COVID-19 vaccine associated demyelination & its association with MOG antibody.

BACKGROUND: ChAdOx1-S (Covishield™/Vaxzervria, AstraZeneca) and BBV152 (Covaxin) SARS-CoV-2 vaccines are proven to be safe and effective, but rare complications have been reported. OBJECTIVE: To describe reports of central nervous system (CNS) demyelination following ChAdOx1-S and BBV152 vaccinations. METHODS & RESULTS: We report 29 (17 female; mean 38 years) cases of CNS demyelination; twenty-seven occurred in temporal association with ChAdOx1-S vaccine; two in association with BBV152 vaccine. Eleven patients had presentation with myelitis, six patients developed optic neuritis, five had acute demyelinating encephalomyelitis, three presented with brainstem demyelination, and four had multiaxial involvement. Myelin oligodendrocyte glycoprotein (MOG) antibodies were positive in ten patients. One patient with ADEM and tumefactive demyelinating lesions died after a prolonged intensive care unit stay and superimposed infection. As compared to the control group (87); the postvaccinial cases were found to have a significantly higher mean age, presence of encephalopathy (p value:0.0007), CSF pleocytosis (p value: 0.0094) and raised CSF protein (p value: 0.0062). CONCLUSIONS: It is difficult to establish a causal relationship between vaccination and neurological adverse events such as demyelination. The temporal association with the vaccination and the presence of MOG antibodies raises the possibility of an immunogenic process triggered by the vaccine in susceptible individuals.

Acute Necrotizing Encephalopathy as a Complication of Chikungunya Infection.

BACKGROUND: Acute necrotizing encephalopathy (ANE) is a rapidly progressive encephalopathy seen commonly in children triggered by various prodromal viral infections, most common being influenza virus and Human herpes virus-6. OBJECTIVE: We report two rare cases of ANE preceded by Chikungunya infection. CASES: A 13-year old girl presented with a three-day history of headache, fever, seizures, and altered sensorium. Another 42-year old man presented with two days history of fever and altered sensorium. Both were suspected to have viral encephalitis. Evaluation revealed serum positivity for Chikungunya virus. In both cases, diagnosis was clinched by characteristic bilateral symmetrical thalamic lesions with central necrosis and hemorrhage along with lesions in cerebral white matter, brainstem, and cerebellum. CONCLUSIONS: ANE is reported to have high morbidity and mortality. To the best of our knowledge, this is the first report of ANE post-Chikungunya infection. Apart from being rare etiologically, the patients had excellent response to steroids.

Profile of bone marrow examination in HIV/AIDS patients to detect opportunistic infections, especially tuberculosis.

Morphological evaluation of 140 bone marrow aspirations received in haematopathology laboratory with serologically established HIV infection, along with other relevant special haematological tests, was done during 1st Jan 1999 - 31st Dec 2002 at state government run tertiary care General Hospital in Maharashtra state, India. Out of 140 cases: 118 (84.28%) patients had anaemia, 25 (17.86%) had leukopenia, while 13 (9.28%) were thrombocytopenic. Dyserythropoiesis was present in 18 (12.86%) cases, dysmyelopoiesis 37 (26.43%) and micromegakaryocytes were noted in 44 (31.43%) cases. Haemophagocytosis was evident in 8 (5.71%) cases. Plasmacytosis encountered in 120 (85.71%) cases was a common feature. Based on clinical profile and results of other investigations 56 (40%) patients were clinically diagnosed to be of Mycobacterium tuberculosis (TB). Of these, 18 (12.86%) bone marrow aspirates were positive for AFB, Mycobacterium tuberculosis. In 4 cases cryptococci were demonstrated (Mucicarmine stain). There was one case each of Histoplasma capsulatum and leishmaniasis. One patient showed dense parasitemia with Plasmodium falciparum. One patient had immunoblastic lymphoma and showed bone marrow infiltration. Findings in this study strongly indicate that in HIV/AIDS, AFB stain should be done on each marrow aspirate to rule out tuberculosis in countries like India; where TB and AIDS are marching together.

Primary thyroid lymphoma: a report of two cases.

Primary thyroid lymphomas (PTLs) are rare neoplasms which in the past have been classified by various schemes. Clinicopathological findings of two cases which were diagnosed in the past one year in our institute are presented using the Revised European and American classification (REAL) for lymphomas. Both cases presented as enlarging neck masses in elderly female patients, in association with lymphocytic thyroiditis. One case was diagnosed as a MALT (mucosa associated lymphoid tissue) lymphoma while the other was a diffuse large cell lymphoma (DLCL).

