Chronic Inflammatory Cell Infiltration Research Articles

Detection Ewingella americana from a patient with Andersson lesion in ankylosing spondylitis by metagenomic next-generation sequencing test: a case report

BackgroundAndersen’s lesion (AL) is a rare complication of ankylosing spondylitis (AS), characterized by nonneoplastic bone destruction, typically manifested as bone destruction and sclerosis in the vertebral body and/or intervertebral disc area. At present, there is no consensus on the pathology and etiology of AL. Repeated trauma, inflammation in essence and part of the natural history of Ankylosing spondylitis itself are the most widely recognized theories of the etiology of AL. However, positive bacteria cultured in bone biopsy of Andersen’s lesion (AL) in Ankylosing spondylitis patients are extremely rare. Herein, we report a rare case of detecting Ewingella americana from a patient with Andersson lesion in ankylosing spondylitis by Metagenomic Next-Generation Sequencing (mNGS) Test.Case presentationThis case involved a 39-year-old male with a history of AS for 11 years, who developed AL (T11/12) in the thoracic vertebrae. After sufficient preoperative preparation, we successfully performed one-stage posterior approach corrective surgery and collected bone biopsies samples for examination. Cultured bacteria were not found, and pathological histology indicated infiltration of inflammatory cells. However, it is worth noting that we discovered a gram-negative bacterium, the Ewingella americana, through mNGS testing. Further histopathological examination suggests chronic inflammatory cell infiltration. After one-stage posterior approach corrective surgery, the patient’s condition significantly improved. At the 6-month follow-up, the pain significantly decreased, and the patient returned to normal life.ConclusionWe detected Ewinia americana in the bone biopsies of Andersson lesion (AL) in ankylosing spondylitis patient by mNGS.

Case of Erythroderma Skin Disorder Caused by Drug Eruption

Erythrodema or also called exfoliative dermatitis is an inflammatory skin disease with erythema and fine scales that affect almost the entire surface of the skin. Histopathological examination will vary and sometimes be non-specific, depending on the triggering disease. Generally there is hyperkeratosis with focal parakeratosis, mild acanthosis and chronic inflammatory cell infiltration. The author would like to report a case of erythroderma in a 62 year old woman who was hospitalized for 8 days. The diagnosis is made based on the history, clinical picture and histopathological examination. The results of the case report found that skin tissue preparations showed that the epidermis had regenerated. The superficial dermis appears as mild perivascular lymphocytic accompanied by 1-2 eosinophils.

DESI-MSI-guided exploration of metabolic-phenotypic relationships reveals a correlation between PI 38:3 and proliferating cells in clear cell renal cell carcinoma via single-section co-registration of multimodal imaging

A workflow has been evaluated that utilizes a single tissue section to obtain spatially co-registered, molecular, and phenotypical information suitable for AI-enabled image analysis. Desorption electrospray ionization mass spectrometry imaging (DESI-MSI) was used to obtain molecular information followed by conventional histological staining and immunolabelling. The impact of varying DESI-MSI conditions (e.g., heated transfer line (HTL) temperature, scan rate, acquisition time) on the detection of small molecules and lipids as well as on tissue integrity crucial for integration into typical clinical pathology workflows was assessed in human kidney. Increasing the heated transfer line temperature from 150 to 450 °C resulted in a 1.8-fold enhancement in lipid signal at a scan rate of 10 scans/s, while preserving histological features. Moreover, increasing the acquisition speed to 30 scans/s yielded superior lipid signal when compared to 10 scans/s at 150 °C. Tissue morphology and protein epitopes remained intact allowing full histological assessment and further multiplex phenotyping by immunofluorescence (mIF) and immunohistochemistry (mIHC) of the same section. The successful integration of the workflow incorporating DESI-MSI, H&E, and immunolabelling on a single tissue section revealed an accumulation of ascorbic acid in regions of focal chronic inflammatory cell infiltrate within non-cancerous kidney tissue. Additionally, a strong positive correlation between PI 38:3 and proliferating cells was observed in clear cell renal cell carcinoma (ccRCC) showing the utility of this approach in uncovering molecular associations in disease pathology.Graphical

