Asian Journal of Research and Reports in Gastroenterology

Intragastric Foreign Body: A Case Study

2026-01-20T12:24:48+00:00

We report the case of a 25-year-old female patient seen in consultation for foreign body ingestion. The patient had swallowed a toothbrush for 10 days. The study aims to report and analyse a case of an intragastric foreign body, highlighting its diagnosis, management, and outcomes. After swallowing the brush, she consulted a health facility where a laxative and analgesic-based treatment was instituted, and she was reassured that the brush would come out in the stool. When she failed to see the brush in the stool and experienced additional abdominal pain, she consulted us for treatment.

She had no previous medical or surgical history. Oesogastroduodenal endoscopy revealed a toothbrush, part of which was downstream of the pylorus. We attempted extraction using the diathermic loop. After several unsuccessful attempts, we observed the lower part of the brush embedded in the wall (or mucosa) of the descending duodenum (D2), with suspected perforation. We therefore proposed surgical management, which involved the extraction of a toothbrush by approaching the duodenal bulb, followed by epiplooplasty. Post-operative management was straightforward. Foreign body ingestion is most often accidental, as in our patient. Endoscopy remains the most appropriate extraction method, but if extraction by this route is not possible, surgery remains a good alternative.

Evaluation of the Knowledge and Practical Attitudes of General Practitioners Regarding Helicobacter pylori Infection in the Bamako District, Mali

2026-01-20T13:14:50+00:00

Background: Helicobacter pylori (H. pylori) infection is one of the most widespread bacterial infections worldwide and a major public health problem in developing countries. It is implicated in the development of numerous digestive disorders, including chronic gastritis, peptic ulcers, and certain gastric cancers. In Mali, the high prevalence of the infection and the heterogeneity of medical practices justify an assessment of general practitioners' knowledge and attitudes toward this disease.

Objective: The study aims to evaluate the knowledge and practical attitudes of general practitioners working in the Reference Health Centres (CSREF) of the Bamako district. Methodology: This was a descriptive cross-sectional study conducted from March 20, 2024, to March 31, 2025, among general practitioners at community health centres (CSREFs) in the six communes of the Bamako district. Data were collected using a structured questionnaire assessing knowledge, diagnostic attitudes, and therapeutic practices. Statistical analysis was performed using SPSS software, employing the chi-square and Fisher's exact tests with a significance threshold set at p < 0.05.

Results: The study included 109 general practitioners, predominantly male (65.1%), with a predominance of practitioners under 30 years of age (40.4%). Almost all (92.7%) had already diagnosed with a case of H. pylori infection. Epigastric pain was the most frequently reported symptom (86.2%). The most commonly mentioned routes of transmission were oral-oral (63.3%) and faecal-oral (55.9%). Gastroduodenal ulcer (98.2%), gastric cancer (70.6%), and chronic gastritis (64.2%) were the most frequently associated pathologies. Regarding indications for screening, a gastroduodenal ulcer was the most frequently cited (97.2%). Serology was the most commonly used first-line diagnostic test (68.8%), while only 19.3% used the breath test. Therapeutic practices were variable, and the use of recommended protocols remained uneven.

Conclusion: This study highlights significant disparities in the knowledge and practices of general practitioners regarding H. pylori infection in the Bamako district and international guidelines. Improved continuing education and the dissemination of updated recommendations are necessary to optimise the management of this infection.

The Significance of Eosinophils in Acute Appendicitis: A Comparative Study

2026-02-05T06:44:53+00:00

Background: Acute appendicitis is one of the most common abdominal emergencies worldwide. Bacterial infection is the most common cause. Even though it is rare, acute eosinophilic appendicitis (AEA) is an overlooked entity by both clinicians and histopathologists in Sri Lanka that may contribute to the clinical presentation of acute appendicitis.

Objectives: This study aimed to evaluate the prevalence of AEA compared to a control group from post-mortem cases unrelated to sepsis and to increase awareness among clinicians to consider it in the differential diagnosis and the possibility of treating medically in addition to usual treatment with antibiotics.

