A CASE IN POINT WALKED IN, GENETIC AT WORK!
==========================================RECEPTOR FAILURE LEADS TO THE CROHN'S SYNDROME.


Last night at 1:am I received a call from the Emergency Room at a local hospital, a 29 year old mother of 4, under some stress had been taking Advil 6 tablets a day for Headache for 3-4 weeks, she now presented to the emergency room with 5 days of diarrhea and fever, with Hypokalemia (K=3.0) and severe Right  lower Quadran of the Abdomen.  An appendicitis was suspected and a CT of the abdomen and pelvis was obtained suggesting changes consistent with Appendicitis but most significant is a thick swollen initial colon (CECUM) with some surrounding "fluid" and minimal surrounding Adenopathies.  A surgical consultation has been obtained, the surgeon however is advising input first from a Colonoscopy.  We are waiting for the Gastroenterologist input as we speak!  The patient is NPO and Cipro-and IV Flagyl is being given, and further laboratory results are awaited!
If this case turns out to be an inflammatory bowel disease, It will be a classic reportable case!

Indeed "Non steroidal anti-inflammatory drugs (NSAID-in this case Advil taken for Headache) appear to be associated with exacerbations of disease". (GARY LICHTEINSTEIN)

First thing to remember as we discussed failure of receptors as a cause of Triple negative Breast cancers where defect in Heparan sulfate the Glycocalyx covering receptor on breast tissue  was a cause.  Here in the terminal Ileum and early Cecum, it is the Muramyl Dipeptide, a Peptidoglycan component of  gram positive bacteria which fails to interact with a Mutated NOD2 gene product. And these failure of stimulation at cellular levels are a potential irritant to the stress related c-JUN, and to production of Heat stroke proteins (most likely HSP90) and secondary stimulation of the NF-kB which leads to Cytokines.  In Inflammatory Bowel diseases, The cytokyne of choice is IL23, its opposing cytokine (may be IL4) knocked down by the NSAID, leads to a significant exacerbation of disease!
There is susceptility conferred by class II antigen DR molecule.  And of interest is the found Hypokalemia which result from Cation related ion-channel disturbance linked to the OCTN1 GENE.  "OCTN1,LOCATED ON 5q31, codes for an ion channel".  The DLG5 is involved. It "codes for a scaffolding protein that is important for maintaining epithelial integrity in various organs".

WE WILL INFORM YOU WHEN ALL IS SAID AND DONE  IN THIS INTERESTING CASE!