gamifant (emapalumab-lzsg) / SOBI
Does the H Stand for Herpes Simplex or Hemophagocytic Lymphohistiocytosis? A Challenging Case of Acute Liver Failure (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_3043;
The patient was started on IV methylprednisolone for presumed HLH...Within the first day, ferritin levels dropped to 365 though he continued to deteriorate clinically with worsening hemodynamic instability, respiratory failure, and encephalopathy despite addition of etoposide and emapalumab...Despite challenges, it is imperative to distinguish these two entities due to risks of worsening infection with HLH-directed immunosuppression. We recommend a high degree of suspicion for HSV-1 in febrile patients with ALF, even if immunocompetent, as early acyclovir therapy has the potential to improve outcomes.
- |||||||||| Avastin (bevacizumab) / Roche, Mavyret (glecaprevir/pibrentasvir) / AbbVie, Enanta Pharma, Tecentriq (atezolizumab) / Roche
A Rare Case of Drug-Induced Immune Thrombocytopenia From Hepatocellular Carcinoma Treatment (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_3041;
Case Description/ A 65-year-old male with Mavyret-treated HCV and alcoholic cirrhosis complicated by metastatic HCC, on active treatment with Atezolizumab/Bevacizumab, presented for hemoptysis and a bleeding lip ulcer...He was evaluated by hematology for ITP concerns and was started on IVIG and pulse dose dexamethasone...Thrombocytopenia in patients with melanoma receiving immune checkpoint inhibitor therapy. 2017 Feb 21 Figure: Title: Platelet count during the hospital stay x-axis: Number of lab draw y-axis: Platelet count arrow: Platelet transfusion
- |||||||||| From Baby Joy to Liver Ploy: Ante-Partum HLH (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_3009;
2017 Feb 21 Figure: Title: Platelet count during the hospital stay x-axis: Number of lab draw y-axis: Platelet count arrow: Platelet transfusion Patient
- |||||||||| Nucala (mepolizumab) / GSK
Eosinophilic Gastrointestinal Disease Presenting With Eosinophilic Hepatitis (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_3000;
Management of these patients involves immunosuppression with systemic steroids, although there may also be a role for biologics such as anti-IL-5 agents. Eosinophilic hepatitis is an uncommon diagnosis yet should remain on the differential for patients with evidence of hepatitis and other hypereosinophilic syndromes.
- |||||||||| prednisone / Generic mfg., hydrocortisone / Generic mfg., sterile N-Acetylcysteine / Generic mfg.
Colon Cleanse Revenge Fenbendazole Causes Severe Drug-Induced Liver Injury (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2984;
Eosinophilic hepatitis is an uncommon diagnosis yet should remain on the differential for patients with evidence of hepatitis and other hypereosinophilic syndromes. Poison control was consulted and suggested a 21-hour IV N acetylcysteine protocol...Thus, the patient was determined not responding to NAC therapy and Cortef was started...After 9 days of hospitalization the patient
- |||||||||| Actemra IV (tocilizumab) / Roche, JW Pharma
Early Tocilizumab as a Rescue Therapy for SteroidDependent Immune Checkpoint Inhibitor-Mediated Hepatotoxicity: A Case for Decoupling Steroid Dependency (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2982;
He received 2 cycles of ipilimumab and nivolumab (8/2022 and 10/2022)...Ursodiol was empirically started 10 days later...IV methylprednisolone was initiated (30 mg for 2 doses, 55 mg for 4 doses), which curtailed further ALT increase...This mitigated hyperglycemic issues, for instance, and patient did not require other adjuncts such as mycophenolate mofetil...Instead, a relatively rapid steroid taper was possible, with the expectation that tocilizumab would offer the remainder of the therapeutic response towards biochemical remission, effectively decoupling the toxicity from steroid dependency. Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase; GGT, gamma-glutamyl transferase; d, day; IV, intravenous; MP, methylprednisolone; pred., prednisone; TCZ, tocilizumab; Nivo, nivolumab.