A Young Man With Hereditary Motor And Sensory Neuropathy: A Rare Genetic Association

Hereditary motor and sensory neuropathies with early onset are uncommon conditions that include Dejerine-Sottas neuropathy, which begins in infancy, and congenital hypomyelinating neuropathy, which manifests in the early postnatal period. However, these two historically defined disease entities are only small parts of the clinical spectrum. It is well recognized that very early onset hereditary neuropathies are frequently caused by de novo dominant mutations in PMP22, MPZ, and EGR2. In addition, mutations in several other dominant and recessive genes for Charcot-Marie-Tooth disease may lead to similar phenotypes. A 20-year-old boy had complaints of weakness of both lower limbs for 1 year, followed by wasting and foot drop, which subsequently involved the upper limbs. Nerve conduction velocity and electromyography of both lower limbs revealed demyelinating sensory motor polyneuropathy. Histological examination of the sural nerve revealed a nerve trunk with perineural soft tissue, with the nerve bundles being irregular and separated by fibrous tissue bands. The later reveals small perivascular infiltration of chronic inflammatory cells, and no granuloma or AFB is seen. The genetic test of whole exome screening for heriditatory neuropathy showed pathogenic (PM2, PVS, PP5) with a gene impact of (NF2: c.363+1G>T), which is a rare entity in our case study to consider the diagnosis despite negative family history. We highlight this rare disease in young man with a high index of clinical suspicion for its diagnosis. Bangladesh J Medicine 2024; 35: 101-105

Urinary liver-type fatty acid-binding protein level as a prognostic indicator of acute kidney injury secondary to severe falciparum malaria.

Acute kidney injury (AKI) secondary to severe falciparum malaria possesses a high mortality rate; however, a prognostic marker of renal dysfunction has not yet been identified. Thus, we reported a case of a patient with AKI secondary to falciparum malaria who underwent hemodialysis and a renal biopsy due to prolonged renal dysfunction. The male patient, in his 50s, presented to our hospital with vomiting, diarrhea, fever, and decreased level of consciousness. The Giemsa-stained peripheral blood film revealed approximately 5% parasitemia, and a rapid diagnostic test was positive for Plasmodium falciparum. He was diagnosed with severe falciparum malaria and was started on quinine hydrochloride. Hemodialysis was initiated due to the decreased urine output and fluid retention. Subsequently, he was weaned off hemodialysis. The histopathological analysis of a renal biopsy revealed interstitial fibrosis, tubular atrophy, and chronic inflammatory cell infiltration; thus, malarial nephropathy was diagnosed. Thereafter, his renal function stabilized, and he was discharged from the hospital. The urinary liver-type fatty acid-binding protein (L-FABP) level decreased before renal function improved. Our report highlighted that long-term follow-up is essential for severe AKI secondary to malaria. The urinary L-FABP level may be a useful prognostic indicator of AKI secondary to severe falciparum malaria.

Ameloblastic Carcinoma in a Young Adult Male Patient - A Case Report

ABSTRACT Ameloblastic carcinoma is a rare malignant odontogenic tumor that is further classified into being primary or secondary arising from a preexisting benign ameloblastoma. It affects the mandible in two thirds of the patients. There is no standard treatment protocol for this lesion but radicalsurgical excision with or without radiotherapy is reported in the majority of cases. In this paper, we present a case of a 22 year old male diagnosed with Ameloblastic carcinoma of the mandible with a clinical course of typical aggressiveness and extensive destruction. Histopathological examination of the incised biopsy showed a parakeratinized stratified squamous epithelium with underlying fibrous connective tissue stroma. The stroma is highly myxomatous and exhibits islands of odontogenic epithelium and chronic inflammatory cell infiltrates. Interlacing strands of odontogenic epithelium shows stellate reticulum-like cells and occasional areas of squamous metaplasia with cellular and nuclear pleomorphism. In addition, mitotic figures were noted. With the correlation of clinical, radiographic, and histological features, the lesion is diagnosed as ameloblastic carcinoma. The lesion was surgical excised and post-treatment follow-up for 6 months revealed no recurrence of the malignancy.

