RESUMO
BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a rare, severe complication of coronavirus disease 2019, commonly involving the gastrointestinal tract. Some children with MIS-C undergo appendectomy before the final diagnosis. There are several hypotheses explaining the pathomechanism of MIS-C, including the central role of the viral antigen persistence in the gut, associated with lymphocyte exhaustion. We aimed to examine appendectomy specimens from MIS-C patients and assess their pathologic features, as well as the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigens. METHODS: In this cross-sectional study we included 21 children with MIS-C who underwent appendectomy. The control group included 21 sex- and age-matched children with acute appendicitis (AA) unrelated to SARS-CoV-2 infection. Histologic evaluation of appendiceal specimens included hematoxylin and eosin staining and immunohistochemical identification of lymphocyte subpopulations, programmed cell death protein-1 (PD-1) and SARS-CoV-2 nucleocapsid antigen. RESULTS: Appendices of MIS-C patients lacked neutrophilic infiltrate of muscularis propria typical for AA (14% vs. 95%, P < 0.001). The proportion of CD20+ to CD5+ cells was higher in patients with MIS-C (P = 0.04), as was the proportion of CD4+ to CD8+ (P < 0.001). We found no proof of SARS-CoV-2 antigen presence, nor lymphocyte exhaustion, in the appendices of MIS-C patients. CONCLUSIONS: The appendiceal muscularis of patients with MIS-C lack edema and neutrophilic infiltration typical for AA. SARS-CoV-2 antigens and PD-1 are absent in the appendices of children with MIS-C. These findings argue against the central role of SARS-CoV-2 persistence in the gut and lymphocyte exhaustion as the major triggers of MIS-C.
Assuntos
Apendicectomia , Apendicite , COVID-19 , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica , Humanos , Estudos Transversais , COVID-19/patologia , COVID-19/imunologia , COVID-19/complicações , Apendicite/patologia , Apendicite/virologia , Masculino , Criança , Feminino , Síndrome de Resposta Inflamatória Sistêmica/patologia , Pré-Escolar , SARS-CoV-2/imunologia , Adolescente , Apêndice/patologiaRESUMO
Hantaviruses are Bunyaviridae viruses that cause hemorrhagic fever with renal syndrome. Appendicitis caused by Hantaan virus has not been reported previously. An 81-year-old man who underwent laparoscopic appendectomy for suspected appendicitis based on abdominal pain, fever, hypotension, and computed tomography findings. Based on a suspicion of hemorrhagic fever with renal syndrome, the patient's plasma was simultaneously analyzed using an indirect immunofluorescent antibody assay and nested reverse transcription-polymerase chain reaction (RT-PCR). The appendix tissue was also analyzed using nested RT-PCR and immunohistochemical (IHC) staining to identify the presence of Hantaan virus. Nested RT-PCR detected the presence of Hantaan virus, and indirect immunofluorescent antibody assay results revealed the presence of elevated antibody levels. Furthermore, IHC staining of the appendix tissue confirmed Hantaan virus antigens in the peripheral nerve bundle. Based on these findings, we confirmed the nerve tropism of the Hantaan virus. Hantaan virus in plasma and appendix tissue samples was confirmed using PCR and phylogenetic tree analysis. Moreover, we detected hypertrophy of the submucosa and periappendiceal adipose tissue nerve bundle along with Hantaan virus antigens in peripheral nerve bundles using IHC staining. Hence, we report that Hantaan virus infection may be accompanied by appendicitis.