- |||||||||| Actemra IV (tocilizumab) / Roche, JW Pharma
Implementation of an Enhanced "Step-Up" Approach Towards Early Tocilizumab for Management of Immune Checkpoint Inhibitor-Mediated Hepatotoxicity: A Case Study in Revisiting Paradigms of Treatment (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2981;
After starting induction IV methylprednisolone (MP) 93.75 mg followed by 60 mg/d and then prednisone, ALT improved to 368, but it subsequently rose again to 976...Prompt identification of steroid-resistance allowed for escalation to early TCZ, without requiring mycophenolate mofetil...Because tocilizumab allows for decoupling of steroids, tocilizumab was administered followed by an accelerated steroid taper to compress the steroid exposure. Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase; GGT, gamma-glutamyl transferase; Ipi, ipilimumab; Nivo, nivolumab; d, day; IV, intravenous; MP, methylprednisolone; pred., prednisone; TCZ, tocilizumab.
- |||||||||| Keytruda (pembrolizumab) / Merck (MSD)
A Case of Delayed Imm (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2970;
We present a case of a 78 year old patient with a past medical history of malignant melanoma who presented with painless jaundice and elevated liver enzymes and found to have biopsy proven hepatitis secondary to immune checkpoint therapy three years after receiving treatment with pembrolizumab...The decision was made to start the patient on intravenous methylprednisolone 1 mg/kg/day for three days and sent home on prednisone taper with resolution of liver enzymes after 6 weeks...Figure: Pathology of immune check point inhibitor hepatitis. Hematoxylin and eosin stain of hepatocytes demonstrating lymphocytic aggregation and fibrosis.
- |||||||||| Keytruda (pembrolizumab) / Merck (MSD)
An Unusual Presentation of Immune Checkpoint Inhibitor Hepatotoxicity With Cholestatic Transaminitis (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2934;
He had a medical history of lung cancer treated with pembrolizumab which was discontinued six months prior for concerns of possible ICIH...Oncology recommended IV solumedrol and increasing tacrolimus to 1 mg twice daily...The patient was discharged home and was transitioned to oral prednisone at 2 mg/kg/day, tacrolimus 1 mg twice daily, and mycophenolate mofetil at 1,000 mg twice daily...As such, alternative pathophysiology for CICIH must be considered. This may help to tailor treatment in the future.
- |||||||||| lenalidomide / Generic mfg., dexamethasone injection / Generic mfg.
Isolated Hyperbilirubinemia - A Rare Initial Presentation of Multiple Myeloma (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2923;
However, only rare cases have been reported of massive plasma cell infiltration of the liver that leads to non-obstructive cholestasis with possible progression to liver failure. Gastroenterologists must harbor a high index of suspicion for this presentation so as to avoid delayed diagnosis and treatment.
- |||||||||| prednisone / Generic mfg., carvedilol / Generic mfg., hydrocortisone / Generic mfg.
Myocarditis in Ulcerative Colitis - Complication of Disease or Therapy? (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2738;
Myocarditis can also develop as an extra-intestinal manifestation of UC flare-up. Irrespective of the cause, albeit mesalamine toxicity or UC flare-up, early recognition of myocarditis as an etiology of hemodynamic instability in UC patients and treatment with a combination of increased steroid dose and stopping mesalamine can prevent the cascade of shock and respiratory failure.
- |||||||||| Remicade (infliximab) / Merck (MSD), Mitsubishi Tanabe, J&J
A Case of Acute Severe Ulcerative Colitis in a Hospitalized Patient With a Positive QuantiFERON (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2721;
This case report describes the effectiveness of aggressive biologic such as infliximab in ASUC after failure of IV steroids despite her latent TB. Early recognition of ACUS enables the physician to construct an appropriate treatment plan for the individual patient given their unique presentation including early surgical consult if colectomy is needed.
- |||||||||| Humira (adalimumab) / AbbVie
Rash and Remedy: Leukocytoclastic Vasculitis Associated With Adalimumab Therapy in Crohn's Disease (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2719;
After improving, he was discharged on a prolonged prednisone taper...There should be further discussion about deciding which biologic therapy to switch to based on side effect profiles. Figure: Figure 1: Images of skin lesions on thigh (A), lateral ankle (B), medial ankle (C), sole (D), forefoot (E), and elbow (F).
