budesonide / Generic mfg. - LARVOL DELTA

Uncommon Case of Isolated Collagenous Gastritis and Duodenitis (ACG 2026) - "He took budesonide for 8 weeks and pantoprazole 40 mg daily. We suggest considering collagenous colitis and duodenitis when young patients with unclear cause of IDA are being evaluated, especially if they need EGD for celiac biopsies. Figure: Figure 1: Collagenous gastritis Figure: Figure 2: Collagenous duodenitis"

Clinical • Constipation • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Hematological Disorders • Immunology • Inflammatory Arthritis • Rheumatoid Arthritis • Sjogren's Syndrome

From Aberrant Lymphocytes to Aggressive Lymphoma: A Case of Refractory Celiac Disease Type II (ACG 2026) - "Case Description/ A 53 year-old male patient with RCD and small bowel T-cell lymphoma treated with CHOP (Cyclophosphamide, Hydroxydaunorubicin, Oncovin and Prednisone) therapy presented with abdominal pain, jaundice, and watery diarrhea associated with weight loss, fever, and decreased appetite for the past month...Pathology later showed RCD II and budesonide 9 mg was initiated...Figure: Image 1. Small bowel thickening and mesenteric lymphadenopathy"

Clinical • Cardiovascular • Celiac Disease • Hematological Disorders • Hematological Malignancies • Hepatology • Immunology • Lymphoma • T Cell Non-Hodgkin Lymphoma

Three-in-One: Immune-Effector Cell Enterocolitis With Concurrent Clostridioides difficile Infection and Cytomegalovirus Viremia (ACG 2026) - "Introduction: Immune effector cell-associated enterocolitis (IEC-EC) is a rare complication of B-cell maturation antigen-directed chimeric antigen receptor T-cell (CAR-T) therapy, particularly ciltacabtagene autoleucel or Carvykti...Despite oral vancomycin, symptoms persisted...She was treated with budesonide followed by intravenous methylprednisolone without improvement...Due to persistent symptoms despite corticosteroids, ruxolitinib was subsequently initiated, resulting in improvement of diarrhea, discontinuation of parenteral nutrition, and eventual discharge...AI was used in formatting of this article. Figure: Figure 1: A- Body of the stomach with friability on EGD, B- Congested and edematous mucosa of colon Figure: Figure 2: A- Small bowel with crypt loss, 10x, B- Small bowel with apoptotic bodies and plasma cell depletion, 20x, C- Colon with apoptotic bodies and plasma cell depletion, 20x"

Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Hematological Malignancies • Immunology • Infectious Disease • Multiple Myeloma

Collateral Damage: IgA Nephropathy Complicating Long-Term Certolizumab Pegol Use in Crohn's Disease (ACG 2026) - "Case Description/ A 36-year-old male with CD diagnosed in 2010 (Paris classification: A2, L1, B2), underwent ileocolonic resection and was started on certolizumab pegol in 2011 after failing 5-aminosalicylic acid, 6-mercaptopurine, and infliximab therapy...Certolizumab pegol was stopped and CD treatment with vedolizumab was started. Treatment with corticosteroids, mycophenolate, losartan, and atrasentan was initiated...Targeted budesonide was not a treatment option in this case given prior bowel resection, which emphasizes a treatment consideration unique to CD patients. This case emphasizes the importance of routine renal monitoring in patients on long-term anti-TNF therapy. Figure: Light microscopy (PAS stain) demonstrating mesangial hypercellularity Figure: Immunofluorescence microscopy demonstrating diffuse mesangial IgA deposits"

Crohn's disease • Gastroenterology • Glomerulonephritis • IgA Nephropathy • Immunology • Inflammation • Inflammatory Bowel Disease • Nephrology • Renal Disease

Case of Perianal Fistulizing Crohn's Disease Complicated by Granulomatosis With Polyangiitis and Rituximab-Induced Hypogammaglobulinemia (ACG 2026) - "Infliximab was initiated 6 months after initial symptom presentation at 5 mg/kg then escalated to 10 mg/kg every 6 weeks. By 8 weeks, the patient gained 30 pounds, discontinued budesonide, and regained functional independence...Figure: Figure 2. Small bowel enteroscopy and aborted colonoscopy showing inflammation with aphthous ulceration in the proximal jejunum, duodenum, gastric antrum, sigmoid colon, and rectum, consistent with Crohnâs ileitis and perianal disease."

