Immunological Tests Research Articles

Competency of iPSC-derived retinas in MHC-mismatched transplantation in non-human primates.

Transplantation of embryonic/induced pluripotent stem cell-derived retina (ESC/iPSC-retina) restores host retinal ganglion cell light responses in end-stage retinal degeneration models with host-graft synapse formation. We studied the immunological features of iPSC-retina transplantation using major histocompatibility complex (MHC)-homozygote monkey iPSC-retinas in monkeys with laser-induced retinal degeneration in MHC-matched and -mismatched transplantation. MHC-mismatched transplantation without immune suppression showed no evident clinical signs of rejection and histologically showed graft maturation without lymphocytic infiltration, although immunological tests using peripheral blood monocytes suggested subclinical rejection in three of four MHC-mismatched monkeys. Although extensive photoreceptor rosette formation was observed on histology, evaluation of functional integration using mouse models such as mouse ESC-retina (C57BL/6) transplanted into rd1(C3H/HeJ, MHC-mismatched model) elicited light responses in the host retinal ganglion cells after transplantation but with less responsiveness than that in rd1-2J mice (C57BL/6, MHC-matched model). These results suggest the reasonable use of ESC/iPSC-retina in MHC-mismatched transplantation, albeit with caution.

Associations between High Blood Levels of Copper, Nickel and Chromium and Indicators of Their Adverse Effects on Respiratory Organs, Blood and the Immune System

Introduction: An urgent hygienic problem in the regions with intensive industrial development is the persistence of ambient air pollutants and their adverse health outcomes in the population leading to higher incidence rates of non-communicable diseases and their chronicity. Objective: To substantiate the relationships between high blood levels of copper, nickel, and chromium and biomarkers of their adverse effects on blood, respiratory and immune systems for the tasks of early detection and prevention of poor health outcomes of the combined inhalation exposure to copper, nickel and chromium oxides on the example of the adult population at risk. Materials and methods: We carried out a hygienic assessment of ambient air quality in residential areas and analyzed general population incidence and prevalence for 2016–2020. We also examined the health status of women of reproductive age environmentally exposed to nickel, chromium and copper oxides in the area of residence and of relatively unexposed controls. About 5,000 chemical, clinical, immunological, and biochemical tests were done in 2022. Results: We established associations between higher blood levels of copper, nickel, and chromium and changes in the indicators of adverse health effects. Biomarkers of nonspecific and specific sensitization, chronic inflammation accompanied by an imbalance in the humoral and cellular immunity were hyperproduction of eosinophils in the nasal mucus, blood lymphocytes, specific IgG to copper, a decrease in the phagocytic index and number; lower ferritin marked disorders of iron homeostasis, higher malondialdehyde indicated induction of oxidative processes, and a decrease in antioxidant activity gave evidence of depletion of the total antioxidant activity. Conclusions: It is expedient to use our findings for early detection and subsequent substantiation of targeted measures aimed at preventing disorders of the respiratory and immune systems, blood, and certain disorders involving the immune mechanism, etiopathogenetically related to the combined exposure to the metal oxides tested.

