Capecitabine is a well-established agent for adjuvant chemotherapy in breast and colorectal cancers. However, one of the limiting adverse events of this therapy is severe diarrhea, which is reported with increasing frequency as of late. Capecitabine-induced ileitis should be suspected in cases with severe, treatment-refractory diarrhea. We present a case of capecitabine-induced terminal ileitis in a patient who received the medication as adjuvant therapy for previously resected colon adenocarcinoma. Capecitabine-induced diarrhea secondary to ileitis is a severe adverse drug event, which occurs during adjuvant chemotherapy and does not respond to conservative treatment with antidiarrheals, often necessitating permanent drug withdrawal. A high index of suspicion is critical as the complications, such as dehydration and the associated electrolyte derangements, may be life-threatening if diagnosis and cause-specific treatment are delayed.

Perinatal tuberculosis (TB) is a rare disease with nonspecific clinical symptoms that can result in delayed treatment, and contribute to high morbidity and mortality. We report a case of perinatal TB in a 25-day-old newborn who presented with fever, respiratory distress, disseminated intravascular coagulation (DIC), and marked abdominal distension with hepatosplenomegaly. Further workup revealed culture negative sepsis, peritonitis, and diffuse nodular infiltrate in the lungs, liver, and spleen. After an extensive diagnostic workup for potential gastrointestinal causes of sepsis, the diagnosis of TB was finally established via paracentesis and maternal testing. Our objective is to draw attention to the multifaceted clinical manifestations of perinatal TB despite classically being associated with pulmonary symptoms; extensive gastrointestinal involvement should not exclude perinatal TB from the differential during the workup of culture-negative sepsis.

Background and Aims: Postoperative recurrence in Crohn’s disease remains a significant clinical challenge, with high recurrence rates despite advancements in medical therapy. This study aims to evaluate the efficacy of various treatments for managing postoperative recurrence following ileocolonic resection in Crohn’s disease. Methods: A comprehensive search of PubMed, Cochrane, and Scopus databases was performed to identify studies reporting on the therapeutic management of postoperative recurrence in Crohn’s disease. Studies encompassing patients with an endoscopic Rutgeerts score of at least I2 were included. Results: Ustekinumab showed promise, achieving significant endoscopic and clinical success in difficult-to-treat patients. Anti-TNF agents demonstrated superior endoscopic and clinical remission rates compared to mesalamine and azathioprine. Retreatment with anti-TNF therapy remained effective even after preoperative failure. Thalidomide showed efficacy in refractory Crohn’s disease, but carries significant toxicity risks, necessitating careful patient selection and monitoring. Combination therapies and non-pharmacologic strategies like enteral nutrition offer additional options, though patient compliance remains challenging. Conclusions: Personalized treatment plans based on individual risk factors and biomarkers are crucial. Infliximab is recommended as the first-line treatment, with ustekinumab and vedolizumab as alternatives in case of anti-TNF failure or intolerance. Early intervention, patient education, and ongoing evaluation are essential for optimizing long-term outcomes in managing postoperative recurrence in Crohn’s disease.

Psoriasis vulgaris is a complex immune-mediated disorder that manifests as a chronic skin disorder, characterized by well-circumscribed inflammatory, erythematous plaques. In this case report, we present a patient with generalized pustular psoriasis (GPP) who presented to the nephrology department with rapidly progressive decline in renal function. The diagnosis of GPP was made a month ago, secondary to a coagulase-negative staphylococcal superinfection. Intrinsically, this introduced a diagnostic challenge as the presumed diagnosis of immunoglobulin A (IgA) nephropathy had to be distinguished from IgA-dominant infection-related glomerulonephritis. We further discuss the current evidence and immunohistological profiles of IgA nephropathy in psoriasis and detail the evolution of renal function of our patient over 25 months after he presented to our department.

Background and Objectives: Gut microbiota plays an important role in the wellbeing of the host through different interactions between microflora constituents. In certain instances, Clostridioides difficile may pullulate, causing infection with associated colitis that may vary in terms of severity from mild disease to severe colitis, with increased associated mortality due to its complications. However, there are few literature data regarding the association between Clostridioides difficile and ischemic colitis. Case report: We report the case of a 30-year-old male patient, overweight, with impending dehydration, who presented with hematochezia and colicky abdominal pain, with positive fecal tests for the detection of Clostridioides difficile infection and endoscopic appearance suggesting ischemic colitis in the sigmoid and left colon, confirmed by computed tomography and histology. The patient was treated with oral Vancomycin, with resolution of symptoms, and was reevaluated through colonoscopy eight weeks after discharge, with endoscopic mucosal normalization and histological scarring process on biopsy samples. Conclusion: We report one of the few cases in the literature of ischemic colitis associated with Clostridioides difficile infection, with resolution of clinical, endoscopic, and histologic changes after specific treatment with oral Vancomycin suggesting a possible association between the two diseases. We also review the existing literature data regarding this comorbid association.

While the pulmonary and pancreatic involvement of cystic fibrosis (CF) is commonly described and therefore best studied, the cutaneous manifestations are frequently underdiagnosed, despite being important markers of disease severity. We report a case of antineutrophil cytoplasmic antibody-negative cutaneous vasculitis in a 15-year-old female CF patient in tandem with infection and subsequent colonization by Burkholderia cepacia complex (BCC). The flares of cutaneous vasculitis is associated closely with an infective exacerbation of CF and improved upon treatment of the infective exacerbation. We further discuss how the appearance of BCC colonization and cutaneous vasculitis affected both lung function and lung parenchyma by tracking spirometry and imaging changes over the subsequent four years.