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Diagnostics (Basel, Switzerland) Aug 2022Hepatic portal venous gas (HPVG) detected by ultrasound (US) following liver transplantation or in suppurative cholangitis was described previously. To our knowledge,...
Hepatic portal venous gas (HPVG) detected by ultrasound (US) following liver transplantation or in suppurative cholangitis was described previously. To our knowledge, there have been no descriptions of HPVG detected by US in acute mesenteric ischemia. Here we present diagnostic images of a 52-year-old female who was admitted to the intensive care unit (ICU) following successful embolization of a ruptured saccular aneurysm of the right vertebral artery. During their stay in the ICU, the patient developed hypotension with low systemic vascular resistance and hypovolemia. Based on physical examination of the abdomen and laboratory results, preliminary diagnosis of intra-abdominal sepsis was made. Early abdominal US was performed to find the source of sepsis. The preliminary diagnosis of stomach/small intestine ischemia was made by ultrasonic detection of HPVG. Other less likely diagnoses were pneumobilia due to cholangitis, hepatic micro-abscesses, and punctuate calcifications. The diagnosis was confirmed by multi-phase abdominal computed tomography. The explorative laparotomy revealed necrosis of the stomach, small intestine, and liver. Due to the severity of necrosis, surgical treatment was abandoned. Provided sonographic images show HPVG as an ominous sign of small intestine and stomach ischemia. Early liver US should be performed whenever intra-abdominal pathology is suspected.
PubMed: 36140436
DOI: 10.3390/diagnostics12092034 -
Zhonghua Jie He He Hu Xi Za Zhi =... Sep 2022We report an unusual case presented as acute gastrointestinal perforation and large confluent pulmonary cavities. A 23-year-old male was admitted to the emergency...
We report an unusual case presented as acute gastrointestinal perforation and large confluent pulmonary cavities. A 23-year-old male was admitted to the emergency department with complaints of abdominal pain for 1 month, which exacerbated for 1 day. He also reported a 3-month history of diarrhea and productive cough. Computed tomography (CT) scan showed multiple large confluent cavities in the lung, along with massive free gas in the abdomen suggesting gastrointestinal perforation. Exploratory laparotomy was performed and affected bowel segment was resected. His sputum examination was positive for both acid-fast staining and complex gene (Xpert) testing. Pathology of small intestine revealed micro-abscess formation and was positive for acid-fast bacilli. A final diagnosis of pulmonary tuberculosis and intestinal tuberculosis was made.
Topics: Adult; Humans; Male; Tomography, X-Ray Computed; Tuberculosis, Gastrointestinal; Tuberculosis, Lymph Node; Tuberculosis, Pulmonary; Young Adult
PubMed: 36097928
DOI: 10.3760/cma.j.cn112147-20220209-00102 -
Open Forum Infectious Diseases Sep 2022A more complete understanding of the epidemiology, risk factors, and clinical features of cat scratch disease (CSD) in children could help guide patient care.
BACKGROUND
A more complete understanding of the epidemiology, risk factors, and clinical features of cat scratch disease (CSD) in children could help guide patient care.
METHODS
We conducted a retrospective analysis of children presenting to a tertiary pediatric hospital system in Atlanta, Georgia between January 1, 2010 and December 31, 2018 who had serology, polymerase chain reaction, and/or cytopathological results consistent with a infection. We also retrospectively reviewed veterinary diagnostic results performed at the University of Georgia from 2018 to 2020 to ascertain the burden of bartonellosis in companion animals within the state.
RESULTS
We identified 304 children with CSD over 9 years with the largest proportion of diagnoses made during August (41 of 304, 13.5%) and September (47 of 304, 15.5%). The median age of child cases was 8.1 years (interquartile range [IQR], 5.4-12.1); 156 (51.3%) were female; 242 of 262 (92.4%) reported feline exposure; and 55 of 250 (22%) reported canine exposure of those with exposure histories documented in the medical record. Although lymphadenopathy was present on physical examination in the majority of cases (78.8%), atypical presentations lacking lymphadenopathy were also common (63 of 304, 20.7%). Among children with radiographic imaging, 20 of 55 (36.4%) had splenomegaly and 21 of 55 (38.1%) had splenic and/or hepatic microabscesses. Among veterinary data, seroprevalence was 12 of 146 (8.2%), all among canines, with a geographic distribution that spanned the state of Georgia.