Helicobacter pylori Increasing Spread of An Inflammation Cells and Gastric Mucosal Atrophy in Gastritis Patients

Background Helicobacter pylori (H. pylori) is a bacterium which could reason chronic gastritis and then has the capability to purpose gastric mucosal atrophy. The modifications within the degree of gastric mucosal atrophy have been appreciably correlated with the degree of risk of gastric cancer. The purpose of the observe turned into to research the relationship among H. pylori and the spread of inflammatory cellular infiltration and gastric mucosal atrophy in gastritis patients in Banjarmasin. Method The study was carried out in September-November 2021 using a cross-sectional method with purposive sampling, that is as many as 87 samples of histopathological slides of gastritis patients in the anatomical pathology laboratory of Sari Mulia Hospital, Banjarmasin for the period 2019. Research analysis used Kolmogorov-Smirnov. Slide preparations were stained with immunohistochemistry (IHC) and hematoxylin-eosin (HE). Inflammatory cellular clearance was measured the use of a scale from revised Sydney system and gastric mucosal atrophy become measured the use of the OLGA staging system. Results The results showed as many as 40 (45.98%) H.pylori-positive patients with the most chronic inflammatory cell infiltration in 24 (60%) patients at grade 3 (p<0.001) and for gastric mucosal atrophy as many as 29 (72, 50%) of patients at various stages (p<0.001). Conclusion H. pylori has a significant relationship with inflammatory cell infiltration and gastric mucosal atrophy. H. pylori-positive causes a growth within the severity of inflammatory cellular irritation and mucosal atrophy in gastritis patients.

Compositional and surface changes of retrieved stainless-steel hardware and its effects on surrounding soft tissues: A prospective study.

To evaluate the surface, compositional, and histological changes in the overlying soft tissues of retrieved stainless-steel mini-plates and screws used for rigid internal fixation in the maxillofacial skeleton. A prospective study was conducted comprising 60 patients who sustained maxillofacial trauma and underwent ORIF in our unit previously and who required hardware retrieval in the post-operative phase. The retrieved hardware was evaluated for surface and compositional changes with the help of a scanning electron microscope for surface roughness and corrosion changes. Energy-dispersive X-ray study was done to know the composition and metal release from the hardware. The data obtained from these results were compared with a control unused and a sterile stainless-steel mini-plate and screw. The effects of the corrosion changes of this hardware on the adjacent soft tissues were evaluated histologically to assess the cellular changes of the soft tissue cover overlying the stainless-steel mini-plates and screws. A total of 96 stainless-steel mini-plates and 380 stainless-steel screws were retrieved from 60 patients. The control plate was smooth without any surface and corrosion defects, while the retrieved mini-plates irrespective of the reason for removal have shown surface roughness. Fe and Ni ions were found to be significantly reduced in the retrieved mini-plates. The presence of CrC in the retrieved plates indicates corrosion, which was seen only in hardware retrieved from symptomatic patients. The histological study revealed chronic inflammatory cell infiltrate with hyalinized connective tissue in all the samples irrespective of the reason for the removal of the plate. Stainless-steel mini-plates and screws act as a potent foreign body material and initiate a localized inflammatory reaction due to its corrosive products with longer duration of stay. Hence, the authors advocate the overall shift in the use of stainless-steel hardware to titanium hardware for ORIF.