- |||||||||| Humira (adalimumab) / AbbVie
An Atypical Case of Yersinia enterocolitica Infection in a Patient Suspected With Ulcerative Colitis Flare-Up (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2718;
Owing to the chief complaints and prior history, she suspected to have an UC flare-up, and was started on IV Solu-Medrol 40 mg every 8 hours with IV fluids...She was transitioned to supportive care with hydration and nutritional support but was continued on her chronic home dose of prednisone and Humira to prevent flare-ups...At the same time, it could be possible that having ulcerative colitis was a risk factor for an enteric infection like Yersinia, especially when you consider that many patients with ulcerative colitis are on immunosuppressive drugs. Figure: CT Abdomen/Pelvis conducted during the time of admission
- |||||||||| Remicade (infliximab) / Merck (MSD), Mitsubishi Tanabe, J&J, Avsola (infliximab-axxq) / Amgen
Therapeutic Hemicolectomy for Intractable Hemorrhage in New-Onset Fistulizing Crohn (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2716;
Figure: Figure 1: Multiple oozing ulcers visualized in the descending colon Figure 2: Active bleeding visualized throughout the ascending colon Figure 3: Large clot present in the sigmoid colon. Figure 4: Normal appearing ileum with an iatrogenic petechia.
- |||||||||| Remicade (infliximab) / Merck (MSD), Mitsubishi Tanabe, J&J, Entyvio (vedolizumab) / Takeda
Hyperbaric Oxygen Enabled a Transition to Oral Steroids in an Acute Severe Ulcerative Colitis Flare (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2715;
Case Description/ 71-year-old female with extensive ulcerative colitis on infliximab presented with abdominal pain and more than 10 bloody bowel movements per day...She was started on hydrocortisone 100mg IV every eight hours and given one dose of vedolizumab with improvement in her CRP from 56 to 40...She was discharged on oral prednisone and outpatient vedolizumab infusions...Blue lines show stool frequency. She was discharged on HD 12 and had a follow up appointment on day 25 after admission.
- |||||||||| Remicade (infliximab) / Merck (MSD), Mitsubishi Tanabe, J&J
Don (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2714;
Case Description/ A 17-year-old male with newly diagnosed fistulizing ileocolonic Crohn's disease and no known allergies, was initiated on IFX 5mg/kg and weekly methotrexate 12.5 mg...Prior to the second infusion, he was premedicated with diphenhydramine and IV methylprednisolone...IFX desensitization was performed and on each subsequent visit, he received montelukast, loratadine, IV diphenhydramine, famotidine, and methylprednisolone...Successful desensitization has been reported in other biologics including ustekinumab and adalimumab. Although multiple other advanced therapies are available to treat patients with IBD, desensitization should remain an option in select cases.
- |||||||||| Rinvoq (upadacitinib) / AbbVie
Upadacitinib - A Treatment Alternative for Severe Ulcerative Colitis in the Hospital (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2713;
It involves intravenous corticosteroids and addition of biologic agents or cyclosporine...Failed oral prednisone and mesalamine, adequate Infliximab trough level and no antibodies...Started intravenous methylprednisolone day 1, added Upadacitinib 45 mg orally day 2...Was on Adalimumab, stopped in 2014 due to side effects...However, clinical trials to study use in this population is required. There may be a significant cost advantage to the hospital compared to biologics in the inpatient setting.
- |||||||||| capecitabine / Generic mfg.
Drug-Induced Collagenous Colitis Secondary to Capecitabine (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2710;
Three years ago, the patient was diagnosed with grade 3 invasive ductal carcinoma and lymphovascular invasion and underwent chemotherapy with doxorubicin, pegfilgrastim, and cyclophosphamide...The patient was prescribed budesonide...Several studies have reported the effect of these medications and collagenous colitis, however, there is no evidence for a causal relationship. While these studies discussed many drugs, from our review of the literature, none have noted capecitabine as a potential causative agent for drug-induced collagenous colitis.
- |||||||||| dexamethasone / Generic mfg.