CONCLUSIONS
Distinguishing clinical features of CSD included subacute regional lymphadenopathy in school-aged children in the late summer, almost all of whom had cat exposure. Atypical clinical manifestations of CSD were also commonly identified.
PubMed: 36072697
DOI: 10.1093/ofid/ofac426 -
Animal Biotechnology Dec 2023To understand the pathology of natural cases of pathotypes infection in bovine calves, 45 cases of bovine calves, below one month of age, died due to enteritis were...
To understand the pathology of natural cases of pathotypes infection in bovine calves, 45 cases of bovine calves, below one month of age, died due to enteritis were studied. Total seventeen cases (37.77%) turned positive for different pathotypes of by RT-PCR. Out of seventeen positive samples for , six cases (35.29%) were positive for gene, three cases (17.64%) for and eight cases (47.05) for gene of . Gross lesions in these cases showed pin-point to ecchymotic hemorrhages in the mucosa of jejunum, ileum and colon. The draining mesenteric lymph nodes were swollen, enlarged and showed cord -like structure. Histopathology of small intestine showed, villi lining cells were sloughed off, tips of villi capillary plexus were congested and hemorrhagic, and skipping lesions of microabscesses in the crypts of mucosa were observed. In the duodenum, necrosis of crypts and infiltration of mononuclear cells in the lamina propria and around Brunner's gland. In mesenteric lymph nodes the subscapular space were infiltrated with mononuclear cells with depletion of lymphoid follicles in cortical area. Peri-trabecular and medullary sinuses of mesenteric lymph nodes were necrosed.
Topics: Animals; Cattle; Escherichia coli; Diarrhea; Escherichia coli Infections; Ileum; Jejunum; Cattle Diseases
PubMed: 36007588
DOI: 10.1080/10495398.2022.2114003 -
European Archives of... Mar 2023To evaluate association between clinical and pathological findings and repeated recurrence in sinonasal inverted papilloma.
PURPOSE
To evaluate association between clinical and pathological findings and repeated recurrence in sinonasal inverted papilloma.
METHODS
Retrospective cohort study conducted at a tertiary care teaching hospital included all patients operated for inverted papilloma from January 2010 to December 2019. Patients were categorized as primary and recurrent cases. Based on disease status at follow-up, they were subcategorized into 'primary with no recurrence' (PnR), 'primary with recurrence' (PwR), 'recurrent with no further recurrence' (RnR), and 'recurrent with further recurrence' (RwR) groups. Data including demography, clinical, endoscopic and pathological findings were collected and analyzed.
RESULTS
Increased incidence of pale appearance of lesion in RnR group (p = 0.017), polypoidal appearance in primary group (p = 0.002) and fibrous appearance in the recurrent group (p = 0.002) were statistically significant. Predominant epithelium was combined respiratory and squamous epithelium in primary and recurrent groups and also in RnR group (p = 0.019), while it was squamous (p = 0.024) in RwR group. Epithelial hyperplasia was more common in primary and RnR groups. Oncocytic change, cystic dilatation, microabscess and squamous metaplasia were seen more in recurrent and RnR groups. Cytoplasmic glycogenation was more in recurrent and RwR groups. Stroma was predominantly edematous in all the groups.
CONCLUSIONS
Patients with recurrence are younger and present earlier than those with primary disease. Fleshy appearance and pink/red colour of tumour, lining epithelium being squamous and cytoplasmic glycogenation could be considered as features predicting recurrence. Negative predictors of recurrence of IP include pale appearance of tumour, combined respiratory and squamous epithelium lining and squamous metaplasia.
Topics: Humans; Papilloma, Inverted; Retrospective Studies; Paranasal Sinus Neoplasms; Epithelium; Neoplasm Recurrence, Local; Carcinoma, Squamous Cell; Nose Neoplasms
PubMed: 35932314
DOI: 10.1007/s00405-022-07585-3 -
Journal of Cardiology Cases Jul 2022A 42-year-old man with a history of acute myocarditis after streptococcal pharyngitis developed recurrent fulminant myocarditis. Endomyocardial biopsy revealed myocyte...
UNLABELLED
A 42-year-old man with a history of acute myocarditis after streptococcal pharyngitis developed recurrent fulminant myocarditis. Endomyocardial biopsy revealed myocyte degeneration, interstitial edema, and neutrophil infiltration. The patient's cardiac function deteriorated rapidly, and he died despite mechanical circulatory support. Autopsy revealed neutrophil infiltration, interstitial edema, and micro-abscesses containing masses of streptococci and neutrophilic phagocytosis within the myocardium. The patient did not meet the diagnostic criteria for acute rheumatic fever; thus, he was diagnosed with non-rheumatic streptococcal myocarditis. Non-rheumatic streptococcal myocarditis rarely recurs, but it can be fulminant upon recurrence.