Xanthogranulomatous Osteomyelitis: Two Rare Cases Report

INTRODUCTION: Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory lesion that is histologically characterized by the presence of foamy histiocytes and plasma cells (1-8). Radiologic and gross examinations can mimic malignancy (9), so carful workup and definitive diagnosis should be made by histopathologic evaluation. Case Report: There are two rare cases being reported here; the first one is a 21-year-old male who presented with chronic pain and swelling of upper leg for one year. He has history of healed traumatic fracture of fibula 7 years ago. Radiological examination revealed highly suspicious radio opaque lesions of upper fibula. The second case is a 30 years old female, presented with pain and swelling of wrist for six months with clinical suspicion of Ewing sarcoma. Radiological examination revealed highly suspicious radio opaque, lytic lesions of lower radius. Biopsy of both lesions were done. Microscopic examination showed marked chronic inflammatory cells infiltration mainly foamy histiocytes and lymphoid cells with many foreign body giant cells. No evidence of tuberculosis or malignancy. Conclusion: As these lesions were clinically highly suspicious of malignancy or associated with other diseases, so proper diagnostic roles in xanthogranulomatous osteomyelitis should include histopathological examination in order to rule out any malignant conditions of the bone.

Congenital Pulmonary Airway Malformation Type 1 with Pulmonary Neuroendocrine Cell Hyperplasia in an Adult Male: a Rare Case Report

Abstract Introduction/Objective Congenital pulmonary airway malformations (CPAM) is rare, usually diagnosed in the pediatric population, and may occur in adults. Pulmonary neuroendocrine cell hyperplasia (PNECH) mimicking diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) associated with CPAM has not been described previously. We report a case of CPAM Type 1 with PNECH. Methods/Case Report A 33-year-old male, with past medical history of latent tuberculosis (TB) by Quantiferon blood testing, recurrent pneumonia, recurrent lung abscesses, and lung cavitary lesion for three years, presented with fever, cough with hemoptysis, shortness of breath, and left-sided chest pain. Computerized tomography of chest displayed a 10.8 cm cavitary lesion in the left lower lobe of the lung. The patient underwent left lower lobectomy of the lung. Grossly, the lobectomy specimen revealed a 10.5 cm irregular cavity communicating to the superior segmental bronchus of the left lower lobe. Microscopically, the dominant large cyst was surrounded by lung parenchyma and small cystically dilated spaces resembling bronchioles under the fibrotic pleura. The large cyst was lined by respiratory epithelium with rare pathognomonic mucous cells in clusters. Cyst walls contained smooth muscle, small islands of cartilage, and focal intense acute and chronic inflammatory cell infiltrates with hemorrhage. There were multiple foci of proliferation of pulmonary neuroendocrine cells centered around bronchioles surrounding the large cyst. The neuroendocrine cells were arranged from individual cells and cellular aggregates to larger tumorlets, highlighted by Synaptophysin and Chromogranin immunostains. No granuloma or necrosis was present. No acid-fast bacilli or fungal microorganisms were identified by special stains. The findings are consistent with CPAM type 1, with PNECH. Results (if a Case Study enter NA) NA Conclusion Our study demonstrates a histologically diagnosed adult congenital pulmonary airway malformations type 1 with an incidental pulmonary neuroendocrine cell hyperplasia, which mimics diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. To the best of our knowledge, this is the first report of such an association.

Nasal Gouty Tophus

A 48-year-old, non-hypertensive, non diabetic man with uncontrolled gouty arthritis presented with a four-day swollen nasal mass. He was assessed to have a nasal abscess at the emergency room and was admitted for urgent management. Paranasal computed tomography (CT) scans showed a heterogeneously enhancing focus with areas of hypodensities in the nasal apex and dorsum extending into the right ala measuring 1.5 x 2.8 x 3.4 cm. with associated erosion of the cartilaginous part of the anterior nasal septum, soft tissue swelling and skin thickening in the nasal dorsum, nasal tip and right zygomatic region that was suspected to relate to an aggressive etiology. Tissue correlation was therefore recommended, and he underwent endoscopic-guided incision and drainage with biopsy and debridement of the nasal mass. The specimen submitted consisted of red to white, irregular, soft tissue fragments with an aggregate measurement of 1.5 x 1.5 x 0.5 cm. Microsections showed deposits of amorphous white to pink material with surrounding fibrosis and acute and chronic inflammatory cell infiltrates and foreign body giant cells. (Figures 1 and 2) Also seen in the background were fragments of sclerotic bone and bacterial colonies. These findings were consistent with gouty tophus with acute and chronic inflammation and bacterial colonization. The culture and sensitivity test of the nasal discharge showed growth of Enterobacter aerogenes (currently named Klebsiella aerogenes) which was identified by an automated mass spectrometry microbial identification system (VITEK® MS). Work-up also included uric acid levels which were within the reference interval at that time (6.57 mg/dL).

