Sign of Leser-Trélat Associated with Kaposi Sar-coma in an Immunocompetent Man.

A 68-year-old Latino man presented at our clinic with asymptomatic, indurated red nodules and macules of 2-month duration on the left arm, forearm, and palm (Figure 1). Performed punch biopsy presented characteristic -features of Kaposi sarcoma (KS). Immunohistochemistry was positive for human herpesvirus 8 (HHV8), a highly correlated viral marker, confirming the diagnosis of KS (Figure 2). He was referred to oncology for further management, where he was found to be fully immunocompetent with a negative assessment of human immunodefi-ciency virus (HIV). Computed tomography (CT) performed of his chest and abdomen revealed no involvement of internal organs.

[Anti-MOG antibody spectrum disease with annular-enhancing brain lesions in an immunocompetent child]. / Maladie du spectre des anticorps anti-MOG avec lésions cérébrales à rehaussement annulaire chez un enfant immunocompétent.

We report a rare diagnosis of ring-enhanced brain lesions. We describe a case of a 4-year-old immunocompetent girl presenting with a subacute alteration of her general condition and a walking disorder a few weeks after her return from a trip to Bangladesh. The etiological work-up revealed ring-enhanced brain lesions on magnetic resonance imaging (MRI). A wide range of etiologies, including infectious, tumoral and inflammatory causes, were considered. Given the clinical and radiological suspicion of neurocysticerosis, the patient was initially treated with corticosteroids and various infectious serologies were carried out, with negative results. Following a rapidly favourable clinical course on corticosteroids alone, further biological investigations revealed the presence of anti-MOG antibodies in both serum and cerebrospinal fluid, suggesting MOGAD (myelin oligodendrocyte glycoprotein antibody-associated disease). This case report highlights the complexity of diagnosing ring-enhanced brain lesions. It also draws attention to MOGAD in immunocompetent patients as a rare but possible etiology, to be systematically investigated in the presence of this type of lesion. Indeed, consideration of inflammatory and autoimmune causes is crucial for accurate diagnosis, enabling earlier targeted treatment.

Nous rapportons un diagnostic rare de lésions cérébrales à rehaussement annulaire. Il s'agit d'une jeune patiente immunocompétente de 4 ans présentant une altération subaiguë de son état général et un trouble de la marche survenus quelques semaines après son retour d'un voyage au Bengladesh. La mise au point étiologique a mis en évidence la présence de lésions cérébrales à rehaussement annulaire à l'imagerie par résonnance magnétique (IRM). Un large éventail d'étiologies a été envisagé. Devant la suspicion clinique et radiologique de neurocysticerose, la patiente a initialement été traitée avec des corticoïdes. Les différentes sérologies infectieuses sont revenues négatives. Face à une évolution clinique rapidement favorable sous corticothérapie seule, des investigations biologiques supplémentaires ont été réalisées révélant la présence d'anticorps anti-myéline oligodendrocyte (MOG) au niveau du sérum et du liquide céphalo-rachidien, suggérant une MOGAD (maladie auto-immune avec anticorps anti-myéline oligodendrocyte). Ce cas clinique met en lumière la complexité du diagnostic de ces lésions cérébrales. Il attire également l'attention sur la MOGAD chez des patients immunocompétents comme une étiologie possible à rechercher de manière systématique devant ce type de lésion. En effet, la prise en compte des causes inflammatoires et auto-immunes est cruciale pour un diagnostic précis permettant un traitement ciblé plus précoce.

Sulfuric acid-induced skin neoplasms in immunocompetent mice.

This study investigates the carcinogenic potential of chronic dermal exposure (16 weeks) to sulfuric acid (SA) in immunocompetent mice. Clinical assessments, histopathological analyses, immunohistochemical analyses and biochemical assays were conducted to evaluate skin irritation, oxidative stress biomarkers and the potential carcinogenic effect of SA. Results indicated that prolonged exposure to SA leads to various alterations in skin structure, notably inflammation, preneoplastic and neoplastic proliferation in hair follicles, as well as hyperkeratosis and acanthosis, resulting in an increased epidermal thickness of 98.50 ± 21.6 µm. Immunohistochemistry analysis further corroborates these observations, showcasing elevated nuclear expression of p53 and Ki-67, with a significant mitotic index of (57.5% ± 2.5%). Moreover, biochemical analyses demonstrate that SA induces lipid peroxidation in the skin, evidenced by a high level of Malondialdehyde and a consequential reduction in catalase activity. These findings suggest that prolonged exposure to SA can induce skin neoplasms, highlighting the need for stringent safety measures in environments where SA is frequently used. This study underscores the potential occupational health risks associated with SA exposure.

