Emphysematous pyometra and emphysematous hepatitis caused by Klebsiella pneumoniae infection in a diabetic dog.

A 14-year-old intact female diabetic dog presented with seizures and hyperglycemic hyperosmolar syndrome. Radiographs revealed gas-filled tubular structures in the right and left caudal abdomen, raising concerns of emphysematous pyometra or small intestinal ileus. Ultrasonography played a pivotal role in confirming emphysematous pyometra, a technique previously documented only once in veterinary practice. This report also presents the first documented case of emphysematous pyometra in a diabetic dog attributed to Klebsiella pneumoniae and complicated by emphysematous hepatitis.

Sternal Abnormalities on Thoracic Radiographs of Dogs and Cats.

Evaluation of the sternum is part of the routine examination of small animal thoracic radiographs. However, descriptions on frequency and type of abnormalities are lacking. This retrospective observational study aimed to describe abnormal radiographic findings of the sternum in a cross-section of client-owned dogs and cats undergoing thoracic radiography between 1 January 2019 and 1 January 2021 for reasons unrelated to diseases of the sternum. The study population consisted of 777 dogs (mean age, 7.3 ± 3.9 years) and 183 cats (mean age, 7.3 ± 5.1 years). Sternal abnormalities were observed in 189/777 (24%) dogs and 53/183 (29%) cats, mostly around the intersternebral cartilages, accounting for 32/80 (40%) dogs and 20/35 (57%) cats. This was followed by an abnormal number of sternal segments (8% dogs, range 3-9 sternebrae; 15% cats, range 7-9 sternebra). Pectus excavatum was observed in 6/777 (0.8%) dogs and 6/183 (3%) cats, and pectus carinatum in 18/777 (2%) dogs and 2/183 (1%) cats. Post-traumatic changes, such as subluxation, were observed in nine dogs (1.1%) and three cats (1.6%). Presumed prostatic carcinoma metastasis and malignant lymphoma were observed in two dogs (0.2%). Incidental radiographic sternal abnormalities are common in cats and dogs but mostly of unknown clinical relevance.

Ultrasound and Microbubbles Mediated Bleomycin Delivery in Feline Oral Squamous Cell Carcinoma-An In Vivo Veterinary Study.

To investigate the feasibility and tolerability of ultrasound and microbubbles (USMB)-enhanced chemotherapy delivery for head and neck cancer, we performed a veterinary trial in feline companion animals with oral squamous cell carcinomas. Six cats were treated with a combination of bleomycin and USMB therapy three times, using the Pulse Wave Doppler mode on a clinical ultrasound system and EMA/FDA approved microbubbles. They were evaluated for adverse events, quality of life, tumour response and survival. Furthermore, tumour perfusion was monitored before and after USMB therapy using contrast-enhanced ultrasound (CEUS). USMB treatments were feasible and well tolerated. Among 5 cats treated with optimized US settings, 3 had stable disease at first, but showed disease progression 5 or 11 weeks after first treatment. One cat had progressive disease one week after the first treatment session, maintaining a stable disease thereafter. Eventually, all cats except one showed progressive disease, but each survived longer than the median overall survival time of 44 days reported in literature. CEUS performed immediately before and after USMB therapy suggested an increase in tumour perfusion based on an increase in median area under the curve (AUC) in 6 out of 12 evaluated treatment sessions. In this small hypothesis-generating study, USMB plus chemotherapy was feasible and well-tolerated in a feline companion animal model and showed potential for enhancing tumour perfusion in order to increase drug delivery. This could be a forward step toward clinical translation of USMB therapy to human patients with a clinical need for locally enhanced treatment.

Successful Clindamycin Therapy of an Infected Subcutaneous Permanent Pacing Lead in a Dog after a Failed Course with Potentiated Amoxicillin and Enrofloxacin.