Assuntos
Apendicite/virologia , Febre Hemorrágica com Síndrome Renal/diagnóstico , Idoso de 80 Anos ou mais , Apendicectomia , Apendicite/etiologia , Apendicite/patologia , Apendicite/cirurgia , Apêndice/patologia , Apêndice/virologia , Vírus Hantaan/genética , Febre Hemorrágica com Síndrome Renal/complicações , Humanos , Masculino , Filogenia , Reação em Cadeia da PolimeraseRESUMO
BACKGROUND: To date, there are only sporadic reports of acute abdomen and appendicitis in children with coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C). METHODS: Children 17 years of age or younger assessed in 5 Latin American countries with a diagnosis of microbiologically confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and children fulfilling MIS-C definition were included. For children with acute abdomen, we investigate main radiologic patterns, surgical treatment and intraoperative findings, outcomes. FINDINGS: One-thousand ten children were enrolled. Forty-two children (4.2%) had a clinical diagnosis of acute abdomen. Four (9.5%) were diagnosed with MIS-C and did not undergo surgery. The remaining 38 children (3.8%) underwent abdominal surgery due to suspected appendicitis, 34 of them (89.7%) had an intraoperative diagnosis of acute appendicitis (AA), while 4 of them had nonsurgical findings. Eight children died (0.8%), none of them being diagnosed with appendicitis. Children with AA were significantly older than those without (P < 0.0001). Children with complicated appendicitis had more frequently fever (85.7% vs. 60%), intestinal distension on the abdominal radiograph (7.1% vs. none), leukocytosis (85.7% vs. 40%) and high levels of C-reactive protein (35.7% vs. 5%), although differences were not statistically significant. CONCLUSIONS: Our study showed that children may present with acute abdomen during COVID-19 or MIS-C, which is not always associated with intraoperative findings of appendicitis, particularly in case of MIS-C. Further studies are needed to better characterize children with acute abdomen during COVID-19 or MIS-C, to avoid delay in diagnosis of surgical conditions and at the same time, minimize unnecessary surgical approaches.
Assuntos
Abdome Agudo/etiologia , Abdome Agudo/virologia , Apendicite/etiologia , Apendicite/virologia , COVID-19/complicações , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/virologia , Adolescente , COVID-19/etiologia , COVID-19/virologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , América Latina , Masculino , SARS-CoV-2/patogenicidadeRESUMO
Typical presentations of Coronavirus Disease 2019 (Covid-19) including respiratory symptoms (cough, respiratory distress and hypoxia), fever and dyspnoea are considered main symptoms in adults, but atypical presentation in children could be a diagnostic challenge. We report three children whose initial presentation was gastrointestinal, and in whom Covid-19 infection was found, concluding that cases of acute appendicitis, mesenteric adenitis and flank tenderness may mask an infection with this virus, and should therefore be investigated.
Assuntos
Dor Abdominal , Apendicite , COVID-19 , Dor Abdominal/diagnóstico , Dor Abdominal/virologia , Apendicite/diagnóstico , Apendicite/virologia , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/patologia , Criança , Pré-Escolar , Tosse , Feminino , Cefaleia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , SARS-CoV-2 , VômitoRESUMO
BACKGROUND: We describe the temporal pattern of COVID-19 admissions to a tertiary care children's hospital in central New Jersey during the SARS-CoV-2 surge, covering the time period from March 29 to July 26, 2020. METHODS: Medical charts were reviewed for the date of admission, past medical history, and demographic variables, presenting signs and symptoms, admitting laboratory values, diagnostic imaging, diagnosis, treatment modalities, and outcomes including length of stay and disease severity. RESULTS: Patients with symptomatic SARS-CoV-2 infection tended to present with pneumonia early during the study period, which coincided with the early surge in New Jersey cases. Approximately 2 weeks after the peak in reported SARS-CoV-2 cases in New Jersey, we began to see fewer pneumonia cases and an increase in admissions for Multi-Inflammatory Syndrome in Children and cases of acute appendicitis in association with a diagnosis of SARS-CoV-2 infection. CONCLUSIONS: We present a novel association of acute appendicitis in children infected with SARS-CoV-2 and postulate that it may represent a postinfectious hyperinflammatory complication of SARS-CoV-2 infection occurring 2 weeks after the early manifestation of acute pneumonia disease in children.
