Lymphocytic thrombophilic arteritis with lower-limb ulcers

Abstract Lymphocytic thrombophilic arteritis is a recently described entity, histopathologically characterized by lymphocytic vasculitis that affects the arterioles of the dermo-hypodermic junction, associated with deposition of fibrin and a luminal fibrin ring. A 49-year-old female patient presented with achromic maculae and a well-defined ulcer on the medial aspect of the left lower limb. The biopsy showed intense inflammatory infiltrate in the papillary dermis with a predominance of lymphocytes, and medium-caliber vessels surrounded by mononuclear infiltrates in the deep reticular dermis. Masson's trichrome staining showed intense destruction of the muscle layer of the vascular wall and a fibrin ring. Good clinical response was attained with azathioprine. The authors believe that the ulceration might be another clinical presentation or represent an atypical progression of this condition.

Coronary arteritis as a cause of sudden cardiac death in a young girl

A case of probable coronary arteritis in a young girl who died suddenly and unexpectedly is presented. The histologic presentation of the disorder is discussed, especially the differential diagnosis of arteritis of the coronary arteries with an emphasis on tuberculosis (TB). TB myocarditis with or without concomitant lung involvement is rare, and tubercular coronary arteritis without underlying pulmonary Koch's disease is all the rarer. We herein describe a case where the cause of death was ascertained on post-mortem examination.

Arterite sifilítica / Retinal arteritis related to syphilis

Resumo Apresentamos um caso de neurosífilis em um homem jovem, com queixa de baixa acuidade visual (BAV) em olho esquerdo. Cursou com lesões eritemato-descamativas nas palmas das mãos, plantas dos pés e úlceras orais, sem lesões genitais. O exame oftalmológico revelou arterite em arcada nasal superior no olho afetado. Apresentou VDRL (1:4096) e FTA-Abs positivos. O exame do líquor cefalorraquidiano foi negativo. O tratamento foi realizado com ceftriaxona 2g/ dia por 14 dias, associado à prednisona 0,5mg/kg oral 48h após início do antibiótico. Após 15 dias de tratamento, houve melhora da AV, regressão da vasculite e redução da titulação do VDRL para 1:128.

Abstract We present a case of neurosyphilis in a young man with a complaint of low visual acuity in the left eye. He had erythematous-scaly lesions on the palms of the hands, soles of the feet and oral ulcers, without genital lesions. The ophthalmic examination revealed arteritis in the upper nasal arcade in the affected eye. He presented VDRL (1: 4096) and FTA-Abs positive. The cerebrospinal fluid cerebrospinal fluid test was negative. The treatment was performed with ceftriaxone 2g / day for 14 days, associated with prednisone 0.5mg / kg oral 48h after antibiotic onset. After 15 days of treatment, there was improvement of AV, regression of vasculitis and reduction of VDRL titration to 1: 128.

Is macular lymphocytic arteritis limited to the skin? Long-term follow-up of seven patients

Abstract Background: Macular lymphocytic arteritis most commonly presents as hyperpigmented macules on the lower limbs. The pathogenesis of this disease is still unclear and there is an ongoing debate regarding whether it represents a new form of cutaneous vasculitis or an indolent form of cutaneous polyarteritis nodosa. Objective: To describe clinical, histopathological, and laboratory findings of patients with the diagnosis of macular lymphocytic arteritis. Methods: A retrospective search was conducted by reviewing cases followed at the Vasculitis Clinic of the Dermatology Department, School of Medicine, University of São Paulo, between 2005 and 2017. Seven patients were included. Results: All cases were female, aged 9-46 years, and had hyperpigmented macules mainly on the legs. Three patients reported symptoms. Skin biopsies evidencing a predominantly lymphocytic infiltrate affecting arterioles at the dermal subcutaneous junction were found, as well as a typical luminal fibrin ring. None of the patients developed necrotic ulcers, neurological damage, or systemic manifestations. The follow-up ranged from 18 to 151 months, with a mean duration of 79 months. Study limitations: This study is subject to a number of limitations: small sample of patients, besides having a retrospective and uncontrolled study design. Conclusions: To the best of the authors' knowledge, this series presents the longest duration of follow-up reported to date. During this period, none of the patients showed resolution of the lesions despite treatment, nor did any progress to systemic vasculitis. Similarities between clinical and skin biopsy findings support the hypothesis that macular lymphocytic arteritis is a benign, incomplete, and less aggressive form of cutaneous polyarteritis nodosa.

