Diffuse Erythema Research Articles

Erythema Infectiosum: A Narrative Review.

Erythema infectiosum occurs worldwide. School-aged children are most often affected. Since the diagnosis is mainly clinical, physicians should be well-versed in the clinical manifestations of erythema infectiosum to avoid misdiagnosis, unnecessary investigations, and mismanagement of the disease. The purpose of this article is to familiarize physicians with the wide spectrum of clinical manifestations and complications of erythema infectiosum associated with parvovirus B19 infection. A search was conducted in July 2022 in PubMed Clinical Queries using the key terms "Erythema infectiosum" OR "Fifth disease" OR "Slapped cheek disease" OR "Parvovirus B19". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. Erythema infectiosum is a common exanthematous illness of childhood caused by parvovirus B19. Parvovirus B19 spreads mainly by respiratory tract secretions and, to a lesser extent, the saliva of infected individuals. Children between 4 and 10 years of age are most often affected. The incubation period is usually 4 to 14 days. Prodromal symptoms are usually mild and consist of lowgrade fever, headache, malaise, and myalgia. The rash typically evolves in 3 stages. The initial stage is an erythematous rash on the cheeks, with a characteristic "slapped cheek" appearance. In the second stage, the rash spreads concurrently or quickly to the trunk, extremities, and buttocks as diffuse macular erythema. The rash tends to be more intense on extensor surfaces. The palms and soles are typically spared. Central clearing of the rash results in a characteristic lacy or reticulated appearance. The rash usually resolves spontaneously within three weeks without sequelae. The third stage is characterized by evanescence and recrudescence. In adults, the rash is less pronounced than that in children and is often atypical. Only approximately 20% of affected adults have an erythematous rash on the face. In adults, the rash is more frequently found on the legs, followed by the trunk, and arms. A reticulated or lacy erythema is noted in 80% of cases which helps to distinguish erythema infectiosum from other exanthems. Pruritus is noted in approximately 50% of cases. The diagnosis is mainly clinical. The many manifestations of parvovirus B19 infection can pose a diagnostic challenge even to the best diagnostician. Complications include arthritis, arthralgia, and transient aplastic crisis. In most cases, treatment is symptomatic and supportive. When parvovirus B19 infection occurs in pregnant women, hydrops fetalis becomes a real concern. Erythema infectiosum, the most common clinical manifestation of parvovirus B19 infection, is characterized by a "slapped cheek" appearance on the face and lacy exanthem on the trunk and extremities. Parvovirus B19 infection is associated with a wide spectrum of clinical manifestations. Physicians should be aware of potential complications and conditions associated with parvovirus B19 infection, especially in individuals who are immunocompromised, chronically anemic, or pregnant.

A study to determine the efficacy of intense pulse light in vascular mode for topical steroid damaged facies

Objectives: Misuse of topical corticosteroids on the face has gradually evolved over the years and has now reached phenomenal proportions on account of easy availability, widespread misinformation, and the fairness craze sweeping across the land. Topical steroid-damaged/dependent facies (TSDFs) may present with diffuse erythema, telangiectasia, papules, and atrophy. Current modalities used for the management of TSDF, such as topical tacrolimus and oral antibiotics, have shown a variable response. Intense pulsed light (IPL) systems are economical, have a higher safety margin, and are widely available. The goal of treating vascular lesions with IPL is to raise blood vessel temperature high enough to cause coagulation, leading to destruction and healing with fibrosis. In our study, we exploit these properties of IPL for the management of TSDF. Material and Methods: A total of 15 patients of TSDF were recruited and were treated with three sessions of IPL treatments (vascular mode) 3 weeks apart and were assessed based on a clinical score for TSDF, visual analog scale (VAS) for erythema assessed by the physician and patient at the end of 9 weeks. Results: There was a significant response with a reduction in clinical score of 5.4 points (P > 0.001) and a reduction in physician and patient-assessed VAS for erythema of 3.47 and 3.73, respectively. Conclusion: There is a scarcity of data regarding the efficacy of various treatment modalities for TSDF. Our study establishes IPL (vascular mode) as an innovative emerging modality of treatment.