Assuntos
Apendicite/diagnóstico , Apendicite/virologia , COVID-19/diagnóstico , SARS-CoV-2/isolamento & purificação , Adolescente , Apendicite/fisiopatologia , COVID-19/fisiopatologia , Criança , Pré-Escolar , Feminino , Trato Gastrointestinal/fisiopatologia , Trato Gastrointestinal/virologia , Hospitalização , Hospitais Pediátricos , Humanos , Lactente , Masculino , New Jersey , Índice de Gravidade de Doença , Atenção Terciária à SaúdeRESUMO
Multiple tissue samples were obtained during emergent abdominal surgery in 4 patients with coronavirus disease 2019 (COVID-19) to examine for tissue involvement by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first patient underwent a laparoscopic cholecystectomy for gallbladder empyema and died from severe respiratory failure. The second patient with Crohn disease underwent emergent laparotomy for a perforation in the terminal ileum and recovered. The third patient underwent an open appendectomy and recovered. The fourth patient underwent emergent laparotomy for a perforated peptic ulcer and died from sepsis. Although the SARS-CoV-2 RNA was found in the feces of 3 patients and in the duodenal wall of the patient with perforated peptic ulcer, real time reverse transcriptase polymerase chain reaction (RT-PCR) examination of abdominal fluid was negative for the virus. The RT-PCR did not detect viral RNA in the wall of small intestine, appendix, gallbladder, bile, liver, and urine. Visceral fat (omentum) and abdominal subcutaneous fat of 4 patients were also not infected with the SARS-CoV-2. Although this limited experience did not show direct involvement of abdominal fluid and omentum, assessment in large series is suggested to provide answers about the safety of abdominal surgery in patients with COVID-19.
Assuntos
Apendicite/cirurgia , COVID-19/diagnóstico , Colecistite/cirurgia , Úlcera Péptica Perfurada/cirurgia , Peritonite/cirurgia , SARS-CoV-2/isolamento & purificação , Adulto , Idoso , Apendicite/virologia , COVID-19/complicações , COVID-19/cirurgia , Teste de Ácido Nucleico para COVID-19 , Colecistite/virologia , Feminino , Humanos , Masculino , Úlcera Péptica Perfurada/virologia , Peritonite/virologia , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
Measles, which was once thought to be a disappearing viral infection due to effective vaccination, has been re-emerging globally, with increasing cases in adolescents and adults. This has been attributed to anti-vaccination campaigning in the early 21st century, which has resulted in a drop in overall herd immunity. In this case series we report three patients with complications secondary to measles who presented to a hospital in Malta in 2019. Through this series, we discuss the range of possible complications caused by the measles virus, ranging from mild viraemic symptoms to multiorgan involvement which could possibly lead to high-dependency care and may even be fatal. We also highlight recent global statistics which reflect the exponential increase in the incidence of measles, with a special focus on Europe. It is emphasised that vaccine education and compliance with the two-dose measles vaccine should be implemented worldwide.
Assuntos
Apendicite/virologia , Hepatite Viral Humana/etiologia , Sarampo/complicações , Meningite Viral/virologia , Adolescente , Adulto , Diagnóstico Diferencial , Feminino , Humanos , MasculinoRESUMO
A 40-year-old British man presented to the emergency department for the second time in 10 days following a 2-week holiday in Thailand with malaise, bilateral conjunctivitis and a morbilliform rash. He had previously seen his general practitioner and ophthalmology and was diagnosed with conjunctivitis. We confirmed measles following RNA detection on a mouth swab. Four days after admission he developed abdominal pain and a CT abdomen demonstrated acute appendicitis with large appendicoliths. A perforated appendix was identified intraoperatively. Measles RNA was detected in the resected appendix. Preoperatively he developed hypoxia with right upper lobe changes seen on a CT pulmonary angiogram. Bronchoalveolar lavage performed in theatre isolated measles RNA at high level, consistent with measles pneumonitis. He required ventilatory support in the intensive care unit and was also treated with intravenous antibiotics. He made a complete recovery.
Assuntos
Apendicite/diagnóstico , Sarampo/diagnóstico , Pneumonia Viral/etiologia , Adulto , Apendicite/microbiologia , Apendicite/cirurgia , Apendicite/virologia , Busca de Comunicante/métodos , Diagnóstico Tardio , Humanos , Masculino , Sarampo/complicações , Sarampo/genética , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/terapia , Respiração Artificial , Salmonella/isolamento & purificaçãoRESUMO
We present the case of a young man with acute lymphoblastic leukemia who developed cytomegalovirus (CMV) appendicitis after receiving alemtuzumab for acute refractory graft-versus-host disease after allogeneic hematopoietic stem cell transplantation (HSCT). CMV appendicitis is a rare complication; and we are reporting the first case to our knowledge of CMV appendicitis following HSCT. Our case highlights the importance of recognition of CMV viral reactivation following the use of alemtuzumab. Using a preemptive strategy of checking CMV PCR, with initiation of early effective treatment on detection of CMV replication, may be appropriate following use of alemtuzumab in hematologic malignancies in patients after HSCT.
