Good Clinical Response Research Articles

Prediction of Clinical Response to Venetoclax Plus Decitabine in AML Using a 7-Day Ex Vivo Assay

Prediction of Clinical Response to Venetoclax Plus Decitabine in AML Using a 7-Day Ex Vivo Assay

Paradoxical manifestations during tuberculous meningitis treatment among HIV-negative patients: a retrospective descriptive study and literature review.

Tuberculous meningitis (TBM) is the most frequent, severe, and disabling form of central nervous system (CNS) tuberculosis (TB). TBM paradoxical manifestations are characterized by clinical or paraclinical worsening after 1month of effective anti-TB treatment in patients who initially responded to treatment despite the use of adjunctive corticosteroids. Retrospective descriptive study of consecutive HIV-negative adult patients (≥ 18years) with definitive TBM who developed a paradoxical manifestation following anti-TB in a tertiary-care hospital in Mexico from 2009 to 2019; we also conducted a literature review of published cases/series of paradoxical manifestations in HIV-negative patients from 1980 to 2020. We detected 84 cases of definitive TBM; 55 (68.7%) HIV-negative patients and 29 (36.3%) HIV-infected patients. Among HIV-negative patients, four (7.3%), three female and one male (19-49years old), developed a paradoxical manifestation within 4-14weeks following treatment initiation despite receiving adequate corticosteroid doses; Mycobacterium bovis was isolated from the cerebrospinal fluid of three cases and Mycobacterium tuberculosis in one more. Two patients developed vasculopathy-related cerebral infarctions, one severe basilar meningitis, and hydrocephalus, one more a tuberculoma. Two were treated with intravenous cyclophosphamide, and two with steroids. One of the patients treated with steroids died; patients who received cyclophosphamide had a good clinical response. This case series illustrates the diverse clinical/radiologic paradoxical manifestations of TBM in HIV-negative patients. Cyclophosphamide may be safe and effective in treating TBM-associated paradoxical manifestations. Specific diagnostic and care protocols for these patients are needed.

O13 A case of chronic recurrent multifocal osteomyelitis

O13 A case of chronic recurrent multifocal osteomyelitis

Sarcoidosis is a multisystemic disease and its diagnostic difficulties

The peculiarities of the clinical symptoms of sarcoidosis and complexity of its diagnosis have been considered on the clinical example of sarcoidosis manifestations in a young man. Sarcoidosis is a relatively rare multisystem inflammatory granulomatous disease of unknown etiology. The incidence of sarcoidosis varies according to different authors from 7.5 to 64 cases per 100.000 population. The clinical manifestations of sarcoidosis are determined by the number of affected organs, the degree of their structural and functional disorders, and the severity of general inflammatory symptoms. Mostly often, the process involves the intrathoracic lymph nodes, lungs, skin and eyes. Musculoskeletal involvement is rare; about 10 — 15 % of patients with sarcoidosis have associated arthropathy. In this article, special attention is paid to the importance of assessing the articular syndrome and visualization of the chest cavity organs, as well as assessing the dynamics of changes in the progression of the disease. The dynamic changes in laboratory parameters and instrumental diagnostic methods have been highlighted. The analysis of the literature data about sarcoidosis was carried out. The emphasis is stroked on the limitations of modern diagnostic methods, as well as the non‑specificity of clinical manifestations. A doctor can only rely on the results of histological studies or imaging using computed tomography or nuclear magnetic resonance imaging. It is noted that the symptom complex, known as Löfgren’s syndrome, manifests with a combination of skin manifestations, hilar lymphadenopathy and articular syndrome, and is very rare. In the presented clinical case, medrol 16 mg per day was used as a basic therapy. Therapy with glucocorticosteroids was associated with a good clinical and laboratory response, a decrease in the size of the mediastinal neoplasm, and an improvement in the patient’s well‑being.