A PATIENT WITH KABUKI SYNDROME AND HYPOGAMMAGLOBULINEMIA DEVELOPS BURKITT LYMPHOMA

<h3>Introduction</h3> Kabuki syndrome (KS) is a rare genetic disorder characterized by congenital abnormalities, autoimmunity, intellectual disability, distinctive facial abnormalities, and hypogammaglobulinemia. <h3>Case Description</h3> A 24-year-old male with KS and hypogammaglobulinemia presented to the emergency department (ED) with lower back pain and extremity paralysis. His previous genetic diagnosis of KS had a heterozygous novel variant causing a premature translational stop signal p.Pro235Alafs*6 in the KMT2D gene. The patient also has a history of congenital heart disease, autoimmune cytopenias, and longstanding hypogammaglobulinemia on/off replacement immunoglobulin with baseline IgG 300-400 mg/dL, low IgA 10-20 mg/dL, normal IgM 50-60 mg/dL, normal lymphocyte subsets, and absent protein and polysaccharide vaccine responses consistent with common variable immunodeficiency. On arrival at the ED, spinal imaging revealed a compression fracture and underlying mass. Right-axillary and bone marrow biopsies confirmed Burkitt lymphoma. He was treated with chemotherapy, radiation, and replacement immunoglobulin. He has suffered from pneumonia, adenovirus, ileus<b>,</b> heart failure, and stroke. Routine immunologic testing performed at time of diagnosis revealed normal complete blood cell count, mild transaminitis from baseline (AST/ALT 61/71 U/L), baseline immunoglobulins, and normal lymphocyte subsets. <h3>Discussion</h3> While KS is a well-known cause of hypogammaglobulinemia, the authors have identified only two other published cases of Burkitt lymphoma in KS. This case emphasizes the importance of oncological screening and that routine immunologic testing of lymphocyte subsets and immunoglobulins may not have abnormalities from baseline in patients with active lymphoma. A mild transaminitis, however, might be concerning for malignancy in these patients.

RECURRENT FUNGAL INFECTIONS FROM BIRTH TO ADULTHOOD: UNKNOWN DIAGNOSIS UNTIL GENETIC TESTING FOR STAT-1 VARIANTS

<h3>Introduction</h3> Signal transducer and activator of transcription 1 (STAT-1) is a transcription factor that plays key roles in cell viability and pathogen responses. Mutations in STAT-1 result in differing degrees of susceptibility to viral, fungal and bacterial infections, vascular alterations, failure to thrive, and autoimmunity. We report a case of STAT-1 variant presenting with a life-long history of recurrent fungal infections where the diagnosis required genetic testing. <h3>Case Description</h3> A 33-year-old man presented for an evaluation of recurrent fungal infections. He experienced oral thrush, tinea pedis, tinea corporis, and onychomycosis since infancy. He was hospitalized twice for Candida esophagitis requiring IV antifungals. He required treatments with oral antifungals every few months, as he was refractory to topical treatments. He had no bacterial or viral infections, and otherwise unremarkable past medical history. He had thorough workups through multiple specialists with no diagnosis made as his immunologic laboratory studies were normal. However, his 4-year-old son was diagnosed with chronic mucocutaneous candidiasis (CMCC) and had genetic testing showing a STAT-1 variant (c.1159A>G (p.Thr387Ala)). The patient then underwent genetic testing which revealed the same pathogenic STAT-1 variant. Further evaluation showed normal T-cell mitogen studies, total IgG/A/M/E, IgG subclass levels, and vaccine responses. Flow cytometry showed mild B-cell lymphopenia and normal T/NK cells. <h3>Discussion</h3> Patients with pathogenic STAT-1 variants can present with variable infection histories and normal immunologic testing. This case highlights the importance of genetic testing for patients presenting with CMCC regardless of normal immunologic testing to identify a specific diagnosis and defects associated with CMCC.

Screening of winter soft wheat varieties of Russian and foreign breeding for resistance to brown rust in the conditions of the foothill zone of the Central Caucasus

The article describes the stages of immunology testing for the development of winter soft wheat varieties. It also discusses the issues of leaf rust resistance, the population structure of Puccinia tritici f. sp. tritici Eriks., the methods of evaluation and selection of stock material for selective breeding with multiple resistance genes and showing high genetic diversity. 25 samples of winter soft wheat (Triticum aestivum L) obtained from the N.I. Vavilov’s (VIR) plant genetic resources gene bank and 47 Thatcher isogenic lines with the following genes were used as test articles. The study showed that the following genes could be considered effective for the resistance to a local population of leaf rust: Lr9, Lr19, Lr24, Lr25, Lr30, Lr32, Lr34, Lr36, Lr41, Lr42, Lr45, Lr47, Lr51, Lr53, Lr67.The analysis of phenotypic traits allowed identifying 6 phenotypic groups: MHTT, PGTT, RHTT, NHKP, ТQТР, QHKP. The T-group phenotype that is virulent toLr9, Lr16 and has an incidence rate of 40.0% is typical for all grain producing regions in Russia and worldwide. They are predominant in the studied population of P. triticinа. The incidence rates of RHTT, QHKP, MHTT phenotypes that are avirulent to Lr9, Lr24 genes are 13.3, 3.3 and 10.0%, respectively. The incidence rate of PGTT and NHKP phenotypes that are avirulent to, Lr9, Lr24 Lr26, Lr2а, Lr3 genes is 33.3%. The intrapopulation genetic variation estimated using the Shannon–Weaver diversity index is high (H=2.51).The screening allowed identifying leaf rust resistant winter soft wheat varieties ranked as follows: resistant – 11, intermediate – 9, susceptible – 5 samples. It was proposed to use winter soft wheat varieties of foreign breeding from the Collection of Worldwide Crop Genetic Resources (Vavilov All-Russian Scientific Research Institute of Plant Industry (VIR)), such as Dorota (France), Genoveva (Slovakia), Arial (Ukraine), Elton (USA), Verita (Slovakia), Muza (Poland), Alauda (Germany), Fenezja (Poland), Vatazbok (Ukraine), and Russian varieties of Prima and Omskaya 5.