Adrenocortical Carcinoma Presenting as Abdominal Pain (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2477;
An extensive endocrinology work up showed normal dexamethasone, ACTH, and cortisol (no Cushing syndrome), normal DHEA, testosterone, and estrogen (no masculinization or feminization), normal aldosterone and renin (no Conn syndrome), normal norepinephrine, epinephrine, normetanephrine, metanephrine, and dopamine (no pheochromocytoma)...This case shows that abdominal pain presenting to GI can be caused by a non-GI etiology. Cooperation with surgery, endocrinology, oncology, and radiation oncology is crucial in the treatment of ACC.
- |||||||||| Dupixent (dupilumab) / Sanofi, Regeneron
Double Trouble: Eosinophilic Esophagitis and Barrett (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2399;
She was started on omeprazole 40 by mouth twice daily but reported poor symptomatic response prompting transition to fluticasone 440mcg swallowed twice daily and once daily omeprazole...Patient was transitioned to dupilumab 300mg subcutaneously once weekly and continued omeprazole for chemoprophylaxis with plans for a repeat EGD...Repeat EGD with proximal esophageal stricture and expected treatment effect (mucosal rent) after dilation with standard gastroscope. Barrett
- |||||||||| ampicillin/sulbactam / Generic mfg., dexamethasone / Generic mfg.
Proximal Esophageal Rupture Secondary to Sexual Assault (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2396;
B: X-Ray esophagram with oral contrast that is consistent with leak involving the posterior aspect of the distal pharynx and proximal esophagus with extravasation of contrast posteriorly (arrow)?. C: X-Ray esophagram with oral contrast that revealed no leak of contrast into the cervical paraesophageal tissues after two weeks?.
- |||||||||| budesonide / Generic mfg., fluticasone / Generic mfg.
Topical Steroids: An Effective Treatment Option for Lymphocytic Esophagitis (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2395;
She took budesonide for 3 months; while she endorsed improvement in dysphagia, repeat EGD showed persistent LE...She received one month of inhaled fluticasone without improvement in symptoms; however, repeat EGD showed resolution of LE...Figure: Figure 1. Histologic sections show stratified epithelium with numerous intraepithelial lymphocytes and intraepithelial edema (spongiosis) with occasional dyskeratotic cells.
- |||||||||| Darzalex (daratumumab) / J&J
Beyond the Bone Marrow: Uncommon Manifestation of Multiple Myeloma - A Case Report of Extramedullary Esophageal Involvement (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2354;
The patient was started on chemotherapy and received 1 cycle of cyclophosphamide, bortezomib and dexamethasone (CyborD) followed by 3 cycles of daratumumab, bortezomib, lenalidomide and dexamethasone (DARA-VRd)...Patient received 1 cycle of dexamethasone, and 4-day continuous of cisplatin, doxorubicin, cyclophosphamide and etoposide (D-PACE)...D: Esophageal mass biopsy showing hematolymphoid neoplasm with plasmacytic immunophenotype. E: Bone marrow with trilineage hematopoiesis and no evidence of plasma cell neoplasm.
- |||||||||| Cinqair (reslizumab) / Merck (MSD), UCB, Teva, Dupixent (dupilumab) / Sanofi, Regeneron
Comparative Efficacy of Pharmacotherapy in Eosinophilic Esophagitis: A Network Meta-Analysis (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2325;
Our search yielded a total of 20 RCTs with 19 discrete interventions and 1430 patients randomized. Compared to placebo, the following interventions improved histology (based on study definitions): Dupilumab weekly (RD: 0.56, CI 0.38-0.74), Dupilumab q2weekly (RD: 0.56, CI: 0.28-0.83), Esomeprazole (RD: 0.67, CI: 0.33-1.00), Oral viscous budesonide (OVB) medium dose (RD: 0.54, CI: 0.33-0.75), OVB high dose (RD: 0.68, CI: 0.51
- |||||||||| budesonide / Generic mfg.