Acute fibrinous and organizing pneumonia: two case reports and literature review

BackgroundAcute fibrinous and organizing pneumonia (AFOP) is a rare histologic interstitial pneumonia pattern characterized by the intra-alveolar fibrin deposition and organizing pneumonia. Its clinical characteristics are still not well known and there is no consensus on treatment yet.Case presentationWe report two female cases in their fifties diagnosed with AFOP confirmed by a second lung biopsy. Case 1 was idiopathic AFOP with manifestation of 6-week fever, dyspnea, and cough, while case 2 was secondary to systemic lupus erythematosus and fever was the major symptom. Their chest CT scans revealed bilateral multiple consolidations, predominantly in the lower lobes. Both cases were initially diagnosed with pneumonia, but did not improve after treatment with broad-spectrum antibiotics. In both cases, transbronchial biopsy and bronchoalveolar lavage fluid examination were inconclusive and the pathological diagnosis was confirmed by percutaneous lung biopsy. Both patients had a good clinical response to prednisone.ConclusionsWe report two rare AFOP cases to highlight the importance of awareness of this disease. We further perform the most comprehensive review to date in AFOP, including 150 patients since 2002. Consolidation was the most common imaging pattern, followed by ground-glass opacity and nodules. A lung biopsy is required for a definitive diagnosis. Corticosteroids is recommended as the most effective therapy, but treatment options should depend on the etiology and disease severity.

Preclinical and histological study of boron-containing compounds hydrogels on experimental model of periodontal disease.

Periodontitis is a disease that affects a wide group of people, and there has been an increased interest in the research of finding useful materials that help reduce inflammation and the further loss of tissue. In this study, we have tested a boron-containing compound (BCC) Calcium Fructoborate (CaFB) and Boric Acid (BA) hydrogels on the gingival level on Wistar rats. First, we have induced the periodontal disease at the lower incisors, we have applied the hydrogels and after a week, we have euthanized the rats. Next, the oral soft tissue reaction was clinically and then histologically investigated. Our study has shown good clinical response of the oral tissue, and we have noticed lower levels of inflammation on the experimental groups treated with the BCCs hydrogels. Despite the generally good response of the biological structures to the presence of BA and CaFB on periodontal level, more scientifically proved information is needed to obtain the desired biological responses in all clinical situations.

Role of modified TAN score in predicting prognosis in patients with acute ischemic stroke undergoing endovascular therapy

ObjectiveThe study aimed to evaluate the prognostic role of modified TAN collateral score in predicting functional independence in ischemic stroke patients, who underwent endovascular therapy. IntroductionIdentifying the group of patients, who will benefit most from arterial recanalization in patients with acute ischemic stroke, is the basis of success. Collateral circulation is a physiological condition that protects the brain against ischemia and inhibits the growth of a damaged area. The presence of collaterals is a well-known determinant for functional independence. Numerous collateral scoring systems are used for this purpose. The aim of this study was to evaluate the prognostic role of modified TAN collateral score (MTCS) in predicting functional independence in patients, who received endovascular therapy. Materials and methodsProspective data of 101 patients, who received endovascular therapy from the stroke team of Eskisehir Osmangazi University (ESOGÜ) between 2016 and 2017, were examined retrospectively for this purpose. Collateral assessments were performed in Computed Tomography Angiography (CTA) according to the modified TAN scoring system (< 50% refers to poor collateral status, ≥ 50% refers to good collateral status). Good clinical outcome was assessed as mRS 0–2 in the 3rd month. The TICI scoring system was used in the evaluation of recanalization. Patients treated within the first 6 h of symptom onset, patients with NCCT and contrast CTA, patients with internal carotid artery and middle cerebral artery occlusion were included in the study. Posterior system stroke was not included in the study. ConclusionOf the 101 patients, 50 (49%) had poor MTCS. Presentation and 24th hour NIHSS values of the patients with poor MTCS were higher (p:0.003). The third month mRS values were low in patients with good MTCS on admission, while these values were high in patients, who presented with poor MTCS. Mortality rates were significantly higher in the patient group with poor collateral circulation score (32–5.9%) (p:0.001). No significant differences were found in the presentation ASPECT values and (TICI 2b/3) recanalization rates of the patients. The rate of futile recanalization was significantly higher in the group with poor collateral circulation (52–8%) (p:0.0001). Presentation glucose, NIHSS, mTAN, symptom-puncture time, and good ASPECT score were found to be predictive markers for good outcome by univariate analysis. The major risk factors were determined by performing multiple logistic regression analysis. Presentation glucose, NIHSS, and mTAN (OR:1.013, 1.29, 0.198, respectively) were found to be strong and independent predictors for good clinical outcome. According to Multiple Binary Logistic Regression analysis Backward-ward model, Baseline NIHSS, poor collaterals and baseline glucose are found as predictors for poor outcome. DiscussionThis study shows that good collateral score is associated with good clinical response, small final infarct volume, third month low mRS, low admission, and 24-hour NIHSS rates. The likelihood of having long term prognosis is 7 fold higher in patients with poor collaterals. The use of the MTCS system is recommended and supported due to its easy and rapid applicability.