Endoscopic findings of immune checkpoint inhibitor-related gastrointestinal adverse events.

The use of immune checkpoint inhibitors (ICIs) for the treatment of various malignancies is increasing. Immune-related adverse events can occur after ICI administration, with gastrointestinal adverse events constituting a significant proportion of these events. When ICI-related diarrhea/colitis is suspected, endoscopic evaluation is recommended to differentiate it from other etiologies and assess the severity of colitis. The distribution of intestinal inflammation in ICI-related colitis demonstrates a high frequency of extensive colitis (23-86%). However, isolated right-sided colitis (3-8%) and ileitis (2-16%) are less prevalent. Endoscopic findings vary and predominantly encompass features indicative of inflammatory bowel disease, including aphthae, ulcers, diffuse or patchy erythema, mucosal edema, loss of vascular pattern, and friability. The presence of ulcers and extensive intestinal inflammation are associated with a reduced response to treatment. Microscopic inflammation can be observed even in endoscopically normal mucosa, underscoring the need for biopsies of seemingly normal mucosa. Histological findings present with acute/chronic inflammation and occasionally exhibit characteristics observed in inflammatory bowel disease, microscopic colitis, or ischemic colitis. The first-line therapeutic choice for ICI-related diarrhea/colitis with a common terminology criteria for adverse events grade of 2 or above is corticosteroids, whereas infliximab and vedolizumab are recommended for refractory cases.

Impact of high-altitude hypoxia on Helicobacter pylori-induced gastritis pathological manifestations and inflammatory responses

BackgroundChronic gastritis caused by Helicobacter pylori (Hp) infection is a common gastrointestinal disorder. Despite the high prevalence of Hp infection and chronic gastritis in the Tibetan Plateau, there is a lack of studies elucidating the influence of plateau hypoxia on Hp-induced gastritis. This study aimed to investigate the impact of high-altitude hypoxia on Hp-induced gastritis, particularly focusing on pathological manifestations and inflammatory responses.MethodsThis study was conducted from July 2023 to March 2024 at the Department of Gastroenterology, Affiliated Hospital of Qinghai University. Ninety patients diagnosed with chronic gastritis were enrolled in the study and divided into four groups based on their residential altitude and Hp infection status. Data on endoscopic and pathological characteristics were collected, along with serum oxidative stress and inflammatory markers.ResultsPatients with Hp gastritis exhibit distinctive features in the gastric mucosa, including diffuse erythema, enlarged folds, and white turbid mucus during endoscopy. Notably, individuals with Hp gastritis at high altitudes show a higher prevalence of diffuse erythema and enlarged folds. Pathological analysis reveals that these patients have elevated gastric mucosal inflammation scores and increased chronic and active inflammation. Furthermore, individuals with Hp gastritis at high altitudes demonstrate elevated levels of serum TNF-α, IL-1β, IL-6, and MDA, as well as reduced serum SOD and GSH-Px activities.ConclusionsHigh-altitude hypoxia may exacerbate gastric mucosal damage by enhancing oxidative stress and inflammatory response induced by Hp infection.

Dermatitis Eksfoliatif Generalisata

Generalized exfoliative dermatitis, also known as erythroderma, is a skin disease with dermatological features in the form of diffuse erythema and scaling that affects more than 90% of the skin surface. This report describes the case of a 65 year old man who came with the main complaint, the skin all over his body felt itchy and peeling since approximately 2 years ago. The itching experienced by the patient worsens during hot weather/temperature, usually occurring during the day and night, but the itching experienced is more severe at night. The patient's complaints began with the appearance of redness on the skin in the left and right hand area, then spread to the chest area, groin/genital area, both legs, and throughout the body up to the head. Dermatological status examination revealed diffuse erythema macules accompanied by rough scales all over the body. The patient was diagnosed with generalized exfoliative dermatitis. In management, patients are given education to maintain skin moisture, avoid scratching the skin, and consume foods high in protein such as red meat. The pharmacological management given is in the form of corticosteroid drugs, antibiotics, proton pump inhibitors, antihistamines, and several topical drugs to reduce complaints of itching and peeling skin in patients.

