Kaposi sarcoma in an individual recently diagnosed with HIV.

Kaposi Sarcoma (KS) commonly manifests with multiple vesicular cutaneous and mucosal nodules, with four subtypes clinically recognized. Although commonly seen in younger men, our patient presented with presumed epidemic KS at an older age. Additionally, our patient presented with Kaposi sarcoma during primary HIV infection which is atypical for Kaposi sarcoma presentation. The patient's clinical course is important to follow, as his rectal involvement indicates the patient would benefit from systemic therapy. Furthermore, our case highlights the need for a keen clinical index of suspicion in all patients with new HIV diagnosis and new onset suspicious lesions, regardless of age.

Diagnostic delays in vasculitis and factors associated with time to diagnosis.

BACKGROUND: Patients with vasculitis, a set of rare diseases, encounter delays in obtaining an accurate diagnosis which can lead to substantial morbidity and increased mortality. This study sought to describe the diagnostic journey of patients with vasculitis and identify factors associated with time to diagnosis. METHODS: Patients with vasculitis enrolled in an online registry completed a two-stage study: Stage 1: survey of open-ended questions about patients' diagnostic journeys and perceived factors associated with rapid or delayed diagnosis; Stage 2: survey with specific questions based on data from Stage 1 and additional investigator-identified factors. RESULTS: 375 patients with vasculitis participated in Stage 1; 456 patients participated in Stage 2. 85% of patients were seen by a healthcare provider within 3 months of the onset of symptoms. The median time to diagnosis of vasculitis was 7 months. 313/456 (73%) of patients were misdiagnosed initially. 40% of diagnoses were made in a hospital setting; 2% of diagnoses were made at a specialized vasculitis center. 60% of patients had at least 1 visit to an emergency room prior to diagnosis. Unemployment, time to travel to a medical center > 1 h, initial misdiagnosis, and delays in seeing a specialist were all associated with longer times to diagnosis. 373/456 (82%) of patients reported that a delayed diagnosis had negative consequences on their health. CONCLUSION: Patients with vasculitis encounter substantial delays in achieving an accurate diagnosis and these delays are associated with negative health consequences. Both patient-related factors and healthcare-related factors are associated with diagnostic delays.

Vasculitis associated with immune checkpoint inhibitors-a systematic review.

Recent experimental and genetic studies have implicated the role of programmed cell death protein 1 (PD-1), programmed cell death protein-ligand 1 (PDL-1), and cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) in the pathogenesis of medium and large vessel vasculitis. This study sought to evaluate the occurrence and nature of vasculitis associated with cancer treatment using immune checkpoint inhibition (anti-PD-1, anti-PDL-1, and anti-CTLA4). A systematic review of the medical literature was conducted by searching all available clinical data up to February 2018 in several databases and search engines including Cochrane Library, Embase, Google Scholar, Medline, Scopus, Web of Science, and Clinicaltrials.gov . Searches included the following FDA-approved anti-PD1 (nivolumab and pembrolizumab), anti-PDL1 (atezolizumab, avelumab, and durvalumab), and anti-CTLA4 (ipilimumab). The vasculitis cases were compiled and classified based on the 2012 revised Chapel Hill Consensus Conference nomenclature. The clinical feature of the vasculitis cases and their relationship to immune checkpoint inhibition was assessed. There were 53 cases of vasculitis of which 20 were confirmed. The main reported type of vasculitis was large vessel vasculitis and vasculitis of the central and peripheral nervous system. All cases resolved with either holding the immune checkpoint inhibitors and/or administering glucocorticoids. No death related to vasculitis was reported. Vasculitis, namely large vessel and vasculitis of the nervous system, is associated with immune checkpoint inhibition. Results of this study add to the growing evidence regarding the relationship between immune checkpoints and vasculitis and suggest that the pathway may be a therapeutic target.

Science on a salad plate?: Thinking about the representation of natural history in the Canadian Historic Dinner Service project.

The Women's Art Association of Canada marked the 400th anniversary of John Cabot's "discovery" of Canada (celebrated in 1897) through the production of the "Canadian Historic Dinner Service." The high-profile project, which resulted in a set of hand-painted porcelain dinnerware, was a celebration not only of nation-building, but also of the natural history of the country. Visual reference material provided to the women selected to create the individual pieces included photographs, natural history texts, and illustrations that W.H. Bartlett produced for Canadian Scenery earlier in the century. This article explores this visual reinterpretation of Canada's natural history in order to raise questions about how a recontextualization of scientific material shapes narratives of nation and nature in the 'New World'.