S3620 New Diagnosis of Crohn’s Disease After COVID-19

Introduction: Coronavirus disease 2019 (COVID-19) dysregulates the immune response and promotes overwhelming levels of inflammation. Data is scarce on the consequent effects of COVID-19 on the immune system and whether patients with COVID-19 are more prone to developing inflammatory bowel disease (IBD). We report two cases of previously healthy patients with a family history of IBD and recent COVID-19 diagnoses who were subsequently diagnosed with Crohn's disease. Case Description/Methods: Case 1: A previously healthy 17-year-old female presented with fever, bloody diarrhea, and weight loss. The patient had a diagnosis of COVID-19 from one month prior and a family history of Crohn's disease in her father. She underwent colonoscopy, which revealed ulcerations in terminal ileum and throughout the colon. Pathology demonstrated acute and chronic inflammation as well as chronic post-inflammatory changes throughout the colon and terminal ileum. She was diagnosed with Crohn's ileocolitis and treated with steroids followed by infliximab with a good clinical response. Case 2: A previously healthy 19-year-old male presented with recurrent abdominal pain and non-bloody diarrhea of two months. The patient had numerous first-degree relatives with Crohn's disease and a recent diagnosis of COVID-19 six months prior. Subsequent colonoscopy demonstrated a terminal ileum stricture with scarring and denuded mucosa. Pathology illustrated markedly active chronic ileitis. Magnetic resonance enterography (MRE) showed small bowel obstruction related to a long segment of active inflammation and stricturing within the terminal ileum. The patient was diagnosed with Crohn's disease and treated with steroids followed by adalimumab with marked improvement. Discussion: In our two cases, both patients were previously healthy aside from a recent COVID-19, and both had family history of Crohn's disease. IBD is thought to develop in patients with a genetic predisposition whose immune systems encounter an environmental trigger that promotes the inappropriate inflammation to normal intestine. New infections have been implicated as possible trigger events culminating in the pathogenesis seen in IBD. COVID-19 may represent one type of infection that drives new IBD development, especially given its known dysregulatory effects on the immune system. Whether our patients' new diagnoses of Crohn's disease were related to their recent COVID-19 infection remains unclear, and large epidemiological studies are required to investigate further.

Small molecule tyrosine kinase inhibitors modulated blood immune cell counts in patients with oncogene-driven NSCLC