Abstract PO1-25-04: PTN-positive luminal progenitors induce angiogenesis and metastasis in inflammatory breast cancer

Abstract Background Inflammatory breast cancer (IBC) is a lethal subtype of breast cancer characterized by rapidly arising diffuse erythema and edema of the overlying skin that was thought to contribute to rapid metastasis. Dissecting the intricate cellular ecosystems within tumors and affected skin and their complex interplay may be pivotal in unraveling the aggressive nature of IBC. Methods Integrative analysis containing single-cell RNA sequencing, bulk RNA sequencing, and whole exome sequencing, was performed on paired tumor and skin samples from 17 treatment-naive IBC patients and 5 non-IBC patients from multiple centers. Meanwhile, paraffin sections and serum specimens from two centers were conducted to validate the omics results. Additionally, public single-cell transcriptomic data of non-IBC tumors and normal mammary glands, RNA microarray data from IBC cases, and the Cancer Genome Atlas (TCGA) database were utilized to validate the characteristics of IBC microenvironment. The regulatory mechanism was verified by in vitro experiments. Results We delineated the landscapes of IBC tumor and affected skin microenvironment at the single-cell level and demonstrated that the luminal progenitors (LP) cells highly expressing pleiotrophin (PTN) were most significantly enriched in IBC tumors compared to non-IBC tumors and normal mammary glands, in two independent cohorts. Moreover, the serum concentrations of PTN were significantly higher in IBC patients compared with non-IBC patients. Notably, PTN secreted by PTN+ LP cells interacted with Neuropilin 1(NRP1) receptor on endothelial tip cells in both tumor and affected skin of IBC. Moreover, in vitro assay demonstrated knocking down the expression of NRP1 on human umbilical vein endothelial cells significantly blocked PTN-induced migration, tube formation and sprouting, which might be independent of VEGFA. In addition, two immature phenotypes of PVL_MMP9 and PVL_CCL19 cells recruited by endothelial tip cells via PDGFB/PDGFRB axis were accumulated in affected skin of IBC, which might be associated with promotion of malignant cell metastasis. Finally, we revealed that malignant cells in affected skin of IBC had a higher ability of epithelial-mesenchymal transition than IBC intratumoral malignant cells and identified enhanced crosstalk between immature PVL cells and malignant cells in the skin affected with IBC , through TNFSF12-TNFRSF12A, TGFB-TGFBR1/TGFBR2, MDK-SDC1/4/NCL/(ITGA6+ITGB1). Conclusion We identified a unique, non-malignant epithelial cell subpopulation PTN+ LP cells, which induce massive angiogenesis via the PTN-NRP1 axis, recruit the immature phenotype PVL cells accumulated in affected skin of IBC thus promoting tumor progression. Our findings offer comprehensive insights into the pathogenesis of IBC and uncover a previously unknown, promising therapeutic target. Patient of discovery cohort details Clinical and pathology details for inflammatory breast cancer(IBC) and non-IBC patients analysed by single-cell RNA sequencing(scRNA-seq), bulk RNA sequencing(bulk RNA-seq) and whole exome sequencing(WES) in this study. Clinicalpathological feature of validation cohort Citation Format: Mengmeng Zhang, Kaiwen Zhou, Ting Liu, Filipa Lynce, Filipa Lynce, Wendy Chen, Qianjun Chen, Xiaoping Li, Zhongyu Yuan, Juan Xu, Zhenhai Cai, Jianping Guo, Nan Shao, Ying Lin. PTN-positive luminal progenitors induce angiogenesis and metastasis in inflammatory breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-25-04.