Assuntos
Apendicite/virologia , Infecções por Citomegalovirus/complicações , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Adulto , Antineoplásicos/farmacologia , Antivirais/uso terapêutico , Apendicite/cirurgia , Infecções por Citomegalovirus/tratamento farmacológico , Ganciclovir/uso terapêutico , Humanos , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapiaAssuntos
Apendicite/virologia , Hiperplasia/virologia , Doenças Linfáticas/virologia , Criança , Humanos , MasculinoRESUMO
Cytomegalovirus (CMV) is a common viral pathogen. Asymptomatic infection or a mononucleosis syndrome are the most common manifestations in otherwise healthy individuals. End-organ disease is rare in immunocompetent individuals. Here, we describe a case of CMV appendicitis in a patient without an immune-compromising condition.
Assuntos
Apendicite/etiologia , Apendicite/patologia , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/patologia , Citomegalovirus/isolamento & purificação , Apendicite/virologia , Infecções por Citomegalovirus/virologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Although acute appendicitis is the most common cause for abdominal surgery in children, its etiology is still largely unknown. The aim of this study was to evaluate the role of bacterial and viral pathogens for the etiology of appendicitis in children. METHODS: Between 2000 and 2010, 277 children underwent appendectomy in our institution. On this collective, a retrospective study was performed on to identify the presence of bacterial or viral pathogens. RESULTS: Intraoperatively, 39% of cases showed acute, 9% of cases chronic, and 41% of cases ulcerous inflammation. Bowel perforation was found in 7% of cases and four percent of the children had no inflammation of the appendix at all. Escherichia coli was the predominant bacterium with an incidence of 27.4%, followed by streptococci (9.8%). Concerning viral pathogens, adenovirus was the most common with an incidence of 5.4% followed by rotavirus (4.7%). Significant correlations between histopathological findings and present pathogens were found: in cases of bowel perforation there were significantly more infections with E. coli bacteria (32.2%, p < .001), streptococci (12.2%, p < 0.001), and Pseudomonas aeruginosa (6.7%, p < .001) whereas chronic inflammations were accompanied with a significantly elevated rate of yersinia infections (2.5%, p = .016). Acute inflammations were significantly more often associated with campylobacter (1.7%, p = .011) and oxyures infections (6.1%, p < .001). In relation to the patients' age, a significant accumulation of different pathogens was observed. CRP- and leukocyte counts showed differences between viral and bacterial inflammations. CONCLUSIONS: Our data indicates that appendicitis in children might be triggered by bacterial and viral pathogens and that the type of pathogen directly correlates with patient age, type of inflammation, and level of inflammation values. To confirm and further evaluate these findings, additional studies need to be conducted.
Assuntos
Apendicectomia , Apendicite/microbiologia , Apendicite/virologia , Inflamação/microbiologia , Inflamação/virologia , Perfuração Intestinal/microbiologia , Doença Aguda , Adolescente , Fatores Etários , Apendicite/etiologia , Apendicite/cirurgia , Bactérias/isolamento & purificação , Criança , Pré-Escolar , Doença Crônica , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Inflamação/sangue , Masculino , Estudos Retrospectivos , Vírus/isolamento & purificaçãoRESUMO
Cytomegalovirus (CMV) disease is a common complication following solid organ transplantation with a variety of gastrointestinal (GI) tract manifestations. CMV appendicitis, however, is a rare complication in a solid organ transplant patient, having been reported only once previously. We have recently seen two cases in solid organ transplant recipients at our institution, one a liver recipient and the other a heart recipient. Both patients underwent surgical resection. Pathologic evaluation of both resected appendices as well as polymerase chain reaction (PCR) amplification for CMV from the serum revealed the virus as the etiology. Both patients received induction intravenous ganciclovir followed by oral valganciclovir and have done well post-operatively. Tissue-invasive CMV disease should be considered in the differential diagnosis for solid organ transplant patients with symptoms suggesting acute or chronic appendicitis. Both PCR testing as well as pathologic review of tissue specimens should be considered to ensure accurate diagnosis and management.
