Celiac Disease and Thrombotic Events: Systematic Review of Published Cases.

Extraintestinal manifestations of celiac disease (CD) should be considered, even in patients without typical intestinal symptoms. The aim of our study is to examine the literature regarding the occurrence of thrombotic events in CD, and to synthesize the data from case reports and case series. A systematic review of the literature was conducted by searching the Pub-Med/MEDLINE database, from the date of database inception to January 2022, to identify published cases and case series on this topic, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 55 cases were included in the study. The majority of patients were previously healthy individuals, with no comorbidities. In less than one-third of the cases (30.91%), the diagnosis of CD was established before the onset of thrombosis, while in the remaining cases (34.54%), thrombosis preceded the diagnosis or was diagnosed concomitantly with CD. The most common sites for thrombosis occurrence were hepatic veins (30.91%), while thrombosis of cerebral blood vessels, deep venous thrombosis of lower extremities, and pulmonary thromboembolism were less frequent. Thrombosis was most commonly isolated to one site only (78.18%). In 69.09% of cases (n = 38), some form of anticoagulation, along with a gluten-free diet, was initiated.

Human Granulocytic Anaplasmosis-A Systematic Review of Published Cases.

Anaplasma phagocytophilum is an emerging, Gram-negative, obligate intracellular pathogen that is transmitted by a tick vector. Human infection ranges from asymptomatic to severe disease that can present with pancytopenia, multiorgan failure, and death. The aim of this systematic review is to analyze case reports and case series reported over the last two decades in peer-reviewed journals indexed in the Medline/PubMed database according to the PRISMA guidelines. We found 110 unique patients from 88 case reports and series. The most common mode of transmission was tick bite (60.9%), followed by blood transfusion (8.2%). Infection was acquired by blood transfusion in nearly half (42%) of the immunocompromised patients. Most patients reported fever (90%), followed by constitutional (59%) and gastrointestinal symptoms (56%). Rash was present in 17% of patients, much higher than in previous studies. Thrombocytopenia was the most common laboratory abnormality (76%) followed by elevated aspartate aminotransferase (AST) (46%). The diagnosis was most commonly established using whole-blood polymerase chain reaction (PCR) in 76% of patients. Coinfection rate was 9.1% and Borrelia burgdorferi was most commonly isolated in seven patients (6.4%). Doxycycline was used to treat 70% of patients but was only used as an empiric treatment in one-third of patients (33.6%). The overall mortality rate was 5.7%, and one patient died from trauma unrelated to HGA. The mortality rates among immunocompetent and immunocompromised patients were 4.2% (n = 4/95) and 18.2% (n = 2/11), respectively. Four of the six patients who died (66.6%) received appropriate antibiotic therapy. Among these, doxycycline was delayed by more than 48 h in two patients.

The Many Faces of Purpura: Vancomycin-Induced Leukocytoclastic Vasculitis.

Leukocytoclastic vasculitis is a rare form of immune-mediated vasculitis that might be caused by infections or autoimmune diseases or might be precipitated by specific medications. We describe a 65-year-old patient, who was receiving vancomycin for a methicillin-sensitive Staphylococcus aureus permacath infection. Vancomycin was chosen due to medication non-adherence and the patient's desire to receive antimicrobial therapy in conjunction with his scheduled dialysis sessions. The patient's medical history was notable for untreated hepatitis C infection and end-stage renal disease, requiring hemodialysis three times a week. Vancomycin was administered during dialysis sessions. After one week of therapy, the patient developed bilateral lower extremity purpura. Skin biopsy was suggestive of leukocytoclastic vasculitis with an absence of intravascular thrombi. Serum cryoglobulins were negative, making cryoglobulinemia due to HCV infection unlikely. Following cessation of vancomycin therapy, the rash gradually disappeared with scarring in the form of post-purpuric hyperpigmentation. Despite its widespread use, vancomycin is a rare cause of leukocytoclastic vasculitis. Clinicians should keep in mind a wide range of differential diagnosis of bilateral lower extremity purpura as treatment differs depending on its underlying etiology.

Outcomes in patients with symptomatic cerebrovascular disease undergoing heart transplantation.

OBJECTIVES: We sought to determine outcomes in patients with and without symptomatic cerebrovascular disease (sCVD) undergoing heart transplantation. Second, we sought to determine factors associated with stroke in the perioperative period after heart transplantation. BACKGROUND: sCVD is considered a relative contraindication to heart transplantation. Despite this concern, outcomes in patients with sCVD undergoing heart transplantation have not been well defined. METHODS: Data on all single-organ heart transplants performed in the United States between April 1994 and December 2006 in patients age 40 years or older were analyzed. Survival analysis was performed to examine the effect of sCVD on the combined outcome of stroke or death, stroke, death, and functional decline, adjusting for potential confounding variables over long-term follow-up. In a separate analysis, predictors of perioperative stroke during the transplant-related hospitalization were examined using multiple logistic regression. RESULTS: There were 1,078 patients with and 16,765 patients without sCVD. The annualized rates of stroke or death (11.5% vs. 7.8%; p < 0.001), stroke (4% vs. 1.4%; p < 0.001), death (8.9% vs. 7.4%; p < 0.001), and functional decline (3.7% vs. 3.0%; p = 0.002) were higher in patients with sCVD than in patients without sCVD. In multivariable analysis, patients with sCVD were at increased risk of stroke or death (hazard ratio [HR]: 1.29; 95% confidence interval [CI]: 1.17 to 1.42), stroke (HR: 2.24; 95% CI: 2.02 to 2.87), and functional decline (HR: 1.21; 95% CI: 1.03 to 1.42) compared with those without sCVD. We did not identify a higher risk of death in patients with sCVD (HR: 1.08; 95% CI: 0.98 to 1.20), compared with those without sCVD. sCVD, ventilator use, and ventricular assist device use were the most important predictors of perioperative stroke. CONCLUSIONS: Patients with sCVD are at an increased risk of stroke and functional decline after transplantation independent of other variables, but not death, during long-term follow-up. These results should assist programs in making informed decisions in patients with sCVD who are undergoing evaluation for heart transplantation.