ISOLATION AND PURIFICATION OF PREGNANCY-ASSOCIATED GLYCOPROTEINS

The aim of these studies was to develop a protocol for the isolation and purification of pregnancy-associated glycoproteins (PAG) from cotyledons from placenta of pregnant cows. As a result of this work, processes and parameters of the PAG isolation were determined, including: extraction in a buffer system, two-stage precipitation with ammonium sulfate (40% and 80% saturation) and purification of the target product using ion-exchange chromatography using Q Sepharose Fast Flow. The resulting product having a molecular weight of 55 kD was identified by MALDI-TOF mass-spectrometry analysis as "Pregnancy-associated glycoprotein 1". As a result of the immunoblotting, the presence of proteins with a molecular weight of 55 kDa in the obtained preparation, reacting with previously obtained monoclonal antibodies (MABs) specific to PAG1 was confirmed. To determine antigenic properties of the purified PAG, laboratory animals were immunized. It was found that immunization with the purified PAG efficiently elicits specific antibodies. These antibodies, after the proper purification procedure, can be used as components of immunological test systems for determining pregnancy in cows.

Immunological testing for faecal occult blood

Immunological testing for faecal occult blood

Human Neurocysticercosis: An Overview.

Human cysticercosis is caused by ingestion of T. solium eggs from taenia carriers. Neurocysticercosis (NCC), defined as the infection of the CNS and the meninges by the larval stage of Taenia solium, is the most common helminthic infection of the CNS worldwide. Parasites may lodge in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing pathological changes that account for the pleomorphism of this disease. Seizures/epilepsy are the most common clinical manifestation, but other patients present with headache, focal deficits, intracranial hypertension, or cognitive decline. Accurate diagnosis of NCC is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunological tests. However, neuroimaging studies are fundamental for diagnosis because immunological test and clinical manifestations only provide circumstantial evidence of NCC. The introduction of cysticidal drugs changed the prognosis of most NCC patients. These drugs have been shown to reduce the burden of infection and to improve the clinical course of the disease in many patients. Efforts should be directed to eradicate the disease through the implementation of control programs against all the steps in the life cycle of T. solium, including carriers of the adult tapeworm, infected pigs, and eggs in the environment.

Pulmonary Manifestations In Patients With Rheumatoid Arthritis Visiting Tertiary Care Hospital.

Rheumatoid arthritis is a common problem in elderly individuals. It is reported that lung involvement in these patients is widely present. This study was done with the purpose to assess the burden and characteristics of lung involvement in rheumatoid arthritis patients attending rheumatology clinic. This descriptive cross-sectional study, in which data was retrospectively collected, was carried out from April 2019 to December 2020 at the Rheumatology Department of Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. All adult rheumatoid arthritis individuals, irrespective of gender or duration of disease, were consecutively enrolled. Information regarding the baseline characteristics, medication history for rheumatoid arthritis, findings of immunological tests along with the frequency of lung involvement and its pattern were observed. Of 254 patients, the mean age was 37.46 ±12.39 years. Females were predominantly higher as compared to males, i.e., 232 (91.3%) vs. 22 (8.7%) respectively. Current smoking status was found positive in 7 (2.8%) patients. The mean disease duration was 4.41±3.96 years. Furthermore, frequency of pulmonary manifestation was observed in 45 (17.7%) patients. A significantly higher mean difference of age (p-value <0.001) and disease duration (p-value <0.001) was observed among patients with and without pulmonary manifestation. Moreover, a significant association of current smoker was also observed with pulmonary manifestation. A considerable number of patients with rheumatoid arthritis had pulmonary manifestation. Furthermore, a significant relationship was observed with age, duration of disease, and current smokers.