Methodology: Previously reported appendectomy cases (N=257) were reassessed by two histopathologists blinded to each other. The frequencies of possible causes of all cases with concordant diagnoses were compared to the control group. Fisher’s Exact Test was used to compare the prevalence of AEA between groups.

Results: Acute eosinophilic appendicitis was identified in 16/257 (6.22%) of the study group and in 0/100 (0%) of the control group. The difference in prevalence was statistically significant (Fisher’s Exact Test, p = 0.0045), supporting AEA as a probable cause for clinical appendicitis.

Conclusions and Recommendations: AEA may represent an overlooked contributor to acute appendicitis. As it is a type I hypersensitivity reaction, there is a possibility of treating it medically. Increased recognition of this entity could be considered as a hypothesis and develop more studies on it to reduce surgical interventions. Clinical trials by surgeons may value further validating these findings. This is a flatform for future studies and invention of novel investigations on that.

Factors Associated with Hepatocellular Carcinoma at Gabriel Touré University Hospital, Bamako, Mali

2026-02-06T10:19:47+00:00

Introduction: Hepatocellular carcinoma (HCC) is a major public health problem in developing countries, particularly in sub-Saharan Africa.

Objective: To evaluate the factors associated with hepatocellular carcinoma (HCC) in patients admitted to the hepatogastroenterology department of the Gabriel Touré University Hospital.

Study Setting and Methods: This was a prospective, observational, case-control study of incident and control HCC cases between February 2024 and January 2025. We conducted a 1:1 matched case-control study (matched by sex and age) involving 218 patients, comprising 109 HCC cases and 109 controls.

Results: Our study found a prevalence of 11.8%, with a male-to-female ratio of 5:1. The mean age was 48 years. A significant association was found with HBV infection (OR = 24.17; p = 0.01), alcohol and tobacco use (OR = 4.06; p = 0.02), tobacco use alone (OR = 2.23; p = 0.05), and the use of traditional medicines (OR = 3.27; p = 0.001). The majority of cases were diagnosed at an advanced stage (85.32% were classified as BCLC D), indicating a poor prognosis.

Conclusion: Hepatocellular carcinoma is common in our region. Its diagnosis is most often delayed, and its prognosis therefore remains poor. This study highlights the need for early screening and a targeted prevention strategy that takes into account local specificities.

Early-Onset Gastric Cancer in Casablanca, Morocco: A 10-Year Epidemiological and Etiological Retrospective Study

2026-03-24T07:43:10+00:00

Background and Objective: Gastric cancer remains a major cause of mortality worldwide. It is frequently diagnosed in elderly individuals. However, its incidence is increasing among young patients (≤40 years). Gastric cancer in young subjects often presents particular clinical and etiological characteristics that may differ from those observed in older populations. The main risk factors include Helicobacter pylori infection, smoking, and a family history of gastric cancer. This trend has been reported in some Moroccan studies. However, no specific local study focusing on this population has been conducted, hence the relevance of our work. The objective of this study was to establish the epidemiological and etiological profile of gastric cancer in young subjects.

Materials and Methods: This was a retrospective study conducted in the Hepato-Gastroenterology Department over a 10-year period, between September 2015 and August 2025. All patients aged 16 to 40 years hospitalized for histologically confirmed primary gastric cancer were included. Data, included demographic characteristics, risk factors, clinical presentation, diagnostic delay, histopathological findings, and disease stage at diagnosis, were collected from medical records, entered, and analyzed using Jamovi software.

Results: During the study period, a total of 131 hospitalized cases of gastric cancer, 9 cases (6.8%) involved patients aged ≤40 years, representing an annual average of 0.9 cases. The mean age was 33.5 years (range: 20–40 years), with a predominance in the 36–40 age group (55.6%). A female predominance was noted (56%) with a female-to-male ratio of 1.2. The mean diagnostic delay was 6.7 months (range: 1–24 months). The predominant symptoms were epigastric pain (89%), anemia (78%), general deterioration of health status (56%), and upper gastrointestinal bleeding (44%). Risk factors were identified in 78% of cases. Helicobacter pylori infection and smoking were the two main risk factors, identified in 56% and 33% of cases, respectively. Adenocarcinoma accounted for 89% of cases. The majority of patients (67%) had metastatic disease at diagnosis. The prognosis was poor.

