Clostridioides difficile infection in a patient with immunoglobulin A vasculitis: a triggering factor or a rare complication of the disease? A case-based review.

IgA vasculitis, formerly known as Henoch-Schonlein purpura (HSP), is the most common form of systemic vasculitis in children and is characterized by inflammation of the small vessels with typical deposition of IgA immune complexes. It is a leukocytoclastic type of vasculitis and is characterized by a tetrad of clinical manifestations: non-thrombocytopenia or coagulopathy-induced palpable purpura, arthritis, or arthralgia, gastrointestinal, and renal involvement. The exact cause of IgA vasculitis is not known yet, although infections, vaccinations and insect bites have been implicated in the appearance of the disease. The main risk factors for Clostridioides difficile infection (CDI) are previous CDI, age > 65 years old, pharmacologic agents (antibiotics, PPIs, histamine-2 receptor antagonists, glucocorticoids, and chemotherapy), prior hospitalization, the presence of co-morbidities, especially inflammatory bowel diseases and chronic kidney disease (CKD) and immunosuppression. Oral vancomycin or fidaxomicin are the gold standard of the therapy, with metronidazole being an alternative choice. The purpose of this study was to describe a case of IgA vasculitis and Clostridioides difficile infection to see whether there is any association between the two distinct clinical entities. Herein, we describe a 17-year old patient with IgA vasculitis and bloody diarrhea due to Clostridioides difficile infection and we discuss the co-existence of these two pathological conditions. The patient presented to the hospital with diffuse abdominal pain, nausea, vomiting, and two episodes of bloody diarrhea. Stools tested positive for Clostridioides difficile toxins, while he remained afebrile with hs-CRP = 1.5 mg/dL (normal range < 0.5 mg/dL). Direct immunofluorescence from the extremities' purplish eruption showed leukocytoclastic vasculitis with IgA deposition. Whether co-existence of the two above-mentioned distinct clinical entities is just a co-incidence or CDI is a triggering factor for IgA vasculitis remains to be elucidated in future large-scale studies.

Open versus closed surgical exposure of palatally impacted maxillary canines: comparison of the different treatment outcomes-a systematic review.

Objective: This study aims to compare the effectiveness of two different canine exposure techniques (open and closed) regarding periodontal outcomes, duration of surgical treatment and canine's eruption, patient's inconvenience, aesthetics, and orthodontic treatment complications. Search methods: Electronic database searches of published and unpublished literature were performed. The reference lists of eligible studies were hand searched for additional studies. Selection criteria: Randomized clinical trials (RCTs), quasi-randomized clinical trials (Q-RCTs) and non-randomized trials of prospective and retrospective design with patients of any age that compared group with palatally impacted canines treated by open exposure to a similar group treated by closed exposure technique were selected. There was not any restriction in language or year of publication. Data collection and analysis: Study selection, data extraction, and risk of bias assessment were performed individually and in duplicate. Results: Search strategy resulted in 159 articles and nine articles were selected for the final analysis. They were three non-randomized trials, one Q-RCT, and two reports of another Q-RCT and three reports of one RCT. The level of reported evidence was high for the RCT and one Q-RCT but poorer for the other trials. Four articles reported periodontal outcomes, three searched the duration of surgical procedure, two the duration of canine eruption, two investigated patient's inconvenience, two reported on failure rates and two addressed aesthetic outcomes. The results are inconsistent and there is considerable disagreement for the majority of the outcomes among studies. Conclusion: According to existing articles we may conclude that there is no difference between the two techniques regarding the periodontal outcomes and aesthetic appearance. The surgical procedure is shorter in the open exposure group and the amount of postoperative pain during the first day is similar between the open and closed surgical exposure patients. However, these conclusions are based on two single trials with high level of evidence, while the rest of the studies present high risk of bias.

Condylar resorption in orthognathic patients after mandibular bilateral sagittal split osteotomy: a systematic review.

Objective: To systematically search the literature and assess the available evidence regarding the incidence and quantification of condylar resorption following bilateral sagittal split osteotomy (BSSO) of the mandible in orthognathic patients. Search methods: Electronic database searches of published and unpublished literature were performed. The reference lists of eligible studies were hand searched for additional studies. Selection criteria: Randomized clinical trials (RCTs), prospective, and retrospective studies with patients of any age that underwent BSSO were included. Data collection and analysis: Study selection, data extraction, and risk of bias assessment were performed individually and in duplicate. Results: One RCT, 3 prospective, and 10 retrospective studies were included in this review. The lack of standardized protocols and the high amount of heterogeneity precluded a valid interpretation of the actual results through pooled estimates. There was a substantial consistency among studies, however, that young, female patients with mandibular deficiency and high mandibular plane angle, submitted to surgical counterclockwise rotation of mandibular segments, were more prone to a higher risk for condylar resorption after BSSO. The level of evidence was found to be low given the high/serious risk of bias in all included studies. Conclusions: Condylar resorption should be taken into account as a potential postsurgical complication after BSSO. However, its incidence and quantification need precautious interpretation owing to the low level of evidence and the high heterogeneity of studies. Additional high-quality prospective research assisted by 3D imaging technology is needed to allow more definitive conclusions. Registration: Study not registered. Conflict of interest: None.