A CRITICAL REVIEW ON KAPHAJ YONIVYAPADA W.S.R CHRONIC CERVICITIS

In Ayurvedic classics, almost all gynecological disorders come under the big heading of Yonivyapada. This also includes menstrual disorders, abortions or stillbirths and diseases of uterus, cervix and vagina. Chronic cervicitis is judged by the presence of a heavy mixed chronic inflammatory cell infiltrate. This condition causes congestion and fibrosis of cervix and is characterized by mucopurulent vaginal discharge with foul smelling, pruritus vulvae, dyspareunia, failure of conception etc. The disease chronic cervicitis can be put parallel to kaphaj yoni vyapada on the basis of signs and symptoms. Here an attempt has been made to correlate chronic cervicitis with kaphaj yoni vyapada describes in Ayurvedic classics.

In Silico Assessment of Naphthalene Interaction with Glutathione Reductase and Histological Changes in Naphthalene Exposed Rats Tissues

Naphthalene (NA), a bicyclic aromatic compound that is widely used in various commercial and industrial applications including lavatory scent disks and mothballs, is known to be readily absorbed into the systemic circulation following either inhalation or ingestion and may cause systemic toxicity. This study examined the histopathological changes in some tissues (lung, liver and kidney) of NA-exposed Wistar rats. Twenty-four rats (175-250 g) were randomly divided into six groups of four rats each. The rats in all groups were given food and water while in addition rats in the experimental groups were exposed to NA at 0.75 mg/m3 and 1.50 mg/m3 for 2 h and 4 h. Rats were sacrificed at 24 h after the last hour of NA exposure. The tissues were excised for histological examination. The effects of NA and some selected metabolites using the rat glutathione reductase homology model were examined via molecular docking and dynamic simulation. From this study, exposure of rats to NA resulted in hepatocyte necrosis at 0.75 mg/m3 for 2 h, dilation of the alveolar duct of the lung at 0.75 mg/m3 and severe epithelial hyperplasia and chronic infiltration of inflammatory cells in the lung at 1.50 mg/m3 for 4 h. Also, vascular congestion was observed in the kidneys at 0.75 mg/m3 for 2 h and 1.50 mg/m3 for 4 h. The in silico study revealed the NA metabolite toxic potential, and NA showed the lowest binding score (-5.40± 0.00 kcal/mol). Therefore, the study concludes that NA exposure irrespective of duration can lead to hepatic and alveolar damage in the absence of mechanisms that can ameliorate its toxic effects.

Role of Hydrodistention and Intravesical Hyaluronic Acid in Treatment of Bladder Pain Syndrome: Case Report

Bladder pain syndrome (BPS) causes decreased mental and physical quality of life. The diagnosis and treatment of BPS must be made effective; however, the treatment of BPS was still not satisfactory for most patients. Two cases of BPS were presented to the urology clinic and were treated with a combination of hydrodistention and intravesical hyaluronic acid (HA) periodically. After 3-8 hydrodistension and hyaluronic acid instillation, the patients showed symptom improvement indicated by O’Leary Sant Questionnaire (symptom score 19-21 before treatment became 3-4 after treatment, problem score 8-16 before treatment became 0-2 after treatment), visual analogue scale (7-10 before treatment to 3-4 after treatment), and the global response assessment (GRA) scale were markedly improved. Both patients had glomerulations during cystoscopy, and the second had Hunner Lesion. A pathological examination of bladder biopsy specimens indicated acute and chronic inflammatory cell infiltration. The combination of hydrodistention and intravesical HA was beneficial for treating BPS in this study. Further study such as a clinical trial is needed to prove the efficacy and safety of this treatment.