Conclusion: Gastric cancer in young patients is a real and significant entity, with a predominance of adenocarcinoma. The identified risk factors justify targeted screening and preventive measures.

Assessing the Prognostic Performance of Albumin-Bilirubin Score and C-Reactive Protein to Albumin Ratio in Patients with Decompensated Cirrhosis

2026-04-07T09:19:14+00:00

Aims: To evaluate and compare the prognostic performance of the C-reactive protein to albumin ratio (CAR), albumin-bilirubin (ALBI), Child-Pugh (CP), and Model for End-Stage Liver Disease (MELD) scores in predicting 1-year mortality in patients with decompensated cirrhosis (DeCi).

Study Design: Single-center retrospective observational study.

Place and Duration of Study: Gastroenterology Department, January 2020 to June 2023.

Methodology: A total of 152 hospitalized DeCi patients were included. Clinical and biochemical data were collected at admission, and CAR, ALBI, CP, and MELD scores were calculated. Patients were followed for 1 year. Prognostic performance was assessed using ROC curves. Statistical analysis was performed with JAMOVI 2.5.

Results: Mean age was 64.7 ± 11.1 years (sex ratio 2.1). Variceal bleeding occurred in 44.7%, ascites in 71.1%, and hepatic encephalopathy in 13.2%. Median scores were: CAR 0.79, ALBI −1.49, CP 8, and MELD 13.

In univariate analysis, sex (p=0.011), MELD (p<0.001), CP (p=0.047), CAR (p=0.002), and ALBI (p=0.016) were associated with mortality. In multivariate analysis, only MELD (OR 1.29; 95% CI 1.14–1.46; p<0.001) and CAR (OR 1.44; 95% CI 1.10–1.90) remained independent predictors.

CAR and ALBI correlated with CP (r=0.32; r=0.78) and MELD (r=0.22; r=0.55). MELD showed the highest predictive accuracy (AUC=0.75).

Conclusion: CAR and MELD are the strongest independent predictors of mortality in DeCi. While ALBI correlates with established scores, MELD remains the most accurate prognostic tool. Combining CAR with MELD may improve risk stratification.

Enteric Pathogens Associated with Acute Gastroenteritis and Antibiotic Susceptibility Patterns among Children Under-Five Years in Nasarawa West, Nigeria

2026-04-10T06:43:44+00:00

Background: Acute gastroenteritis remains a leading cause of morbidity and mortality among children under five years, particularly in low- and middle-income countries where poor sanitation, unsafe water, and inadequate hygiene promote disease transmission.

Objectives: This study investigated the bacterial, viral, fungal, and protozoal pathogens associated with acute gastroenteritis among children under 5 years of age in Nasarawa West, Nigeria, and evaluated their antibiotic susceptibility profile.

Methods: A hospital-based cross-sectional study analysed 420 diarrheic stool samples collected from children aged 0–5 years attending five health facilities between July 2024 and August 2025. Demographic and clinical information were obtained using structured questionnaires. Stool samples were analysed using standard microbiological and biochemical methods. Data were analysed using Chi-square, Fisher’s exact, and Cochran–Armitage tests, with statistical significance set at P < 0.05.

Results: Of the 420 samples analysed, 355 (84.5%) yielded diarrhoeagenic pathogens. Escherichia coli was the most prevalent bacterial pathogen (27.4%), followed by Salmonella typhi (2.4%) and Shigella species (1.7%). Among protozoa, Entamoeba histolytica (12.9%) predominated, while Candida albicans accounted for 14.3% of isolates. Rotavirus was the most common viral pathogen (15.2%). Coinfections involving E. coli, E. histolytica, and C. albicans occurred in 15.5% of cases (P < 0.05). Infection was significantly associated with age (25–36 months), and male sex (P < 0.05). Rotavirus infection was significantly lower among vaccinated children (3.2%) compared with unvaccinated children (20.4%) (P < 0.05). High resistance rates were observed against amoxicillin (84.3%), ceftriaxone (81.7%), ofloxacin (79.1%), gentamicin (76.5%), and ceftazidime (75.7%). Salmonella typhi and Shigella species showed extensive multidrug resistance, whereas imipenem demonstrated the highest susceptibility across isolates.

