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Journal of the American Veterinary... Mar 2022A 19-year-old male bottlenose dolphin (Tursiops truncatus) presented with inappetence and avoidant behavior.
CASE DESCRIPTION
A 19-year-old male bottlenose dolphin (Tursiops truncatus) presented with inappetence and avoidant behavior.
CLINICAL FINDINGS
Ultrasound revealed a large-volume left-sided pleural effusion, which was consistent with chronic nonchylous lymphatic effusion and mild chronic hemorrhage by cytology. Computed tomography identified ipsilateral rib fractures, atelectasis, nodular pleuritis, marginal lymph node enlargement, and suspected dilation of the thoracic duct and internal thoracic veins. Fifteen lipids were significantly higher in serum of the dolphin as compared with controls (n = 3) using nontargeted lipidomics.
TREATMENT AND OUTCOME
A series of thoracentesis procedures were performed. Follow-up CT demonstrated marked reduction in pleural effusion with persistence of thoracic duct dilation and mass-like areas of pleural thickening. Ultrasonographic resolution of pleural effusion occurred 14 months after presentation; however, recrudescence was noted 5 months later. Over a total of 24 months, 21.52 L of pleural effusion was removed. Despite the presence of pleural effusion, the patient was clinically stable during this time and quality of life was considered good on the basis of continuous animal welfare evaluations. Humane euthanasia was elected following acute clinical decline 27 months after initial diagnosis. Necropsy confirmed severe pleural effusion, chronic severe pleural fibrosis with chronic hemorrhage, and mediastinal fibrosis with entrapped lymph nodes and thymic tissue.
CLINICAL RELEVANCE
Pleuritis and effusion were suspected sequelae of previous rib fractures. To our knowledge, this is the first report of nonchylous lymphatic pleural effusion with repeated pleural drainage and diagnostic imaging for clinical management in a bottlenose dolphin.
Topics: Animals; Bottle-Nosed Dolphin; Male; Pleural Effusion; Pleurisy; Quality of Life; Rib Fractures
PubMed: 35298406
DOI: 10.2460/javma.21.06.0311 -
Free Radical Biology & Medicine Jan 2009MnTBAP is often referred to as an SOD mimic in numerous models of oxidative stress. We have recently reported that pure MnTBAP does not dismute superoxide, but... (Comparative Study)
Comparative Study
Pure MnTBAP selectively scavenges peroxynitrite over superoxide: comparison of pure and commercial MnTBAP samples to MnTE-2-PyP in two models of oxidative stress injury, an SOD-specific Escherichia coli model and carrageenan-induced pleurisy.
MnTBAP is often referred to as an SOD mimic in numerous models of oxidative stress. We have recently reported that pure MnTBAP does not dismute superoxide, but commercial or poorly purified samples are able to perform O2.- dismutation with low-to-moderate efficacy via non-innocent Mn-containing impurities. Herein, we show that neither commercial nor pure MnTBAP could substitute for SOD enzyme in a SOD-deficient Escherichia coli model, whereas MnTE-2-PyP-treated SOD-deficient E. coli grew as well as a wild-type strain. This SOD-specific system indicates that MnTBAP does not act as an SOD mimic in vivo. In another model, carrageenan-induced pleurisy in mice, inflammation was evidenced by increased pleural fluid exudate and neutrophil infiltration and activation: these events were blocked by 0.3 mg/kg MnTE-2-PyP and, to a slightly lesser extent, by 10 mg/kg of either MnTBAP. Also, 3-nitrotyrosine formation, an indication of peroxynitrite existence in vivo, was blocked by both compounds; again MnTE-2-PyP was 33-fold more effective. Pleurisy model data indicate that MnTBAP exerts some protective actions in common with MnTE-2-PyP, which are not O2.- related and can be fully rationalized if one considers that the common biological role shared by MnTBAP and MnTE-2-PyP is related to their reduction of peroxynitrite and carbonate radical, the latter arising from ONOOCO2 adduct. The log kcat (O2.-) value for MnTBAP is estimated to be about 3.16, which is approximately 5 and approximately 6 orders of magnitude smaller than the SOD activities of the potent SOD mimic MnTE-2-PyP and Cu,Zn-SOD, respectively. This very low value indicates that MnTBAP is too inefficient at dismuting superoxide to be of any biological impact, which was confirmed in the SOD-deficient E. coli model. The peroxynitrite scavenging ability of MnTBAP, however, is only approximately 2.5 orders of magnitude smaller than that of MnTE-2-PyP and is not significantly affected by the presence of the SOD-active impurities in the commercial MnTBAP sample (log k red (ONOO-) = 5.06 for pure and 4.97 for commercial sample). The reduction of carbonate radical is equally fast with MnTBAP and MnTE-2-PyP. The dose of MnTBAP required to yield oxidative stress protection and block nitrotyrosine formation in the pleurisy model is > 1.5 orders of magnitude higher than that of MnTE-2-PyP, which could be related to the lower ability of MnTBAP to scavenge peroxynitrite. The slightly better protection observed with the commercial MnTBAP sample (relative to the pure MnTBAP) could arise from its impurities, which, by scavenging O2.-, reduce consequently the overall peroxynitrite and secondary ROS/RNS levels. These observations have profound biological repercussions as they may suggest that the effect of MnTBAP observed in numerous studies may conceivably relate to peroxynitrite scavenging. Moreover, provided that pure MnTBAP is unable to dismute superoxide at any significant extent, but is able to partially scavenge peroxynitrite and carbonate radical, this compound may prove valuable in distinguishing ONOO-/CO3.- from O2.- pathways.