Ulcerative Gastritis in Sarcina Ventriculi: A Case Report

Background: Sarcina Ventriculi is a Gram-positive organism, which has not been found in gastric samples from patients with gastroparesis. We report the observation of a patient with ulcerative gastritis in Sarcina Ventriculi collected in the pathological anatomy department at the Mohammed VI University Hospital in Marrakech. Case Presentation: This is a 64-year-old woman, with a history of accidental ingestion of Hydrochloric acid, who presented with chronic epigastralgia. An upper endoscopy revealed diffuse gastric erythema. The biopsies revealed a reported inflammation with the formation of an ulcerated ulcer and the presence of Sarcina organisms. Conclusions: Sarcina Ventriculi is an increasingly common Gram-positive coccus recognized in gastric biopsies, especially in patients with delayed gastric abnormalities. It occurs most often in adult females and can be easily identified by its morphological features such as basophilic staining, cuboid shape, tetrad arrangement, red blood cell-sized bundles, flattened cell walls, and nature. refractile under an optical microscope. Although the pathogenesis of the organism is debated, it has been implicated in cases of gastric perforation, emphysematous gastritis and peritonitis, as well as in the development of gastric adenocarcinoma.

A retrospective study on adverse events of intravenous administration of sulfur hexafluoride microbubbles in abdominal and superficial applications in 83,778 patients.

To investigate the rate of adverse events (AEs) caused by intravenous administration of sulfur hexafluoride microbubbles in abdominal and superficial applications retrospectively and to explore practical measures for prevention and treatment of them. This study enrolled 83,778 contrast-enhanced ultrasound (CEUS) examinations using sulfur hexafluoride microbubbles intravenously performed during 11 years. Age, gender, and target organs of all CEUS patients were recorded. For cases of AEs, their medical history and laboratory results were also collected. The process of AEs was assessed and categorized. Besides, the management of AEs were recorded. Twenty patients had sulfur hexafluoride microbubbles-related AEs. The AE rate was 0.024%. No significant difference was observed between patients with AEs and the whole group for age and sex distribution. All AEs happened in liver examinations. Among them, 7 (35%) were mild, 8 (40%) were moderate, and 5 (25%) were severe. They were categorized into 15 allergic-like reactions and 5 physiologic reactions. The manifestations of mild and moderate AEs mainly include urticaria, chills, and mild hypoxia, which could be eased by simple management. Severe cases had anaphylactic shock, generalized convulsions, and diffuse erythema with hypotension respectively. They need close monitoring and oxygen inhalation with anti-shock and anti-anaphylactic treatment. Most cases started within 30 min and recovered within 1 day. Intravenous administration of sulfur hexafluoride microbubbles in abdominal and superficial applications was safe with rare AEs. AEs were more likely to happen in abdominal applications than superficial ones. A well-designed emergency plan should be available for clinical use of sulfur hexafluoride microbubbles to reduce AEs and to deal with AEs properly. Intravenous administration of sulfur hexafluoride microbubbles in abdominal and superficial applications reported few AEs and could be considered safe but severe AEs are life-threatening. We analyzed the influence factors of AEs and propose some methods for prevention and treatment of them, which can further improve the safety of sulfur hexafluoride microbubbles in clinical practice. • The AE rate of sulfur hexafluoride microbubbles in abdominal and superficial applications was 0.024%. • Patients were more likely to have AEs in abdominal applications than superficial ones. • Severe AEs are life-threatening and need prompt identification and treatment. • We summarized some detailed suggestions for clinical prevention and treatment of AEs.

Severe ulcerative colitis induced by COVID-19 vaccination

A 37-year-old woman developed severe colitis with diffuse mucosal erythema and ulcerations throughout the entire colon after the 3rd vaccination of COVID-19. Stool culture was negative, and the pathological findings showed increased lymphoplasmacytic and neutrophilic infiltration in the colonic lamina propria, which were consistent with ulcerative colitis. After the treatment with anti-tumor necrosis factor-α agent, the ulceration markedly improved with development of severe colonic stenosis, which was successfully dilated with endoscopic balloon dilation. In case of COVID-19 vaccination, it should be noted that vaccination could be a trigger for the onset of UC.

The correlation between dermoscopy and clinical and pathological tests in the evaluation of skin photoaging.