Conclusion: Enteric pathogens and multidrug-resistant bacteria remain highly prevalent among children under five in Nasarawa West. Strengthening antimicrobial stewardship, improving diagnostic capacity, enhancing vaccination coverage, and implementing community-led sanitation interventions are critical to reducing diarrheal disease burden in the region.

Ameliorative and Protective Potential of Elaeis guineensis on the Small Intestine of Adult Mice Exposed to Diazepam Toxicity

2026-05-15T05:29:10+00:00

The small intestine plays a vital role in digestion, nutrient absorption, and immune defense, and its structural integrity is essential for maintaining gastrointestinal health. However, exposure to certain xenobiotics, including benzodiazepines such as diazepam, may induce oxidative stress and inflammatory responses that compromise intestinal architecture. This study investigated the ameliorative and protective potential of Elaeis guineensis on the small intestine of adult mice exposed to Diazepam-induced toxicity. Sixteen adult mice weighing between 25 g and 40 g were acclimatized for two weeks and randomly assigned to four groups (n = 4). Group A served as the control and received water and feed only. Group B received E. guineensis followed by diazepam (18.75 mg/ml) two hours later. Group C received diazepam followed by E. guineensis two hours later, while Group D received diazepam only. The experiment lasted 28 days. At the end of the study, the small intestines were harvested under anesthesia, fixed in 10% formalin, processed histologically, and stained using hematoxylin and eosin for microscopic examination. Histological findings showed that Groups A, B, and C maintained normal intestinal architecture characterized by intact mucosal layers and well-defined muscularis mucosa. In contrast, Group D exhibited distorted intestinal architecture, including mucosal damage and areas of hemorrhage, indicating diazepam-induced toxicity. The preservation of intestinal structure in Groups B and C suggests that E. guineensis possesses both protective and ameliorative properties against drug-induced intestinal injury. The observed effects may be attributed to the antioxidant and anti-inflammatory phytochemicals present in the plant. In conclusion, E. guineensis demonstrates significant potential in protecting the intestinal mucosa from diazepam-induced damage and may serve as a natural therapeutic agent for mitigating gastrointestinal toxicity.

Endoscopic Biliary Drainage in Malignant Biliopancreatic Strictures: Clinical Characteristics and Therapeutic Management

2026-05-15T13:06:14+00:00

Background: Malignant biliopancreatic strictures are a frequent cause of obstructive jaundice and are associated with poor prognosis. Their management remains complex, particularly in cases of hilar involvement, advanced disease, or poor performance status. Endoscopic biliary drainage plays a key role in their management.

Aim: The aim of this study is to describe the clinical, biological, radiological, and endoscopic characteristics of malignant biliopancreatic strictures and to evaluate the outcomes of Endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary drainage in routine clinical practice.

Methods: A retrospective descriptive study was conducted including patients with confirmed malignant biliopancreatic strictures who underwent ERCP between January 2020 and September 2024. Clinical data, laboratory findings, imaging results, etiological diagnoses, and endoscopic outcomes were analyzed.

Results: A total of 39 patients were included (mean age 66 years, male-to-female ratio 2.9). Cholestatic jaundice was present in all patients. Pancreatic cancer was the most frequent etiology (43.6%), followed by cholangiocarcinoma (20.5%). ERCP was technically successful in 82.1% of cases, with biliary drainage achieved mainly using metallic or plastic stents. Radiological drainage was required in cases of ERCP failure.

Conclusion: Malignant biliopancreatic strictures are most commonly caused by pancreatic and biliary malignancies and are often diagnosed at an advanced stage. ERCP-guided biliary drainage is effective and remains the cornerstone of management in routine clinical practice.

HBsAg Seroprevalence in Pregnant Women at the Maternity Ward of the Military Medical-surgical Center of Bamako

2026-01-14T12:45:55+00:00

Objective: The objective was to study the seroprevalence of HBsAg in pregnant women in the maternity ward of the medical-surgical center of the armed forces in Bamako.