A Rare Case of Microscopic Colitis With Adjacent Metastatic Serous Carcinoma and Focal Intramucosal Carcinoma of the Colon (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2141;
Treatment of MC varies based on severity, but medical therapy (e.g., budesonide) remains first-line with surgical intervention reserved for refractory cases. Figure: Focal intramucosal carcinoma arising from a tubulovillous adenoma in the ascending colon is shown in A. Cells in the transverse colon with abundant cytoplasm, marked atypia, and prominent nucleoli consistent with metastatic serous carcinoma are shown in B. Colonic mucosa with moderate chronic inflammation with lymphocytosis and lymphoid aggregates compatible with microscopic/lymphocytic colitis is shown in C. Nodular rectum is shown in D, the transverse colon mass-like lesion is shown in E, and the ascending colon mass-like lesion is shown in F.
- |||||||||| budesonide / Generic mfg.
Neither One nor the Other: Lymphocytic Enterocolitis as the Cause of Chronic Diarrhea (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2129;
Given histologic findings patient was treated with budesonide and achieved complete resolution of his symptoms...Literature review describes similar cases of patients with a sprue that is refractory to gluten free diet and that have been subsequently found with both upper and lower GI lymphocytic infiltrates. This condition has been termed lymphocytic
- |||||||||| Erbitux (cetuximab) / Eli Lilly, EMD Serono
There Is More to the Folds: The Challenges of Menetrier (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1892;
The patient was discharged in a stable condition with a plan to initiate cetuximab...Figure: EGD showing diffuse, hypertrophic gastric folds (A, B) and deep tissue gastric fold biopsy taken with endoscopic mucosal resection (B). Low power magnification (2x) of the gastric mucosa with foveolar hyperplasia, superficial shallow erosions, tortuous gastric pits, and occasional cystic glandular dilatation (C).
- |||||||||| Dupixent (dupilumab) / Sanofi, Regeneron
Beyond the Esophagus: Dupilumab (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1889;
Despite continuing with budesonide slurry and PPI, repeat EGD showed persistent gastric ulcer for over the next 6 years...Figure: Fig 1a: EGD showing patient's gastric ulcer, indicated by yellow arrow, upon initial discovery. Fig 1b: EGD showing patient's gastric ulcer, indicated by yellow arrow, after 6 months of dupilumab treatment.
- |||||||||| Remicade (infliximab) / Merck (MSD), Mitsubishi Tanabe, J&J, Keytruda (pembrolizumab) / Merck (MSD), Entyvio (vedolizumab) / Takeda
Immunotherapy-Induced Isolated Gastritis in a Tonsillar Cancer Case (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1845;
Patient responded well, with no further hematemesis, and was discharged on Prednisone taper...In some cases, Vedolizumab and Infliximab have been tried with success in treating this infamous immune mediated side effect...Promptly recognizing toxicity in ICI-treated patients and initiating corticosteroids can aid in quick symptomatic relief, improving quality of life and uninterrupted care. Figure: Ulcerated Gastric Mucosa
- |||||||||| Rituxan (rituximab) / Biogen, Zenyaku Holdings, Roche
Rheumatoid Vasculitis: An Unusual Cause of Abdominal Pain in an Older Patient (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1794;
She was on multiple medications for her RA including prednisone, methotrexate and rituximab...Her rheumatologist increased her oral prednisone from 30mg to 60mg daily, gave her two doses of IV methylprednisolone, and started monthly IV cyclophosphamide (375 mg/m 2 )...Figure: Figure 1 (A, B): MRA shows stenosis of the celiac and superior mesenteric artery in a patient with long-standing severe rheumatoid arthritis (A). MRA shows significant improvement after aggressive immunotherapy (B).