Estimation Of Interleukin 27 And Interleukin 33 Serum Levels In Iraqi Neonatal Sepsis

Bloodstream infections in neonates are one of the most life-threatening infections in them . In this study, a total of 140 blood samples werecollected from neonates at AL-Batoul Teaching Hospital for Gynecology and Pediatrics in Baqubah/Diyala, their ages ranging from 1 dayto 28 days during the period from November 2021 to March 2022. The samples were subjected to a culture study as well as hematologicaland immunological tests (CRP, measuring the level of IL-27 and IL-33). Out of total cultured samples 45 give a positive blood culture, 45specimens from blood culture negative was chosen to become (control group) to be comparable to positive culture specimens. The resultsof the CRP test showed in the Gram-negative bacteria group, the positive result was 76.92% (10 of 13). In the Gram-positive bacteria group,the positive CRP percentage was 84.85% (28 of 33). While in the control group the positive result was 13.33% (6 of 45) , significantdifferences appeared between the compared groups. The results showed the mean levels of IL-27 in the sepsis patient group and controlgroup were (21.14 ± 1.01 and 14.49 ± 0.34 pg/ml, respectively). also showed the mean levels of IL-33 were in the sepsis patient group andcontrol group (250.28 ± 15.75 and 101.16 ± 3.38 pg/ml, respectively). There was a significant increased level of IL-27 and IL-33 in the sepsispatients’ group compared to the control group.

Investigation of Bovine, Caprine and Ovine Brucellosis in North Bahri, Sudan

The study was conducted at Bahri North, Khartoum State, Sudan, during the year 2021. The study was aiming at detection of bovine, caprine and ovine brucellosis in North Bahri. A total of 1050 bovine, 2081 caprine and 870 ovine blood samples were collected. Sera were separated from blood samples and kept at -20o at the laboratory of College of Veterinary Medicine, University of Bahri. Sera were tested using Rose Bengal Plate Test (RBPT) and modified Rose Bengal Plate Test (mRBPT) for detection of Brucella antibodies. By using RBPT for testing the sera for brucellosis, the prevalence of bovine brucellosis was 0.95, caprine brucellosis 11.24% and ovine brucellosis 1.14%. By using mRBPT for testing the sera for brucellosis, the prevalence of bovine brucellosis was 1.42, caprine brucellosis 13.83% and ovine brucellosis 1.95%. mRBPT is more sensitive than RBPT in detection of Brucella antibodies. Investigation of more animals covering the whole state, using of other serological and immunological test and vaccination of animals are recommended.

Seroprevalence of SARS-CoV-2-specific anti-spike IgM, IgG, and anti-nucleocapsid IgG antibodies during the second wave of the pandemic: A population-based cross-sectional survey across Kashmir, India.