BackgroundLack of biomarkers and in vitro models has contributed to inadequate understanding of the mechanisms underlying the inferior clinical response to immune checkpoint inhibitors (ICIs) in patients with oncogene-driven non-small cell lung cancer (NSCLC).MethodsThe effect of small molecule tyrosine kinase inhibitors (TKIs) on peripheral blood mononuclear cells (PBMCs) in 34 patients with oncogene-driven NSCLC (cohort A) was compared with those from 35 NSCLC patients without oncogene-driven mutations received ICI (cohort B) or from 22 treatment-naïve NSCLC patients (cohort C). Data for each blood biomarker were summarized by mean and standard deviation and compared by Wilcoxon rank sum tests or Kruskal-Wallis tests with significance at 2-sided p value < 0.05. Co-culture of PBMCs and pleural effusion-derived tumor cells from individual patients with oncogene-driven NSCLC was used to determine the in vitro cytotoxicity of TKI and ICI.ResultsExcept for low CD3% in cohort A, there were no significant differences in other 12 blood biomarkers among the 3 cohorts at baseline. TKI treatment in cohort A was associated with significant increase in CD3% and decrease in total and absolute neutrophils (p < 0.05). In cohort B, patients with good clinical response to ICI treatment (N = 18) had significant increases in absolute lymphocyte counts (ALCs), CD4 and/or CD8 cell counts. Conversely, those patients with poor clinical response to ICI (N = 17) had significant decreases in these cell counts. Of the 27 patients with pre- and post-treatment blood samples in cohort A, 11 had poor clinical response to TKIs and decreased lymphocyte counts. Of the remaining 16 patients who had good clinical response to TKI therapy, 10 (62.5%) patients had decreased, and 6 (37.5%) patients had increased lymphocyte counts. Multicolor immunophenotyping of PBMCs revealed ICI treatment activated additional immune cell types that need further validation. We confirmed that TKI treatment could either antagonize or enhance the effect of ICIs in the co-culture assay using patient’s tumor cells and PBMCs.ConclusionsTo the best of our knowledge, this is the first study showing that TKIs can have various effects on blood immune cells, which may affect their response to ICIs. Further validation of the blood biomarker and in vitro assay is warranted.

PD36-05 URINARY MMP-2 IS SIGNIFICANTLY ASSOCIATED WITH THE RISK OF INTRADETRUSOR TOXIN INJECTIONS FAILURE IN PATIENTS WITH SPINA BIFIDA

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction (PD36)1 Sep 2021PD36-05 URINARY MMP-2 IS SIGNIFICANTLY ASSOCIATED WITH THE RISK OF INTRADETRUSOR TOXIN INJECTIONS FAILURE IN PATIENTS WITH SPINA BIFIDA Benoit Peyronnet, Claire Richard, Claude Bendavid, Juliette Hascoet, Charlene Brochard, Magali Jezequel, Jacques Kerdraon, Emmanuelle Samson, Caroline Voiry, Guillaume Bouguen, Andrea Manunta, and Xavier Gamé Benoit PeyronnetBenoit Peyronnet More articles by this author , Claire RichardClaire Richard More articles by this author , Claude BendavidClaude Bendavid More articles by this author , Juliette HascoetJuliette Hascoet More articles by this author , Charlene BrochardCharlene Brochard More articles by this author , Magali JezequelMagali Jezequel More articles by this author , Jacques KerdraonJacques Kerdraon More articles by this author , Emmanuelle SamsonEmmanuelle Samson More articles by this author , Caroline VoiryCaroline Voiry More articles by this author , Guillaume BouguenGuillaume Bouguen More articles by this author , Andrea ManuntaAndrea Manunta More articles by this author , and Xavier GaméXavier Gamé More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002040.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Several studies have suggested that spina bifida patients may have a poorer response to intradetrusor botulinum toxin A (BTX-A) injections than other neurological populations without clear pathophysiological hypothesis to explain this finding. The objective of this study was to evaluate the association between intradetrusor BTX-A injection outcomes and the levels of six urinary biomarkers in spina bifida patients to investigate the possible mechanisms underpinning the poor response to BTX-A in this population. METHODS: A single center prospective study was conducted between March 2015 and March 2017 including all consecutive adult spina bifida patients who underwent intradetrusor BTX-A injection. At the end of the inclusion period, urines were defrosted and urinary NGF, BDNF, TIMP-2, TGF-B1 were assessed using validated ELISA kits. The urinary markers levels were adjusted on the urinary creatinine level. Urinary MMP-2 levels were assessed by zymography. The primary endpoint was the success of BTX-A injection defined as a combination of complete resolution of urinary incontinence and resolution of detrusor overactivity and or impaired bladder compliance on urodynamics 6 to 12 weeks after the injection. RESULTS: Twelve patients were included. The mean age was 38.1 years. The toxin used was onabotulinum toxin A in all cases at a dose of 200 U and 300 U in three and nine patients respectively. Four patients (33.3%) had a good clinical and urodynamic response to BTX-A and BTX-A intradetrusor injection failed clinically and or urodynamically in 8 patients(66.7%). Urinary MMP-2 levels were significantly higher in the failure group (1.30 vs. 0.44 ng/ml; p=0.04). Urinary TGF-B1/Cr and TIMP-2/Cr levels tended to be higher in the failure group (41.7 vs. 9.2 pg/mg of creatinine; p=0.31 and 479.5 vs. 345.1 pg/mg of creatinine; p=0.17). In contrast, urinary PGE2/Cr, NGF/Cr and BDNF/Cr levels did not vary with BTX-A response. CONCLUSIONS: Increased urinary MMP-2 level was associated with failure of intradetrusor BTX-A injections in spina bifida patients. Extracellular matrix remodelling with bladder wall fibrosis could therefore be the main cause of BTX-A injection failure in this population and points to a potential new therapeutic pathway for these patients. Source of Funding: chu rennesfondation de l'avenir © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e597-e597 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benoit Peyronnet More articles by this author Claire Richard More articles by this author Claude Bendavid More articles by this author Juliette Hascoet More articles by this author Charlene Brochard More articles by this author Magali Jezequel More articles by this author Jacques Kerdraon More articles by this author Emmanuelle Samson More articles by this author Caroline Voiry More articles by this author Guillaume Bouguen More articles by this author Andrea Manunta More articles by this author Xavier Gamé More articles by this author Expand All Advertisement Loading ...