Intracoronary Administration of Allogeneic Cardiosphere-Derived Cells Immediately Prior to Reperfusion in Pigs With Acute Myocardial Infarction Reduces Infarct Size and Attenuates Adverse Cardiac Remodeling.

BACKGROUND: Allogeneic cardiosphere-derived cells (CDCs) exert cardioprotective effects when administered intracoronarily after reperfusion in animal models of acute myocardial infarction (AMI). The "no-reflow" phenomenon develops rapidly post-reperfusion and may undermine the efficacy of cell therapy, due to poor cell delivery in areas of microvascular obstruction (MVO). We hypothesized that CDC-induced cardioprotection would be enhanced by cell administration prior to reperfusion, when microvasculature is still relatively intact, to facilitate widespread cell delivery within the ischemic area. METHODS AND RESULTS: We studied 81 farm pigs; 55 completed the specified protocols. A dose-optimization study in infarcted pigs demonstrated that the doses of 5 million and 10 million CDCs are the maximum safe doses that can be administered intracoronarily at 5 minutes prior to and at 5 minutes post-reperfusion, respectively, without aggravating MVO. Quantification of acute cell retention by polymerase chain reaction demonstrated that cell delivery prior to reperfusion resulted in higher cardiac cell retention compared to delivery post-reperfusion. We then performed a randomized, placebo-controlled study to assess the long-term efficacy of intracoronary infusion of 5 million allogeneic CDCs, delivered at 5 minutes prior to reperfusion, in a porcine model of AMI. The CDC therapy resulted in decreased scar size, improved regional systolic function, and attenuation of adverse cardiac remodeling (manifested as preserved global systolic function, preserved end-systolic volume, and decreased interstitial fibrosis) compared to placebo at 30 days post-MI. CONCLUSIONS: Dose-optimized intracoronary infusion of allogeneic CDCs prior to reperfusion in a porcine model of AMI is feasible, safe and confers long-term benefits.

Co-existence of Follicular Lymphoma in the Lymph Node with High-grade B Cell Lymphoma in the Bone Marrow of a Patient with Spontaneous Tumor Lysis Syndrome.

A significant percentage of B-cell lymphomas are characterized by bone marrow involvement (BMI) at diagnosis. In most cases, there is a concordance between the type of lymphoma present in the lymph node and the lymphoma present in the bone marrow. Herein, we presented a sixty-seven years old female patient, who was diagnosed with High-Grade B-cell Lymphoma (HGBL) in the bone marrow, while simultaneously, in the peripheral lymph node, the presence of Follicular Lymphoma (FL) was noted. The patient was presented to the hospital with spontaneous tumor lysis syndrome, a finding compatible with the aggressive course of the HGBL. To our knowledge, this is the first case of the co-existence of HGBL in the bone marrow and FL in a lymph node, which might be attributed to merely a coincidence or to the transformation of the cells in the preferable milieu of the bone marrow.

An HHV-8 Positive HIV Negative Multicentric Castleman's Disease, who Responded well to Rituximab Alone.

BACKGROUND: Multicentric Castleman Disease (MCD) presents with enlarged lymph nodes in multiple regions and systemic inflammatory symptoms, due to the dysregulation of cytokines, most commonly interleukin-6 (IL-6). Human herpes virus-8 (HHV-8) is strongly related to MCD (HHV-8-associated MCD) and is being implicated in cytokine dysregulation in patients, the majority of whom are HIV positive or immunosuppressed. Preferred treatment of HHV-8- associated MCD depends on the presence or not of concurrent Kaposi sarcoma and on whether the patient has life-threatening organ failure or poor performance status thought to be related to HHV- 8-associated MCD. CASE PRESENTATION: Herein, we describe a female patient with HHV-8 positive, HIV negative MCD, who responded well to the administration of rituximab once weekly for four weeks alone for three cycles. CONCLUSION: HHV-8 positive, HIV negative MCD treatment modalities are only anecdotal due to the rarity of this form of MCD. Administration of rituximab alone seems to be beneficial among patients with good performance status and the absence of life-threatening organ failure in cases of HHV-8 positive, HIV negative MCD.

Inferior vena cava thrombosis as the initial presentation of IgG4-related retroperitoneal fibrosis: Case report and literature review.