Topics: Animals; Carrageenan; Escherichia coli; Free Radical Scavengers; Metalloporphyrins; Mice; Models, Animal; Neutrophil Infiltration; Oxidative Stress; Peroxynitrous Acid; Pleural Effusion; Pleurisy; Signal Transduction; Substrate Specificity; Superoxide Dismutase; Superoxides
PubMed: 19007878
DOI: 10.1016/j.freeradbiomed.2008.09.042 -
Internal Medicine (Tokyo, Japan) Jan 2024An 83-year-old man presented with chronic dyspnea, and chest X-ray showed bilateral pleural effusion. Right thoracentesis revealed lymphocyte-predominant exudate with no...
An 83-year-old man presented with chronic dyspnea, and chest X-ray showed bilateral pleural effusion. Right thoracentesis revealed lymphocyte-predominant exudate with no malignancy; bacterial and mycobacterial cultures were negative. Thoracoscopy via the right chest and a biopsy of the same site were performed; these showed lymphoplasmacytic infiltration and fibrosis, ruling out malignancy or tuberculosis. We decided to start corticosteroid therapy for the diagnosis of idiopathic lymphocytic pleuritis (ILP). The patient was discharged after clinical improvement, and steroids were tapered off. An early diagnosis by thoracoscopy and the exclusion of other diseases are important for initiating steroid therapy in patients with ILP.
Topics: Male; Humans; Aged, 80 and over; Pleurisy; Pleural Effusion; Lymphocytes; Thoracentesis; Adrenal Cortex Hormones; Thoracoscopy
PubMed: 37197953
DOI: 10.2169/internalmedicine.1240-22 -
Clinical and Translational Science Dec 2008In this study, we compared several immune parameters in tuberculosis (TB) and nontuberculosis (NTB) pleurisy to gain an understanding of the mechanism behind enhanced... (Comparative Study)
Comparative Study
In this study, we compared several immune parameters in tuberculosis (TB) and nontuberculosis (NTB) pleurisy to gain an understanding of the mechanism behind enhanced Th1 apoptosis that occurs at sites of active Myobacterium tuberculosis (M. tuberculosis) infection. An initial evaluation of the accumulated cytokines in pleural fluid (PF) demonstrated that both TB and NTB pleurisy were associated with prointflammatory cytokines, while only TB pleurisy had augmented expression of interferon (IFN)-gamma and soluble Fas ligand (sFASL). Despite enhanced expression of the apoptosis-inducing molecule in TB pleurisy, T cells derived from both types of pleurisy exhibited significant apoptosis. In both groups, T-cell apoptosis correlated with low expression of CD80 on PF-derived macrophages and elevated accumulation of TGF-beta in the PF. A causative correlation between TGF-beta and low CD80 expression in the two groups was established by in vitro studies demonstrating TGF-beta inhibition of CD80 upregulation in a macrophage cell line. Together, the findings allude to the possibility that activation in the absence of appropriate CD80 costimulation is the mechanism that leads to T-cell apoptosis at sites of active M. tuberculosis infection. Furthermore, the findings also indicate that T-cell apoptosis is perhaps a host regulatory mechanism to limit inflammation, rather than a pathogen-induced immune deviation.