- |||||||||| Development of Celiac Disease After Immunotherapy for Psoriasis, Breast Cancer, and Renal Cell Carcinoma: A Case Series (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1756;
Case Description/ A 21 year old female with psoriasis on ixekizumab (IL-17A antagonist) and recent dose of risankizumab (IL-23A antibody) presented with abdominal pain, diarrhea, and bloating...Colonoscopy showed lymphocytic colitis, and she started budesonide and gluten free diet with some improvement...A 49 year old female with invasive ductal carcinoma was treated with leuprolide, exemestane, trastuzumab and pertuzumab (anti-HER2 antibodies) and developed severe watery diarrhea requiring hospitalization for electrolyte abnormalities and total parenteral nutrition...An 82 year old male with metastatic renal cell carcinoma was treated with axitinib, complicated by diarrhea requiring dose reduction, and pembrolizumab, discontinued due to colitis requiring prednisone, then cabozantinib, complicated by diarrhea which persisted after dose reduction...Figure: Figure: Duodenal Biopsy of Case 3, Celiac Disease in an 82 year old male with metastatic renal cell carcinoma treated with axitinib, pembrolizumab, and cabozantinib. (A) Routine H&E staining of a duodenal biopsy showed subtotal to total villous atrophy, (B) Duodenal biopsy with thickened sub-epithelial collagen layer highlighted on trichrome stain, (C) Duodenal biopsy with intraepithelial lymphocytosis confirmed by CD3 immunohistochemistry Table: Immunotherapies and Presentations of Celiac Disease
- |||||||||| fluticasone / Generic mfg.
Nonadherence in Pediatric Eosinophilic Esophagitis (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1653;
The median age at first visit was 10.5 years and the majority of patients were white and male. The median length of follow up was 3 years (IQR 1.1-5.8) with 6 clinic visits (IQR 3-10).
- |||||||||| budesonide / Generic mfg., albendazole / Generic mfg., acetylcysteine solution / Generic mfg.
Is It Safe to Take Your Dog (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1602;
N-acetylcysteine was empirically started...A liver biopsy was performed, and budesonide was started...Albendazole which is commonly used in humans has been associated with LFT elevation and even acute liver failure and death...Our patient exhibited a hepatocellular injury pattern with improvement upon fenbendazole discontinuation and lack of other identifiable causes of liver injury. Figure: Liver biopsy demonstrating pathologic features consistent with Severe Drug-Induced Liver Injury (A) Zone 3-predominant (centrilobular) collapse with hepatocyte dropout (B) Central Vein (C) Acidophil bodies (D) Portal triads with lymphocyte-predominant inflammatory infiltrates
- |||||||||| budesonide / Generic mfg.
A Rare Case of Non-Cirrhotic Portal Hypertension Caused by Necrobiotic Xanthogranuloma (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1556;
The most common causes of NCPH is chronic infections, medications, thrombophilia, autoimmune disorders, and genetic disorders. NXG should remain on the differential for patients with NCPH without a known cause, as half cases of NCPH do not have a formal diagnosis to account for the patient
- |||||||||| Nafcillin-Induced Liver Injury: Idiosyncratic vs Intrinsic? (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1547;
DILI is a leading cause of acute liver failure and transplantation in Western countries and remains a challenging diagnosis due to a wide variety of causes, clinical presentation, and lack of objective diagnostic tests. Due to its unpredictability and high associated morbidity and mortality; further studies may delineate the role of measuring initial and subsequent liver enzymes while being treated with known causative agents.
- |||||||||| furosemide / Generic mfg., fluticasone propionate/salmeterol xinafoate inhalation powder / Generic mfg.
A Curious Case of Happy Hypoxia in NASH Cirrhosis (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1543;
This alludes to underlying diagnosis of HPS, a management conundrum in the acute setting, associated with dismal outcomes and is an indication independent of MELD for LT. 4
- |||||||||| Opdivo (nivolumab) / Ono Pharma, BMS, Yervoy (ipilimumab) / Ono Pharma, BMS
When Corticosteroids Are Not Sufficient in ImmuneRelated Hepatitis (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1533;
After failure of response to neoadjuvant chemotherapy for his unresectable sarcoma, he has been started on ipilimumab and nivolumab...He was admitted for IV methylprednisolone at 2 mg/kg daily...He was started on Azathioprine (AZA) and prednisone was continued...This decreased the threshold for obtaining a liver biopsy, which is recommended for steroid-refractory disease, Grade 3 or higher hepatitis or if suspicion is present for DILI or AIH. Figure: Moderate chronic lobular hepatitis with centrizonal accentuation and a lymphoplasmacytic inflammatory infiltrate (H and E, x100)
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