IgG4-related disease is an immune-mediated deposition of fibro-inflammatory tissue with IgG4-positive plasma cells and dense fibrosis in a single or multiple organs. It often raises concern for malignancy requiring biopsy for diagnosis. Presentation may vary according to organ involved. IgG4-related retroperitoneal fibrosis accounts for two-thirds of the previously considered idiopathic retroperitoneal fibrosis cases. In IgG4-related retroperitoneal fibrosis, computed tomography scan or magnetic resonance imaging shows periaortic soft tissue that extends from below the kidneys to iliac arteries and entrap ureters causing hydronephrosis and renal failure. We present a rare case of IgG4-related retroperitoneal fibrosis presenting with leg swelling and pain due to inferior vena cava compression and thrombosis, and we review current concepts on disease pathogenesis, diagnosis and treatment.

Pulmonary sarcoidosis associated with psoriasis vulgaris: coincidental occurrence or causal association? Case report.

BACKGROUND: Sarcoidosis is rarely associated with a distinct disease. One disease infrequently associated with sarcoidosis is psoriasis. CASE PRESENTATION: This case study describes a 38-year-old male, who presented with chest pain, high-grade fever, arthralgias and a skin rash accompanied by bilateral hilar lymphadenopathy on his chest radiograph. Extensive investigations including fiber-optic bronchoscopy with bronchoalveolar lavage and labial and skin biopsies, demonstrated that two distinct clinical entities co-existed in the same patient: pulmonary sarcoidosis and psoriasis vulgaris. Combination therapy for both diseases was applied and the patient was greatly improved. CONCLUSION: This is the first well-documented case of sarcoidosis and psoriasis in the same patient, reported on the basis of safe and widely-used techniques that were not available until fairly recently. These disorders might share common pathogenic mechanisms that could explain their co-existence in the patient.

Tracheal pseudo-tumor caused by herpes simplex virus.

BACKGROUND: Herpes simplex virus (HSV) has been shown to cause respiratory tract infections mostly in severely immunocompromised patients. Endobronchial tumor-like lesions have been described very rarely as HSV pulmonary manifestations in critically ill patients or in immunosuppressed individuals. CASE PRESENTATION: This case study describes a 75-yr-old male who presented with persistent hoarseness. Fiberoptic bronchoscopy showed marked mucosal thickening protruding in mid and distal trachea causing stenosis. Biopsy specimens demonstrated cytopathological changes consistent with HSV type 1 and 2 infection. CONCLUSIONS: To the best of the authors' knowledge, this is the first reported case of HSV presenting as an endotracheal tumor in an immunocompetent person.

Alveolar adenoma: an extremely rare innocent coin lesion.

Alveolar adenoma is an extremely rare benign tumour of the lung. Less than 30 cases have been reported in the English literature. A 42-year-old asymptomatic female who presented with a solitary peripheral pulmonary nodule on chest roentgenogram underwent thoracoscopic wedge resection and was diagnosed with this rare tumour. The indolent clinical progression and the absence of recurrence and metastasis after complete resection are the most important characteristics of this tumour. The classical solitary pulmonary nodule is a common and vexing problem. Nodules are extremely common in clinical practice and challenging to manage. Solitary pulmonary nodules can represent different specific lung diseases, focal non-specific inflammations, and primary and secondary malignant tumours. Identification of malignant nodules is important because they represent a potentially curable form of lung cancer.

Synchronous early gastric cancer and gastrointestinal stromal tumor in the stomach of a patient with idiopathic thrombocytopenic purpura.

The synchronous occurrence of gastrointestinal stromal tumour (GIST) in the stomach and early gastric cancer is uncommon, with only a few previous reports. In particular, the collision of GIST and early gastric cancer in a patient with idiopathic thrombocytopenic purpura (ITP) has never been reported. We present the case of a 78-year-old male patient with ITP who was diagnosed with a synchronous development of GIST and early gastric cancer of the stomach. He underwent an elective subtotal gastrectomy with splenectomy. We discuss whether the development of GIST in the stomach in concert with early gastric cancer is an incidental coexistence or involve the same carcinogenic agents. Furthermore, it is not known whether or not such a situation is connected with ITP. To our knowledge this is the second report of a small GIST concomitant with an early gastric cancer and the first one in a patient with ITP.

Autoimmune hepatitis in an HIV infected patient that responded to antiretroviral therapy.

Autoimmune hepatitis is a rare disease with unclear pathogenesis. Several viruses have been proposed to act as triggering agents for the inflammatory process of the disease; however, HIV has only very rarely been reported to be associated. We report a case of a patient with autoimmune hepatitis and HIV infection. The possible pathogenetic mechanism is discussed. Antiretroviral treatment led to normalization of liver biochemistry, supporting the hypothesis of HIV induced autoimmune hepatitis.