Clinical • Colorectal Cancer • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hepatitis B • Hepatology • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Rare Diseases • Vasculitis

Small Bowel Crohnâs Presenting as CMV Ileitis in an Immunocompetent Patient (ACG 2026) - "He was diagnosed with CMV ileitis and treated with valganciclovir 450 mg twice daily for five weeks with significant improvement...He was diagnosed with ileocecal Crohn's disease and started on budesonide followed by adalimumab with significant improvement at 3-month follow up...Figure: FIGURE 1 - Hematoxylin and eosin staining from terminal ileum biopsy demonstrating CMV cytopathic inclusions in a background of chronic active enteritis. Figure: FIGURE 2 - Repeat terminal ileum biopsy demonstrating chronic active ileitis with ulceration and negative CMV immunostaining."

Clinical • Crohn's disease • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • CRP

A Cautionary Tale of Anchoring Bias: Eosinophilic Colitis to Ulcerative Colitis (ACG 2026) - "She was diagnosed with EoC and treated with budesonide and a 6-food elimination diet with initial symptom improvement...Figure: Table 1. Endoscopic and histologic findings"

Colorectal Cancer • Eosinophilia • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammation • Inflammatory Arthritis • Inflammatory Bowel Disease • Musculoskeletal Pain • Ulcerative Colitis • CRP

Beyond the Diarrhea: Varioliform Lymphocytic Gastritis in Common Variable Immunodeficiency (ACG 2026) - "The patient was started on a budesonide taper for lymphocytic gastritis with a plan to repeat endoscopy for surveillance Lymphocytic gastritis has an estimated prevalence of approximately 0.21% among patients undergoing upper endoscopy with biopsy and is defined by â¥25 intraepithelial lymphocytes per 100 epithelial cells in the surface foveolar epithelium...High-power view (left) shows marked intraepithelial lymphocytosis involving the surface and foveolar epithelium. Low-power view (right) demonstrates diffuse chronic gastritis with increased intraepithelial lymphocytes"

Celiac Disease • Cytomegalovirus Infection • Gastric Adenocarcinoma • Gastroenterology • Gastrointestinal Disorder • Hematological Malignancies • Immunology • Infectious Disease • Lymphoma • Primary Immunodeficiency • Solid Tumor • CD20

When GERD Is Not GERD: Unmasking Multisite EGID (ACG 2026) - "She was treated with Omeprazole 40 mg twice daily, famotidine 10 mg daily, and montelukast 10 mg daily, though she frequently missed omeprazole doses...Oral open capsule budesonide 9 mg daily was added, with partial symptom improvement...Further, dupilumab achieved symptomatic, laboratory, and endoscopic remission across all involved sites. Figure: Gastric ulcers of index EGD Figure: Duodenal ulcer of index EGD"

Eosinophilia • Eosinophilic Esophagitis • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Immunology • Peptic Ulcer

Hickamâs Dictum: Disseminated Histoplasmosis and CMV Masquerading as an Ileocecal Mass (ACG 2026) - "Empirical treatment with budesonide yielded no improvement...The patient was initiated on liposomal amphotericin B, and valganciclovir was added for treatment of CMV colitis due to persistent fevers...(B) Grocottâs methenamine silver (GMS) staining highlights numerous oval yeasts with occasional narrow-based budding, morphologically consistent with Histoplasma capsulatum. (C) CMV immunohistochemical staining demonstrates a positive cell within the granulation tissue."