Cutaneous and visceral phaeohyphomycosis in an immunocompetent golden retriever.

A 3-year-old castrated male golden retriever was presented for evaluation of 2 cutaneous masses along the abdominal midline and a 6-month history of progressive lethargy and inappetence. Two years earlier, the dog underwent a gastrotomy to retrieve a foreign object and recovered uneventfully. Fluid aspirated from the lesions was culture-negative for aerobic and anaerobic bacterial growth. Abdominal ultrasound demonstrated a large intra-abdominal mass with apparent communication with the cutaneous lesion, along with gossypiboma from the previous laparotomy. Neoplasia or a sterile abscess were suspected. Exploratory laparotomy was performed and revealed that the intra-abdominal mass was adhered to the abdominal midline and the greater curvature of the stomach. The masses and affected portions of the body wall and stomach were resected and histopathology was consistent with phaeohyphomycosis. Antifungal therapy with voriconazole (6.3 mg/kg, PO, q12h) was initiated. At 1 mo after surgery, all clinical signs had resolved. At 4 and 7 mo after surgery, the dog continued to thrive despite 2 small masses, seen on abdominal ultrasound imaging on the intra-abdominal midline, suggestive of reoccurrence. Continued voriconazole therapy was administered in lieu of further surgical excision. One year after surgery, the masses were no longer present on ultrasonographic evaluation. Phaeohyphomycosis is a rare, opportunistic fungal infection that typically affects the dermis and subcutis of immunocompromised dogs. This is the first report of phaeohyphomycosis in an immunocompetent dog and involving the dermis, subcutis, and abdominal viscera. Key clinical message: This case adds to the very limited literature on phaeohyphomycosis in dogs and illustrates that surgery could be a risk factor for infection, even in dogs with no known underlying disease or immunodeficiency.

Phéohyphomycose cutanée et viscérale chez un golden retriever immunocompétentUn golden retriever mâle castré de 3 ans a été présenté pour évaluation de 2 masses cutanées le long de la ligne médiane abdominale et d'un historique de léthargie et d'inappétence progressive depuis 6 mois. Deux ans plus tôt, le chien avait subi une gastrotomie pour récupérer un objet étranger et s'était rétabli sans incident. Le liquide aspiré des lésions était négatif en culture pour la croissance bactérienne aérobie et anaérobie. L'échographie abdominale a mis en évidence une masse intra-abdominale importante avec une communication apparente avec la lésion cutanée, ainsi qu'un gossyibome issu de la laparotomie précédente. Un néoplasme ou un abcès stérile ont été suspectés. Une laparotomie exploratoire a été réalisée et a révélé que la masse intra-abdominale adhérait à la ligne médiane abdominale et à la grande courbure de l'estomac. La masse et les parties affectées de la paroi corporelle et de l'estomac ont été réséquées et l'histopathologie était compatible avec une phaeohyphomycose. Un traitement antifongique par voriconazole (6,3 mg/kg, PO, toutes les 12 heures) a été instauré. Un mois après l'intervention chirurgicale, tous les signes cliniques avaient disparu. À 4 et 7 mois après l'intervention chirurgicale, le chien a continué à bien allé malgré 2 petites masses, observées à l'échographie abdominale sur la ligne médiane intra-abdominale, évocatrices d'une réapparition. La poursuite du traitement par le voriconazole a été administrée au lieu d'une nouvelle excision chirurgicale. Un an après l'intervention chirurgicale, les masses n'étaient plus présentes à l'évaluation échographique. La phaeohyphomycose est une infection fongique rare et opportuniste qui affecte généralement le derme et le sous-cutané des chiens immunodéprimés. Il s'agit du premier rapport de phaeohyphomycose chez un chien immunocompétent et impliquant le derme, le tissu sous-cutané et les viscères abdominaux.Message clinique clé :Ce cas s'ajoute à la littérature très limitée sur la phaeohyphomycose chez le chien et illustre que la chirurgie pourrait être un facteur de risque d'infection, même chez les chiens sans maladie sous-jacente ou immunodéficience connue.(Traduit par Dr Serge Messier).

An immunocompetent lady with invasive aspergillosis presenting as disseminated lesions: a case report.

