Passage of intestinal casts-An unusual presentation of Cytomegalovirus enterocolitis.

Cytomegalovirus (CMV) is one of the leading opportunistic pathogens affecting immunocompromised patients. We report a case of histologically-confirmed extensive CMV enterocolitis in a young woman after receiving rituximab and tocilizumab for the treatment of autoimmune encephalitis. During the antiviral treatment, she spontaneously excreted small intestinal casts per oral and colonic casts per anus. Even though intestinal cast is an extremely unusual condition, CMV infection should be included in the differential diagnosis.

Lupus protein-losing enteropathy patient with protein C and protein S deficiency-induced thrombosis: A case report with review of the literature.

A case report of SLE with PLE in an Asian female; presented with edema, pleural effusion, ascites and profound hypoalbuminemia. She also had severe protein C and protein S depletion from GI loss which caused extensive thrombosis. Her disease was refractory to the treatment with high dose steroid, azathioprine, mycophenolate mofetil and cyclophosphamide. Bowel resection was performed without improvement. Fortunately, the patient responded to another course of pulse methyl prednisolone and a second line medication after surgery.

Clinical and histologic features of Azathioprine-induced hepatotoxicity.

BACKGROUND: Hepatoxicity is a relative uncommon complication related with Azathioprine, however most studies were performed in inflammatory bowel diseases patients. The aim of this study is to report the clinical profile of patients with Azathioprine-induced hepatotoxicity. METHODS: All medical records of patients received Azathioprine from 2010 to 2015 were retrospectively reviewed. Hepatotoxicity was defined as serum alanine aminotransferase (ALT) or aspatate aminotransferase (AST) or total bilirubin >2 times upper limit normal. Other causes of liver diseases were excluded. All subjects were followed until the resolution of liver injury. RESULTS: Two-hundred and ninety-three patients receiving Azathioprine were retrospectively reviewed. Eight patients (2.7%) were diagnosed with Azathioprine-induced hepatotoxicity. The median age was 45 year with female preponderance. The latency to onset of liver injury ranged from 7 to 236 d, and 4 patients were symptomatic. Median peak levels were ALT 295 U/L, alkaline phosphatase 169 U/L, and total bilirubin 1 mg/dl. According to R-ratio, mixed pattern (50%) was more frequent than cholestatic (37.5%) and hepatocellular pattern (12.5%). Liver biopsies were performed in 2 patients, and showed hepatocellular and canalicular cholestasis with mild portal and peri-portal inflammation. All patients recovered fully with a median time of 41.3 days. Two patients developed prolonged cholestasis >2 months, hence none had liver failure or required liver transplantation. CONCLUSION: Hepatotoxicity is relative uncommon in patients receiving Azathioprine, and predominantly is mixed hepatocellular and cholestatic in nature. Even though all patients recover fully after drug withdrawal, severe cholestasis can occur.

Modified toluidine blue: an alternative stain for Helicobacter pylori detection in routine diagnostic use and post-eradication confirmation for gastric cancer prevention.

BACKGROUND: Modified toluidine blue staining (MTBs) is a simple, inexpensive and time saving method to detect H. pylori in gastric biopsy specimens. As a metachromatic stain, it simultaneously highlights intestinal metaplasia, a gastric cancer precancerous lesion. The aim of this study was to assess the reliability of MTBs compared with hematoxylin-eosin (H and E) for H. pylori detection using immunoperoxidase staining as the gold standard. This technique would be beneficial for a routine diagnosis and confirmation of H. pylori eradication in developing countries where endoscopic-based approaches are dominant. MATERIALS AND METHODS: Esophagogastroduodenoscopy with triple site gastric biopsies was undertaken in 207 dyspeptic patients at Thammasat University Hospital, Thailand between 1997 and 1999. H and E, MTBs and immunoperoxidase staining were applied to each specimen. The presence or absence of H. pylori with each stain was interpreted separately and the sensitivity, specificity, positive and negative predictive values of H and E and MTBs were calculated. RESULTS: A total of 282 specimens from 207 patients were evaluated. Using immunoperoxidase staining, organisms were positive in 117 specimens (41%). MTBs proved almost equally sensitive as immunoperoxidase (99%) and significantly more sensitive than H and E (85%). It has comparable specificity (96% vs 96%), PPV (95% vs 94%), and NPV (99% vs 90%) to H and E, using immunoperoxidase staining as gold standard. MTBs compared with immunoperoxidase staining, is cheaper (2 USD vs 12 USD) and faster (20 min vs 16 hrs) compared to immunoperoxidase staining. CONCLUSIONS: MTBs is effective, economical and easy to use in daily practice for the detection of H. pylori in gastric biopsy specimens. In addition to saving time in evaluating H. pylori associated gastritis, with a high sensitivity and ability to demonstrate intestinal metaplasia, the technique may have a role in confirmation of H. pylori eradication for gastric cancer prevention in a developing country setting.

Do NSAIDs inhibit growth of precancerous cervical cells in vitro?

BACKGROUND: Cervical cancer is one of the most common cancers worldwide. A promising, novel strategy for cancer treatment is chemoprevention. Non-steroidal anti-inflammatory drugs (NSAIDs) have chemopreventive effects on several cancers including those of cervix. There are few clinical trials of the effects of NSAIDs on precancerous cervical lesions but data from in vitro studies are lacking. OBJECTIVE: To study growth inhibitory effects of nonselective and selective NSAIDs on immortalized cervical cells in vitro. MATERIAL AND METHOD: Cytotoxicity of ibuprofen and celecoxib on immortalized cervical cells was analyzed by Cell Proliferation (MTT) Assay. Propidium Iodide (PI) Assay was used to analyze apoptotic cell death. RESULTS: Ibuprofen and celecoxib had significant growth inhibitory effects with IC50 of 3.00 +/- 0.44 mM and 30. 00 +/- 11.00 uM, respectively. Both drugs significantly induced apoptosis. CONCLUSION: Ibuprofen and celecoxib can inhibit growth and induce apoptotic cell death in immortalized cervical cells. results from the present study highlight the need for further in vivo researches and clinical trials in search of novel strategies for cervical cancer prevention.

Dual infection with Mycobacterium tuberculosis and Pneumocystis jiroveci Lymphadenitis in a Patient with HIV infection: case report and review of the literature.

We report a case of dual Mycobacterium tuberculosis (TB) and Pneumocystis jiroveci (carinii) (PCP) lymphadenitis in a patient with HIV who had been receiving trimethoprim-sulfamethoxazole (TMP-SMX) as systemic prophylaxis for PCP. This patient was successfully treated with antituberculosis medications and TMP-SMX. Our review of the literature identified this as the first reported case of dual TB and PCP lymphadenitis in an HIV-infected host and highlights the potential limitations of TMP-SMX prophylaxis.