Scientific letter
Intestinal pseudopolyps in a patient with Crohn's disease and renal transplant – An unexpected diagnosis
Pseudopólipos intestinales en un paciente trasplantado renal y con enfermedad de Crohn – un diagnóstico inesperado
Marco Silva
, Elisabete Rios, Armando Peixoto, Guilherme Macedo
Corresponding author
Department of Gastroenterology – Centro Hospitalar de São João; Porto Medical School, Porto, Portugal
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He referred several trips to the Middle East in recent years and he was immunosuppressed with tacrolimus and prednisolone. Due to CD activity and malabsorption of immunosuppressive drugs, infliximab was initiated a few months after transplant, with clinical improvement. Two years later, the patient reported a slight increase of his bowel movements. Physical examination was relevant for hepatosplenomegaly. Lab workup showed pancytopenia and stool cultures were negative. The ileocolonoscopy showed scarring areas and pseudopolyps of the terminal ileum and the right colon (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Biopsies were performed in the right colon and in the terminal ileum, and the pathological exam revealed preservation of the glandular architecture of the mucosa, with an inflammatory lymphoplasmocytic infiltrate and macrophages with spherical and small amastigotes structures of <span class="elsevierStyleItalic">Leishmania sppI</span> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Polymerase chain reaction analysis of the biopsy specimens was performed and confirmed the presence of <span class="elsevierStyleItalic">Leishmania infantum</span>. HIV screening test was negative. The patient started therapy with liposomal amphotericin B.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Leishmaniasis is a chronic protozoan disease of the mononuclear phagocytic system.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleItalic">Leishmania spp</span> is endemic in several regions of the world, including the Mediterranean área.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The incubation period is usually long, and under conditions of immunosuppression, there is evidence of activation of latent infection several years after exposure to the parasite.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> TNF-α has a major role in mediating host protection against visceral leishmaniasis (VL), so the use of anti-TNF agents may potentially cause worsening or reactivation of latent infection.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Cutaneous leishmaniasis is the most common leishmanial syndrome worldwide.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> VL, which reflects dissemination of Leishmania parasites throughout the reticuloendothelial system, is potentially life threatening without treatment.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> VL is a systemic disease characterized by hepatosplenomegaly, fever, cachexia, hypergammaglobulinaemia, and pancytopenia.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Nevertheless, asymptomatic leishmanial infection has been reported previously.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The diagnosis of enteric VL is histological, requiring visualization of amastigotes inside macrophages of the intestinal lamina própria.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> A characteristic endoscopic image of this invasion has not been described so far, and the diagnosis is established by taking biopsies.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> A correct diagnosis of VL is challenging and easy to miss, especially in cases that are not clinically suspected, as the case reported. Liposomal amphotericin B is the preferred treatment choice.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 564 "Ancho" => 1500 "Tamanyo" => 95422 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ileocolonoscopy imaging showing scars and pseudopolyps of the terminal ileum and the ileocecal valve.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1892 "Ancho" => 1222 "Tamanyo" => 532647 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histological showing small amastigotes structures of <span class="elsevierStyleItalic">Leishmania spp</span>, in the right colon mucosa (A) and in the terminal ileum (B).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anti-tumour necrosis factor-induced visceral and cutaneous leishmaniasis: case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. 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| 2023 September | 14 | 4 | 18 |
| 2023 August | 11 | 0 | 11 |
| 2023 July | 10 | 4 | 14 |
| 2023 June | 17 | 0 | 17 |
| 2023 May | 12 | 1 | 13 |
| 2023 April | 15 | 2 | 17 |
| 2023 March | 18 | 1 | 19 |
| 2023 February | 14 | 1 | 15 |
| 2023 January | 9 | 3 | 12 |
| 2022 December | 12 | 4 | 16 |
| 2022 November | 29 | 13 | 42 |
| 2022 October | 24 | 17 | 41 |
| 2022 September | 22 | 10 | 32 |
| 2022 August | 22 | 13 | 35 |
| 2022 July | 21 | 14 | 35 |
| 2022 June | 28 | 16 | 44 |
| 2022 May | 24 | 9 | 33 |
| 2022 April | 34 | 8 | 42 |
| 2022 March | 42 | 8 | 50 |
| 2022 February | 25 | 3 | 28 |
| 2022 January | 40 | 9 | 49 |
| 2021 December | 17 | 10 | 27 |
| 2021 November | 18 | 8 | 26 |
| 2021 October | 39 | 7 | 46 |
| 2021 September | 26 | 7 | 33 |
| 2021 August | 21 | 4 | 25 |
| 2021 July | 46 | 4 | 50 |
| 2021 June | 16 | 7 | 23 |
| 2021 May | 18 | 5 | 23 |
| 2021 April | 23 | 16 | 39 |
| 2021 March | 30 | 8 | 38 |
| 2021 February | 28 | 10 | 38 |
| 2021 January | 40 | 5 | 45 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 1 | 0 | 1 |
| 2019 July | 1 | 0 | 1 |
| 2019 March | 3 | 2 | 5 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 43 | 20 | 63 |
| 2018 July | 0 | 1 | 1 |
| 2018 June | 0 | 1 | 1 |
| 2018 May | 0 | 4 | 4 |
Show all