Methodology: This was a descriptive longitudinal study from November 2023 to June 2024, conducted at the Maternity Ward of the Bamako Armed Forces Medical-Surgical Center.

Results: During our study, 1,095 pregnant women were seen at the ANC, of whom 800 patients were screened for HBsAg, representing a prevalence of 73.05%.

Of these 800 pregnant women screened for this marker, 75 tested positive, representing a prevalence of 9.37%. The mean age of our patients was 26.6 +/- 7.5 years, with a range of 18 to 45 years. Our patients were multiparous in 34.7% of cases. 58.7% of these women were housewives, and 32% were not in school. Fifty-six percent of pregnant women had their first ANC between 12 and 24 weeks of gestation, and 10.6% had a family history of liver disease.

Tattoos and piercings were the most common risk factors associated with HBsAg carriage. Clinical alarms were absent in 100% of cases. Hepatic cytolysis was found in 5.6%; anemia was present in 21.1% of cases; HBeAg viral replication was found in 6.6% of cases, and viral load was elevated in 44.4% of cases.

Abdominal ultrasound was normal in 93.4% of cases, and fibrosis was significant according to the APRI score in 2.8% of cases. Chronic HBeAg-negative infection was 91.8%, and serovaccination was absent in 8.5% of our newborns. Our patients' partners did not agree to screening in 72% of cases.

Conclusion: Its prevalence among pregnant women remains high. This infection primarily affects housewives, particularly young adults. Early prevention of mother-to-child transmission of the hepatitis B virus contributes to improved maternal and fetal health.

Massive Ascites as the Initial Manifestation of Systemic Lupus Erythematosus: A Case Report

2026-02-02T11:11:22+00:00

Although systemic lupus erythematosus (SLE) can manifest differently in each patient, ascites is a rare first sign. The diagnosis of SLE can be easily missed when the initial presentation is uncommon. This is the case report of a 20 year old woman with no medical history, who experienced 8 months of abdominal distension and weakness, with concurrent 10 kg weight loss. She presented skin lesions of the erythematous type on the dorsal surface of her hands, non-scarring alopecia, Raynaud's syndrome, and joint involvement consisting of symmetrical distal polyarthralgia of the small joints. There were no signs of thyroid dysfunction, cardiac dysfunction, cancers, infectious diseases, hepatitis, kidney diseases, or other diseases.The investigation also allowed the confirmation of SLE. Thus, the hypothesis of lupus peritonitis with ascites became viable. The patient was treated with prednisone and MMF, with substantial improvement of her condition.

Recurrent Dysphagia Beyond the Usual Diagnoses: A Case of Fibrostenotic Eosinophilic Esophagitis in an Adult

2026-02-21T10:29:30+00:00

Background: Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disease and an increasingly recognized cause of dysphagia in adults. Diagnostic delay remains frequent and is associated with progression toward fibrostenotic disease and esophageal strictures.

Case Presentation: We report the case of a 38-year-old man presenting with long-standing progressive dysphagia, initially attributed to other causes. Upper gastrointestinal endoscopy revealed a tight distal esophageal stenosis. Initial biopsies were non-diagnostic, and the patient underwent repeated endoscopic dilations with only transient improvement. Systematic esophageal biopsies obtained during reassessment demonstrated marked eosinophilic infiltration consistent with eosinophilic esophagitis. A diagnosis of fibrostenotic EoE was established.

The patient was treated with a combined strategy including progressive esophageal dilation and anti-inflammatory medical therapy with topical corticosteroids, followed by orodispersible budesonide. This approach resulted in sustained clinical improvement, increased esophageal caliber, and histological remission under maintenance therapy.

Conclusion: This case highlights the consequences of delayed diagnosis of eosinophilic esophagitis in adults and underscores the importance of systematic esophageal biopsies in patients with unexplained dysphagia. In fibrostenotic EoE, combined anti-inflammatory therapy and endoscopic dilation are essential to achieve durable symptom control and prevent disease progression.