BACKGROUND: Invasive Aspergillosis is a fungal infection caused by Aspergillus species, typically posing life-threatening risks to immunocompromised individuals. While occurrences in immunocompetent hosts are rare, a recent case report documented fulminant pulmonary aspergillosis in an immunocompetent patient during autopsy. Here, we present a case of invasive aspergillosis in an immunocompetent woman, manifesting with disseminated lesions. CASE PRESENTATION: A 29-year-old Asian woman presented to our hospital in March 2022, reporting chest pain and shortness of breath persisting for two months. Upon examination, she appeared thin and unwell, with no notable abnormalities otherwise. Radiographic imaging revealed an ill-defined lesion in her left lung. Subsequent bronchoscopy and lavage were performed, followed by initiation of empirical antibiotic therapy. Lavage results were negative for gram staining, culture, and ZN staining for AFB, but revealed numerous septate hyphae on fungal smear. Histopathological examination indicated chronic granulomatous inflammation with septal fungal hyphae, indicative of aspergillosis. Subsequent culture confirmed Aspergillus species, prompting initiation of voriconazole therapy. Remarkably, the patient exhibited significant improvement, with weight gain and restored appetite observed within a short period. Within 2 months of treatment, her symptoms resolved, and she resumed near-normal daily activities. CONCLUSION: This case highlights the diagnosis of aspergillosis in an immunocompetent individual presenting with disseminated nodular lesions across the lungs, mediastinum, and abdomen. Clinicians should maintain a high index of suspicion for aspergillosis in cases of non-resolving pneumonia and disseminated nodular lesions, even in patients lacking traditional predisposing factors.

[Systemic disseminated nocardiosis in a patient with normal immune function: a case report].

Nocardiosis, characterized by poor prognosis and high mortality, is a local or systemic suppurative or granulomatous disease caused by Nocardia that is common in immunosuppressed individuals but rare in populations with normal immune function. This paper described one case of Nocardia gipuzkoensis disseminated infection in a patient with normal immune function by outlining the process of treatment, conducting literature review and by outlining the clinical characteristics, diagnostic criteria and standardized treatments of nocardia disease, in the hope of providing reference for subsequent treatment of rare Nocardia subspecies infections.

Study of Diagnostic Yield of Nucleic Acid Amplification Test among Tuberculous Cervical Lymphadenitis in Immunocompetent Patients.

BACKGROUND: The most common form of extrapulmonary tuberculosis (TB) is tuberculous lymphadenitis, which constitutes about 30-40% of all extrapulmonary TB cases. A new diagnostic method like the nucleic acid amplification test (NAAT) is a very sensitive and rapid test for diagnosing tuberculous cervical lymphadenopathy. It also detects rifampicin sensitivity among positive patients. OBJECTIVES: (1) To evaluate the diagnostic yield of TrueNAT for detecting Mycobacterium tuberculosis bacteria in the fine-needle aspirated samples of cervical lymph nodes compared with Ziehl-Neelsen (ZN) staining; (2) to evaluate the diagnostic yield of TrueNAT for diagnosis of tuberculosis through comparison with the cytology report of fine-needle aspiration (FNA) sample of cervical lymph node and with necrotic cervical lymph node on ultrasonography (USG) neck. MATERIALS AND METHODS: A total of 50 patients enrolled in this prospective study from January to December 2022. Demographic profile and clinical history were noted. Fine-needle aspirate samples were sent for TrueNAT assay, cytological examination, and ZN staining. USG neck was done for necrotic findings in the cervical lymph nodes. RESULTS: The TrueNAT positivity rate was 70%. TrueNAT sensitivity and specificity were assessed according to the cytology report, acid-fast bacilli (AFB) positivity on ZN stain, and the finding of necrosis in the cervical lymph node on the USG neck. The sensitivity and specificity of the TrueNAT assay were 80.49 and 77.78%, respectively, in accordance with necrosis on FNA cytology; 17.14 and 93.33%, respectively, in accordance with AFB positivity on ZN stain; and 74.29 and 33.33%, respectively, in accordance with lymph node necrosis on USG neck. CONCLUSION: The TrueNAT assay should be used as an adjunctive test in addition to the conventional cytological examination of the FNA sample of lymph nodes for the rapid diagnosis of tuberculosis. It also detects rifampicin resistance simultaneously.

Disseminated tuberculosis in an immunocompetent 15-year-old adolescent.

Tuberculosis is one of the oldest known diseases and it remains one of the main causes of morbidity and mortality, especially in developing countries. It is associated with social inequalities and affects different age groups. Tuberculosis in children and adolescents should be considered a sentinel event, since it is linked to a recent infection through contact with bacilliferous adults. We report an immunocompetent 15-year-old adolescent with tuberculosis, exhibiting pulmonary, osteoarticular, and cutaneous involvement. Conventional treatment with tuberculostatic drugs for a year had satisfactory results without sequelae.