Chemoradiation with Weekly Paclitaxel and Carboplatin in Esophageal Squamous Cell Carcinoma: A Prospective Study.

Objective Neoadjuvant chemoradiation (CRT) using paclitaxel and carboplatin has significantly improved the survival rates in carcinoma esophagus, especially in squamous cell carcinoma (SCC). This regimen has not been adequately explored prospectively as a definitive CRT strategy. Our aim was to evaluate the efficacy, toxicity, and compliance to this regimen in a prospective setting in locally advanced esophageal SCC. Materials and Methods Patients with locally advanced esophageal SCC were planned for definitive CRT by using weekly paclitaxel 50 mg/m 2 and carboplatin area under curve 2 along with radical radiotherapy to a dose of 50.4 to 54 Gy. Treatment-related toxicity was assessed by using the common terminology criteria for Adverse Events Version 4.0, and the response was assessed by using endoscopy and computed tomography (CT) 4 to 6 weeks following CRT. The pathological response was documented for those who underwent surgery. Results Fifteen patients were included in the study, and all patients completed the planned course of radiation. The median number of chemotherapy cycles received was four. In total, 66% of the patients had delay or interruptions in chemotherapy, mostly due to neutropenia, and 66% of the patients had a clinical complete response (CR). Four patients underwent definitive esophagectomy, and the histopathology revealed pathologic CR. Overall CR rate was 80%. The median overall survival was 14 months, and 1-year survival was 57%. Conclusion Definitive CRT in esophageal SCC using weekly paclitaxel and carboplatin was relatively well tolerated with manageable toxicities and good clinical response rates. It may potentially represent a new standard of care as definitive therapy in the management of these tumors.

A Prospective Study to Assess the Toxicity and Response of Preoperative Chemoradiotherapy in Oesophageal or Oesophagogastric Junction Cancer

