Bone marrow metastasis from gastric adenocarcinoma is uncommon and may present with cytopenias and diffuse skeletal lesions, mimicking primary hematologic disorders. Herein, we report the case of a 53-year-old man of North African descent who presented with a two-month history of epigastric pain, unintentional weight loss, and functional decline. Laboratory testing revealed thrombocytopenia (80 × 10 3 /mm 3 ) and markedly elevated alkaline phosphatase (1500 IU/L). Contrast-enhanced computed tomography showed diffuse osteolytic lesions without an evident primary tumor. Bone marrow trephine biopsy demonstrated extensive replacement by a malignant epithelial proliferation. Tumor cells stained positive for cytokeratin, consistent with metastatic carcinoma. Upper gastrointestinal endoscopy identified an ill-defined ulceroinfiltrative lesion along the lesser curvature with friable margins and spontaneous bleeding on minimal touch. Biopsies confirmed poorly differentiated signet ring cell adenocarcinoma. The diagnosis of gastric carcinoma with bone marrow metastasis was then retained. The patient was managed with palliative systemic chemotherapy as well as supportive care and remains alive at 10 months of follow-up. This case highlights that diffuse osteolytic disease with unexplained cytopenias and disproportionate alkaline phosphatase elevation should prompt consideration of occult solid malignancy with marrow involvement. Early bone marrow biopsy with immunohistochemistry can rapidly establish epithelial lineage and should prompt evaluation for an occult gastrointestinal primary malignancy.

Background: Patients with inflammatory disease treated with biological agents are at an increased risk of developing various adverse effects. However, little is known about the risk of nephrotoxicity, such as induced tubulointerstitial nephritis and immune-mediated inflammatory diseases involving the interstitium and renal tubule. Case Presentation: We herein describe a case of biopsy-proven tubulointerstitial nephritis, induced by PR3-ANCA-associated vasculitis following adalimumab therapy in a patient with Crohn's disease and ankylosing spondylitis. We review the current evidence on adalimumab-induced nephrotoxicity and the potential underlying mechanisms. Conclusion: Monitoring of renal function is strongly recommended in all patients treated with adalimumab. Early diagnosis of drug-induced tubulointerstitial nephritis due to vasculitis and immediate withdrawal of the offending drug are key to renal recovery and prevention from irreversible serious organ damage.

Backgroundatezolizumab–bevacizumab is the standard first-line systemic treatment for unresectable hepatocellular carcinoma (HCC). Immune checkpoint inhibitor (ICI)-associated myocarditis is a rare but potentially life-threatening immune-related adverse event. Evidence regarding ICI rechallenge after myocarditis remains limited, particularly in patients with HCC.Case presentationWe report the case of a 59-year-old man with hepatitis C–related cirrhosis and advanced HCC with portal vein tumor thrombosis, treated with atezolizumab-bevacizumab. After two treatment cycles, he developed non-fulminant ICI-associated myocarditis, characterized by chest pain, elevated cardiac biomarkers, and cardiac magnetic resonance imaging findings consistent with acute myocarditis. Atezolizumab was discontinued, and high-dose corticosteroid therapy was initiated, resulting in complete clinical, biochemical, and radiological recovery. The patient initially achieved a partial tumor response with normalization of alpha-fetoprotein (AFP). During temporary treatment interruption, he subsequently developed radiological disease progression, including enlargement of the hepatic lesion, portal vein tumor thrombosis, and extensive supra- and infradiaphragmatic necrotic lymphadenopathy. Following multidisciplinary evaluation and documented resolution of myocarditis, atezolizumab–bevacizumab rechallenge was undertaken under corticosteroid cover. The patient received six additional cycles with good tolerance, no recurrence of myocarditis, and stable disease on follow-up imaging.ConclusionThis case suggests that atezolizumab–bevacizumab rechallenge may be feasible in carefully selected patients with advanced HCC after recovery from non-fulminant ICI-associated myocarditis under close multidisciplinary supervision. It also highlights the importance of histological confirmation in atypical nodal progression during immunotherapy, particularly when imaging findings may be confounded by alternative explanations.

Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest solid malignancies despite advances in surgery, perioperative care, and systemic therapies. Pretherapeutic radiological sarcopenia has emerged as a clinically relevant body-composition phenotype associated with poor outcomes in oncology. This imaging-based concept differs from contemporary geriatric definitions of sarcopenia, which require impaired muscle strength and incorporate low muscle quantity and/or quality. This narrative review critically examines radiological assessment, biological context, prognostic implications, artificial intelligence (AI)-enabled quantification, and interventional evidence in PDAC. A structured narrative search of PubMed/MEDLINE, Embase, and Google Scholar was conducted from database inception through July 31, 2026. Computed tomography (CT)-based skeletal muscle index remains the most widely validated imaging biomarker, although substantial heterogeneity persists in methods and diagnostic thresholds. Low muscle mass is most consistently associated with reduced survival, whereas associations with postoperative morbidity and systemic treatment toxicity are more heterogeneous. Exercise, nutritional, and multimodal cachexia interventions appear feasible and may provide functional or nutritional benefits, but evidence remains insufficient to establish a survival benefit from improving muscle status. AI-based approaches enable scalable body-composition analysis, although external validation, methodological standardization, and prospective clinical integration remain necessary. Overall, radiological sarcopenia is a promising prognostic and potentially actionable phenotype in PDAC.

Peritoneal tuberculosis (PT) is a rare form of extrapulmonary Mycobacterium tuberculosis infection that may closely mimic Crohn’s disease (CD) or intra-abdominal malignancy, leading to diagnostic delay, particularly in endemic areas. We report two illustrative cases complicated by localized abscess formation. The first case involved a 40-year-old woman presenting with chronic right lumbar pain. Computed tomography (CT) revealed a large right psoas abscess associated with circumferential thickening of the cecal base and terminal ileum, along with necrotic mesenteric and iliac lymphadenopathy. Colonoscopy showed ulcerative ileocolitis, and histology demonstrated chronic granulomatous inflammation suggestive of either tuberculosis or CD. CT-guided biopsy of the abscess wall was performed, and polymerase chain reaction testing for Mycobacterium tuberculosis was positive. Histopathology examination was consistent with tuberculosis. The patient responded well to anti-tuberculous therapy with complete radiological resolution. The second case concerned a 17-year-old male admitted with right iliac fossa pain, fever, weight loss, and night sweats. CT showed a right pelvic collection adjacent to the ileocecal junction with distal ileal and cecal thickening, initially suggesting CD. Colonoscopy revealed ulcerative ileitis with granulomatous inflammation. As radiological drainage was not feasible, laparoscopy was performed and showed a friable micronodular peritoneum with terminal ileitis. Peritoneal biopsies demonstrated non caseating granulomatous inflammation, consistent with peritoneal and ileocecal tuberculosis. These cases highlight that PT may present as localized abdominal or psoas abscesses and closely mimics CD. Early integration of imaging, endoscopy, tissue sampling, and microbiological or molecular testing is essential for prompt diagnosis and appropriate curative treatment.

Background: This study evaluates the REMIND score’s performance in predicting postoperative Crohn’s disease recurrence compared to the Rutgeerts score, which has the limitation of grouping anastomotic and neo-terminal ileal lesions together with equal prognostic value.Methods: We conducted a monocentric, retrospective, evaluative study of patients operated for Crohn’s disease. All patients had a follow-up colonoscopy within one year of surgery. Clinical relapse was defined by the Crohn’s disease related symptoms or complications, such as intra-abdominal collection or occlusion, or subsequent postoperative surgery. Data analysis was performed using SPSS.25.Results: Eighty patients were included. Clinical recurrence-free survival was significantly shorter in patients with ileal lesions whatever their severity was I(1,2,3,4)A(x), compared with patients without ileal lesions I(0)A(x): p<0,001 and not significantly different between patients withoutanastomotic lesions I(x)A(0) and patients with anastomotic lesions whatever their severity was I(x)A(1,2,3): p=0,2. However, patients with at least semicircumferential anastomotic ulcerations A(2,3) had more anastomotic occlusive complications than patients classified A0 or A1: A0 VS A2 p=0,01 A0 VS A3 p<0,001 A0 VS A1 p=0,9. The I(x) score, compared with the Rutgeerts and A(x) scores, had the best values in terms of discriminative capacity (Area under the curve= 0,83 VS 0,73 VS 0,61), monotonicity (linearity test χ2 of 26,77 VS 12,36 VS 3,89), and homogeneity (likelihood ratio χ2 of 33,91 vs 18,45 VS 5,49).Conclusion: The I(x) score outperformed both the Rutgeerts and A(x) scores in predicting postoperative recurrence. Consequently, evaluating ileal and anastomotic lesions separately provides a more accurate assessment of endoscopic recurrence