Topics: Adult; Aged; Apoptosis; B7-1 Antigen; B7-2 Antigen; Cytokines; Female; Humans; Lipopolysaccharide Receptors; Male; Middle Aged; Pleurisy; T-Lymphocytes; Transforming Growth Factor beta; Tuberculosis, Pleural
PubMed: 20443851
DOI: 10.1111/j.1752-8062.2008.00057.x -
Respiration; International Review of... 2018While nontuberculous mycobacterial (NTM) pleuritis rarely complicates pulmonary NTM infection, high mortality has been reported in case reports and small studies.
BACKGROUND
While nontuberculous mycobacterial (NTM) pleuritis rarely complicates pulmonary NTM infection, high mortality has been reported in case reports and small studies.
OBJECTIVES
The purpose of this study was to clarify the clinical features and treatment outcomes of pulmonary NTM infection cases accompanied by NTM pleuritis.
METHODS
Medical records of 1,044 patients with pulmonary NTM disease were retrospectively reviewed to select patients complicated by NTM-proven pleuritis. We investigated clinical characteristics, pathogens, pleural effusion examinations, radiographic findings, treatments, and clinical course of the NTM pleuritis patients.
RESULTS
Among 1,044 cases with pulmonary NTM, NTM pleuritis occurred in 15 cases (1.4%). The mean age was 69 years with a performance status of mostly 2 or better (80.0%), and 6 cases (40.0%) were complicated by pneumothorax. Subpleural cavities were radiologically detected in 11 cases (73.3%), and extrapulmonary air-fluid level was detected in 14 cases (93.3%). Eleven patients were treated with combinations of 2-4 antimycobacterial drugs, including clarithromycin, and 2 patients were treated with isoniazid, rifampicin, and ethambutol. Chest tube drainage was performed in 11 cases, and surgical approach was added in 6 cases. The pleural effusion of 2 patients treated with only antimycobacterial medications gradually deteriorated. Two patients died from NTM pleuritis, and 1 patient died from pneumonitis during a mean of 1.8 years of follow-up.
CONCLUSIONS
Comorbid NTM pleuritis was difficult to treat by medical therapy alone and resulted in a poor prognosis. In addition to antimycobacterial agents, chest tube drainage and surgical procedures in the early stages should be considered to treat NTM pleuritis.
Topics: Aged; Aged, 80 and over; Female; Humans; Japan; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Pleura; Pleurisy; Prognosis; Retrospective Studies
PubMed: 30286448
DOI: 10.1159/000490548 -
BMC Infectious Diseases Nov 2020Etiological diagnosis of tuberculous pleuritis is challenging, owing to a paucity of Mycobacterium tuberculosis (MTB) in the affected region. Moreover, currently...
BACKGROUND
Etiological diagnosis of tuberculous pleuritis is challenging, owing to a paucity of Mycobacterium tuberculosis (MTB) in the affected region. Moreover, currently available methods, such as the detection of acid-fast bacilli and microbiological culture, are not always conducive to timely diagnosis and treatment. In this study, we evaluated the performance of Xpert® MTB/RIF assay (hereinafter referred to as "Xpert") in detecting MTB in difficult-to-diagnose patients using suspensions of pleural biopsy tissue specimens obtained under direct thoracoscopic guidance.
METHODS
One hundred and sixty patients with an unexplained pleural effusion were included from the Shenyang Tenth People's Hospital and Shenyang Chest Hospital, China, between 2017 and 2018. The included patients underwent thoracoscopy under local anesthesia, with an intercostal incision of approximately 1.0 cm for biopsy. The biopsy specimens were used for pathological and etiological examinations. The Xpert test was evaluated for its sensitivity and specificity, as well as positive and negative predictive values (PPV and NPV, respectively), against data obtained using standards: the BACTEC™ MGIT™ 960 liquid culture system and a composite reference standard (CRS).
RESULTS
The sensitivity and specificity of Xpert were 68.8 and 64.6%, respectively, against the MGIT 960 culture data. The PPV and NPV of Xpert were 56.4 and 75.6%, respectively. The sensitivity of Xpert was 69.0% against the CRS data, which was significantly higher than that of MGIT 960 culture (56.6%). The PPV and NPV of Xpert against the CRS data were 100.0 and 57.3%, respectively.