Role of Hydrodistention and Intravesical Hyaluronic Acid in Treatment of Bladder Pain Syndrome: Case Report

Bladder pain syndrome (BPS) causes decreased mental and physical quality of life. The diagnosis and treatment of BPS must be made effective; however, the treatment of BPS was still not satisfactory for most patients. Two cases of BPS were presented to the urology clinic and were treated with a combination of hydrodistention and intravesical hyaluronic acid (HA) periodically. After 3-8 hydrodistension and hyaluronic acid instillation, the patients showed symptom improvement indicated by O’Leary Sant Questionnaire (symptom score 19-21 before treatment became 3-4 after treatment, problem score 8-16 before treatment became 0-2 after treatment), visual analogue scale (7-10 before treatment to 3-4 after treatment), and the global response assessment (GRA) scale were markedly improved. Both patients had glomerulations during cystoscopy, and the second had Hunner Lesion. A pathological examination of bladder biopsy specimens indicated acute and chronic inflammatory cell infiltration. The combination of hydrodistention and intravesical HA was beneficial for treating BPS in this study. Further study such as a clinical trial is needed to prove the efficacy and safety of this treatment.

Intrahepatic cholelithiasis with gallbladder-like metaplasia of intrahepatic bile ducts associated with gallbladder agenesis in a wild boar.

An unknown-aged adult female wild boar (Sus scrofa) was brought to Kyungpook National University for postmortem examination. Gross examination revealed gallbladder agenesis. Histologically, the liver was cirrhotic and had intrahepatic cholelithiasis, the choleliths were yellow, brown, gray, and black, and had coffin-lid and pyramidal appearances. Fourier-transform infrared spectroscopy analysis revealed that the components were 80% struvite and 20% calcium oxalate monohydrate. Chronic inflammatory cell infiltration was observed, with hyperplastic hepatocellular nodules characterized by large nuclei, prominent nucleoli, and scant cytoplasm with frequent binucleation, surrounded by thick fibrous septa. The epithelium of intrahepatic bile ducts that contained choleliths had undergone gallbladder-like metaplasia, which might have been induced by chronic irritation from the stones or by the accompanying chronic bacterial infection that was observed in Gram stains.

A Case of Multiple Gastrointestinal Ulcer: A Rare Presentation of Strongyloidiasis

Strongyloides stercolaris is a common intestinal nematode in tropical and subtropical countries like Bangladesh. The presentation of this infection is nonspecific. Mostly it remains asymptomatic with peripheral eosinophilia. Immunocompromised individuals are at high risk of hyper infection to disseminated disease. We present a case of Strongyloides in an immunocompetent patient with features of gastric outlet obstruction. Laboratory findings revealed hypereosinophilia with multiple gastrointestinal ulcers on endoscopy. Biopsy was taken from a gastric ulcer which revealed ulceration and dense infiltration of acute and chronic inflammatory cells along with extensive intestinal metaplasia. There were tiny helminthic bodies within the mucosal glands and on the surface consistent with Strongyloides stercoralis. Routine examination of stool also revealed larvae of Strongyloides stercolaris. J Dhaka Med Coll. 2022; 31(1) : 163-166

Histological analysis on tissues around orthodontically intruded maxillary molars using temporary anchorage devices: A case report

Before progress was recently made in the application of temporary anchorage devices (TADs) in bio-mechanical design, orthodontists were rarely able to intrude molars to reduce upper posterior dental height (UPDH). However, TADs are now widely used to intrude molars to flatten the occlusal plane or induce counterclockwise rotation of the mandible. Previous studies involving clinical or animal histological evaluation on changes in periodontal conditions after molar intrusion have been reported, however, studies involving human histology are scarce. This case was a Class I malocclusion with a high mandibular plane angle. Upper molar intrusion with TADs was performed to reduce UPDH, which led to counterclockwise rotation of the mandible. After 5 months of upper molar intrusion, shortened clinical crowns were noticed, which caused difficulties in oral hygiene and hindered orthodontic tooth movement. The mid-treatment cone-beam computed tomography revealed redundant bone physically interfering with buccal attachment and osseous resective surgeries were followed. During the surgeries, bilateral mini screws were removed and bulging alveolar bone and gingiva were harvested for biopsy. Histological examination revealed bacterial colonies at the bottom of the sulcus. Infiltration of chronic inflammatory cells underneath the non-keratinized sulcular epithelium was noted, with abundant capillaries being filled with red blood cells. Proximal alveolar bone facing the bottom of the gingival sulcus exhibited active bone remodeling and woven bone formation with plump osteocytes in the lacunae. On the other hand, buccal alveolar bone exhibited lamination, indicating slow bone turnover in the lateral region.

