title: Mucosal necrosis of the small intestine in myopathy, encephalopathy, lactic acidosis, and stroke-like episodes syndrome.
abstract: This report presents a case of massive mucosal necrosis of the small intestine in a patient with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS), which particularly affects the brain, nervous system and muscles. A 45-year-old Japanese female, with an established diagnosis of MELAS, presented with vomiting. Computed tomography showed portomesenteric venous gas and pneumatosis intestinalis. She underwent a resection of the small intestine. A microscopic study showed necrosis of the mucosa and vacuolar degeneration of smooth muscle cells in the arterial wall. Immunohistochemistry showed anti-mitochondrial antibody to be highly expressed in the crypts adjacent the necrotic mucosa. The microscopic and immunohistochemical findings suggested the presence of a large number of abnormal mitochondria in MELAS to be closely linked to mucosal necrosis of the small intestine.
authors.affiliation: Department of Gastroenterological Surgery, Takamatsu Red Cross Hospital, Takamatsu 760-0017, Japan. fk506.cni@gmail.com
authors.forename: Keita
authors.initials: K
authors.lastname: Fukuyama
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Ishikawa
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ogino
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Inoue
authors.forename: Ryoya
authors.initials: R
authors.lastname: Yamaoka
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Hirose
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Nishihira
mesh_terms: D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D007421:Intestine, Small / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D017241:MELAS Syndrome / Q000150:complications* / Q000378:metabolism / Q000473:pathology; D008875:Middle Aged; D008928:Mitochondria / Q000737:chemistry / Q000473:pathology*; D009336:Necrosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: Acute mesenteric ischemia; Anti-mitochondrial antibody; Immunohistochemistry; Myopathy, encephalopathy, lactic acidosis, and stroke-like episodes syndrome; Pathology