CONCLUSIONS
Xpert is a good rule-in test but has limited value as a rule-out test for the diagnosis of tuberculosis pleuritis.
Topics: Adolescent; Adult; Aged; Biopsy; China; Female; Humans; Male; Middle Aged; Mycobacterium tuberculosis; Nucleic Acid Amplification Techniques; Pleural Cavity; Pleural Effusion; Pleurisy; Sensitivity and Specificity; Thoracoscopy; Tuberculosis, Pleural; Young Adult
PubMed: 33183269
DOI: 10.1186/s12879-020-05578-3 -
European Journal of Pharmacology Jun 2016Uvaol, a triterpene present in olives and virgin olive oil, has been shown to possess anti-inflammatory properties and antioxidant effects. However, until now, no...
Uvaol, a triterpene present in olives and virgin olive oil, has been shown to possess anti-inflammatory properties and antioxidant effects. However, until now, no studies have demonstrated its potential effects on allergic inflammation. The aim of this study was to evaluate the anti-inflammatory effects of uvaol in a mouse model of allergy characterized by eosinophil-dominant inflammation in actively sensitized mice. The anti-inflammatory effect of uvaol was analyzed in two murine models of allergic inflammation (pleurisy and asthma). In these models, Swiss mice were sensitized and challenged with ovalbumin (OVA). In the pleurisy model, the pleural eosinophilic inflammation and IL-5 concentrations were examined 24h after the OVA challenge, while in the asthma model were examined the airway inflammation via bronchoalveolar lavage (BAL) fluid cytology and lung histopathology analyses. Our results showed that uvaol decreased the accumulation of eosinophils and the concentration of IL-5 in pleural effluent. Uvaol also demonstrated important anti-inflammatory activity by inhibiting production of IL-5 and influx of leukocytes, mainly of eosinophils, in BAL fluid, but without interfering with levels of reactive oxygen species in leukocytes. Moreover, the eosinophil infiltration, mucus production, number of alveoli that collapsed, and IL-5 levels in the lung were clearly decreased by uvaol treatment. These findings indicate that uvaol can be a good candidate for the treatment of allergic inflammation by inhibiting eosinophil influx and IL-5 production in ovalbumin-induced allergy.
Topics: Allergens; Animals; Eosinophils; Hypersensitivity; Inflammation; Lung; Male; Mice; Ovalbumin; Pleurisy; Triterpenes
PubMed: 27038519
DOI: 10.1016/j.ejphar.2016.03.056 -
International Journal of Clinical and... 2014IgG4-related sclerosing disease is an established disease entity with characteristic clinicopathological features. Some recent reports have demonstrated that this... (Review)
Review
IgG4-related sclerosing disease is an established disease entity with characteristic clinicopathological features. Some recent reports have demonstrated that this disease can occur in the respiratory system including the pleura. Herein, we describe the first documented case of concomitant occurrence of IgG4-related pleuritis and periaortitis. A 71-year-old Japanese female with a history of essential thrombocythemia presented with persistent cough and difficulty in breathing. Computed tomography demonstrated thickening of the right parietal pleura, pericardium, and periaortic tissue and pleural and cardiac effusions. Histopathological study of the surgical biopsy specimen of the parietal pleura revealed marked fibrous thickening with lymphoplasmacytic infiltration. Phlebitis was noted, however, only a few eosinophils had infiltrated. Immunohistochemical study revealed abundant IgG4-positive plasma cell infiltration and high ratio of IgG4-/IgG-positive plasma cells (84%). Therefore, a diagnosis of IgG4-related pleuritis was made with consideration of the elevated serum IgG4 level (684 mg/dL). Recently, the spectrum of IgG4-related sclerosing disease has expanded, and this disease can occur in the pleura, pericardium, and periaortic tissue. Although histopathological analysis of the pericardium and periaortic tissue was not performed in the present case, it was suspected that thickening of the pericardium and periaortic tissue was clinically due to IgG4-related sclerosing disease. Our clinicopathological analyses of IgG4-related pleuritis and pericarditis reveal that this disease can present as dyspnea and pleural and pericardial effusion as seen in the present case, therefore, it is important to recognize that IgG4-related sclerosing disease can occur in these organs for accurate diagnosis and treatment.