There are no standards for evaluating skin photoaging. Dermoscopy is a non-invasive detection method that might be useful for evaluating photoaging. To assess the correlation between the dermoscopic evaluation of photoaging and clinical and pathological evaluations. The age, clinical evaluation (Fitzpatrick classification, Glogau Photoaging Classification, and Chung's standardized image ruler), histopathology (Masson staining and MMP-1 immunohistochemistry), and dermoscopy (Hu's and Isik's) of 40 donor skin samples were analyzed statistically, and Spearman rank correlation analysis was performed. There was a robust correlation between the total Hu scores and Isik dermoscopy. The correlation of dermoscopy with histopathology was higher than that of clinical evaluation methods. There is a strong correlation between telangiectases and lentigo. Xerosis, superficial wrinkle, diffuse erythema, telangiectases, and reticular pigmentation were significantly correlated with the three clinical evaluation methods. Superficial wrinkles were correlated with Masson, MMP-1, various clinical indicators, and other dermoscopic items. There is a good correlation between dermoscopy and clinical and histopathological examination. Dermoscopy might help evaluate skin photoaging.

Diagnosis and management of erythroderma; a systematic review

Erythroderma, a condition characterized by diffuse erythema and scaling covering at least 90 percent of the skin\'s surface, poses a serious and potentially life-threatening threat. This systematic study aimed to establish diagnosis and management guidelines for erythroderma. Following PRISMA guidelines, a comprehensive review was conducted using PubMed/Medline, Scopus, and Embase databases focusing on English-language articles from 2010 to 2023. From 279 studies, seven articles were included, mainly comprising surveys and analyses of national databases. Erythroderma, as a clinical sign, can manifest as a consequence of various cutaneous and systemic diseases, drug hypersensitivity reactions, and rarely, Sezary syndrome. In pediatric patients, the clinical presentation encompasses a spectrum of acquired and inherited diseases, including infections, inflammatory skin conditions, ichthyoses, and congenital immunodeficiencies. Diagnosing erythroderma proves challenging due to its syndromatic nature, presenting with nonspecific clinical features. Dermatologists must diligently seek cause-oriented clues, employing multiple biopsies to enhance diagnostic accuracy. Initial management should include nutritional expert evaluation, assessment of fluid imbalance, skin barrier maintenance, sedative anti-histamines, and exclusion of secondary bacterial infection. Given its life-threatening potential, erythroderma might necessitate hospitalization. This study provides valuable insights into the complexities of erythroderma diagnosis and highlights essential considerations for effective management.

Traumatic Ulcer Associated with Iatrogenic Trauma After Basal Cell Adenoma Surgery

Traumatic ulcer is an oral cavity lesion characterized by loss of epithelial lining, reaching the lamina propria. This condition presents a single lesion with irregular borders, surrounded by diffuse erythema, and covered with pseudo-membrane. In specific case, the traumatic ulcer was caused by iatrogenic trauma after basal cell adenoma surgery. This case report aimed to discuss the causes of traumatic ulcer. A 39-year-old female was referred to the Oral Medicine Clinic from the Ear, Nose, and Throat Department, complaining of pain in the oral mucosa after basal cell adenoma surgery. On extraoral examination, the facial symmetry was intact along with dry and exfoliative lips. A solitary, oval, yellowish-white intraoral ulcer covered with pseudomembrane, irregular borders surrounded by diffuse erythema on the palate, left buccal mucosa and upper labial mucosa was present. The patient was diagnosed with traumatic ulcer due to iatrogenic trauma after surgery for basal cell adenoma located within the parotid gland that extended to the left palate. The treatment administered comprised instructions to clean the oral cavity using gauze and a cotton stick soaked in 0.2% chlorhexidine gluconate. Additionally, compressing the affected areas with gauze soaked in 0.9% NaCl and applying a thin coating of Vaseline album on the lips were part of the therapeutic measures. Given the iatrogenic nature of traumatic cancer, comprehensive therapy was considered essential to prevent secondary infection and address issues related to speech, appearance, and masticatory functions.