Though permanent pacemaker implantation is the only effective therapy for certain bradyarrhythmias in dogs, it is not without risks. Bacterial infection of the device is one of the most common complications. Human guidelines recommend besides systemic antibiotics, surgical explantation of the pacing lead and pulse generator in case of device-infection. This report describes a 13.5-year-old dog that received a transvenous endocardial permanent pacemaker because of syncopal episodes resulting from paroxysmal third-degree atrio-ventricular block. Five days after an uneventful surgery, a painful swelling appeared around the subcutaneous part of the lead where this was inserted into the jugular vein. A 4-week course of amoxicillin and clavulanic acid combined with enrofloxacin failed to clear the infection on long-term. Ultrasound-guided puncture of the abscess was performed to gain a sample for bacterial culture and antibiogram. Oral clindamycin of 4 weeks' duration successfully resolved the infection with Staphylococcus aureus without having to explant the device. Repeated ultrasonographic examinations and fine-needle aspiration biopsies were used to evaluate for persistent local inflammation, guiding the length of the antibiotic therapy. Though the described approach has traditionally been ill-advised because of the risk of introducing bacteria and damaging the pacemaker lead, it was successful in our case.

Anatomic, computed tomographic, and ultrasonographic assessment of the lymph nodes in presumed healthy adult cats: the abdomen, pelvis, and hindlimb.

BACKGROUND: The computed tomography (CT) and ultrasonography (US) features of lymph nodes of the abdomen, pelvis, and hindlimb in healthy cats are poorly described in the current literature. A prospective anatomic and reference interval study was therefore performed. The lymph nodes of six feline cadavers were identified, and dimensions were measured (length, width, and height). The lymph nodes from 30 healthy adult cats were identified and measured using CT (pre- and postcontrast) and US. The identification and dimensions of the separate lymph nodes were compared between imaging techniques and the anatomic study. RESULTS: The identification of lymph nodes was most frequent in CT, and the dimensions were overall larger than those identified and measured in US and the anatomic study. The caudal epigastric and sacral lymph nodes were not identified in the anatomic study. The ischiatic, lumbar aortic, internal iliac, and caudal epigastric lymph nodes were not visualized in US. The height presented the main statistical differences among techniques. The lymph nodes were mainly homogeneous in pre- and postcontrast CT and US images. Some lymph nodes showed a hyperattenuating periphery with a hypoattenuating center (on pre- and postcontrast images) and a hypo-/isoechoic periphery with a hyperechoic center, representing the hilar fat. The lymph nodes were commonly elongated and rounded except for the jejunal lymph nodes, which had an irregular shape. CONCLUSIONS: The assessment of most of the abdominal, pelvic, and hindlimb lymph nodes in the cat is feasible using CT and US, with CT performing best. Factors like the amount of adipose tissue and contrast administration subjectively improved the lymph node visualization and assessment. The measurements and features reported are proposed as reference values.

Non-Invasive Imaging and Scoring of Peritoneal Metastases in Small Preclinical Animal Models Using Ultrasound: A Preliminary Trial.

BACKGROUND: The peritoneum is a common site for the formation of metastases originating from several gastrointestinal and gynecological malignancies. A representative preclinical model to thoroughly explore the pathophysiological mechanisms and to study new treatment strategies is important. A major challenge for such models is defining and quantifying the (total) tumor burden in the peritoneal cavity prior to treatment, since it is preferable to use non-invasive methods. We evaluated ultrasound as a simple and easy-to-handle imaging method for this purpose. METHODS: Peritoneal metastases were established in six WAG/Rij rats through i.p. injections of the colon carcinoma cell line CC-531. Using ultrasound, the location, number and size of intraperitoneal tumor nodules were determined by two independent observers. Tumor outgrowth was followed using ultrasound until the peritoneal cancer index (PCI) was ≥8. Interobserver variability and ex vivo correlation were assessed. RESULTS: Visible peritoneal tumor nodules were formed in six WAG/Rij rats within 2-4 weeks after cell injection. In most animals, tumor nodules reached a size of 4-6 mm within 3-4 weeks, with total PCI scores ranging from 10-20. The predicted PCI scores using ultrasound ranged from 11-19 and from 8-18, for observer 1 and 2, respectively, which was quite similar to the ex vivo scores. CONCLUSIONS: Ultrasound is a reliable non-invasive method to detect intraperitoneal tumor nodules and quantify tumor outgrowth in a rat model.