BackgroundWithin Kashmir, which is one of the topographically distinct areas in the Himalayan belt of India, a total of 2,236 cumulative deaths occurred by the end of the second wave. We aimed to conduct this population-based study in the age group of 7 years and above to estimate the seropositivity and its attributes in Kashmir valley.MethodsWe conducted a community-based household-level cross-sectional study, with a multistage, population-stratified, probability-proportionate-to-size, cluster sampling method to select 400 participants from each of the 10 districts of Kashmir. We also selected a quota of healthcare workers, police personnel, and antenatal women from each of the districts. Households were selected from each cluster and all family members with age 7 years or more were invited to participate. Information was collected through a standardized questionnaire and entered into Epicollect 5 software. Trained healthcare personnel were assigned for collecting venous blood samples from each of the participants which were transferred and processed for immunological testing. Testing was done for the presence of SARS-CoV-2-specific anti-spike IgM, IgG antibodies, and anti-nucleocapsid IgG antibodies. Weighted seropositivity was estimated along with the adjustment done for the sensitivity and specificity of the test used.FindingsThe data were collected from a total of 4,229 participants from the general population within the 10 districts of Kashmir. Our results showed that 84.84% (95% CI 84.51–85.18%) of the participants were seropositive in the weighted imputed data among the general population. In multiple logistic regression, the variables significantly affecting the seroprevalence were the age group 45–59 years (odds ratio of 0.73; 95% CI 0.67–0.78), self-reported history of comorbidity (odds ratio of 1.47; 95% CI 1.33–1.61), and positive vaccination history (odds ratio of 0.85; 95% CI 0.79–0.90) for anti-nucleocapsid IgG antibodies. The entire assessed variables showed a significant role during multiple logistic regression analysis for affecting IgM anti-spike antibodies with an odds ratio of 1.45 (95% CI 1.32–1.57) for age more than 60 years, 1.21 (95% CI 1.15–1.27) for the female gender, 0.87 (95% CI 0.82–0.92) for urban residents, 0.86 (95% CI 0.76–0.92) for self-reported comorbidity, and an odds ratio of 1.16 (95% CI 1.08–1.24) for a positive history of vaccination. The estimated infection fatality ratio was 0.033% (95% CI: 0.034–0.032%) between 22 May and 31 July 2021 against the seropositivity for IgM antibodies.InterpretationDuring the second wave of the SARS-CoV-2 pandemic, 84.84% (95% CI 84.51–85.18%) of participants from this population-based cross-sectional sample were seropositive against SARS-CoV-2. Despite a comparatively lower number of cases reported and lower vaccination coverage in the region, our study found such high seropositivity across all age groups, which indicates the higher number of subclinical and less severe unnoticed caseload in the community.

"COUGHING CHYLOTHORAX": TRAUMATIC NONIATROGENIC THORACIC DUCT LEAK

"COUGHING CHYLOTHORAX": TRAUMATIC NONIATROGENIC THORACIC DUCT LEAK

S2704 A New Protein Losing Enteropathy: Autoimmune Cryptolytic Enterocolitis

Introduction: Protein losing enteropathy (PLE) can be classified into erosive, non-erosive, and increased interstitial pressure PLE. Presenting signs are often chronic non-bloody diarrhea, anasarca, abdominal pain, and weight loss. We present a complex case of a PLE presentation with a novel diagnosis. Case Description/Methods: A 30-year-old woman with a history of migraines presented with severe abdominal pain and chronic diarrhea. She was on long-term combined estrogen-progestin oral contraceptive pills (OCP) and chronic high dose non-steroidal anti-inflammatory (NSAID) medications. She was exposed to mycoplasma pneumoniae one month prior to presentation, without other infectious exposures. Laboratory tests were notable for hemoglobin 6 g/dL, albumin 0.5 g/dL, stool pathogen PCR negative, and fecal calprotectin >3000µg/g. Extensive infectious work up only revealed Mycoplasma IgM+. Inflammatory markers and alpha-1 anti-trypsin clearance were elevated, and she was found to have warm autoimmune hemolytic anemia. CT angiography excluded ischemia and vasculitis (autoimmune serologies were negative), revealing diffuse enterocolitis, confirmed on magnetic resonance enterography with ileal ulcers. Endoscopic evaluation revealed diffuse superficial ulcerations terminal ileum and colon with diffuse mucosal sloughing. Histopathology revealed diffusely injured crypts with crypt drop-out and minimal inflammation, without any findings to suggest infection, inflammatory bowel disease (IBD) or autoimmune enteritis (Figure). Normal B-cell switching studies excluded common variable immunodeficiency (CVID). Due to profound anasarca and inability to tolerate oral intake, albumin infusions and total parenteral nutrition were started. There was minimal response to systemic or topical steroids. Diarrhea was mildly improved with albumin repletion, and she was empirically started on vedolizumab. Discussion: Given the absence of classic IBD findings, negative infectious and immunological testing, we present the first case of autoimmune cryptolytic enterocolitis, a histopathologic diagnosis of unclear etiology and pathogenesis. The patient has responded to vedolizumab infusions as an empiric treatment for an IBD-like entity. Nevertheless, supporting the autoimmune component of this entity, is a possible concomitant potential pathway of molecular mimicry in the setting of post-mycoplasma infection along with chronic high dose NSAID and OCP exposure.Figure 1.: Terminal Ileum and Sigmoid Colon with Diffuse Crypt Dropout.