Background: Carcinoma of the esophagus is an aggressive disease. Neoadjuvant chemoradiotherapy achieves the highest complete pathologic response rates, R0 resection rates, and improves 3-5 years survival rates. Methods: Patients with resectable carcinoma oesophagus were included in this prospective study. 22 patients were enrolled. All eligible patients were given radiation for a total radiation dose of 41.4Gy in 23 fractions of 1.8Gy each with five fraction administered per week. Weekly chemotherapy given with carboplatin (AUC 2mg/mm/mt) and paclitaxel (50mg/m2 of BSA). The patients were monitored weekly during the treatment for toxicities. These patients were evaluated with CECT after four to six weeks, and sent for surgery. Histopathological reports of these patients which included lymph node status, pathological response and resection margins were noted. Results: A total of 22 patients were enrolled. Neutropenia was the most common hematological toxicity and 4.5% had grade 2 neutropenia.There was no Grade 3 or 4 hematological toxicity. Most common GI toxicity seen was esophagitis and anorexia. 1 patient developed grade 3 esophagitis. 22% patients had grade 2 anorexia.17 patients underwent surgery and all of them had negative resected margins, 5 out of these 17 patients had pathological complete response. Conclusion: Preoperative chemoradiotherapy with weekly paclitaxel and carboplatin have good clinical response in terms of negative resection margin and pathological complete response with accepted level of toxicity. Prospective trials in larger series of patients are needed with long follow up.

The Synovitis, Acne, Pustulosis, Hyperostosis, And Osteitis (SAPHO) syndrome: A two-center study of 23 patients

IntroductionThe Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) syndrome is a rare autoinflammatory disease. The clinical presentation is heterogeneous, hence the difficulty of making the diagnosis. Aim of the workTo assess clinical, laboratory parameters and radiological features, and to detail the therapeutic options of SAPHO syndrome. Patients and methodsPatients diagnosed with SAPHO syndrome were retrospectively studied from two rheumatology centres in Tunisia. The epidemiological, clinical, radiological, and therapeutic data were collected from patients’ medical records. ResultsTwenty-three patients were enrolled. The mean age was 44.7 ± 16.9 years (14–76 years). Skin involvement was found in a third of patients. Osteoarticular manifestations involved anterior chest wall damage in 56% of cases and axial skeletal lesions in 93% of patients. Ten (43%) patients had peripheral joint involvement, and one reported bone pain in the forearm. HLA-B27 was positive in a third of the patients. All patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) with variable clinical responses. Antibiotic therapy with doxycycline was prescribed in 3 cases, with no clinical improvement. Sulfasalazine was used in 4 cases after therapeutic failure of NSAIDs. Methotrexate was prescribed in 4 cases. Tumor necrosis factor (TNF) inhibitors (Etanercept) were provided for 2 with a good clinical response, and were planned for two others. Pamidronate was given to a patient with bone involvement with pain relief and clinical improvement. ConclusionPatients with SAPHO were relatively young. Skin lesions were not common. The involvement of the anterior chest wall and the axial skeleton was predominant.

Primary pituitary abscess: case report and suggested management algorithm

Purpose To describe a case of successful treatment of a patient with a rare primary pituitary abscess (PA) and propose a management algorithm. Summary of background data PA is an infrequent entity that can be life-threatening if not promptly diagnosed and treated. PAs can be primary or secondary, the latter in the presence of sellar anomalies, risk factors or a systemic or local infection. Symptoms are nonspecific, making clinical suspicion imperative. Magnetic Resonance Imaging (MRI) is the radiological tool of choice. Despite some characteristic radiographic signs, oftentimes the diagnosis is not suspected until surgical exploration. Treatment includes transsphenoidal decompression surgery with sampling of purulent material and abscess wall for appropriate microbiological staining and cultures (bacteria, mycobacteria and fungus) and prolonged antibiotic treatment. Pituitary hormonal deficiencies must be addressed as well. Methods and results We describe a case of a female patient who presented with headaches, anorexia and bitemporal hemianopsia. MRI revealed a peripherally enhancing sellar mass. Transsphenoidal surgery was performed, with intra-operative finding of purulent material. Cytology confirmed the presence of abundant leucocytes, but no pathogen was isolated. Patient completed three weeks of antibiotic therapy, with good clinical and radiological response. Headaches and visual deficits resolved. Hormonal substitution therapy was needed for six months after surgery. Conclusion This report highlights the importance of early recognition and treatment of PAs. The diagnosis is commonly very difficult before surgery, due to overlapping clinical, radiological and laboratorial findings with various other pathologies. Prompt management, with surgical decompression and appropriate antibiotic treatment, typically results in a low mortality rate and higher chance of full recovery of pituitary function. We propose a management algorithm for sellar masses suspected of being PAs.