Anatomic, computed tomographic, and ultrasonographic assessment of the lymph nodes in presumed healthy adult cats: The head, neck, thorax, and forelimb.

Assessment of the lymph nodes is key in staging cancer patients. Descriptions of normal features of the feline lymph nodes using computed tomography (CT) and ultrasound (US) are limited. A prospective anatomic and comparative imaging study was performed. The frequency of identification and the size of the lymph nodes during gross pathology from 6 feline cadavers were compared to the images of lymph nodes from 30 presumed healthy adult cats obtained by CT and US. Measurements (length, width, and height) were compared among techniques. The CT and US features of the identified lymph nodes were also recorded. The frequency of identification of the lymph centers varied among techniques and individually. The mandibular lymph nodes were identified in 100% of the cadavers and in 100% of the healthy cats using CT and US. The medial retropharyngeal lymph nodes were identified in 100% of the cats using CT and US. The deep cervical lymph nodes were not visualized in the cadavers. The cranial mediastinal and tracheobronchial lymph nodes were not visualized using US. Lymph nodes showed a higher length on CT and higher width on US. The height was the most statistically significant variable measurement among techniques. On CT, lymph nodes were most frequently isoattenuating or slightly hypoattenuating to surrounding musculature, with homogeneous contrast enhancement. On US, most lymph nodes were isoechoic or hypoechoic to surrounding fat tissue. The lymph nodes were most frequently elongated or rounded.

Medición del Ángulo de Inclinación del Ligamento Cruzado Anterior (LCA). Serie de Casos / Anterior Cruciate Ligament (ACL) Inclination angle measurement. Case Series

Introducción La evaluación de la inclinación del ligamento cruzado anterior(LCA) es útil tanto en pacientes que no han sido llevados a procedimientos reconstructivos para aclarar dudas diagnósticas ante la sospecha de una lesión parcial como para el planeamiento quirúrgico; y en el postoperatorio para evaluar la calidad y efectividad al restaurar las inserciones anatómicas del ligamento. Sin embargo en nuestro medio no existe un referente local de medición ni un entrenamiento en la toma de la misma. Objetivo Medir el ángulo de inclinación del LCA en rodillas sanas de nuestra población, utilizando técnicas de medición por resonancia magnética (RM) entre junio del 2013 y junio del 2017. Métodos Estudio descriptivo tipo serie de casos, se incluyeron los pacientes sometidos a RM en el servicio de radiología de nuestro hospital que fueron leídas como normales. Las mediciones del ángulo de inclinación se tomaron en los planos sagital, coronal y axial. Resultados Se incluyeron 91 pacientes (45% (n=41) Hombres / 55% (n=50) Mujeres). Se encontró un ángulo de inclinación del LCA en el plano sagital con una media de 45.31 (DE: 5.39), en el plano coronal de 70.68 (DE:5.79) y 68.49 (DE:5.61) en el plano axial, sin encontrarse diferencias imagenológicas segmentados por sexo, edad o lateralidad. Discusión No se aprecian diferencias en las imágenes de RM en el ángulo de inclinación en ninguno de los tres planos entre hombres y mujeres, tampoco respecto a lateralidad o grupos de edad. Se obtuvieron resultados que aún no están descritos en la literatura; los obtenidos son similares a los reportados en la literatura

Background The evaluation of the inclination of the anterior cruciate ligament (ACL) is useful to clarify diagnostic doubts in patients who have not been taken to reconstructive procedures and to evaluate the quality and effectiveness of restoring the anatomical attachments of the ligament. after an ACL surgery reconstruction. However, in our environment there is no local measurement reference or training in measuring it inclination angle. The aim of the study is to measure the inclination angle of the ACL in healthy knees of our population, using magnetic resonance (MRI) measurement techniques. Methods A Case Series study was performed, including patients who underwent to knee MRI between June 2013 and June 2017 that were read as normal. Inclination angle measurements of the ACL were taken in the sagittal, coronal, and axial planes. Results 91 patients were included (45% (n=41) Men / 55% (n=50) Women). An ACL inclination angle was found in the sagittal plane with a mean of 45.31 (SD: 5.39), in the coronal plane of 70.68 (SD: 5.79) and 68.49 (SD: 5.61) in the axial plane, with no imaging differences found. segmented by sex, age or laterality. Discussion There are no differences in the MRI images in the angle of inclination in any of the three planes between men and women, neither with regard to laterality or age groups. Results were obtained that have not yet been described in the literature; those obtained are similar to those reported in the literature

CT characterisation of feline adrenal glands.