Topics: Aged; Autoimmune Diseases; Biomarkers; Biopsy; Female; Humans; Immunoglobulin G; Immunohistochemistry; Pericardium; Plasma Cells; Pleurisy; Predictive Value of Tests; Retroperitoneal Fibrosis; Steroids; Tomography, X-Ray Computed; Treatment Outcome; Up-Regulation
PubMed: 24551308
DOI: No ID Found -
The American Journal of Case Reports Jul 2020BACKGROUND Severe acute respiratory syndrome coronavirus 2, the virus responsible for Coronavirus Disease 2019 (COVID-19), has infected more than 8 million people...
BACKGROUND Severe acute respiratory syndrome coronavirus 2, the virus responsible for Coronavirus Disease 2019 (COVID-19), has infected more than 8 million people worldwide and placed massive strains on healthcare systems around the world. Although classically causing cough, fever, and shortness of breath, increasing evidence suggests that manifestations of COVID-19 can be more subtle or masquerade as other clinical entities. CASE REPORT A 48-year-old man with hypertension and type 2 diabetes mellitus presented to the Emergency Department with acute-onset pleuritic chest pain that had developed 1 day earlier and was found to be hypoxemic, requiring supplemental oxygen. He was admitted under the internal medicine service and underwent an extensive workup for his chest pain and hypoxemia, including a negative computed tomography scan with pulmonary embolism protocol, negative nuclear medicine ventilation/perfusion scan, normal electrocardiogram, and normal echocardiography. In the end, he was diagnosed with viral pleuritis as the diagnosis of exclusion. Our patient subsequently developed a fever and shortness of breath and his nasopharyngeal swab performed on admission to hospital returned positive for COVID-19. The patient's pleuritic pain and oxygen requirements improved with supportive management over the next several days. CONCLUSIONS I report a patient who experienced pleuritic chest pain from viral pleurisy that was the initial manifestation of COVID-19 which, to the best of my knowledge, has not yet been reported in the literature. This case report further emphasizes that COVID-19 may present with atypical symptoms. It is crucial to be aware of these atypical presentations of COVID-19 so that patients are appropriately identified, isolated, and treated, while protecting health care workers from exposure.
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Diabetes Mellitus, Type 2; Emergency Service, Hospital; Humans; Hypertension; Male; Middle Aged; Pandemics; Pleurisy; Pneumonia, Viral; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 32706769
DOI: 10.12659/AJCR.925775 -
Biology of Sex Differences Dec 2019Systemic lupus erythematosus (SLE) predominantly affects women, but previous studies suggest that men with SLE present a more severe disease phenotype. In this study, we...
OBJECTIVE
Systemic lupus erythematosus (SLE) predominantly affects women, but previous studies suggest that men with SLE present a more severe disease phenotype. In this study, we investigated a large and well-characterized patient group with the aim of identifying sex differences in disease manifestations, with a special focus on renal involvement.
METHODS
We studied a Swedish multi-center SLE cohort including 1226 patients (1060 women and 166 men) with a mean follow-up time of 15.8 ± 13.4 years. Demographic data, disease manifestations including ACR criteria, serology and renal histopathology were investigated. Renal outcome and mortality were analyzed in subcohorts.
RESULTS
Female SLE patients presented more often with malar rash (p < 0.0001), photosensitivity (p < 0.0001), oral ulcers (p = 0.01), and arthritis (p = 0.007). Male patients on the other hand presented more often with serositis (p = 0.0003), renal disorder (p < 0.0001), and immunologic disorder (p = 0.04) by the ACR definitions. With regard to renal involvement, women were diagnosed with nephritis at an earlier age (p = 0.006), while men with SLE had an overall higher risk for progression into end-stage renal disease (ESRD) with a hazard ratio (HR) of 5.1 (95% CI, 2.1-12.5). The mortality rate among men with SLE and nephritis compared with women was HR 1.7 (95% CI, 0.8-3.8).
CONCLUSION
SLE shows significant sex-specific features, whereby men are affected by a more severe disease with regard to both renal and extra-renal manifestations. Additionally, men are at a higher risk of developing ESRD which may require an increased awareness and monitoring in clinical practice.
Topics: Adult; Disease Progression; Female; Humans; Kidney Diseases; Lupus Erythematosus, Systemic; Male; Middle Aged; Pericarditis; Pleurisy; Serositis; Severity of Illness Index; Sex Characteristics; Sweden; Young Adult
PubMed: 31843005
DOI: 10.1186/s13293-019-0274-2