LEARNING OBJECTIVE
We report a rare case of recurrent fulminant non-rheumatic streptococcal myocarditis. Endomyocardial biopsy and autopsy revealed neutrophil infiltration and micro-abscesses containing bacterial masses of streptococci and neutrophilic phagocytosis in the myocardium. The patient did not meet the diagnostic criteria for acute rheumatic fever; thus, he was diagnosed with non-rheumatic streptococcal myocarditis. Non-rheumatic streptococcal myocarditis rarely recurs, but it can be fulminant upon recurrence.
PubMed: 35923528
DOI: 10.1016/j.jccase.2022.02.004 -
Obstetric Medicine Jun 2022We present the case of a healthy nulliparous woman who presented with persistent fever, proteinuria and elevated transaminases at 33 weeks' gestation. Following initial...
We present the case of a healthy nulliparous woman who presented with persistent fever, proteinuria and elevated transaminases at 33 weeks' gestation. Following initial treatment for suspected chorioamnionitis and potential pre-eclampsia, she had a caesarean section delivering a healthy male infant. However, on her third post-operative day, she developed neurological symptoms and accompanying severe sepsis, necessitating inotropic support and transfer to a higher level of care. A comprehensive work-up revealed herpes simplex Virus-2 (HSV-2) in serum and cerebrospinal fluid. Abdominal imaging was suggestive of accompanying hepatitis with micro-abscesses. This lady recovered well following intravenous acyclovir for 14 days. Her infant was not affected and was discharged home with his mother. Herpes simplex encephalitis and hepatitis associated with HSV-2 have been described three times previously in pregnancy. We delineate the diagnostic challenges that rare conditions such as this pose and emphasise the importance of multi-disciplinary care in managing complicated medical conditions in pregnancy.
PubMed: 35845225
DOI: 10.1177/1753495X20978037 -
Radiographics : a Review Publication of... 2022When a pediatric hepatic cystic lesion is identified at imaging, the differential diagnosis may be broad, including developmental, infectious, neoplastic, and...
When a pediatric hepatic cystic lesion is identified at imaging, the differential diagnosis may be broad, including developmental, infectious, neoplastic, and posttraumatic or iatrogenic causes. The location of a cystic lesion and its number, size, composition, and relationship to the biliary system are features that help in narrowing the differential diagnosis. An incidentally detected simple hepatic cyst is the most commonly encountered. Ciliated foregut cysts are typically located in hepatic segment IVa. The presence of multiple cysts should raise suspicion for fibropolycystic liver disease, a group of related lesions-including biliary hamartoma and choledochal cyst-caused by abnormal embryologic development of the ductal plate. Communication of the cystic lesion with the biliary tree can confirm the diagnosis of choledochal cyst. In a neonate with jaundice, a cystic lesion at the porta hepatis should raise suspicion for choledochal cyst versus cystic biliary atresia. Hepatic abscess can appear cystlike, though typically with internal contents. In an immunocompromised child, multiple cystlike lesions should raise concern for fungal microabscesses. A complex cystic mass in a young child should raise suspicion for mesenchymal hamartoma, which can evolve into undifferentiated embryonal sarcoma if untreated. Hepatic hematoma and biloma can appear cystlike in children with a history of trauma or recent intervention. In neonates with an umbilical vein catheter (UVC), an intrahepatic cyst along the course of the UVC should raise concern for infusate extravasation. Familiarity with imaging findings and clinical features is essential for achieving accurate diagnosis of pediatric hepatic cystic lesions, which in turn can guide appropriate clinical management. RSNA, 2022.
Topics: Child; Choledochal Cyst; Cysts; Diagnosis, Differential; Hamartoma; Humans; Infant, Newborn; Liver Diseases; Liver Neoplasms; Multimodal Imaging
PubMed: 35839138
DOI: 10.1148/rg.220006 -
BMC Veterinary Research Jul 2022Cutaneous epitheliotropic T-cell lymphoma is a malignant tumour of the skin already reported in humans, dogs, cats, horses, and other species, but not previously in...