Giant Gastric Trichobezoar: A Rare Cause of Chronic Epigastric Pain

2026-05-22T13:25:51+00:00

Gastric trichobezoar is a rare cause of chronic digestive symptoms and gastric outlet obstruction, predominantly affecting young females. We report the case of an adolescent presenting with chronic epigastric pain and a large gastric mass. Imaging by abdominal computed tomography revealed a heterogeneous intragastric mass containing air bubbles, confirmed by endoscopy, making endoscopic extraction impossible. The patient persistently denied any history of trichophagia, highlighting the diagnostic challenge. Surgical gastrotomy allowed complete removal of the trichobezoar. This case highlights the the importance of considering gastric trichobezoar in young females with a gastric mass and chronic digestive symptoms, even in the context of denial, as well as the essential roles of imaging, endoscopy, surgery, and psychiatric follow-up to prevent recurrence.

Type II Ileal Atresia in a Premature Low Birth Weight Neonate Mimicking an Intra-abdominal Mass: A Case Report

2026-03-23T08:33:07+00:00

Background: Jejunoileal atresia is a common cause of neonatal intestinal obstruction, with type II atresia accounting for approximately 10–15% of cases. However, atypical presentations may obscure early diagnosis, particularly in premature and low birth weight neonates. Type II ileal atresia is uncommon and may present with nonclassical clinical and radiologic features, leading to diagnostic delay and increased morbidity.

Case Presentation: We report a premature low birth weight neonate who presented with recurrent bilious vomiting, abdominal distension, and a palpable right-sided abdominal mass shortly after birth. Initial imaging demonstrated a homogeneous right-sided intra-abdominal opacity with displacement of bowel loops, raising suspicion of an intra-abdominal mass rather than intestinal obstruction. The clinical course was further complicated by severe neonatal anemia and associated congenital anomalies, including congenital talipes equinovarus and hydronephrosis, which contributed to the diagnostic complexity of the case. Despite supportive management, symptoms persisted, prompting exploratory laparotomy. Intraoperatively, a type II ileal atresia was identified, characterized by blind-ending bowel segments connected by a fibrous cord with preserved mesentery. Resection of the atretic segment and primary ileoileal anastomosis were performed. The postoperative course was uneventful, and the patient achieved good feeding tolerance and clinical recovery.

Conclusion: This case highlights a rare diagnostic pitfall in which type II ileal atresia mimicked an intra-abdominal mass. Awareness of such atypical presentations and early surgical consultation are essential to avoid delays in diagnosis and to optimize outcomes in high-risk neonatal populations.

Rectal Tuberculosis Presenting with Chronic Rectal Bleeding in an Immunocompetent Patient

2026-03-30T12:48:20+00:00

Rectal tuberculosis is a rare manifestation of gastrointestinal tuberculosis and an uncommon cause of chronic rectal bleeding, particularly in adolescents. Its clinical and endoscopic presentation is often nonspecific and may mimic inflammatory or neoplastic diseases. We report the case of a 15- year-old girl presenting with chronic rectal bleeding and mucoid discharge evolving over two months. Colonoscopy revealed an edematous, congested, and ulcerated rectal mucosa associated with a trilobed rectal polyp. Polymerase chain reaction testing for Mycobacterium tuberculosis performed on rectal biopsy specimens confirmed the diagnosis. Antitubercular therapy resulted in complete clinical resolution. This case highlights the importance of considering rectal tuberculosis in the differential diagnosis of chronic proctitis and rectal bleeding, especially in endemic areas, and emphasizes the diagnostic value of molecular testing on biopsy.

Gastric Heterotopia of The Duodenal Bulb: An Unusual Cause of Melena

2026-04-27T12:20:19+00:00

Gastric heterotopia (GH) is a rare congenital condition characterized by the presence of gastric mucosa outside its normal anatomical location. Although typically benign, GH can occur throughout the gastrointestinal tract and most frequently involves the duodenal bulb, where it often presents as polypoid lesions. Despite its rarity, GH should be considered in the differential diagnosis of polypoid gastrointestinal lesions associated with bleeding or obstructive symptoms, particularly in younger patients.