Increase in serum and salivary neutrophil gelatinase-associated lipocalin levels with increased periodontal inflammation

Abstract Objective: This study aimed to determine serum and salivary levels of neutrophil gelatinase-associated lipocalin (NGAL) and evaluate NGAL correlation with key anti-interleukin 10 (IL-10) and pro-inflammatory (IL-1β) cytokines in different severities of periodontal diseases. We also calculated the systemic inflammation using the periodontal inflamed surface area (PISA) to evaluate its correlation with NGAL in the study groups. Methodology: Eighty systemically healthy and non-smoking individuals were separated into four groups of 20: clinically healthy (Group 1), gingivitis (Group 2), stage I generalized periodontitis (Group 3, Grade A), and stage III generalized periodontitis (Group 4, Grade A). Sociodemographic characteristics and periodontal parameters were recorded, and PISA was calculated. The serum and salivary levels of interleukin (IL)-1β, IL-10, and NGAL were determined using the enzyme-linked immunosorbent assay (ELISA). Results: We observed a significant increase in serum and salivary NGAL levels from healthy to periodontitis groups (p=0.000). Group 2 presented significantly higher serum and salivary IL-10 levels and salivary IL-1β levels than Group 3 (p=0.000). Serum and salivary parameters (IL-1β, IL-10, and NGAL levels) were strongly positively correlated to periodontal parameters and PISA values (p=0.000). Groups 2 and 3 showed overlapping PISA values. Conclusion: The overlapping PISA values found in Groups 2 and 3 suggest that gingivitis might progress to a systemic inflammatory burden somewhat comparable to stage I periodontitis. This finding is supported by the higher serum and salivary cytokines/mediators levels in the gingivitis group than in stage I periodontitis group. Serum and salivary NGAL levels increased proportionally to disease severity and PISA. NGAL seems to play a role in the pathogenesis of periodontal disease, within the limitation of our study.

"In God We Trust... All Others, Must Show Data". Proverbio Científico en Estados Unidos / In God We Trust... All Others, Must Show Data. Scientific Proverb in the United States

El frecuente reclamo de datos que pretendemos y a veces exigimos los que creemos que hacemos ciencia, nos enfrenta a menudo a realidades numéricas difíciles de entender o justificar. Pero los datos, son datos, y lo único útil es tratar de analizarlos, y nunca enojarse con ellos

Manejo de arteritis de células gigantes en Argentina. Encuesta GESAR Vasculitis / Management of giant cell arteritis in Argentine: Vasculitis Study Group Survey

Introducción: Hasta ahora el diagnóstico de la Arteritis de Células gigantes (ACg) se ha basado fundamentalmente en la clínica y la biopsia de arteria temporal y el tratamiento en corticoides. En los últimos años, han aparecido nuevos métodos que ayudan en el diagnóstico, y recientemente nuevos tratamientos. Objetivos: Describir el manejo actual de ACg en Argentina. Métodos: Una encuesta corta online de 10 preguntas, diseñada por miembros del grupo de Estudio de Vasculitis de la Sociedad Argentina de Reumatología, fue enviada vía mail a los médicos socios de la Sociedad Argentina de Reumatología (SAR). Resultados: Se obtuvieron las respuestas de 188 médicos. Solo un 13,4% de los reumatólogos estima que logra hacerle una biopsia temporal a la mayoría de sus pacientes con sospecha de ACg, mientras que un 45% puede realizarles ecodoppler. Las dosis de corticoides utilizadas y la duración del tratamiento es variable. No es frecuente el uso de otros tratamientos distintos de los corticoides. Conclusión: El uso prolongado de corticoides es el tratamiento más usado para pacientes con ACg en Argentina con escaso uso de otros inmunosupresores. El uso de ecodoppler de arteria temporal parecería estar más fácilmente disponible como herramienta diagnóstica que la biopsia

Characterisation of the vascular pathology in Sigmodon hispidus (Rodentia: Cricetidae) following experimental infection with Angiostrongylus costaricensis (Nematoda: Metastrongylidae)

