Cronkhite-Canada Syndrome Presenting as Acute Colitis; Confirmed by Colonoscopy, Upper Endoscopy, Capsule Endoscopy, and Pathology
Bibliographic record
Abstract
Cronkhite-Canada syndrome is a rare disease first described in 1955. The clinical features include diarrhea, nail dystrophy, alopecia, and hyperpigmentation of the skin. We describe a case of Cronkhite-Canada Syndrome presenting as acute colitis with evidence of disease found on upper endoscopy, sigmoidoscopy, and capsule endoscopy. A 49 year old male presented to the Emory University GI clinic with total body hair loss and bloody diarrhea which began suddenly six weeks prior to presentation. He described the diarrhea as loose, predominantly liquid stool with red blood mixed in occuring 4–5 times per day. The diarrhea also occurs at night and wakes the patient from sleep. He was seen by a gastroenterologist who performed a colonoscopy and was found to have erythema throughout his colon. He was diagnosed with indeterminate colitis from a biopsy showing mucin filled crypts and chronic active inflammation without malignancy and started on 5-ASA therapy without improvement. At the time of presentation to our clinic, he had no remaining hair on his head and had also lost his eyelashes and body hair including his pubic hair. He also reported that he had lost his finger nails and toe nails. In addition he had a fifty pound weight loss and systemic fatigue. He also reported alterations in his sense of smell and a decreased appetite because food no longer tasted good. Physical exam was notable for diffuse hair loss including loss of his eyelashes, loss of his finger nails and toe nails but was otherwise unremarkable. Upper endoscopy and flexible sigmoidoscopy were repeated in addition to capsule endoscopy for additional evaluation. The upper endoscopy was remarkable for nodular, friable, erythematous gastic mucosa. There was also duodenitis with erythema and ulcerations noted. The esophageal mucosa was normal. The flexible sigmoidoscopy demonstrated erythematous and friable mucosa from the rectum to the transverse colon with exudative ulcerations. Capsule endoscopy showed diffuse, nodular erythematous mucosa throughout the entire small bowel. After a thorough review of the patient's history, physical exam and discussion with our pathologist the diagnosis of Cronkhite-Canada Syndrome was made and treatment was started. The patient was treated with antihistamines, H-2 blockers, prednisone, and the first reported use of the antibiotic Rifaximin for the treatment of Cronkhite-Canada Syndrome with a good response.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".