OBJECTIVES: The objectives of this study were to describe the CT characteristics of the adrenal glands in healthy cats, to provide normal reference biometry for adrenal gland size and attenuation values, and to investigate the association with age, sex, laterality and body weight. METHODS: Retrospective evaluation of 30 CT studies of healthy adult cats recruited from September 2013 to July 2015 was performed. Healthy cats >1 year of age were included based on the absence of clinical signs, unremarkable physical examination, normal results of the complete blood count, biochemical profile, feline immunodeficiency virus, feline leukaemia virus and Bartonella species infection tests. The relationship between gland biometry (size and attenuation values) and the age, sex, laterality and body weight of cats were tested by two-way ANOVA. The intraclass correlation coefficient was assessed and mean, SD, range and reference interval provided. RESULTS: Twenty-seven cats were included. Bilobed, arrowhead and oval adrenal gland shape patterns were recognised, the first being most common. No statistically significant differences were observed between the biometric parameters (length, height and attenuation values) and age, sex, laterality or body weight of the cats. Regarding the width of the adrenal glands, there was a statistically significant effect of sex and laterality. The length (11.6 ± 2.1 mm) and height (6.1 ± 1.3 mm) were the most consistent biometrical parameters to describe adrenal glands. CONCLUSIONS AND RELEVANCE: Adrenal gland shape, size and attenuation CT data of healthy feline patients are provided in this study, as well as normal reference intervals for morphometric characterisation based on adrenal length and height.

CT characterisation of the feline os penis.

OBJECTIVES: The aim of this study was to investigate the frequency of identification and to describe the CT features of the os penis in cats without genitourinary disorders. METHODS: CT studies from cats that underwent an abdominal or pelvic examination between October 2013 and May 2019 were reviewed retrospectively. Cats with no signs of urinary disease and with the external genitalia included in the scan were recruited. Length, width, height and pre- and post-contrast attenuation values of the os penis in soft tissue and bone algorithms were measured independently by two observers. RESULTS: Twenty-three cats met the inclusion criteria. A cylindrical bone-attenuating structure inside the glans penis compatible with the os penis was visible in 20/23 (87%) cats. Mean length, width and height values were 3.48 mm × 1.41 mm × 1.37 mm in the soft tissue algorithm, and 3.26 mm × 1.15 mm × 1.06 mm in bone algorithm. The size of the os penis was not significantly different in neutered vs intact cats, but it was significantly larger in soft tissue vs bone algorithm. Age and body weight did not influence os penis size. Pre-contrast mean ± SD attenuation was 216.7 ± 69.5 Hounsfield units (HU) for soft tissue and 320.1 ± 135.9 HU for bone algorithms. Post-contrast attenuation was 289.1 ± 68.8 HU for soft tissue and 383.4 ± 130.9 HU for bone algorithms. A significant correlation between the attenuation in bone algorithm with body weight was noted, where the os penis was less attenuating with increased body weight (pre-contrast: r = -0.479; P = 0.038). CONCLUSIONS AND RELEVANCE: The feline os penis is commonly seen on CT images, being more frequently detected than on radiographs. Its presence should not be mistaken for uroliths in the penile urethra.

Altered recruitment of Lyn, Syk and ZAP-70 into lipid rafts of activated B cells in Systemic Lupus Erythematosus.