Anorexia • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Human Immunodeficiency Virus • Immunology • Infectious Disease

Role of Mast Cell Activation in the Pathogenesis of Ulcerative Colitis Associated With Neurofibromatosis Type I (ACG 2026) - "Pantoprazole 40 mg IV q 12 hours was started. EGD revealed a cratered gastric ulcer with a visible vessel at the pylorus thought to be from ibuprofen use...After treatment with budesonide 9 mg po daily, she experienced complete resolution of GI symptoms...This case adds to the growing body of evidence that NF1 and UC share a common pathway through mast cell activation. Further investigation is needed to confirm pathogenic connections and consider therapeutic implications of this association."

Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Immunology • Inflammation • Inflammatory Bowel Disease • Musculoskeletal Diseases • Musculoskeletal Pain • Neurofibromatosis • Orthopedics • Peptic Ulcer • Solid Tumor • Ulcerative Colitis • KIT • NF1

Successful Live MMR Vaccination in a Patient With Ulcerative Colitis Receiving Maintenance Ustekinumab Considering Pregnancy (ACG 2026) - "While safety data exist for live vaccines alongside anti-tumor necrosis factor agents and vedolizumab, data regarding ustekinumab are scarce...Diagnosed in 2016, she escalated to ustekinumab in 2018 after failing mesalamine and budesonide...Additionally, adopting a titer-based strategy, instead of a standard two-dose empiric schedule, limited live virus exposure while ensuring protective immunity. This single case suggests that in high-stakes scenarios, such as pre-conception planning or residence in outbreak zones, live vaccination may be feasible for patients on ustekinumab without interrupting therapy."

Clinical • Gastroenterology • Gastrointestinal Disorder • Gynecology • Immunology • Infectious Disease • Inflammatory Bowel Disease • Measles • Mumps • Polyendocrine Metabolic Ovarian Syndrome • Rubella • Ulcerative Colitis • TNFA

Heartburn of a Different Kind: Mesalamine-Induced Myopericarditis in Ulcerative Colitis (ACG 2026) - "He was started on colchicine and prednisone with improvement...He was discharged on colchicine, ibuprofen, budesonide, and omeprazole, with outpatient gastroenterology follow-up to discuss alternative UC therapy...Management centers on drug discontinuation, with NSAIDs and colchicine as adjuncts. Clinicians should suspect 5-ASA cardiotoxicity in any IBD patient with new cardiac symptoms shortly after initiation."

Cardiovascular • CNS Disorders • Depression • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Influenza • Musculoskeletal Pain • Novel Coronavirus Disease • Respiratory Diseases • Ulcerative Colitis • CRP

Overlapping Gastrointestinal Presentations of Alpha-Gal Syndrome and Crohns Disease: A Case Report (ACG 2026) - "Patient was started on budesonide for ileal CD and was counseled to follow an alpha-gal-avoidant diet...A,B) View of the terminal ileum during colonoscopy demonstrating mucosal erythema, edema and active bleeding. C) Pathology from samples taken during colonoscopy consistent with active Crohns disease D) Abnormal Alpha-Gal panel showing elevated Alpha Gal IgE as well as specific sensitization to pork, beef and lamb consistent with active Alpha-Gal syndrome."

Case report • Clinical • Celiac Disease • Constipation • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Respiratory Diseases • Tuberculosis

Biopsy-Proven Pluvicto (Lutetium-177 Vipivotide Tetraxetan)-Induced Colitis in a Patient With Metastatic Prostate Cancer: A Case Report (ACG 2026) - "Case Description/ A 60-year-old man with stage IVB metastatic prostate adenocarcinoma (BRCA2-mutated), previously treated with radiotherapy and docetaxel, began lutetium-177 vipivotide tetraxetan therapy at an outside institution...Budesonide 9 mg daily led to rapid symptom improvement...No granulomas or viral cytopathic effect is identified Figure: Colonic mucosa demonstrates focally active chronic colitis with cryptitis, mixed inflammatory infiltrates in the lamina propria, and mild and focal crypt architectural distortion. No granulomas or viral cytopathic effect is identified"