BACKGROUND Angiostrongylus costaricensis is a nematode that causes human abdominal angiostrongyliasis, a disease found mainly in Latin American countries and particularly in Brazil and Costa Rica. Its life cycle involves exploitation of both invertebrate and vertebrate hosts. Its natural reservoir is a vertebrate host, the cotton rat Sigmodon hispidus. The adult worms live in the ileo-colic branches of the upper mesenteric artery of S. hispidus, causing periarteritis. However, there is a lack of data on the development of vasculitis in the course of infection. OBJECTIVE To describe the histopathology of vascular lesions in S. hispidus following infection with A. costaricensis. METHODS Twenty-one S. hispidus were euthanised at 30, 50, 90 and 114 days post-infection (dpi), and guts and mesentery (including the cecal artery) were collected. Tissues were fixed in Carson’s Millonig formalin, histologically processed for paraffin embedding, sectioned with a rotary microtome, and stained with hematoxylin-eosin, resorcin-fuchsin, Perls, Sirius Red (pH = 10.2), Congo Red, and Azan trichrome for brightfield microscopy analysis. FINDINGS At 30 and 50 dpi, live eggs and larvae were present inside the vasa vasorum of the cecal artery, leading to eosinophil infiltrates throughout the vessel adventitia and promoting centripetal vasculitis with disruption of the elastic layers. Disease severity increased at 90 and 114 dpi, when many worms had died and the intensity of the vascular lesions was greatest, with intimal alterations, thrombus formation, iron accumulation, and atherosclerosis. CONCLUSION In addition to abdominal angiostrongyliasis, our data suggest that this model could be very useful for autoimune vasculitis and atherosclerosis studies.

Vasculitis de miembros superiores e inferiores por arteritis de células gigantes / Vasculitis of upper and lower limbs due to giant cell arteritis

El compromiso extracraneal de la arteritis de células gigantes está dado fundamentalmente por la afectación del cayado aórtico y la aorta torácica. La vasculitis de grandes vasos en miembros superiores e inferiores es una manifestación infrecuente que puede determinar una importante morbimortalidad, siendo difícilmente reconocida si no existe la sospecha. Presentamos el caso de un varón de 63 años que en el contexto de un síndrome constitucional se le realizó una tomografía por emisión de positrones (PET) en la cual se identificaron imágenes sugestivas de arteritis en miembros superiores e inferiores

Estudo da evolução das lesões vasculares presentes na angiostrongilíase abdominal experimental em Sigmodon hispidus (Rodentia: Cricetidae) / Study of the vascular lesions evolution which present in experimentalabdominal angiostrongyliasis in Sigmodon hispidus (Rodentia: Cricetidae)

Introdução: O Angiostrongylus costaricensis é um nematódeo que causa aangiostrongilíase abdominal. O ciclo de vida deste parasita envolve um hospedeiro invertebrado (intermediário) e um hospedeiro vertebrado mamífero (definitivo). Na natureza, um dos principais hospedeiros definitivos deste parasita é o roedor Sigmodon hispidus. O nematódeo instala-se na artéria mesentérica superior do hospedeiro definitivo, causando inicialmente uma periarterite e o sinofílica e posteriormente um trombo. Histopatologicamente, uma tríade de achados fundamentais define esta patologia: massivo infiltrado e o sinofílico; vasculiteeosinofílica e reação granulomatosa. Apesar da importância clínica, pouco se sabe a cerca dessa patologia. Objetivos: Caracterizar as lesões histopatológicas do território vascular e intestinal; acompanhar a dinâmica hematológica periférica e central; avaliar colesterolemia total e a presença de bactérias na lesão de S. hispidusinfectados com A. costaricensis. Material e Métodos: S. hispidus infectados com A. costaricensis foram eutanasiados em 30, 50, 90 e 114 dpi e foram coletados o intestino e mesentério (incluindo a artéria cecal). Os tecidos foram fixados emformalina Millonig de Carson e, histologicamente processados para microscopia de luz ou imunohistoquímica. O sangue também foi coletado através de punção cardíaca ou do plexo braquial e utilizado para realização de hemograma e análise da colesterolemia total e análise microbiológica. A lesão local também foi coletada para análise microbiológica. Resultados e discussão:...