There is evidence that B cells from patients with Systemic Lupus Erythematosus (SLE) could be hyperactivated due to changes in their lipid rafts (LR) composition, leading to altered BCR-dependent signals. This study aimed to characterize possible alterations in the recruitment of protein tyrosine kinases (PTK) into B cells LR from SLE patients. Fifteen patients with SLE and ten healthy controls were included. Circulating B cells were isolated by negative selection and stimulated with goat Fab´2 anti-human IgM/IgG. LR were isolated with a non-ionic detergent and ultracentrifuged on 5-45% discontinuous sucrose gradients. Proteins from each fraction were analyzed by Western Blot. Total levels of Lyn, Syk, and ZAP-70 in resting B cells were similar in SLE patients and healthy controls. Upon BCR activation, Lyn, Syk and ZAP-70 recruitment into LR increased significantly in B cells of healthy controls and patients with inactive SLE. In contrast, in active SLE patients there was a great heterogeneity in the recruitment of signaling molecules and the recruitment of ZAP-70 was mainly observed in patients with decreased Syk recruitment into LR of activated B cells. The reduction in Flotilin-1 and Lyn recruitment in SLE patients seem to be associated with disease activity. These findings suggest that in SLE patients the PTK recruitment into B cell LR is dysregulated and that B cells are under constant activation through BCR signaling. The decrease of Lyn and Syk, the expression of ZAP-70 by B cells and the increase in Calcium fluxes in response to BCR stimulation in active SLE patients, further support that B cells from SLE patients are under constant activation through BCR signaling, as has been proposed.

Pseudotumor cerebri syndrome in a pregnant woman with systemic lupus erythematous.

Systemic lupus erythematous is a chronic multi-systemic autoimmune disease that affects multiple organ systems, including the central nervous system. Pseudotumor cerebri is a disorder associated with increased intracranial pressure in the absence of a space-occupying lesion or other identifiable cause that affects young and obese women.We present the case of a pregnant woman with both pseudotumor cerebri and a new diagnosis of active systemic lupus erythematous.

Síndrome de seudotumor cerebral en una mujer embarazada y con lupus eritematoso sistémico / Pseudotumor cerebri syndrome in a pregnant woman with systemic lupus erythematous

Resumen El lupus eritematoso sistémico es una enfermedad autoinmunitaria crónica que afecta múltiples sistemas orgánicos, incluido el sistema nervioso central. El seudotumor cerebral es un síndrome clínico que se caracteriza por aumento de la presión intracraneal en ausencia de lesiones que ocupen espacio u otra causa detectable, que afecta con frecuencia a mujeres jóvenes y obesas. Se presenta el caso de una mujer con diagnóstico de seudotumor cerebral y lupus eritematoso sistémico diagnosticado de novo durante el embarazo.

Abstract Systemic lupus erythematous is a chronic multi-systemic autoimmune disease that affects multiple organ systems, including the central nervous system. Pseudotumor cerebri is a disorder associated with increased intracranial pressure in the absence of a space-occupying lesion or other identifiable cause that affects young and obese women. We present the case of a pregnant woman with both pseudotumor cerebri and a new diagnosis of active systemic lupus erythematous.

Cocaine-Levamisole-Induced Vasculitis/Vasculopathy Syndrome.

PURPOSE OF REVIEW: To understand the clinical spectrum of cocaine-levamisole-induced vasculitis. Worldwide recreational drug consumption is high among the adult population from various social strata. The use of cocaine with levamisole, a frequently added antiparasitic diluent, favors the manifestations of vasculitic lesions, especially in the skin. RECENT FINDINGS: New insights into immunological mechanisms involved in the pathogenesis of the disease. There are still many unknown aspects in the pathogenesis of this disease, such as the immune system interaction with p-ANCAs and the release of inflammatory NETs (neutrophil extracellular traps), which are the origin of auto-antigens and tissue damage, manifesting as vasculitic purpura on the skin. The clinical presentation constitutes a challenge for the clinician to be able to distinguish it from small-vessel vasculitides. This paper intends to improve the understanding of this condition, exhibiting the broad clinical spectrum of local and systemic manifestations of cocaine-levamisole-induced vasculitis, to facilitate a timely diagnosis, in order to take corrective measures and avoid sequelae, along with tissue damage and the consequent deformities and permanent scars.