Inflammatory Breast Cancer with Diffuse Breast Erythema and Swelling as Symptoms

<p>臨床上，乳房紅腫常會讓人聯想為乳房發炎性疾病。本案例是一位44歲女性，因右側乳房瀰漫性紅腫約四週未改善就醫，後診斷為右側乳癌第三期，並行右側乳房根除性手術，術後三週，住院計畫做化療，發現白血球升高、右胸壁及右腋下多處復發。考量疾病進展迅速，回溯過去病史、治療過程及病理報告，最後診斷為發炎性乳癌（Inflammatory Breast Cancer, IBC），予以多模式治療後，腫瘤消除。發炎性乳癌相當罕見，沒有特定組織學，易與乳房發炎性疾病及其它局部嚴重晚期乳癌（Locally Advanced Breast Cancer, LABC）混淆。建議臨床同仁，如果乳房有發炎現象，使用抗生素兩週無效時，須將發炎性乳癌列為鑑別診斷並將其特徵謹記於心，以免延誤治療和危害病人生命。</p> <p> </p><p>In clinical practice, breast erythema is often linked to breast inflammatory diseases. The case of this study is a 44-year-old female, who went to the hospital due to diffuse erythema with swelling on the right breast for four weeks. She was initially diagnosed with stage III breast cancer and received a right-side radical mastectomy. When she was admitted for chemotherapy three weeks after the sur-gery, she was found to have leukocytosis and multiple metastasis over the right chest wall and right axillary. Therefore, cancer recurrence was suspected. Considering the rapid progression of the disease and reviewing past medical history, medical treatment procedures, and pathological report, the final diagnosis of inflammatory breast cancer (IBC) was made. After multimodal treatments, the tumors were eliminated. Given that IBC is easily confused with inflammatory diseases and other locally advanced breast cancer (LABC), if the breast is inflamed and antibiotic treatments are not effective for two weeks inflammatory breast cancer (IBC) must be included in the differential diagnosis. The healthcare provider must keep IBC’s characteristics in mind to avoid delay treatment which might en-danger the patient’s life.</p> <p> </p>

Differential diagnosis of red scalp: the importance oftrichoscopy.

Red scalp is a common complaint that may constitute a diagnostic and therapeutic challenge in daily clinical practice. Among the numerous diseases to cause diffuse scalp erythema are psoriasis, seborrhoeic dermatitis, contact dermatitis, diffuse lichen planopilaris, dermatomyositis and scalp rosacea. Accurate diagnosis is crucial for optimal treatment outcomes. Histology most frequently discriminates the underlying condition, but it requires scalp biopsy. In many cases, the combination of clinical examination and trichoscopy is sufficient for establishing the correct diagnosis. The main trichoscopic features of psoriasis are silver-white scaling, regularly distributed dotted (glomerular) vessels or twisted red loops, and punctate haemorrhages. Yellowish-white scaling and thin arborizing vessels are typical features of seborrhoeic dermatitis. Contact dermatitis is characterized by the presence of yellow exudate and polymorphic vessels, while perifollicular scaling and erythema with the lack of follicular openings are typical findings in lichen planopilaris. In scalp dermatomyositis, tortuous and arborizing vessels with interfollicular and perifollicular pigmentation may be detected. The most characteristic features of scalp rosacea are perifollicular scaling and polygonal/arborizing vessels. This review also summarizes histological features and therapeutic options for these conditions.

When the diagnosis is written in the DNA: a case of erythropoietic protoporphyria in a patient with a chromosome-18 deletion.

In this case study, we describe a 21-year-old man with erythropoietic protoporphyria who sought medical attention in April 2022 for diffuse edema and erythema of the hands. These symptoms had been present since childhood and usually occurred soon after sun exposure. The patient's medical history showed that chromosome 18's long arm had partially deleted. We performed a number of tests, including measuring total erythrocyte protoporphyrin levels and utilizing a spectrofluorometer to assess the fluorometric emission peak of plasma porphyrins, based on the patient's medical history and clinical symptoms. Furthermore, a genetic analysis identified an intronic variant on one allele, c.315-48T>C (IVS3-48T>C), which is categorized as a susceptibility polymorphism, and a complete deletion of the ferrochelatase gene on the other allele. The patient's clinical condition improved following the June 2022 afamelanotide implant procedure.

