Cutaneous Eruption in a Crohn's Disease Patient Under Tumor Necrosis Alpha Inhibitor Treatment: A Rare Case of Syphilis.

Reaching a diagnosis of a cutaneous eruption in a Crohn's disease (CD) patient treated with anti-tumor necrosis factor alpha (anti-TNFα) can be challenging. Differential diagnosis must include extra-intestinal manifestations of CD, adverse reactions to the therapy itself as well as infectious diseases with cutaneous manifestations. We report the case of a 28-year-old man on infliximab for Crohn's colitis, who presented with painless, non-pruritic genital and body exanthema. After a thorough evaluation, early secondary syphilis was confirmed with a fluorescent treponemal antibodies-absorbed test. Intramuscular (IM) benzathine penicillin G 2.4 million units in a single dose was administered and clinical manifestations resolved completely within a couple of weeks.

Severe osteoporosis as atypical presentation of hereditary hemochromatosis.

Besides important metabolic repercussions, iron overload is reported to be associated with deleterious effects on articulations and bones. We present the case of a male patient diagnosed with severe osteoporosis and vertebral fracture, in whom the evaluation for secondary osteoporosis revealed hereditary hemochromatosis.

Congenital hyperinsulinism-A case of mild hypoglycemia in an adult, detected by family testing.

Symptoms of mild hypoglycemia are easily overlooked especially when there are no complaints from the patients, but it could be a warning sign of an underlying genetic disease. Genetic testing for the entire family is a key step in neonatal hypoglycemia workup.

Rare cause of a resistant hypertension in a middle-aged man: A case report.

Congenital adrenal hyperplasia associated to 11-beta-hydroxylase deficiency is a rare cause of secondary hypertension, usually discovered during childhood; however, a late diagnosis in adults has also been reported. Despite low cortisol levels, accumulated adrenal steroid precursors can activate the glucocorticoid receptor and thus protect the patient against adrenal crisis.

A surprising finding during solid-phase gastric emptying scintigraphy.

In case of repeated episodes of abdominal discomfort and vagal symptoms, especially occurring after ingestion of a rich meal, the diagnosis of intermittent volvulus could be considered. The sudden arrival of large amounts of partially digested food in the intestine after spontaneous resolution might be associated with a dumping syndrome.

In vivo acquisition of a plasmid-mediated bla(KPC-2) gene among clonal isolates of Serratia marcescens.

Three patients admitted to a Greek hospital were infected with Serratia marcescens isolates that exhibited reduced susceptibility to carbapenems and harbored Klebsiella pneumoniae carbapenemase (KPC) enzymes. In two of these cases, the patients were initially infected by carbapenem-susceptible S. marcescens isolates. Molecular typing and plasmid analysis suggested that all three patients had clonally indistinguishable isolates of S. marcescens that acquired a plasmid-mediated bla(KPC-2) gene during the hospitalization.

Feasibility of Percutaneous Bone Biopsy as Part of the Management of Diabetic Foot Osteomyelitis in a 100% Neuropathic, Grade 3 IDSA/IWGDF Population on an Outpatient Basis.

The present study aimed to evaluate the feasibility of percutaneous bone biopsy in an ambulatory setting as part of the management of diabetic foot osteomyelitis (DFO) on an outpatient basis. DFO may complicate some cases of apparently nonsevere foot infections in patients with diabetes and greatly increase the risk of a lower extremity amputation. It has been suggested that bone culture-based antibiotic therapy is a predictive factor of success in patients with diabetes treated nonsurgically for osteomyelitis of the foot. It is recommended to identify the causative microorganism(s) by the means of either a surgical or percutaneous bone biopsy taken appropriately to select the proper antibiotic therapy. Percutaneous bone biopsy in patients not requiring surgery is, however, not performed in everyday practice as it should be according to the current recommendations. In the present retrospective study, we report a series of 23 consecutive patients with a suspicion of DFO in whom 28 bone samples were collected by percutaneous biopsy at the bedside in an outpatient setting. The percentage of positive cultures was in accordance with that reported in the literature. The mean number of isolates per specimen was 1.04. After a mean 12-month follow-up, the remission was almost of 78%. No adverse event related to the bone biopsy was noted. After a 1-year follow-up, no recurrence was recorded among the patients in remission. The results of the present study suggest that bedside percutaneous bone biopsy performed in the ambulatory setting is a valuable and safe tool in the management of DFO on an outpatient basis.

Human herpesvirus-8 seropositivity and clinical correlations in HIV-1-positive and highly exposed, persistently HIV-seronegative individuals in Greece.

The prevalence of anti-human herpesvirus 8 (HHV-8) antibodies was retrospectively assessed in a cohort of 248 consecutive HIV-1-positive patients followed up in an academic unit in Greece during a 14-year period and in 46 highly exposed, persistently HIV-seronegative (HEPS) individuals. The impact of the initial anti-HHV-8 status on tumorgenesis and mortality was studied. The first available serum sample from the department's pool was tested. Demographics and data regarding history of sexually transmitted diseases, Hepatitis B surface antigen (HbsAg) and hepatitis C (HCV) status were collected. Patients who developed either HHV-8-related or non-HHV-8-related neoplasms during long-term follow-up were also identified. Forty-eight percent of the HIV-1-positive patients and 56% of the HEPS subjects were found anti-HHV-8-positive. No difference was observed regarding the development of HHV-8-related or non-HHV-8-related neoplasia and mortality on grounds of initial anti- HHV-8 status. Mortality was positively associated with the presence of HBsAg. HCV infection showed a trend to be more common in anti-HHV-8-positive patients. In summary, the seroprevalence of HHV-8 among HIV-1-positive patients is higher than the one reported in the Western world. The initial anti-HHV-8 status is not a prognostic factor in HIV-1-positive individuals. The high seroprevalence in HEPS individuals possibly reflects their risk-prone lifestyle. HbsAg-positive status is a long-term negative prognostic factor in HIV infection.

Increased angiogenesis in the bone marrow of HIV-positive patients with myelodysplasia.

AIM: Little is known about the significance of angiogenesis in the bone marrow of HIV-positive patients with myelodysplastic features (MDF). However, this process has been associated with the pathogenesis of primary myelodysplastic syndromes (MDS). The aim of the study was to investigate angiogenesis in the bone marrow of HIV-positive patients. METHODS: Bone marrow biopsies from 28 HIV-positive patients were immunostained for factor VIII and the microvessel density (MVD) was quantitatively evaluated and compared with that of 32 biopsies from patients with primary MDS and to 18 control bone marrows from patients with no evidence of bone marrow disease. RESULTS: Bone marrow MVD in HIV-positive patients was similar to that of MDS. However, both groups revealed significantly higher MVD counts compared to those of control bone marrows (MDF vs controls P=0.022, MDS vs controls P=0.001). CONCLUSIONS: Bone marrow from HIV-positive patients with MDF reveals similar microvessel counts compared to those with primary MDS, although both differ significantly from that of control bone marrow. Elucidation of the mechanisms underlying bone marrow angiogenesis in HIV-positive patients, may provide further insights into the pathobiology of AIDS and might be of value for the development of new therapeutic strategies for this disease.