Population Health Risk and Harm Indicators in the System of New Mechanisms for Air Quality Monitoring and Management

Introduction: The article dwells on major legislative and methodical aspects related to the latest update of the system for air quality management in the country. Objective: To summarize the experience in applying the health risk assessment procedure to the system of new mechanisms for ambient air quality monitoring and management. Materials and methods: The study relied on the results obtained by summary estimates of dispersion of emissions from 1.5 to 6.5 thousand sources per city and health risk assessment in twelve cities included in the Federal Clean Air Project. We also analyzed the results of biomedical studies (about two thousand chemical, immunological, and clinical tests done in 2020–2022) in and outside the zones of influence of mining and chemical industries. Results: Health risks were estimated as unacceptable in the cities included in the experiment on introducing new emission control technologies. In some cases, risks were rated as “very high” for diseases of the respiratory system, blood and blood-forming organs, musculoskeletal system, etc. We substantiated the lists of priority pollutants for emission monitoring and quoting and the lists of priority objects generating unacceptable risks. We demonstrate that the evaluation of health damage as an indicator of realized risks under certain circumstances can serve as yet another evidence of adverse health effects of environmental pollution. We suggest a fundamental algorithm for including the assessment of human health risks and damages into the system of air quality management for elaboration of the existing regulatory and methodological framework of monitoring and standardization. Conclusions: The procedures of assessing health risks and damages are a significant component of air quality management. Their results ensure adequacy of the monitoring programs to the current situation, make managerial actions more targeted and precise, and guarantee optimal achievement of the major goal to preserve public health through safe and comfortable environment.

