[Dramatic deterioration after withdrawal of steroid therapy].
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Angiocentric T cell lymphoma may present with cutaneous inflammatory lesions masquerading as cutaneous vasculitis both clinically and pathologically. We describe a case of angiocentric T cell lymphoma. Although initial biopsies in this patient resembled polyarteritis nodosa, subsequent biopsies exhibited more characteristic changes and immunohistochemical stains confirmed the diagnosis of large cell angiocentric cutaneous T cell lymphoma. It is important to differentiate these diseases as treatment and prognostic implications are very different.
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Despite multiple invasive diagnostic procedures including exploratory laparotomy and surgical resection, our patient's diagnosis remained an enigma. However, given the clinical scenario and the documented PG, a trial of steroids was warranted. The patient has fared well since her treatment, with resolution of all her symptoms. We feel confident that her disease process is most consistent with, and is most likely, Crohn's disease. There are several lessons to be learned from this case: 1) Inflammatory bowel disease can present at any age and belongs in a clinician's differential diagnosis of fever and diarrhea. 2) Failure to consider IBD in an elderly patient may lead to significant delay in diagnosis, and may expose the patient to unnecessary and sometimes dangerous intervention. 3) IBD in the elderly generally follows the same clinical patterns seen in younger patients. 4) Appropriate therapy can lead to prompt control or even resolution of the signs and symptoms of IBD.
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Complications of chronic inflammatory bowel diseases (IBD) are commonly mentioned with regards to joints, liver, bile ducts, eyes and skin. But rarely we find case reports or gastroenterology textbook descriptions of corresponding disorders of the myocardium. These complications can be of utmost importance in practical medicine. The following case presents a patient whose life was threatened by a complete heart-block while suffering from a concomitant disorder of ulcerative colitis. The complete heart-block most likely occurs as a result of the colitis. This patient probably would not have survived without the intervention of a permanent pacemaker.
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