Eales Disease Debut in Childhood

Introduction: Eales disease is considered a peripheral retinal vascular disease characterized by inflammation (vasculitis), ischemia, vascular occlusion, and neovascularization. Its etiology is not yet defined, it generally affects young men in the second decade of life. Case: Male patient, 10 years old of age with a red eye with blurred right eye vision of 1 month of evolution that worsened 4 days before coming to the service, accompanied by photophobia and eye pain. Discussion: Eales disease affect to more often young males, whose main characteristic peripheral phlebitis which can cause retinal ischemia and neovascularization. Although its etiopathogenesis is unknown. Some cases in the literature that relate it to a type IV hypersensitivity reaction to M. tuberculosis’s antigens The treatment of choice was systemic and topical corticosteroids, with a very good clinical response and periodic follow-up of the patient, with warning signs.

Erythema induratum of Bazin as an indicative manifestation of cavitary tuberculosis in an adolescent: a case report

BackgroundErythema induratum of Bazin (EIB) is a rare cutaneous manifestation of tuberculosis (TB) that frequently occurs in middle-aged women. The clinical manifestations of EIB can mimic various skin diseases, easily leading to misdiagnosis or underdiagnosis. We report a case of a 16-year-old Chinese girl who initially presented with EIB and was subsequently diagnosed with cavitary TB.Case presentationThe patient is a 16-year-old Chinese girl who presented with clusters of erythematous subcutaneous nodules on the posterior part of her right lower leg matching the clinical manifestations of EIB but was otherwise asymptomatic. The patient was subsequently diagnosed with cavitary TB on the basis of a positive result from a T-SPOT.TB test and the observation of cavitary lung lesions in chest computed tomography scanning. A good clinical response was observed in the patient after the initial phase of a standard 6-month antibiotic regimen.ConclusionsAdolescents infected with Mycobacterium tuberculosis frequently present atypical symptoms. Cutaneous manifestations of tuberculosis in adolescents can be considered good clinical indicators to predict the underlying disease. Strong clinical suspicion is required for a prompt diagnosis in adolescents with EIB.

Hereditary Spherocytosis as an Atypical Presentation of Anemia in Ulcerative Colitis

Anemia is encountered in up to two-thirds of all patients with inflammatory bowel disease (IBD). We are reporting a case of a 9-year-old female with history of very early onset IBD ulcerative colitis, and primary sclerosing cholangitis who was found to have hereditary spherocytosis as the etiology of her anemia. Despite good clinical response to IBD therapy, she continued to have persistent normocytic anemia. Liver biopsy and magnetic resonance cholangiopancreatography for uptrending liver transaminases demonstrated iron deposition which led to a T2-weighted magnetic resonance imaging study that quantified significant iron deposition in her liver and kidneys. Without any history of blood transfusions, these findings were concerning for hereditary hemochromatosis, but the hereditary hemochromatosis gene test was negative. Whole genome sequencing identified a pathogenic de novo variant consistent with hereditary spherocytosis. Table of Contents Summary: A novel presentation of anemia in inflammatory bowel disease

Immune checkpoint inhibitors for progressive multifocal leukoencephalopathy: Identifying relevant outcome factors

Progressive multifocal leukoencephalopathy (PML) is an infectious brain disease caused by JC virus in immunocompromised individuals. Immune checkpoint inhibitors (ICIs) recently emerged as a therapeutic hope for these patients but identification of those likely to respond to the treatment is still an unmet need. We performed a systematic PubMed search for reports of patients treated for PML using an ICI. Clinical, biological and radiological characteristics were contrasted between patients who responded to the treatment (RP) and those who did not (NRP). Thirty-five patients were included in the present study. Twenty-one of them reportedly benefited from the treatment. Age, blood CD4+ cells count, pretreatment viral load in the cerebrospinal fluid (CSF), PML lesions localization, treatment delay since first PML symptoms, type of ICI used and immune-related adverse events (irAEs) occurrence did not significantly differ between RP and NRP. By contrast, a history of therapeutic immune suppression and the use of an immunosuppressive therapy at treatment initiation were significantly associated with a poor response. Besides, reaching an undetectable viral load in the CSF and reduction of the lesion load on magnetic resonance imaging after ICI administration was associated with a good clinical response. Current data suggest that patients with PML under immunosuppressive therapy are less likely to respond to ICIs and raises the issue of the optimal management of irAEs during ICI treatment in this setting.