Allergic fungal rhinosinusitis--a case report.

Allergic fungal rhinosinusitis is a unique disorder characterised by specific immunological hypersensitivity to certain fungal antigens usually presenting with nasal polyps and characteristic CT findings. It is a noninvasive disease and on histopathology shows formation of allergic mucin containing numerous eosinophils, charcot leyden crystals and scattered fungal hyphae. Many cases have been reported in western journals but it has been rarely reported in Indian literature. This case is probably the first case in India. It is presented here for its rarity.

Pathology of Toxoplasma myocarditis in acquired immunodeficiency syndrome.

Involvement of the myocardium by Toxoplasma gondii is seen in patients of acquired immunodeficiency syndrome (AIDS), mostly in association with toxoplasma encephalitis. Only few patients die as a direct result of cardiac dysfunction. Clinico-pathological findings of three cases of toxoplasma myocarditis are reported, one of which presented and died due to massive pericardial effusion. All cases showed diffuse myocarditis with parasites on histopathological examination. Incidence of toxoplasma myocarditis in patients dying with AIDS was 8.3% (3 out of 36 cases).

Clear cell adenocarcinoma of the maxillary sinus: a case report.

A variety of salivary gland tumours histologically show the presence of clear cells. Clear cell adenocarcinoma of salivary glands (CCASG) is a distinct clinico-pathologic entity arising in the minor salivary glands of mainly the oral cavity in elderly women and having a low grade malignant potential. A case occurring in the maxillary sinus and extending to the nasal cavity is reported.

Dedifferentiated chordoma--a case report.

A case of a recurrent sacro-coccygeal chordoma is reported which histologically showed an admixture of a conventional chordoma and a pleomorphic sarcoma. These tumours are called dedifferentiated chordomas and carry an ominous prognosis.

Bacillaemia in lepra reaction: its correlation with liver pathology.

Thirty patients of lepromatous leprosy in a state of reaction (ENL) were studied for bacillaemia and a correlation was made with liver pathology. Buffy coat smears were examined in all, eliminating as far as possible the chances of contamination of blood by the skin bacilli. Thirteen out of thirty patients showed presence of acid fast bacilli (AFB) in the buffy coat smear. Hepatic involvement in the form of leprous granuloma was observed in all, of which 93.3% showed presence of AFB. It is concluded that during reaction the possibility of heightened bacillaemia is less likely and that the systemic spread of infection is not accentuated during the bouts of reaction.

Leprous synovitis. A study of fifty cases.

A study of 50 synovial biopsies of proved lepromatous patients with arthritis was carried out. Out of these 50 cases, 14 cases were suffering from lepra reaction and the histopathological study of the synovium in these 14 cases revealed the presence of only vasculitis and lymphocytic infiltration. In the remaining 36 cases, not associated with lepra reaction, the synovial lining showed hyperplasia and villous hypertrophy, and the synovial tissue showed congestion, pannus formation, the presence of macrophage granulomas and, in some cases, even intact acid-fast bacilli. Since there was no other cause for arthritis, it is perhaps likely that the primary synovial involvement in these 36 cases may be the cause of the arthritis. In the ten cases of lepromatous leprosy without arthritis studied as controls, no histopathological abnormality in the synovium could be detected.

Transplacental hemorrhage during spontaneous and induced abortions.

PIP: Blood smears were examined for the presence of fetal cells in 122 women who had spontaneous or induced abortions in an effort to determine the incidence and magnitude of fetomaternal hemorrhage after abortion. Smears from cord blood of newborn infants served as positive control smears. The amount of fetal blood that had crossed the placental barrier was determined before and after spontaneous and induced abortions in the 1st and 2nd trimester of pregnancy. The incidence of fetomaternal hemorrhage was 2.9% in the 1st trimester and as high as 11.1% in those cases who showed signs of choriodecidual disruption as in threatened abortions. The incidence was slightly higher in 2nd trimester as 6.2% in symptomless cases; it was significantly higher, 22.7%, in cases presenting with vaginal bleeding. The incidence was more in patients who had undergone surgical intervention. In the induced abortion too, the cells score percentage was higher following operation, although it was less as compared to spontaneous abortions.^ieng