Biopsy • Case report • Clinical • Metastases • Castration-Resistant Prostate Cancer • Gastroenterology • Gastrointestinal Disorder • Genito-urinary Cancer • Immunology • Oncology • Prostate Adenocarcinoma • Prostate Cancer • Solid Tumor • BRCA2

Fibromyalgia Turned Refractory Celiac Disease-Associated Myalgia: Resolution Following Cladribine Therapy (ACG 2026) - "Dietitian-verified GFD adherence and failed open-capsule budesonide prompted cladribine over two cycles, infliximab having been initially planned for presumed type 1. (A) Lower-power view showing well-preserved villous architecture (hematoxylin-eosin stain, original magnification x 100). (B) Higher-power view showing intraepithelial lymphocytosis (hematoxylin-eosin stain, original magnification x 400)."

IO biomarker • Celiac Disease • Fibromyalgia • Hematological Malignancies • Immunology • Lymphoma • Musculoskeletal Diseases • Musculoskeletal Pain • Rheumatology • T Cell Non-Hodgkin Lymphoma • CD8

Cryptogenic Multifocal Ulcerous Stenosing Enteritis: A Small Bowel Enteropathy Often Missed or Misdiagnosed (ACG 2026) - "Following an initial diagnosis of Crohnâs Disease (jejuno-ileal/fibrostenosing), an induction course of budesonide was given, followed by azathioprine for maintenance. Figure: Figure 2: A) Plain film of abdomen demonstrating capsule retention. B) Surgical specimen of the ileum."

Crohn's disease • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Immunology • Inflammation • Inflammatory Bowel Disease

Lymphocytic Colitis Evolving into Collagenous Colitis: A Long-Term Retrospective Cohort Study in a Tertiary Center (ACG 2026) - "Budesonide therapy was used in 63.3% of patients, with documented symptomatic improvement in 37.9%... A total of 66 patients met inclusion criteria. The mean age at diagnosis was 62.7 years, and 86.4% were female. The majority (81.8%) demonstrated overlapping or evolving histologic features of LC and CC, while 18.2% had clearly distinct subtype diagnoses at separate time points."

Retrospective data • Celiac Disease • Endocrine Disorders • Gastroenterology • Gastrointestinal Disorder • Immunology

Treating Dilation-Resistant Eosinophilic Esophagitis Strictures With Lumen Apposing Metal Stents (LAMS): A Novel Approach (ACG 2026) - "His dysphagia improved immediately following dilation, and oral pantoprazole 20 mg daily and swallowed budesonide 2 mg twice daily were initiated...Repeat EGD three months later demonstrated features of EoE (E0R1E0F0Syes) with recurrent severe stricture proximal to the GEJ which was dilated to 15 mm with mild mucosal disruption and oozing controlled with diluted epinephrine...Due to progression despite proton pump inhibitor and topical steroid therapy, subcutaneous dupilumab 300 mg weekly was initiated in addition to the twice daily pantoprazole...Figure: Placement of lumen apposing metal stent (LAMS) at the site of distal esophageal stricture. Figure: Patency of esophagus following lumen apposing metal stent (LAMS) removal."

Eosinophilic Esophagitis • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Genetic Disorders • Immunology • Nicotine Addiction • Obesity • Tobacco Addiction

BRAF/MEK Inhibitor-Induced Enterocolitis: A Case Series (ACG 2026) - "(Figure 1) All patients required steroid treatment, 3/5 patients (60%) required a prolonged course of budesonide, and 1/5 patient (20%) required infliximab. Patient Characteristics Figure: A) Localized severe inflammation in the right colon characterized by erythema, friability and deep ulcerations. B&C) H&E stain with patchy active chronic colitis with ulcers and neutrophilic cryptitis; non-necrotizing mucosal granulomas."