Dermoscopy of lichen nitidus: a study of 20 cases

Lichen nitidus (LN) is a chronic inflammatory lichenoid dermatosis, commonly seen in childhood or early adulthood. In this case series, we studied the various dermoscopic features of LN and correlate them with clinical variants, duration of disease and histopathology. A total of 20 patients of LN were studied. The mean age was 25.7 years with 45% and 55% male and female, respectively. The median duration of disease was 6 months. The dermoscopic findings seen on non-polarizing mode were-shiny elevated surface with absence of skin markings (100%), scaling (70%), radial ridges (50%) and central depression (35%). Findings seen on polarizing mode were-hypopigmentation (100%), brown shadow (70%), linear vessels (65%), accentuation of surrounding reticulate pigment network (65%), diffuse erythema (45%). Newer findings seen were central grey-brown structureless areas (30%), speckled brown pigment (40%), curvilinear vessels (50%), branching/serpentine vessels (20%), radial vessels (10%), white dots and streaks (30%) and ring-in-ring appearance (5%). LN presents fairly distinctive dermoscopic features and dermoscopy can be a non-invasive, painless aid in differentiating it from close clinical differentials and avoid the need for a biopsy, especially in children.

Difficult glottis: Diagnostic dilemma in viewof the clinical presentation.

<br><b>Introduction:</b> The taxonomy of vocal fold lesions has been refined, and it serves as a common descriptive language for diagnosis, treatment algorithms, and reporting of outcomes. However, we observe rare cases when numerous pathologies overlap, resulting in an unclear and complicated clinical presentation of the glottis.</br> <br><b>Aim:</b> The aim of this paper is to present cases of overlapping etiopathological factors which poses a challenge when making a diagnosis and referring a patient for adequate treatment.</br> <br><b>Material and method:</b> The study presents different photographs of the glottis, including some unique and unusual images in which overlapping pathologies were captured. The photographs are accompanied by case descriptions, comments, and pathological analyses.</br> <br><b>Results:</b> Four selected photographs showed a bunch of exophytic growth lesions with foci of whitish plaques, covered by yellowish crusts, with thinned, reddened vocal folds presenting foci of leukoplakia. The study discussed possible causes of vocal folds edema, diffuse erythema, presence of crusts or exudate, whitish debris/plaques or development of leukoplakia, non-neoplastic ulceration, as well as injected and reddened mucous membrane. Chronic infectious laryngitis, idiopathic ulcerative laryngitis, and drug-induced laryngitis were also mentioned. The study also raised the issues concerning diabetics and patients treated with inhaled corticosteroids, including candidiasis and primary aspergillosis of the larynx.</br> <br><b>Conclusions:</b> To conclude, everyday clinical practice involves encountering cases of unclear onset and course, with complicated presentation of the glottis. Therefore, comprehensive history-taking and thorough investigation of systemic causes are of immense importance. Recommended management includes conducting the most meticulous differential diagnosis, implementing treatment for the most likely cause, and, whenever possible, refraining from biopsy in order to avoid permanent damage to vocal cords.</br&gt.

