Intestinal, Systemic, and Oral Gluten-related Alterations in Patients With Nonceliac Gluten Sensitivity.

BACKGROUND: Nonceliac gluten sensitivity (NCGS) is an emergent condition, the framework of which is yet unclear, whereas the diagnosis is suggested only by gluten-dependent symptoms after excluding wheat allergy and celiac disease (CD). Our goal was to highlight intestinal, systemic, and oral alterations to clarify the NCGS pathogenesis and identify new diagnostic tools. STUDY: A total of 60 NCGS patients, 20 untreated CD, 20 treated CD, and 20 healthy volunteers were recruited. The differential diagnosis among gluten-related disorders was performed by serological, allergy, and histologic tools. NCGS patients were also subjected to antigliadin antibody (AGA) detection and HLA typing. All participants underwent an oral mucosa patch test for gluten (GOMPT), whereas an oral provocation test (OPT) for gluten was performed in 26 NCGS patients. RESULTS: About 6/60 (10%) NCGS patients showed IgG AGA-positive results, whereas 45/60 (75%) patients carried HLA-DQ2 and/or HLA-DQ8 genes. GOMPT showed positive results in 45/60 (75%) NCGS patients, 3/20 (15%) untreated CD patients, 5/20 (25%) treated CD patients, and in no healthy volunteers. No significant difference was found between the severity of symptoms reported by NCGS patients subjected to OPT with gluten-containing croissants and those who underwent OPT with gluten-free croissants. CONCLUSIONS: GOMPT seems to be a specific tool for NCGS diagnosis, although further investigations are needed to overcome limits due to the small population studied and to contextualize GOMPT false-positive results.

Atrial fibrillation with aberrant ventricular conduction after receiving Bamlanivimab/Etesevimab: a case report.

Coronavirus Disease 2019 (COVID-19) is affecting millions of people globally. Several neutralizing monoclonal antibodies have been developed to limit the progression and complications of the disease. These treatments provide immediate and passive immunity. The combination therapy with Bamlanivimab plus Etesevimab led to a lower incidence of COVID-19-related hospitalization and death and a faster reduction in the SARS-CoV-2 viral load. No or rare cases of cardiovascular side effects are reported. We present the case of a high-risk 79-years-old woman who developed atrial fibrillation with aberrant ventricular conduction after administration of neutralizing monoclonal-antibodies Bamlanivimab plus Etesevimab. The woman with a history of insulin-dependent diabetes and Grade II follicular Non-Hodgkin Lymphoma previously vaccinated with two doses of Pfizer COVID-19 vaccine, presented with malaise, headache, and SARS-CoV-2 nasal swab reverse transcription-polymerase chain reaction tested positive for the infection. She received a single dose of Bamlanivimab (70 mg) + Etesevimab (1400 mg). After about a week, she developed atrial fibrillation with uncontrolled response to frequent premature ventricular complexes and aberrant ventricular conduction. This case presents a high-risk woman with SARS-CoV-2 infection who developed a serious adverse cardiovascular event some days after receiving neutralizing monoclonal antibodies. Risk factors including sex, age, anxiety related to isolation and infection, and COVID-19 itself may have all contributed to atrial fibrillation. Arrhythmia may rarely occur after monoclonal-antibodies treatment, although recommended timing to monitor patients is from 1 to 24 h after the administration of these antibodies. Appreciation of this potential association is important for evaluating monoclonal-antibody treatments' safety and optimizing patient monitoring and follow-up.

Fatal Listeria monocytogenes septicemia and meningitis complicated by Candida glabrata fungemia: a case report.

Listeria monocytogenes is a Gram-positive bacteria and etiological agent of listeriosis. It has the ability to colonize the intestinal lumen and cross the intestinal, blood-brain, and placental barriers, leading to invasive listeriosis responsible for septicemia and meningitis in subjects at risk such as patients with diabetes mellitus, the elderly, and immunocompromised individuals and, for maternal-neonatal infection in pregnant women. We report a rare case of L. monocytogenes septicemia and meningitis complicated by Candida glabrata fungemia on a patient with a history of type 2 diabetes mellitus, hypothyroidism, hypertension, chronic kidney failure, chronic ischemic vascular encephalopathy, and atrial fibrillation. Although adequate therapy was rapidly started with an initial partial clinical improvement, the patient suddenly experienced clinical worsening concomitantly with Candida septicemia resulting in a fatal outcome. To our knowledge, this is the first described case of an invasive L. monocytogenes infection complicated by Candida sepsis. We hypothesize that concomitant Candida infection may play a significant role in the pathogenesis and virulence of L. monocytogenes.