Clinical • IO biomarker • Acute Kidney Injury • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Immunology • Melanoma • Nephrology • Renal Disease • Solid Tumor

Occult Gastrointestinal Kaposi Sarcoma in Advanced HIV With Concurrent Ulcerative Colitis and Enteric Infections (ACG 2026) - "Case Description/ A 41-year-old male with HIV (CD4 < 50 cells/µL) and UC on budesonide, recently hospitalized for UC flare, presented with headache, blurry vision, anorexia, weight loss, and dysphagia prompting a new diagnosis of cryptococcal meningitis...Two additional 5-8 mm sessile polyps, not shown, were identified in the gastric fundus. Biopsies of all lesions were consistent with Kaposi sarcoma."

Metastases • Anorexia • CNS Disorders • Epstein-Barr Virus Infections • Gastroenterology • Gastrointestinal Disorder • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammatory Bowel Disease • Kaposi Sarcoma • Sarcoma • Solid Tumor • Ulcerative Colitis • CD4

Beyond Hepatocytes: Recognizing ICI Cholangitis in the Era of Combination Immunotherapy (ACG 2026) - "Case Description/ A 46-year-old woman with recurrent BRAF V600-positive metastatic melanoma, refractory to targeted therapy and pembrolizumab, was escalated to nivolumab/relatlimab...ICI-related hepatitis was suspected; immunotherapy was held, and prednisone 1mg/kg/day initiated...Adjunctive budesonide led to transient improvement, but taper attempts triggered relapse...Despite normalization of transaminases by October, ALP remained persistently elevated (441 U/L), consistent with bile duct-predominant injury. Abbreviations: CT, computed tomography; MMF, mycophenolate mofetil; UDCA, ursodeoxycholic acid; MRCP, magnetic resonance cholangiopancreatography; SC, sclerosing cholangitis."

Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hepatology • Immunology • Liver Failure • Melanoma • Solid Tumor • BRAF • CD8 • LAG3

Marked Hyperlipasemia Without Acute Pancreatitis in Cirrhosis Complicated by Hepatorenal Syndrome (ACG 2026) - "Case Description/ A 65-year-old man with alcohol-related cirrhosis and IgA nephropathy on budesonide and mycophenolate presented with nausea, vomiting, poor appetite, and vague abdominal discomfort one day after large-volume paracentesis with removal of 7 liters of ascitic fluid...The patient was treated with albumin, octreotide, and midodrine...Misdiagnosis as pancreatitis may lead to unnecessary testing and inappropriate aggressive fluid administration that could worsen ascites and circulatory dysfunction. Careful clinical correlation with imaging findings and hemodynamic context is essential to avoid diagnostic error and guide appropriate management."

Acute Kidney Injury • Fibrosis • Gastrointestinal Disorder • Glomerulonephritis • Hepatology • IgA Nephropathy • Immunology • Inflammation • Liver Cirrhosis • Nephrology • Pancreatitis • Renal Disease

Strongyloides stercoralis Masquerading as Crohn's Disease (ACG 2026) - "Patient was started on budesonide while pathology reports were pending, which did not improve his symptoms...There are documented cases of hyper infection after courses of steroids for six days and with oral prednisolone doses as low as 20 mg daily...Figure: Figure 2. Colonoscopy revealing patchy colitis with erosions in descending colon, initially raising concern for Crohn's colitis."

Cardiovascular • Coronary Artery Disease • Crohn's disease • Diabetes • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Metabolic Disorders • Type 2 Diabetes Mellitus

Got to GOO: Diagnosing Small Bowel Crohn's Disease Following Compressive Polycystic Kidney Removal (ACG 2026) - "The patient was treated with budesonide followed by infliximab, methotrexate, and folic acid. Initial enteroscopy demonstrating jejunal stricture. Subsequent enteroscopy demonstrating resolution of jejunal stricture after therapy."

Crohn's disease • Diabetes • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammation • Inflammatory Bowel Disease • Metabolic Disorders • Polycystic Kidney Disease • Type 2 Diabetes Mellitus