[Disseminated tuberculosis revealed by epididymal localization in an immunocompetent patient: a case report]. / Tuberculose disséminée révélée par une localisation épididymaire chez un patient immunocompétent: à propos d'un cas.

Epididymal tuberculosis is rare and often presents diagnostic difficulties. It may be indicative of a disseminated form of the infection, which is the case of our patient. A 19-year-old man, with no past medical history, was admitted for a swollen painful left scrotum that had been evolving for 8 months. He had undergone an orchiectomy and the anatomopathological examination was consistent with epididymal tuberculosis. The radiological investigations had revealed other localizations of the infection: lymphatic, pulmonary, parietal and osteoarticular tuberculosis. Anti-tuberculosis therapy was introduced. However, in the 4th month of treatment, the patient developed seizures. A cerebral magnetic resonance imaging was practiced, concluding to cerebral tuberculomas. Anti-tuberculosis treatment was continued associated to an anticonvulsant with a favourable outcome. The originality of our observation resides in the mode of revelation of a disseminated paucisymptomatic tuberculosis, by an epididymal localization, in an immunocompetent patient.

Guillain-Barré Syndrome and Encephalitis Following a Cytomegalovirus Infection in an Immunocompetent Adult: A Case Report.

BACKGROUND Cytomegalovirus (CMV) is a common herpesvirus that often causes asymptomatic or mild infections. In immunocompromised patients, CMV can lead to severe complications, including Guillain-Barre syndrome (GBS) and encephalitis. While these conditions have been described in the immunocompetent population, simultaneous presentation of CMV-associated GBS and encephalitis in such individuals has not been previously reported. CASE REPORT We present a case of a 58-year-old woman with poorly controlled diabetes who developed concurrent GBS and encephalitis following a CMV infection. The patient experienced bilateral ascending paraparesis 1 week after self-limited gastrointestinal symptoms. Despite initial treatment with plasma exchange therapy, her condition deteriorated with altered mental status and generalized tonic-clonic seizures, necessitating orotracheal intubation. Laboratory analysis revealed the presence of CMV in her cerebrospinal fluid. After treatment with further sessions of plasma exchange therapy and ganciclovir, her muscular strength in the extremities improved. However, she developed acute lung edema and failed extubation, leading to cardiorespiratory arrest with neurological sequelae. Palliative care was institutionalized, and she died 2 weeks later due to pneumonia. CONCLUSIONS This case highlights an unusual clinical presentation of overlapping CMV-associated GBS and encephalitis in an immunocompetent individual, with diabetes as the only identified risk factor. It underscores the importance of considering CMV as a potential etiological factor in such complex cases and the need for prompt diagnosis to improve patient outcomes. Further research is warranted to explore the underlying mechanisms and implications of this rare overlapping neurological manifestation.

SARS-CoV-2 population dynamics in immunocompetent individuals in a closed transmission chain shows genomic diversity over the course of infection.

BACKGROUND: SARS-CoV-2 remains rapidly evolving, and many biologically important genomic substitutions/indels have characterised novel SARS-CoV-2 lineages, which have emerged during successive global waves of the pandemic. Worldwide genomic sequencing has been able to monitor these waves, track transmission clusters, and examine viral evolution in real time to help inform healthcare policy. One school of thought is that an apparent greater than average divergence in an emerging lineage from contemporary variants may require persistent infection, for example in an immunocompromised host. Due to the nature of the COVID-19 pandemic and sampling, there were few studies that examined the evolutionary trajectory of SARS-CoV-2 in healthy individuals. METHODS: We investigated viral evolutionary trends and participant symptomatology within a cluster of 16 SARS-CoV-2 infected, immunocompetent individuals with no co-morbidities in a closed transmission chain. Longitudinal nasopharyngeal swab sampling allowed characterisation of SARS-CoV-2 intra-host variation over time at both the dominant and minor genomic variant levels through Nimagen-Illumina sequencing. RESULTS: A change in viral lineage assignment was observed in individual infections; however, there was only one indel and no evidence of recombination over the period of an acute infection. Minor and dominant genomic modifications varied between participants, with some minor genomic modifications increasing in abundance to become the dominant viral sequence during infection. CONCLUSIONS: Data from this cohort of SARS-CoV-2-infected participants demonstrated that long-term persistent infection in an immunocompromised host was not necessarily a prerequisite for generating a greater than average frequency of amino acid substitutions. Amino acid substitutions at both the dominant and minor genomic sequence level were observed in immunocompetent individuals during infection showing that viral lineage changes can occur generating viral diversity.

Asymptomatic cytomegalovirus gastritis in an immunocompetent COVID-19 patient: A case report.