BACKGROUND
Cutaneous epitheliotropic T-cell lymphoma is a malignant tumour of the skin already reported in humans, dogs, cats, horses, and other species, but not previously in donkeys. The standard diagnosis is based on clinical, morphological and immunophenotypic data. Differentiation of malignant versus benign proliferation of lymphocytes is crucial; in ambiguous cases T-cell receptor gamma (TRG) molecular clonality should be tested. In the present paper, we report a case of mycosis fungoides diagnosed in a donkey whose diagnosis was based on clinical, histological and immunohistochemical aspects and a positive TRG clonality test.
CASE PRESENTATION
A twenty-five-year-old donkey gelding was referred with a mildly pruritic, generalised and severe exfoliative dermatosis. Otherwise, the animal was clinically healthy, though mildly underweight. Dermatological examination revealed severe generalised alopecic and exfoliative dermatitis, occasionally eroded, with high number of large, thin, greyish scales. All mucocutaneous junctions except the hoofs were affected. Ectoparasites and dermatophytes were ruled out. The complete blood count and blood smear evaluation revealed mild normocytic normochromic anemia. The biochemistry panel showed mild hyperproteinemia with albumin within the normal range. Protein electrophoresis showed moderate polyclonal hypergammaglobulinemia. Histological findings were characterised by interface dermatitis with massive exocytosis in the epidermis of a homogenous population of lymphoid cells showing atypia. Clusters of neoplastic cells were present within the epidermis forming Pautrier "microabscesses". These findings are consistent with cutaneous epitheliotropic lymphoma. Immunohistochemical staining revealed uniform labelling of the neoplastic cells for CD3, and lack of expression of CD20 (a B cell lineage associated marker). Molecular clonality PCR (PARR) was performed using equine TRG primers; this revealed a clonal rearrangement in a heavy polyclonal background. Transmission electronic microscopy showed multiple lymphocytes with convoluted or cerebriform nuclei.
CONCLUSIONS
This case report provides the first evidence of clinical, histopathological, immunophenotypic features, electron microscopy findings and molecular analysis of a cutaneous epitheliotropic T-cell lymphoma (mycosis fungoides) in a donkey. Our observations suggest that cutaneous T-cell lymphoma should be included in the differential diagnoses of exfoliative dermatitis, even those progressing in a chronic pattern and/or with few or no pruritus.
Topics: Animals; Dermatitis, Exfoliative; Equidae; Lymphoma, T-Cell, Cutaneous; Male; Mycosis Fungoides; Receptors, Antigen, T-Cell, gamma-delta; Skin Neoplasms
PubMed: 35821128
DOI: 10.1186/s12917-022-03365-7 -
Dermatologic Therapy Sep 2022We report a case of a 7-year-old male patient with vaccine-induced erythrodermic psoriasis (EP) complicated by pulmonary infection, hypoproteinemia, and liver...
We report a case of a 7-year-old male patient with vaccine-induced erythrodermic psoriasis (EP) complicated by pulmonary infection, hypoproteinemia, and liver dysfunction successfully treated with secukinumab in combination with symptomatic and supportive therapy. The patient presented with diffuse flushing on the head, face, trunk, and limbs, which were covered with chaff-like white scales in the rash-affected area, with no blisters, pustules, and no apparent abnormalities in the palms, soles, nails, and joints. Histopathology analysis revealed hyperkeratosis, focal parakeratosis, thinning or effacement of the granular layer, psoriasiform hyperplasia of the epidermis, neutrophilic microabscess formation in the upper part of the epidermis, edema of the dermal papilla, dilation of blood vessels, and lymphocyte infiltration. The patient was eventually diagnosed with EP. At weeks 0, 1, and 2, the patient received a subcutaneous injection of 150 mg secukinumab (three injections). Fluticasone propionate ointment, taccathitol ointment, yellow vaseline, and other drugs were also given topically. Following 2 weeks of treatment, the child's skin lesions resolved significantly with only slight pigmentation remaining and the Psoriasis Area and Severity Index (PASI) score decreased from 37.5 to 7.5 (PASI 75). Thereafter, 150 mg secukinumab was injected every 4 weeks until the last dose at 18 weeks (four more injections). After 18 weeks, the child's lesion resolved entirely (PASI 100), and no adverse effects were reported.
Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Child; Double-Blind Method; Humans; Injections, Subcutaneous; Male; Ointments; Psoriasis; Severity of Illness Index; Treatment Outcome; Vaccines
PubMed: 35789520
DOI: 10.1111/dth.15684