Calidad de vida en una población con hemofilia: estudio de corte transversal en un centro de tratamiento de hemofilia / Quality of life in a population with haemophilia: a cross-sectional study from a single haemophilia treatment centre

RESUMEN Introducción: En pacientes con hemofilia la calidad de vida se puede afectar por factores como la artropatía, edad e intensidad del dolor. Objetivo: Evaluar la calidad de vida relacionada con la salud en personas con hemofilia, en Medellín durante 2014. Pacientes y métodos: Estudio descriptivo observacional de corte trasversal, realizado en 60 pacientes con hemofilia. Se describen las características demográficas, clínicas y de estilo de vida. Se realizó prueba funcional con medición de arcos de movilidad y test de marcha de 6 min, medición de calidad de vida relacionada con la salud (SF-36 y KIDSCREEN-27), evaluación de discapacidad (WHODAS II), dolor (EAV) y síntomas de depresión (PHQ-9). Resultados: Cincuenta y nueve pacientes aceptaron participar en el estudio, edad promedio de 28 (SD ± 14,8) anos, hemofilia leve 5%, moderada 20,3% y grave 74,5%. El 96,6% estaba en tratamiento con profilaxis y el 84% de los pacientes asistía a terapia física. La mayor comorbilidad fue artropatía hemofílica en el 71% de las personas, seguida de dislipidemia (27%), sobrepeso (20%) y tabaquismo (11,8%). La prueba de marcha reportó una distancia promedio de 584,2 metros y los puntajes del SF-36 fueron similares a los de la población general. Conclusión: Este grupo de pacientes con hemofilia, reporta una calidad de vida tan alta como la población general colombiana sin hemofilia. Este hallazgo reitera la importancia del tratamiento con profilaxis y de la participación activa de los pacientes en un programa de rehabilitación que promueva la independencia funcional y un estilo de vida saludable.

ABSTRACT Introduction: In patients with haemophilia, quality of life can be affected by factors like arthropathy, age, and pain intensity. Objective: To evaluate the health-related quality of life in patients with haemophilia in Medellin during 2014. Patients and methods: An observational, descriptive, cross-sectional study was conducted on 60 patients with confirmed diagnosis of haemophilia. Demographic, clinical and lifestyle characteristics are described. Functional test were performed including measuring ran-ges of mobility and the six-minute walk test. The health-related quality of life (SF-36 and KIDSCREEN-27), disability (WHODAS II), pain (VAS), and depressive symptoms (PHQ-9) were also evaluated. Results: A total of 59 patients agreed to participate in the study. The mean age was 28 years (SD ± 14.8), with mild haemophilia in 5%, moderate haemophilia in 20.3%, and severe haemophilia in 74.5%. Almost all (96.6%) of the patients were under treatment with prophylaxis, and 84% of the patients were having physiotherapy. The main comorbidity was haemop-hilic arthropathy in 71% of cases, followed by dyslipidaemia (27%), overweight (20%), and smoking (11.8%). The six-minute walk test reported mean distance of 584.2 metres, and the SF-36 scores were similar to the general population. Conclusion: This group of patients with haemophilia reported a quality of life as high as the general population in Colombia without haemophilia. This finding reiterated the importance of the treatment with prophylaxis and the active participation of patients in a rehabilitation program, which promotes functional independence and a healthy lifestyle.

Paquimeningitis, aortitis y nefritis simulando arteritis temporal / Pachymeningitis, aortitis and nephritis simulating temporal arteritis

Resumen Se presenta el caso de un hombre de 65 años con cuadro clínico de cefalea y velocidad de sedimentación globular elevada en quien se sospechó arteritis de células gigantes (ACG), pero durante el proceso diagnóstico se le documentó paquimeningitis, hiperproteinorraquia y biopsia de arteria temporal reportada como normal. La búsqueda de otras enfermedades sistémicas que explicaran el cuadro clínico evidenció además la presencia de aortitis, glomerulonefritis y anticuerpos anticitoplasma de neutrófilos (ANCA) positivos, lo cual permitió hacer el diagnóstico de granulomatosis con poliangeítis (GP). Se presenta el análisis y enfoque diagnóstico de esta inusual asociación de paquimeningitis, aortitis y glomerulonefritis. (Acta Med Colomb 2016; 40: 259-265).