Assuntos
Apendicite/diagnóstico , Apendicite/patologia , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/patologia , Transplante de Órgãos/efeitos adversos , Transplantados , Adulto , Antivirais/uso terapêutico , Apendicite/etiologia , Apendicite/virologia , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/tratamento farmacológico , DNA Viral/imunologia , Ganciclovir/análogos & derivados , Ganciclovir/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Resultado do Tratamento , ValganciclovirRESUMO
Swine flu is a multisystemic disease and can affect the gastrointestinal system. There are only three published reports of swine flu cases with acute appendicitis; two of them in children under 16â years of age. We present an unusual case of acute appendicitis in a child already diagnosed with swine flu infection. A 9½-year-old girl presented with febrile illness and mild abdominal pain. PCR (+) was positive for H1N1. 3â days after hospital admission she developed acute appendicitis and was operated on. On the fourth postoperative day she developed right upper lobe atelectasis; she was started on antiviral treatment to which she responded very well. She was discharged on day 7 without further consequences in her postoperative course. Children with swine flu may be susceptible to rapidly deteriorating and complicated acute appendicitis. This calls for more caution especially in periods of epidemics.
Assuntos
Apendicite/virologia , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/diagnóstico , Abdome Agudo/virologia , Antivirais/uso terapêutico , Criança , Diagnóstico Diferencial , Feminino , Humanos , Influenza Humana/tratamento farmacológico , Resultado do TratamentoRESUMO
BACKGROUND: Appendicitis occurs with increased frequency in HIV infected compared to HIV uninfected persons. CMV-related appendicitis specifically presents with typical appendicitis symptoms including surgical abdomen, fever and leukocytosis and may have a more severe course with higher mortality than other types of infective appendicitis. We report the first case of CMV appendicitis as a manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS). CASE PRESENTATION: The patient was a 38 year old woman with a recent diagnosis of HIV infection who complained of right lower quadrant pain, anorexia, nausea and fevers two weeks after initiating antiretroviral therapy. Acute appendicitis was suspected and the patient underwent an appendectomy. Pathologic examination of the resected appendiceal tissue demonstrated inflammation with perforation and cytopathic changes typical of CMV that were positive for CMV by immunostain. This presentation of CMV abruptly after antiretroviral therapy initiation with a pronounced cellular infiltration of the tissue, is consistent with CMV-IRIS presenting as appendicitis. CONCLUSIONS: Appendicitis can be a rare manifestation of CMV-IRIS in HIV-infected patients who start antiretroviral therapy. Evaluation of appendiceal tissue for cytopathic changes and CMV should be considered in acute appendicitis in HIV infected persons.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Apendicite/etiologia , Infecções por Citomegalovirus/etiologia , Infecções por HIV/tratamento farmacológico , HIV-1 , Síndrome Inflamatória da Reconstituição Imune/diagnóstico , Doença Aguda , Adulto , Apendicite/diagnóstico , Apendicite/virologia , Infecções por Citomegalovirus/diagnóstico , Quimioterapia Combinada , Feminino , Infecções por HIV/complicações , Humanos , Síndrome Inflamatória da Reconstituição Imune/complicaçõesAssuntos
Infecções Oportunistas Relacionadas com a AIDS/parasitologia , Dicrocelíase/virologia , Esquistossomose mansoni/virologia , Estrongiloidíase/virologia , Adulto , Albendazol/uso terapêutico , Animais , Anti-Helmínticos/uso terapêutico , Apendicite/parasitologia , Apendicite/virologia , Dicrocelíase/tratamento farmacológico , Dicrocelíase/parasitologia , Dicrocoelium/isolamento & purificação , Feminino , Humanos , Praziquantel/uso terapêutico , Schistosoma mansoni/isolamento & purificação , Esquistossomose mansoni/tratamento farmacológico , Esquistossomose mansoni/parasitologia , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/tratamento farmacológico , Estrongiloidíase/parasitologiaRESUMO
Cytomegalovirus (CMV) infections in transplant patients is a well-known disease. We describe the first case, to our knowledge, documenting CMV appendicitis in a renal transplant patient, and its clinical presentation, diagnosis, and treatment.