Introduction: Angiostrongylus costaricensis is a roundworm which causes theabdominal angiostrongyliasis. This parasite’s life cycle involves an invertebrate host(intermediary) and a vertebrate host (definitive). In nature, the usual definitive host forthis parasite is the rodent Sigmodon hispidus. Adult worms install in the uppermesenteric artery of the definitive host, causing in the beginning an eosinophilicpolyarteritis and then a thrombus. Histopathologically, a triad of essential findingdefines this pathology as: massive eosinophilic infiltrate; eosinophilic vasculitis andthe granulomatous reaction. Despite the clinical importance, we know just a fewabout this pathology. Objectives: To characterize the histopathological lesions of thevascular and intestinal territories; to follow the peripheral and central hematologicdynamics; to evaluate the total cholesterol and the bacteria presence in the lesion onthe infected S. hispidus by A. costaricensis. Material and Methods: S. hispidusinfected by A. costaricensis were euthanized in 30, 50, 90 and 114 dpi and werecolected the intestine and mesentery (including the cecal artery). Tissues were fixedin Carson’s Millonig formalin and, histopathologically processed to light microscopy orimmunohistochemistry. The blood was also gathered through the cardiac puncture orfrom the brachial plexus and used to the CBC conduction and analysis of totalcholesterol and microbiological analysis. The local lesion was also gathered tomicrobiological analysis. Results and discussion:...

Paciente con ataque cerebrovascular isquémicosecundario a arteritis de Takayasu: reporte de caso / Patient with stroke secondary to Takayasu arteritis case report

La arteritis de Takayasu es una vasculopatía crónica inflamatoria e idiopática de las grandesarterias, cuyas consecuencias son cambios oclusivos, estenóticos o aneurismáticos de laaorta y de sus ramas inmediatas.Se presenta el caso de una mujer de 37 anos ˜ con déficit neurológico focal y angiorresonancia,que demuestra disminución del flujo de la arteria carótida interna izquierda yadelgazamiento de la arteria cerebral izquierda con aortograma torácico y de vasos de cuelloque confirma los hallazgos y, además, demuestra estenosis de la arteria subclavia izquierda,cumpliendo los criterios clasificatorios de una arteritis de Takayasu.Se realiza una revisión de la arteritis de Takayasu, haciendo énfasis en la fisiopatología,manifestaciones clínicas, diagnóstico, tratamiento y pronóstico...

Aspectos anatomopatológicos do parasitismo por nematódeos da superfamília filarioidea em capivaras (hydrochoerus hydrochaeris) de vida livre no Centro-Oeste brasileiro / Anatomic pathology aspects of the parasitism by cruorifilaria tuberocauda in capybaras (hydrochoerus hydrochaeris) in midwestern Brazil

São descritos dois casos de parasitismo por Cruorifilaria tuberocauda em capivaras de vida livre no Distrito Federal, Brasil. Macroscopicamente, observou-se nas superfícies de corte dos rins espessamento acentuado de vasos das regiões cortical e córtico-medular. Microscopicamente, havia arterite proliferativa e granulomatosa acentuada associada a filarídeos intralesionais consistentes com Cruorifilaria tuberocauda. Esse é o primeiro relato do parasitismo por esse filarídeo em capivaras no Distrito Federal.

This report describes two cases of parasitism by Cruorifilaria tuberocauda in wild capybaras (Hydrochoerus hydrochaeris) from Distrito Federal, Brazil. Grossly, there was marked thickening of vessels wall of the cortical and corticomedullary regions of both kidneys. Microscopically, there was severe proliferative and granulomatous arteritis associated with intralesional filarids, consistent with Cruorifilaria tuberocauda. For the first time this filarid is reported parasitizing capybaras in Distrito Federal, Brazil.

Acute limb ischemia secondary to radiation-induced arteritis: case report / Insuficiencia arterial aguda secundaria a arterite induzida por radiacao: relato de caso

Radiation-induced arteritis is a rare but well-known complication of radiotherapy. This report describes the case of a 34-year-old woman with uterine cervical cancer who was diagnosed with left iliofemoral deep vein thrombosis (DVT) 2 years after radiotherapy, and 2 months later, during the treatment of DVT with effective anticoagulation, developed an episode of acute arterial ischemia of the left lower limb secondary to a long subocclusive lesion of the external iliac artery. The patient was treated with angioplasty and stenting of the lesion and recovered uneventfully after the endovascular procedure.