#6795 DISSEMINATED STRONGYLOIDES INFECTION IN A PATIENT WITH IGA NEPHROPATHY ON IMMUNOSUPPRESSIVE MEDICATIONS

Abstract Background and Aims Immunosuppressive medications such as high dose steroids and antimetabolites are frequently used in glomerulonephritis. However, use of these medications is usually associated with various adverse effects. Among the drawbacks of immunosuppressive therapy, the risk of reactivation of latent infections, including parasitic infestations, is to be considered. Method Case report. Results Our case is a 28 year old male patient who was diagnosed as a case of IgA nephropathy 7 months back with M1E1S1T1C0 lesions with a serum creatinine of 1.7 mg/dL and eGFR of 56 ml/min/1.73 m2. He was started on prednisolone (40mg daily) and mycophenolate mofetil (1000mg twice daily) for 1 month. He presented with us with diarrhea. He was treated with IV fluids and mycophenolate mofetil was stopped. After two weeks, he was readmitted with a 4-day history of fever, vomiting, and epigastric pain. On examination, he showed mild epigastric tenderness, normal vitals. The laboratory investigations on admission showed hemoglobin-15 g/dL, total leucocyte count-8600, eosinophilia with absolute eosinophil count 1900/ mm3, urea-92 mg/dL, creatinine-2 mg/dL. ECG showed sinus tachycardia, and HRCT chest revealed bilateral ground glass opacities and a calcified nodule in the left upper lobe. Liver function test was normal with normal amylase and calcium level. Blood culture was sterile. Ultrasound abdomen showed a bilateral raised Eco pattern in kidneys rest were normal. Upper GI endoscopy revealed diffuse edema, erythema, and superficial ulceration in duodenum and biopsy was taken. The duodenal biopsy showed features of strongyloidiasis stercoralis (Figure 1). Bronchoesophageal lavage was done which revealed strongyloidiasis stercoralis larvae. Meanwhile, the patient developed subacute small bowel obstruction with abdominal x ray showing multiple air fluid levels and CT scan showed features of small bowel obstruction with transition at mid-ileal level secondary to short segment thickening. Small bowel obstruction was relived with conservative mangement with ryles tube decompression and enemas. He was diagnosed with disseminated strongyloidiasis and treated with ivermectin for 14 days with full recovery Conclusion Our case signifies need of awareness among clinicians of the risk of disseminated strongyloidiasis as a complication of the treatment with immunosuppressive medications even in non-endemic areas.

Endoscopic Features According to Helicobacter pylori Infection Status

It is important to evaluate Helicobacter pylori (<i>H. pylori</i>) infection based on endoscopic results because numerous studies have shown a link between <i>H. pylori</i> infection and upper gastrointestinal conditions, such as gastric cancer. The association between <i>H. pylori</i> infection and gastritis is fully described in the Kyoto classification of gastritis. Typical endoscopic findings in the absence of <i>H. pylori</i> infection are a regular arrangement of collecting venules, fundic gland polyps, red streaks, and other similar features. By contrast, typical endoscopic findings in individuals with active <i>H. pylori</i> infection include diffuse mucosal erythema, atrophy, intestinal metaplasia, inflated or tortuous folds, discharge of sticky mucus, mucosal nodularity, foveolar hyperplastic polyps, and/or xanthomas. Patchy mucosal redness and map-like mucosal redness are typical endoscopic findings in previously infected people. Because of its straightforward application in standard clinical practice, this categorization can reflect the risk of stomach cancer and be useful for both primary care physicians and experienced endoscopists.

Video capsule endoscopy can identify occult luminal Crohn's disease in patients with isolated perianal fistulas.

Accurate tools to distinguish Crohn's disease (CD) from cryptoglandular disease in patients with perianal fistulas without detectable luminal inflammation on ileocolonoscopy and abdominal enterography (isolated perianal fistulas [IPF]) are lacking. We assessed the ability of video capsule endoscopy (VCE) to detect luminal inflammation in patients with IPF. We studied consecutive adults (>17 years) with IPF who were evaluated by VCE after a negative ileocolonoscopy and abdominal enterography between 2013 and 2022. We defined luminal CD by VCE as diffuse erythema, three or more aphthous ulcers, or a Lewis score greater than 135. We compared rates of intestinal inflammation in this cohort to age- and sex-matched controls without perianal fistulas who underwent VCE for other indications. We excluded persons with pre-existing IBD and exposure to non-steroidal anti-inflammatories drugs or immunosuppressive treatments. A total of 45 patients with IPF underwent VCE without complications. Twelve patients (26%) met our definition of luminal CD. Luminal CD was more common in patients with IPF than controls (26% vs. 3%; p < 0.01). Among patients with IPF, male sex (OR, 9.2; 95% CI (1.1-79.4), smoking (OR, 4.5; 95% CI, 0.9-21.2), abscess (OR, 6.3; 95% CI (1.5-26.8), rectal enhancement on MRI (OR, 9.0; 95% CI (0.8-99.3) and positive anti-microbial serology (OR, 7.1; 95% CI, 0.7-70.0) were more common in those with a positive VCE study. VCE detected small intestinal inflammation suggestive of luminal CD in approximately one quarter of patients with IPF. Larger studies are required to validate these findings.