Helicobacter pylori (H. pylori) eradication is a continuously challenging issue as antibiotic resistance is evolving and adversely affecting outcomes of previously effective treatments. Continual assessment and modification of therapeutic approaches is necessary. The aim of our study was to evaluate H. pylori eradication rate in Tunisian patients treated by non-bismuth quadruple therapy and to investigate treatment failure factors. We conducted a prospective multicentric study including patients with H. pylori infection. For all patients, concomitant therapy (amoxicillin 1 g, clarithromycin 500 mg and metronidazole 500 mg plus esomeprazole 40 mg) twice daily for 14 days was prescribed. Mutations conferring resistance of H. pylori to clarithromycin were detected using polymerase chain reaction on gastric biopsies. Eradication was assessed using the urea breath test. 414 patients were included. The mean age was 44.7 ± 14.3 with a sex ratio of M/F = 0.53. Mutations conferring resistance of H. pylori to clarithromycin were observed in 76 patients (18.35

Fibromyalgia is a complex musculoskeletal disorder characterized by widespread chronic pain along with various psychosomatic manifestations that impact the quality of life of patients. This condition is often observed in several chronic inflammatory diseases, particularly inflammatory bowel diseases (IBD). Our study aims to determine the prevalence of fibromyalgia in patients with IBD as well as the predictive factors in order to provide better clinical management for patients affected by these two conditions. This is a cross-sectional study involving 60 patients with inflammatory bowel disease collected in an internal medicine and hepatology and gastroenterology department. The screening for fibromyalgia was conducted using the FIRST questionnaire. The statistical analysis was performed using SPSS version 25 software. Our study included 60 patients, consisting of 48 men and 12 women. The average age of these patients was 44 years ± 15 years. Sixty percent of the patients (n = 36) had Crohn’s disease, while 40 percent (n = 24) had ulcerative colitis, with an average age of diagnosis of IBD at 35 ± 14 years. The patients exhibited extra-digestive manifestations, including spondylarthritis in 18.3%, dermatological or ophthalmological or hepatobiliary manifestations in 3.3%, and thromboembolic manifestations in 1.7% of cases. Fibromyalgia was detected in 31.7% (n = 19) of the patients. We observed that patients with IBD and fibromyalgia were older than those without fibromyalgia, with an average age of 50 ± 13 years and a higher average body mass index of 25.8 ± 6.3, showing a statistically significant difference (p < 0.05). Fifty-two percent of the patients (n = 10) had ulcerative colitis compared to 47.4% (n = 9) who had Crohn’s disease, with a non-significant statistical difference. Socially, we noted that fibromyalgia was associated with the marital and professional status of the patients. Indeed, 94.7% (n = 18) of the patients were married. They all had children, and 47% (n = 9) were active professionally, with a statistically significant difference (p < 0.05). Regarding the extra-digestive manifestations, there was an association between fibromyalgia and spondylarthritis on one hand and hepatobiliary manifestations (mainly primary sclerosing cholangitis PSC) on the other, with a statistically significant difference (p < 0.05). Fibromyalgia is common among patients with inflammatory bowel disease, exacerbating their pain and impairing their quality of life. The links between inflammation, stress, and pain suggest the need for a multidisciplinary approach to better manage these patients. Increased recognition of this co-occurrence will improve treatments and the overall well-being of patients. C. Ben Ammar: None. M. Boudokhane: None. H. Bettaieb: None. E. Chemkhi: None. M. Ayari: None. T. Jomni: None. R. Bourguiba: None. S. Bellakhal: None. M. Douggui: None.