Cronkhite-Canada Syndrome: Complete Endoscopic Resolution of Polyposis With Immunosuppression
Bibliographic record
Abstract
Introduction: This is a case of a patient presenting with diarrhea, nausea, and abdominal pain who underwent endoscopies and was found to have numerous polyps. The diagnosis and treatment of polyposis syndromes is essential for good outcomes. Case Presentation: A 73 year old male initially presented in 2009 with nausea, watery diarrhea and 15 lb weight loss in one month duration. He was found to have moderate alopecia with hyperpigmentation of scalp, thinning of eyebrows and onychomycosis of toenails. Colonoscopy revealed a 5 cm irregular, hemorrhagic mass and 3 sessile polyps in the sigmoid colon. An EGD showed numerous polypoid lesions in the gastric body and antrum with thickened gastric folds. Biopsy from the colonic mass and gastric polyps revealed cystic glandular dilatation, lamina propria edema and chronic inflammation consistent with Cronkhite Canada Syndrome(CCS). Nutritional supplementation with zinc and multivitamin as well as high caloric diet were initiated. Symptoms of diarrhea and alopecia improved after 10 weeks. A few months later patient was diagnosed with un-differentiated autoimmune disease with lupus like features and treated with hydroxychloroquine 200 mg twice a day and prednisone 15 mg daily. Repeat EGDs and colonoscopies over the next 2 years revealed a slight reduction in the number of polyps. Follow up endoscopies in 2013 revealed complete resolution of gastric and colonic polyposis with near normal appearance of the mucosa. Patient continues to remain symptom free on follow up. Discussion: CCS is a rare and non-familial syndrome characterized by presence of diffuse GI polyposis, diarrhea, dystrophic nails, alopecia, cutaneous hyperpigmentation and weight loss. Approximately 400 cases have been reported in the literature thus far. Case reports have shown symptomatic relief with decrease in GI polyposis with various therapies such as nutritional supplements, corticosteroids, H2 blockers and antibiotics. Our case describes, previously undocumented, complete endoscopic resolution of GI polyposis and gastrointestinal symptom control with prednisone and hydoxychloroquine over treatment duration of 4 years. This correlates well with the proposed autoimmune etiology of the disease process and immune-suppressive mechanism of action of these medications. The polyps are typically benign histologically although cases of colonic and gastric malignancies have been reported. Colon cancer screening is complicated in these patients by the presence of multiple polyps and increased risk of bleeding. Therefore complete resolution of polyposis is beneficial in detecting colonic malignancies that could otherwise be missed. This highlights the need for further reseach regarding role of immunosuppressive medications in managing CCS.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 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".