P597 Usefulness of histological monitoring in predicting relapse after de-escalation of thiopurines in Ulcerative Colitis

Abstract Background Thiopurines are useful to maintain remission for ulcerative colitis (UC) and to inhibit immunogenicity in combination with biologics while their long-term use may increase risks of infections and malignancies. Therefore, the risk-benefit balance should be evaluated, and de-escalation needs to be discussed. However, optimal de-escalation strategy such as dosing and monitoring has not been well studied. Methods UC patients in clinical remission (partial Mayo score ≤ 2 and rectal bleeding subscore of 0) who de-escalated thiopurines (dose-reduction or discontinuation) were enrolled. The risk of relapse and changes in Mayo endoscopic subscore (MES) and histological findings after thiopurine de-escalation were retrospectively investigated. The correlation with relapse (treatment escalation (including topical therapy) with the exacerbation of symptoms or rectal bleeding score ≥ 1) was analyzed by logistic regression analysis. Results A total of 69 de-escalation steps (51 dose-reductions and 18 discontinuations) were conducted in 39 patients. The mean duration and dose of thiopurine use were 3.5 years and 66.6mg (converted to azathioprine). Thiopurines were used in combination with biologics in 16 (41.0%). Relapse occurred in 17/69 (24.6%) de-escalation steps (10/17 discontinuations). In 36 de-escalations remaining in remission with available data before and after de-escalations, worsening of MES occurred in 13%, whereas exacerbations of any histopathological finding occurred in 44% (crypt architectural irregularities 25%, chronic inflammatory cell infiltrate 19％, acute inflammatory cell infiltrate 16％, basal plasmacytosis 13%, mucin depletion 13%, crypt abscess 8%). Chronic inflammatory cellular infiltrate (p=0.002), basal plasmacytosis (p=0.008), and acute inflammatory cell infiltrate (p=0.039) at de-escalation were significantly associated with relapse after de-escalation. Nancy Index was also associated with relapse (p=0.011), while MES was not. Conclusion Histological worsening may precede clinical relapse thus may be useful to predict relapse after thiopurine withdrawal.

Histopathological Studies of Eimeria cameli in the intestine of infected one-humped camel (Camelus dromedaries)

Domesticated Old World camels (Camelus dromedarius and Camelus bactrianus) are important for the economy of several countries in Asia, Africa, and the Arabian Peninsula. Coccidiosis is one of the major parasitic diseases in camels which is caused by protozoa of the genus Eimeria, it is considered one of intracellular parasites, transmitted through fecal oral Route. Coccidiosis is responsible for mortality rates of up to 10% in camel calves besides enteritis; also it is characterized by subclinical contagious enteritis in wild and domesticated animals. Although five species of Eimeria were believed to have capability of infecting camels as (E. bactriani, E. rajasthani, E. pellerdyi, and E. dromedarii), the E. cameli is considered the most pathogenic one. A total of 42 samples from small intestine of slaughtered camels were collected from El-Basatin abattoir, Cairo, Egypt. Grossly, the small intestine infected with coccidian showed congested red spots within serosa and mucosa. On histopathological examination, infected tissues showed chronic, hemorrhagic and granulomatous enteritis, the intestinal glands have rose shape appearance in some cases, and complete loss of intestinal gland structure with sever infiltration of chronic inflammatory cells in other cases, hyper eosinophilia and different developmental stages of Eimeria.