Abstract The case of a 65-year-old man with a clinical picture of headache and elevated erythrocyte sedimentation rate in whom giant cell arteritis (GCA) was suspected, but that during the diagnostic process was documented as pachymeningitis, hyperproteinorrachia and temporal artery biopsy reported as normal, is presented. The search for other systemic diseases that could explain the clinical picture also revealed the presence of aortitis, glomerulonephritis and anti-neutrophil cytoplasmic antibodies (ANCA), and allowed to make the diagnosis of granulomatosis with poliangeítis (GPA). The analysis and diagnostic approach of this unusual association of pachymeningitis, aortitis and glomerulonephritis is reported. (Acta Med Colomb 2016; 40:259-265).

Infiltrating CD16+ Are Associated with a Reduction in Peripheral CD14+CD16++ Monocytes and Severe Forms of Lupus Nephritis.

Our aim was to characterize glomerular monocytes (Mo) infiltration and to correlate them with peripheral circulating Mo subsets and severity of lupus nephritis (LN). Methods. We evaluated 48 LN biopsy samples from a referral hospital. Recognition of Mo cells was done using microscopic view and immunohistochemistry stain with CD14 and CD16. Based on the number of cells, we classified LN samples as low degree of diffuse infiltration (<5 cells) and high degree of diffuse infiltration (≥5 cells). Immunophenotyping of peripheral Mo subsets was done using flow cytometry. Results. Mean age was 34.0 ± 11.7 years and the mean SLEDAI was 17.5 ± 6.9. The most common SLE manifestations were proteinuria (91%) and hypocomplementemia (75%). Severe LN was found in 70% of patients (Class III, 27%; Class IV, 43%). Severe LN patients and patients with higher grade of CD16+ infiltration had lower levels of nonclassical (CD14+CD16++) Mo in peripheral blood. Conclusions. Our results might suggest that those patients with more severe forms of LN had a higher grade of CD14+CD16+ infiltration and lower peripheral levels of nonclassical (CD14+CD16++) Mo and might reflect a recruitment process in renal tissues. However, given the small sample, our results must be interpreted carefully.

Tuberculosis infection causing intestinal perforations in 2 patients with systemic lupus erythematosus.

Patients with systemic lupus erythematosus (SLE) have a higher incidence rate of tuberculosis and a more frequent extrapulmonary involvement than the general population. We present 2 SLE patients who developed gastrointestinal tuberculosis complicated with intestinal perforation, a rare but serious complication that could be confused with lupus-associated intestinal vasculitis. Opportunistic infections such as tuberculosis must be suspected in SLE patients with abdominal symptoms on immunosuppressive therapy because its early recognition could prevent catastrophic complications such as intestinal perforation and subsequent peritonitis.

Atrofoderma de Pasini y PieriniPosible variante de la esclerodermia localizada / Pasini and Pierini atrofoderma Possible variant of localized scleroderma

Resumen Reportamos el caso de una paciente con unas lesiones en piel que fueron diagnosticadasinicialmente como morfea, por lo cual fue remitida al servicio de reumatología. Las características clínicas e histológicas nos permitieron descartar morfea clásica y clasificarla mejor como una atrofoderma de Pasini y Pierini. Aunque algunos la consideran una variante localizada y benigna dela morfea para otros se trata de una entidad nosológica distinta. Esta enfermedad debe ser considerada en el diagnóstico diferencial de la esclerodermia localizada y todos aquellos desórdenes que semejan esclerodermia para lograr un diagnóstico correcto y evitar tratamientos y exámenes innecesarios.Informamos la ausencia de respuesta de sus lesiones con el uso de hidroxicloroquina. (Acta MedColomb 2014; 39: 77-80).