Disseminated Phaeohyphomycotic Lymphadenitis with Cladophialophora Species

Objective: This study describes a case of disseminated phaeohyphomycotic lymphadenitis in a young female with delayed diagnosis and good clinical response after appropriate treatment. Methods: A 32-year-old female presented with erythematous to violaceous papules with oozing discharge bilaterally in her inguinal region for a few months. History revealed tuberculous meningitis 4 years earlier treated with first line anti-tuberculous therapy for 18 months, and 2 years previously she developed pigmented discharging lymph nodes bilaterally in her axillae. The histopathology of the biopsy of the axillary nodes showed chronic granulomatous inflammation with multiple branching septate fungal hyphae. She received amphotericin B for 21 days but without improvement. Biopsy from the inguinal lesions was sent for histopathology and culture. Results: Histopathology of the biopsy material showed chronic granulomatous inflammatory process with multinucleate giant cells, epithelioid cells, histiocytes, and lymphocytes with multiple branching septate fungal hyphae. Gram stain revealed moderate septate hyphae with numerous pus cells. Culture on Sabouraud dextrose agar yielded velvety olive–black colonies in the fourth week. Microscopic slide examination of culture material was suggestive of Cladophialophora species. The patient was started on voriconazole, which was continued for 6 months, and showed clinical improvement. Conclusion: Incomplete investigation of infectious lesions may delay diagnosis. Furthermore, clinical presentations are greatly influenced by the immune status of the host. Both histopathological and microbiological assessments are equally important for making a conclusive diagnosis. Anti-fungal therapy may delay the growth of fungi that normally grow within a week; thus, a longer incubation time may be warranted for fungal smear-positive samples.

Salivary IL-8 as a putative predictive biomarker of radiotherapy response in head and neck cancer patients

ObjectivesIonizing radiation increases the expression of a number of salivary proteins involved in immunoregulatory networks related to infection, injury, inflammation, and cancer. Our main objective was to analyze whether there are significant differences in salivary cytokines before and after radiotherapy and whether any of them are associated to better outcomes after radiotherapy serving as a potential predictive biomarker of response to the treatment.Materials and methodsWe analyzed a panel of eight salivary markers (IL-4, IL-6, IL-8, and IL-10; MCP-1; TNF-α; VEGF; and EGF) in a group of HNC patients (N = 30), before and after irradiation treatment pre- and post-RT. We also compared these results with a group of healthy controls (N = 37). In both groups, we used stimulated saliva and we performed immunoassays based on multi-analyte profiling technology (Luminex xMAP).ResultsIn our group of 30 HNC patients, 24 of them showed a good clinical response after radiotherapy treatment while 6 cases did not respond to radiotherapy. The data revealed a post-treatment increase in multiple cytokines in the stimulated saliva of HNC patients; the increases in IL-8 and MCP-1 were statistically significant (p ≤ 0.001 and p ≤ 0.0001, respectively). Analysis of receiver operating characteristic curves indicated the strong potential of IL-8 as a predictive biomarker of RT good outcomes (area under the curve = 0.84; p = 0.018).ConclusionsAfter analyzing the panel of salivary cytokines, IL-8 showed the best association to the response to radiotherapy; in this sense, low IL-8 levels in the saliva of HNC patients before receiving irradiation therapy are associated with positive RT outcomes.Clinical relevanceSalivary IL-8 expression in HNC patients undergoing RT may serve as a potential predictive biomarker of response to the treatment.