A number of complications are associated with COVID-19 due to reduced immunity. Of these, opportunistic infections are of great significance because of their atypical presentation and low detection rates. Co-infection of various parts of the gastrointestinal system with cytomegalovirus (CMV) is a common occurrence in COVID- 19 patients. Dysphagia and odynophagia are the main complaints of oesophagitis caused by CMV. Colitis due to CMV presents with melena, diarrhoea, or constipation. However, gastritis due to the same agent can be asymptomatic or associated with atypical symptoms like fever and epigastric pain. Cytomegalovirus gastritis can be fatal if not detected early. Hence, continued monitoring of routine baseline investigations is imperative until the complete resolution of COVID-19, as prompt diagnosis improves the outcomes.

CMV neuroretinitis in an immunocompetent patient: a unique case report.

Aim: To report a case of cytomegalovirus (CMV) neuroretinitis observed in an immunocompetent patient. Materials and methods: The patient presented with a complaint of diminution of vision in both eyes (BE) and had a traumatic cataract in the right eye (RE). Fundus examination of the left eye (LE) revealed an active white, fluffy lesion with an overlying retinal hemorrhage patch with a macular star. The diagnosis of CMV neuroretinitis was established, and the patient commenced treatment with valganciclovir. Results: The patient exhibited no underlying risk factors. Subsequently, a positive response to oral valganciclovir treatment was observed. Discussion: Cytomegalovirus (CMV) neuroretinitis is typically associated with immunocompromised individuals, such as those with HIV/AIDS. The patient's presentation with a traumatic cataract in the right eye and a distinctive fundus appearance in the left eye posed a diagnostic challenge. The absence of common risk factors for CMV infection necessitated a thorough examination and consideration of rare infectious etiologies. The positive response to valganciclovir reinforces its efficacy in managing CMV-related ocular conditions. This case emphasized the necessity for ophthalmologists to maintain a high index of suspicion for CMV and other unusual pathogens when faced with neuroretinitis in patients who do not present with typical systemic immunosuppressive conditions. Early diagnosis and appropriate antiviral therapy prevent potential complications and preserve vision in such atypical presentations. Conclusion: This case underscores the importance of considering rare infectious agents in immunocompetent patients when encountering neuroretinitis, particularly in the absence of typical symptoms or signs of the disease. Abbreviations: CMV = Cytomegalovirus, BE = Both eyes, RE = Right eye, LE = Left eye, CBC = Complete Blood Count, ESR = Erythrocyte Sedimentation Rate, VDRL = Venereal Disease Research Laboratory, FTA-ABS = Fluorescent Treponemal Antibody Absorption, PPD = Purified Protein Derivative, ANA = Anti-Nuclear Antibodies, RF = Rheumatoid Factor, ACE = Anti Converting Enzyme, Ig G = Immunoglobulin G, HSV = Herpes simplex virus.

Modeling human gastric cancers in immunocompetent mice.

Gastric cancer (GC) is a major cause of cancer-related mortality worldwide. GC is determined by multiple (epi)genetic and environmental factors; can occur at distinct anatomic positions of the stomach; and displays high heterogeneity, with different cellular origins and diverse histological and molecular features. This heterogeneity has hindered efforts to fully understand the pathology of GC and develop efficient therapeutics. In the past decade, great progress has been made in the study of GC, particularly in molecular subtyping, investigation of the immune microenvironment, and defining the evolutionary path and dynamics. Preclinical mouse models, particularly immunocompetent models that mimic the cellular and molecular features of human GC, in combination with organoid culture and clinical studies, have provided powerful tools for elucidating the molecular and cellular mechanisms underlying GC pathology and immune evasion, and the development of novel therapeutic strategies. Herein, we first briefly introduce current progress and challenges in GC study and subsequently summarize immunocompetent GC mouse models, emphasizing the potential application of genetically engineered mouse models in antitumor immunity and immunotherapy studies.

The immunity gap in primates.

Vertebrates exhibit sexual dimorphism in response to infectious diseases and in morbidity and mortality rates to various pathogens. Females are generally more immunocompetent than males, despite their increased reproductive burden and the immunosuppressive effects of gestation. In addition, females generally have lower incidences of cancer compared to males; however, they have higher rates of autoimmune disorders. These sex differences may be a result of life history differences, sexual selection, genetics, and/or the physiological effects of hormones. As highly social mammals with complex life histories, primates offer a unique opportunity to investigate the evolution of enhanced female immunocompetence. This review aims to examine the evidence of this immunity gap, understand current hypotheses for its evolution, and explore the potential role of X chromosome specific genes and heterozygosity within this framework.