Assuntos
Apendicite/virologia , Infecções por Citomegalovirus/etiologia , Transplante de Rim , Antivirais/uso terapêutico , Apendicectomia , Apendicite/diagnóstico por imagem , Apendicite/patologia , Apendicite/cirurgia , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/diagnóstico por imagem , Infecções por Citomegalovirus/patologia , Infecções por Citomegalovirus/cirurgia , Ganciclovir/análogos & derivados , Ganciclovir/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Tomografia Computadorizada por Raios X , Resultado do Tratamento , ValganciclovirRESUMO
Circulating memory B cells are considered as the main reservoir for Epstein-Barr virus. Several studies identified the presence of Epstein-Barr virus-infected B cells in the lesions of Crohn disease and ulcerative colitis suggesting that colon mucosa with chronic inflammation could be a potential site of Epstein-Barr virus replication. However, whether skin could be also an Epstein-Barr virus reservoir has not yet been investigated. We used pilonidal cysts as a model of skin chronic inflammation, and we found in 20 (55.6%) of 36 cases variable amounts of Epstein-Barr virus-infected cells as assessed by in situ hybridization using Epstein-Barr virus-encoded RNA probe and immunostainings. Most (95%) of the Epstein-Barr virus-positive cells were of B-cell phenotype, whereas scattered cells were double stained with Epstein-Barr virus-encoded RNA probes and T-cell markers. Epstein-Barr virus-encoded RNA+ cell density correlated with the intensity of inflammation. This density was similar to that observed in chronic diverticulitis but higher when compared with appendicitis, suggesting that chronic rather than acute inflammation facilitates the recruitment of Epstein-Barr virus-infected cells in diseased tissues. Altogether, these data suggest that, in immunocompetent patients, skin inflammatory lesions contain Epstein-Barr virus-infected cells exhibiting latency type I. Moreover, skin-like gastrointestinal mucosa is a potential site of Epstein-Barr virus replication and spreading. Our results may explain the pathogenesis of the Epstein-Barr virus-positive mucocutaneous ulcer.
Assuntos
Linfócitos B/virologia , Herpesvirus Humano 4/isolamento & purificação , Seio Pilonidal/virologia , Linfócitos T/virologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicite/patologia , Apendicite/virologia , Linfócitos B/patologia , Criança , Colite Ulcerativa/patologia , Colite Ulcerativa/virologia , Feminino , Herpesvirus Humano 4/genética , Humanos , Inflamação/patologia , Inflamação/virologia , Masculino , Pessoa de Meia-Idade , Seio Pilonidal/patologia , RNA Viral/genética , RNA Viral/isolamento & purificação , Linfócitos T/patologiaRESUMO
INTRODUCTION: Obstruction of the appendiceal lumen is the primary cause of appendicitis. The most common causes of luminal obstruction are fecaliths and lymphoid follicle hyperplasia. Additionally, bacterial infections or enteric and systemic viral diseases can cause a reaction of the lymphoid follicle. CASE PRESENTATION: An 11-year-old boy with active phase of chickenpox presented on our Pediatric surgery emergency department under the impression of acute appendicitis. An appendectomy was performed on the same day. An inflamed and edematous retrocecal appendix was removed during surgery. Histological investigation of the appendix revealed transmural acute inflammation, with diffuse proliferation of inflammatory cells, with characteristic intranuclear inclusion surrounded by a clear halo. The PCR analysis of peripheral blood and appendix tissue specimen revealed positive VZV DNA. CONCLUSION: We have shown that varicella-zoster virus infection of the appendix is associated with acute appendicitis and possibly also with severity of the disease.
Assuntos
Apendicite/virologia , Varicela/complicações , Apendicite/patologia , Apêndice/patologia , Criança , Humanos , MasculinoRESUMO
From 2006 to 2009, Switzerland experienced the highest measles incidence rate in Central and Western Europe. This increased occurrence of measles cases is mainly due to insufficient vaccination of the Swiss population over a period of many years. Acute appendicitis is a rare complication of measles infection. To date, 25 cases of measles-associated appendicitis have been documented in the English literature. Sixteen (64.0%) of the 25 patients had developed appendicitis in the prodromal stage of measles before skin rash appeared. This article describes the unusual histopathologic findings of measles-associated appendicitis in a 19-year-old non-measles-vaccinated man in the transitional phase from prodromal to full-blown disease and provides a comprehensive review of the literature.