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Diagnostic Dilemma: GI Disease

Diagnostic Dilemma: GI Disease

Test your diagnostic skills with the following endoscopic quiz. Answers are on page 2.

A 68-year-old man with a history of small-cell lung cancer with bony metastases was admitted with diarrhea. The patient had completed chemotherapy one week earlier with cisplatin and etoposide, along with radiation therapy, and irinotecan (Camptosar). The patient was found to be neutropenic.

His diarrhea, which started 5 days prior to admission, was high volume (700 mL per day), watery, with occasional blood. He also complained of right lower quadrant abdominal pain. The patient had no fevers or chills.

After his white blood count improved, a colonoscopy was performed for further evaluation. This photograph was taken during the colonoscopic examination.

1) The endoscopic photograph above, obtained during colonoscopy, demonstrates:
a) CMV ulcer
b) Pseudomembranous colitis
c) Neutropenic enterocolitis (typhlitis)
d) HSV ulcer

2) The possible treatments for this condition include:
a) Supportive care
b) Granulocyte colony-stimulating factor (G-CSF, Neupogen)
c) Surgery
d) metronidazole (Flagyl and generics)
e) b and d
f) b, c, and d
g) a, b, and c

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