We report the case of an 81-year-old man who presented with melena and intermittent epigastric pain. Esophagogastroduodenoscopy with biopsy revealed a polypoid lesion in the duodenum composed of heterotopic gastric mucosa, along with an associated esophageal hiatal hernia. The patient was managed with endoscopic resection of the lesion, followed by proton pump inhibitor therapy.

The clinical course was favorable, with resolution of bleeding and no recurrence of symptoms during follow-up.

This case highlights the diagnostic challenges of GH, particularly in elderly patients with atypical presentations, and underscores the importance of histopathological confirmation. Endoscopic management is both diagnostic and therapeutic, offering excellent outcomes. Clinicians should maintain awareness of this entity to ensure appropriate management and to avoid misdiagnosis with other potentially malignant lesions.

Late-Onset Systemic Lupus Erythematosus Presenting as Acute Bowel Obstruction Due to Mesenteric Panniculitis and Severe Pancytopenia: A Case Report

2026-05-22T11:23:01+00:00

Background: Systemic lupus erythematosus (SLE) with onset after the age of 50 years accounts for approximately 10–20% of cases and is often associated with atypical clinical features and delayed diagnosis. Gastrointestinal involvement as an initial manifestation is uncommon, and mesenteric panniculitis complicated by bowel obstruction is exceptionally rare.

Case Presentation: We report the case of a 63-year-old woman admitted for acute bowel obstruction manifested by fecaloid vomiting and cessation of flatus and stool for four days. Abdominal computed tomography revealed small bowel obstruction associated with mesenteric fat infiltration suggestive of mesenteric panniculitis, without evidence of a mechanical transition point. Alternative diagnoses, including infectious, neoplastic, and other inflammatory causes, were investigated and excluded based on clinical, biological, and radiological findings. Serum complement levels were reduced, supporting active autoimmune disease.

Laboratory investigations showed severe pancytopenia (hemoglobin 9 g/dL, lymphocytes 300/mm³, platelets 22,000/mm³) with normal bone marrow findings, suggesting peripheral immune-mediated cytopenia. Clinical examination revealed oral and nasal ulcerations and inflammatory arthralgia. Immunological testing demonstrated positive antinuclear antibodies (1:640, homogeneous pattern), markedly elevated anti–double-stranded DNA antibodies (>300 IU/mL), and positive anti-Sm and anti-ribosomal P antibodies. The diagnosis of SLE was established according to the 2019 ACR/EULAR classification criteria (Aringer et al., 2019). Systemic corticosteroid therapy (prednisone 1 mg/kg/day) led to rapid resolution of gastrointestinal symptoms and progressive improvement of hematological abnormalities. At two months of follow-up, the patient remained clinically stable under progressive corticosteroid tapering.

Conclusion: Late-onset SLE may present with atypical and misleading manifestations, including acute gastrointestinal emergencies mimicking surgical conditions. Early recognition is essential to avoid unnecessary surgical interventions and initiate appropriate immunosuppressive therapy.

Adalimumab-induced Cutaneous lupus in Crohn’s Disease: A Case Report

2026-05-29T09:12:37+00:00

Lupus induced by tumor necrosis factor-alpha (anti-TNFα) inhibitors is an uncommon yet well-documented paradoxical event in patients treated for inflammatory bowel disease. We describe the case of a 39-year-old woman with ileocolonic Crohn’s disease who, ten weeks after starting adalimumab, developed erythematous, scaly facial lesions suggestive of cutaneous lupus. The diagnosis was confirmed by positive antinuclear and anti–double-stranded DNA antibodies.

Adalimumab was discontinued, and hydroxychloroquine therapy combined with strict photoprotection was initiated, leading to rapid lesion regression within approximately three weeks. Because disease control remained essential, biologic treatment was switched to ustekinumab, which has a low reported association with lupus-like reactions and a favorable safety profile in this context.

This case underscores the need for systematic dermatologic monitoring in patients receiving anti-TNFα agents and the importance of early drug withdrawal when lupus is suspected. Prompt recognition and management generally result in favorable outcomes, while careful selection of alternative biologic therapy is essential to maintain disease control.