Abstract The case of a patient with skin lesions initially diagnosed as morphea is reported. With this diagnosis, she was referred to rheumatology. The clinical and histological characteristics allowed us to rule out classical morphea and better classify it as a Pasini and Pierini atrofoderma. While some consider it a localized and benign variant of morphea, for others it is a distinct nosological entity. This disease should be considered in the differential diagnosis of localized scleroderma and all those disorders that resemble scleroderma for a proper diagnosis and to avoid unnecessary tests and treatments. The lack of response from her lesions with the use of hydroxychloroquine is reported. (Acta Med Colomb 2014; 39: 77-80).

Anticuerpos Anti-C1q como marcadores de compromiso renal en pacientes con lupus eritematoso sistémico / Anti-C1q antibodies as markers of renal compromise in patients with systemic lupus erythematosus

Resumen El compromiso renal en el lupus eritematoso sistémico (LES) es uno de los mayores determinantes del curso y pronóstico de estos pacientes. Existe evidencia de la asociación de anticuerpos anti-C1q y el desarrollo de nefritis lúpica. El objetivo de este estudio fue determinar la prevalencia de anticuerpos anti-C1q y su asociación con nefritis lúpica en pacientes colombianos con LES. Métodos: Estudio de corte transversal en el cual se incluyeron 80 pacientes con diagnóstico de LES según criterios del Colegio Americano de Reumatología. La cuantificación de anticuerpos anti-C1q séricos se realizó por ELISA, se consideraron positivas concentraciones ≥15 U/ml. Resultados: Los pacientes eran predominantemente mujeres (87%) y 43,7% tuvieron proteinuria >0,5 g/día, la cual fue más común en pacientes jóvenes y apareció tempranamente en la enfermedad. Cuarenta y cuatro (55%) de los pacientes tenían anticuerpos anti-C1q positivos, en quienes la proteinuria fue más frecuente (OR=4.3, IC95% 1.7 - 11, p=0.003). Se encontró correlación inversa débil entre los títulos de anti-C1q, el consumo de C3 (r=-0.54, p<0.001) y la depuración de creatinina (r=-0.33, p=0.035); una correlación directa débil, con la proteinuria (r=0.35, p=0.024) y la actividad de la enfermedad, la cual se determinó con el Índice de Actividad de Enfermedad (SLEDAI) (r=0.48, p<0.0001). Conclusiones: Los anticuerpos anti-C1q pueden ser útiles en la evaluación de la nefritis lúpica activa, y podrían ser implementados como un marcador diagnóstico de nefritis lúpica y como un posible marcador de actividad de la enfermedad en pacientes con LES, tal como lo ha sugerido la Liga Europea contra el Reumatismo (EULAR).

Summary Renal involvement in systemic lupus erythematosus (SLE) is one of the major determinants Anti-C1q antibodies of the course and prognosis of these patients. There is evidence of the association of Anti-DNA antibodies anti-C1q antibodies and the development of lupus nephritis. The aim of this study was to determine the prevalence of anti-C1q antibodies and its association with lupus nephritis in Colombian patients with SLE. Methods: 80 SLE patients as defined by the American College of Rheumatology criteria. Quantification of anti-C1q antibodies in patients' sera was performed by ELISA and concentrations greater than 15U/ml were considered positive. Results: Patients were predominantly women (87%) and 43.7% of them had proteinuria > 0.5 g / 24 hours which was more common in younger patients and early in the course of the disease. Forty-four (55%) of patients had positive anti-C1q, in whom, proteinuria was more frequent (OR = 4.3 95% CI 1.7 - 11, p = 0.003). A weak inverse correlation between anti-C1q titers, C3 consumption (r = -0.54, p <0.001) and creatinine clearance was found (r = -0.33, p = 0.035); similarly, we also found a weak direct correlation with proteinuria (r = 0.35, p = 0.024) and disease activity ascertained with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) (r = 0.48, p <0.0001). Conclusions: Anti-C1q antibodies might be valuable for the evaluation of active lupus nephritis, and might be valuable for the evaluation of active lupus nephritis, and could be included as a diagnostic marker of lupus nephritis and maybe as a marker for disease activity, as suggested by the European League Against Rheumatism (EULAR).