A arterite induzida por radiação é uma rara mas bem documentada complicação da radioterapia. O presente relato descreve o caso de uma mulher de 34 anos, diagnosticada com neoplasia de colo do útero, a qual, dois anos após sessões de radioterapia desenvolveu trombose venosa profunda (TVP) iliofemoral esquerda; dois meses depois, durante tratamento para TVP com devida anticoagulação, a paciente apresentou quadro de insuficiência arterial aguda do membro inferior esquerdo secundária a uma longa lesão suboclusiva da artéria ilíaca externa. A paciente foi tratada com angioplastia transluminal percutânea e implantação de stent autoexpansível, recuperando-se sem intercorrências após o procedimento endovascular.

Arterite actínica de artéria subclávia: relato de caso e revisão de literatura / Actinic arteritis of subclavian artery: case report and literature review

Diversas são as complicações possíveis da radioterapia na adjuvância do tratamento de neoplasias. Lesões actínicas de artéria subclávia em pacientes submetidos a este tipo de tratamento para neoplasia de mama são complicações conhecidas, porém com poucos relatos de casos publicados. No presente relato, descrevemos um caso de oclusão de artéria subclávia direita em paciente submetida à radioterapia para tratamento de neoplasia de mama, tratada com a revascularização convencional, com interposição de enxerto de politetrafluoretileno (PTFE). Na revisão da literatura realizada, foram encontrados doze casos descritos que evidenciaram diferentes opções terapêuticas. Concluímos que a arterite actínica de artéria subclávia é uma doença incomum, entretanto sua hipótese deve ser aventada em todos os pacientes com isquemia de membro superior já submetidos a tratamento de radioterapia.

Several complications may occur as a consequence of adjuvant radiotherapy for cancer. One of these complications is actinic lesions of the subclavian artery in patients undergoing radiotherapy for breast cancer; however, there are few reported cases. In the present case report, we describe a case of right subclavian artery occlusion in a patient undergoing radiotherapy for breast cancer. Occlusion was treated by means of conventional artery bypass with interposition graft with polytetrafluoroethylene (PTFE). Our extensive review of the literature revealed 12 reported cases showing the different treatment options performed. We concluded that actinic arteritis of the subclavian artery is an uncommon condition; however, its presence should be considered in all patients with upper limb ischemia who underwent radiotherapy.

Aneurisma aórtico bacteriano por Salmonella spp: [revisión] / Bacterial aortic aneurym due Salmonella spp. infection: [review]

A pesar de los avances en medicina, especialmente en antimicrobianos, las infecciones siguen siendo una causa importante de morbimortalidad. La fiebre tifoidea, que en el siglo XVIII exterminó gran parte de la población europea, sigue siendo una enfermedad que requiere de toda la atención y estudio para evitar sus importantes implicaciones.Salmonella spp. tiene la capacidad de infectar diferentes partes del cuerpo, entre ellas los grandes vasos, donde comprometen la capa íntima y producen una infección arterial denominada aneurisma infeccioso, con una alta mortalidad cercana a 50 %. Presentamos el caso de un aneurisma bacteriano con úlcera, en un paciente de sexo masculino de 62 años con síntomas previos de infección por Salmonella spp. y hemocultivos positivos para este germen. El paciente fue tratado quirúrgicamente mediante resección del aneurisma y reemplazo in situ con prótesis de dacrón con plata más parche de epiplón. La evolución fue satisfactoria.

In spite of the great advances in medical science, especially regarding the antimicrobial agents, infection remains an important cause of morbidity and mortality. Typhoid fever, which exterminated a major part of the European population in the eighteenth century, continues to be an entity that demands all of our attention so as to avoid its serious complications. The Salmonell sp. have the capacity to infect different organs and parts of the body, including the great vessels, where thy affect the intima layer and produce a condition that is called infectious aneurysm that is associated with a mortality rate around 50%. We report the case of an ulcerated bacterial aneurysm in a 62 year old male with previous symptomatology of Salmonella spp. infection and positive blood cultures for this microorganism. The patient underwent surgical treatment with resection of the aneurisma and a dacron silver coated prosthesis replacement and a patch of greater omentum. Clinical course was satisfactoiry.