WITHDRAWN

SESSION TITLE: Systemic Diseases Causing Pulmonary Havoc SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: Antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is an immune-mediated disease characterized by necrotizing vasculitis of the small blood vessels. Pulmonary involvement is common in AAV. Nodules and pleural effusions are the most common pulmonary finding in AAV. Fibrosing interstitial lung disease (ILD) is rarely associated with AAV, and it has a significant prognostication impact. We present a case of usual interstitial pneumonia (UIP) found in a patient with anti-Myloperoxidase (MPO) ANCA and rapidly progressive disease. CASE PRESENTATION: A 71-year-old female presented to the hospital with progressive exertional dyspnea and weakness for several months. Her physical exam was remarkable for bilateral basilar crackles. Oxygen saturation was 91% on ambient air. Chest radiograph showed lower zones interstitial infiltrates. Computed tomography of the chest showed diffuse reticular opacities in both lungs with honeycombing and traction bronchiectasis consistent with definite usual interstitial pneumonia (UIP) pattern. Laboratory evaluation revealed elevated serum creatinine (5.73 mg/dL). Immunology tests showed elevated anti-MPO ANCA titers. A renal biopsy showed the presence of pauci-immune crescentic glomerulonephritis, confirming the diagnosis of ANCA-mediated vasculitis. The patient was treated with plasmapheresis and 500 mg of intravenous methylprednisolone for three days, followed by cyclophosphamide and a medium dose of prednisone. Her kidney function improved, and she was then discharged to follow-up with pulmonary clinic for initiation of anti-fibrotic. DISCUSSION: ANCA-associated vasculitis (AAV) is a small-vessel vasculitis that can involve multiple organs. Pulmonary involvement has been reported in 25%–80% of cases. Sometimes, it can be the initial manifestation of the disease. The most common form of pulmonary involvement in AAV is diffuse pulmonary nodules, with or without cavitation and pleural effusions. Occasionally, patients can present with fibrosing-ILD, particularly with anti-MPO. This presentation is more prevalent in males and the elderly. Among AAV patients with ILD, UIP is the most frequent radiographic pattern. Non-specific interstitial pneumonia (NSIP) pattern can also be seen. ILD has been linked to increased mortality in AAV patients, particularly those with a UIP pattern. Treatment of fibrosing-ILD in AAV patients is not well established, with a questionable role for immunosuppression. Anti-fibrotic agents might be helpful in patients with a UIP pattern. CONCLUSIONS: UIP is rarely associated with AAV, and it can be the leading diagnostic manifestation. A careful clinical history and laboratory evaluation should be performed in patients with UIP to identify and treat any underlying systemic disease. UIP is a poor prognostic sign in AAV. Clinical trials are needed to establish the role of anti-fibrotic in treating this condition. Reference #1: Maillet T, Goletto T, Beltramo G, Dupuy H, Jouneau S, Borie R, Crestani B, Cottin V, Blockmans D, Lazaro E, Naccache JM, Pugnet G, Nunes H, de Menthon M, Devilliers H, Bonniaud P, Puéchal X, Mouthon L, Bonnotte B, Guillevin L, Terrier B, Samson M; French Vasculitis Study Group (FVSG). Usual interstitial pneumonia in ANCA-associated vasculitis: A poor prognostic factor. J Autoimmun. 2020 Jan;106:102338. doi: 10.1016/j.jaut.2019.102338. Epub 2019 Sep 27. PMID: 31570253. Reference #2: Mohammad AJ, Mortensen KH, Babar J, Smith R, Jones RB, Nakagomi D, Sivasothy P, Jayne DRW. Pulmonary Involvement in Antineutrophil Cytoplasmic Antibodies (ANCA)-associated Vasculitis: The Influence of ANCA Subtype. J Rheumatol. 2017 Oct;44(10):1458-1467. doi: 10.3899/jrheum.161224. Epub 2017 Aug 1. PMID: 28765242. Reference #3: Zhou P, Ma J, Wang G. Impact of interstitial lung disease on mortality in ANCA-associated vasculitis: A systematic literature review and meta-analysis. Chron Respir Dis. 2021 Jan-Dec;18:1479973121994562. doi: 10.1177/1479973121994562. PMID: 33605150; PMCID: PMC7897823. DISCLOSURES: No relevant relationships by Mais Abdou No relevant relationships by Khaled Alshabani

S2018 Concurrent CMV Colitis and GI Amyloidosis as Initial Presentation of Multiple Myeloma: A Case Report

Introduction: Prior associations with Cytomegalovirus (CMV) colitis and multiple myeloma (MM) or amyloidosis are only described in immunocompromised patients undergoing treatments like transplantation, monoclonal antibodies, or chemotherapy. The concurrent presentation of gastrointestinal (GI) amyloidosis with CMV colitis is rarely reported and should be considered more readily in the hospital. Case Description/Methods: 67-year-old male was admitted to the hospital with bilateral lower extremity deep vein thromboses after transurethral resection of the prostate 8 days prior. He was started on anticoagulation, but due to onset of hematuria, anticoagulation was stopped and an IVC filter was placed. The patient then developed bright red blood per rectum with diarrhea and GI was called. On exam, vitals were stable, and abdomen was non-distended and non-tender. Digital rectal exam showed brown stool. A colonoscopy displayed discontinuous areas of ulcerated, erythematous mucosa with loss of vascular pattern (Figure A). A histologic examination showed terminal ileal mucosa with lymphoid aggregates (Figure B), positive Congo red stain with apple green birefringence and cytomegalovirus inclusions in the colon (Figure C). Subsequent immunology testing demonstrated elevated free lambda light chains with a free kappa to lambda ratio of 0.019. A bone marrow biopsy confirmed lambda restriction and >20% CD138-positive plasma cells, consistent with MM. The patient was started on valganciclovir but showed no improvement of symptoms, which was attributed to his confounding amyloidosis. The patient’s clinical status continued to worsen, and he ultimately expired from cardiac causes. Discussion: It is noteworthy that CMV colitis occurred concurrently with amyloidosis. Immune dysfunction and hypogammaglobinemia in amyloidosis lead to susceptibility to infection, but the inciting organisms usually are H. influenzae, S. pneumoniae, and E. coli. The use of immunosuppressing therapies such as transplantation or chemotherapy increases the likelihood of opportunistic infections. Besides these scenarios, CMV has rarely been reported in patients with amyloidosis or MM. We suggest GI amyloidosis and CMV should be considered and treated rapidly in patients presenting with non-specific GI symptoms. However, our case also highlights the difficulty in measuring effectiveness of antiviral treatment for CMV in GI amyloidosis due to overlap of symptoms between both conditions.Figure 1.: A) skiped areas of ulcerated, friable colon. B) immunohistochemistry CMV viral inclusions, C) Colonic epithelium with amyloidosis.

RAPIDLY PROGRESSING DERMATOMYOSITIS-ASSOCIATED RESPIRATORY FAILURE SUCCESSFULLY STABILIZED WITH EXTRACORPOREAL MEMBRANE OXYGENATION

RAPIDLY PROGRESSING DERMATOMYOSITIS-ASSOCIATED RESPIRATORY FAILURE SUCCESSFULLY STABILIZED WITH EXTRACORPOREAL MEMBRANE OXYGENATION

Change of angiogenesis in the nodular form of benign mammary dysplasia during treatment with alkaloids, flavonoids and glycosides

Introduction. The formation of new blood vessels is called angiogenesis. As the tumor grows, the oxygen and nutrient requirements of the abnormal cells continuously increase, and new blood vessels are formed. These processes are disrupted by angiogenesis inhibitors. Therefore, it is warranted to investigate ways to enhance the capabilities of angiogenesis inhibitors alkaloids, flavonoids, and glycosides.&#x0D; Aim. To justify the extension of clinical use of alkaloids, flavonoids and glycosides (Conium maculatum and Hydrastis canadensis, Thuja occidentalis), being a part of the complex medical product Mastopol, taking into account the obtained data on the angiogenic balance in the nodular form of benign mammary dysplasia (BMD).&#x0D; Materials and methods. The study included 69 volunteers divided into two groups: Group 1 included 27 patients with medical history of surgery for nodular BMD who received antiproliferative preoperative therapy with Mastopol for 12 weeks. Group 2 (comparison group), n=42, also included patients with medical history of surgery for nodular BMD but without preoperative therapy with the herbal medicine Mastopol. We studied angiogenesis markers (VEGF-A [vascular endothelial growth factor] and pVEGF-1) and immunohistochemical marker CD34 (cluster of differentiation CD).&#x0D; Results. We found a significantly higher (p0.001) rate of CD34 detection on medium and small caliber vessels in the comparison group, i.e., in the patients who were not treated preoperatively with alkaloids, flavonoids, and glycosides (Mastopol), while blood supply to the nodules by the medium and small vessels was 1.4 and 1.8 times lower in the Group 1, respectively. Analysis of VEGF expression shows an increase of angiogenic promoters VEGF-A and pVEGF-1 in serum before treatment with biologically active herbal components of Mastopol in both groups. There were no statistically significant differences in vascular markers. However, a statistically significant decrease in VEGF-A and pVEGF-1 (p0.001) was noted in Group 1 after Mastopol therapy. Note the presence of a moderate direct correlation (rs=0.49) of CD34 expression with VEGF-A expression in Group 1 and rs=0.41 in Group 2, which indicated a direct relationship between angiogenesis and proangiogenic factors.&#x0D; Conclusion. In addition to the proven antiproliferative, anti-inflammatory, cytokine stabilizing, analgesic, and anti-edema properties of Mastopol, the study also showed the antiangiogenic effect of the herbal drug components. Considering the decreased vascular growth in fibroadenomas during Mastopol treatment, the indications for its use in patients with fibroadenomas before the surgery can be extended. Specific immunological test to measure VEGF can be proposed as a noninvasive screening method to evaluate the effectiveness of conservative treatment in general clinical practice.

P33 The successful use of Belimumab in recurrent small bowel obstruction secondary to Lupus Enteritis

P33 The successful use of Belimumab in recurrent small bowel obstruction secondary to Lupus Enteritis