Longitudinal Furrows Research Articles

First record of Orthohalarachneattenuata in Arctocephalusaustralis in mainland Argentina (Parasitiformes, Mesostigmata, Dermanyssoidea, Halarachnidae) with observations on its ambulacral morphology.

Pinniped respiratory mites of the species Orthohalarachneattenuata have been recorded from various locations around the world but not from continental Argentina. In the present work, we document for the first time the presence of O.attenuata on Arctocephalusaustralis on the Argentine mainland. A total of 23 adult and 381 immature mites were collected from the nose and nasopharyngeal cavity during a necropsy. The mite ambulacrum is described in adults and larvae. This structure consists of a pretarsus, an extensible pulvillum, a pair of claws and paradactyli (pretarsus opercula). The ambulacral structures also have some peculiarities, such as the presence of longitudinal furrows in the claws, straight claws in legs II and III (as opposed to curved in legs I and IV), and the fin-shaped paradactyli. The morphology of the ambulacrum of this mite is interpreted as an adaptation for anchoring to different surfaces of the host, and the protective structures present in the larvae as an adaptation for the dispersal phase in the external environment.

Flow‐induced interfacial deformation structures (FIDS): Implications for the interpretation of palaeocurrents, flow dynamics and substrate rheology

ABSTRACTSole structures on the base of turbidites, and other bed types, are typically classified into scour marks and tool marks, such as flutes, grooves, skim marks and prod marks. Yet, there are a range of other common sole marks that are unrelated to scouring or tools, and whose origin is poorly understood. Prominent among these sole structures are longitudinal ridges and furrows, and ‘dinosaur leather’ structures associated with mud ripples. Herein, these features are described and it is argued that they are the product of deformation of the substrate during a sediment gravity flow event. In these flow‐induced interfacial deformation structures (FIDS), a soft cohesive substrate undergoes deformation in response to a buoyant force induced by the denser basal component of an overriding flow, and the flow interacts with this buoyant deformation through shear to remould the substrate. Variations in the relative strength of these buoyant and shear‐induced forces explain the wide range of FIDS that can form. This FIDS model reinterprets the formation of longitudinal ridges and furrows, which have previously been classified as scour marks, and explains their distinctive spatial patterns. Furthermore, the new model builds on the seminal work of Dżułyński and colleagues in the 1960s and 1970s, who identified that these structures contain key palaeocurrent information, and it is argued that such information is largely under‐utilized. Importantly, alongside their utility as palaeocurrent indicators, FIDS provide insights into the rheology of the substrate at the time of their formation, and thus the nature of basal flow conditions in the formative flows.

Impacts of straw mulching in longitudinal furrows on hillslope soil erosion and deposition in the Chinese Mollisol region

In the Northeast Mollisol region of China, straw mulching has a great effect on preventing soil loss from ridge tillage, but how furrow straw mulching (FSM) impacts the spatial distribution of erosion-deposition and sediment sources in longitudinal ridge tillage systems is still unclear. Therefore, this study was to quantify the effects of the FSM on the spatial distribution of soil erosion-deposition and sediment sources in longitudinal ridge tillage systems by using the magnetism tracing methodology and indoor simulation rainfall experiments. The experimental treatments included two surface treatments: without the FSM (NFSM) and with the FSM of 0.30 kg·m−2 amount, two rainfall intensities of 50 and 100 mm h−1 were included; each experiment was run for 60 min at a soil pan with a 5° slope gradient, 6.2 m length, 1.3 m width and 0.7 m depth. The results indicated that, compared with the NFSM treatment, the total slope runoff and soil loss in the FSM treatment at two rainfall intensities were decreased by 41.6 % and 99.5 % and by 37.9 % and 97.7 %, respectively, and the reduction in slope runoff and soil loss decreased with an increase of rainfall intensity. The total mass of sediments intercepted by straw mulching on the entire slope accounted for 36.9 % and 10.4 % of the total soil loss in the NFSM treatment, respectively. Erosion regimes dominated on the hillslope of the NFSM treatment with strong-weak alternation at two rainfall intensities, while for the FSM treatment, only deposition regime was observed at 50 mm h−1 rainfall intensity; a slight change with erosion-deposition on the ridge tops was observed and deposition in the furrows was observed at 100 mm h−1 rainfall intensity. Furthermore, the FSM treatment changed the main sediment source from ridge tops to furrows on the hillslope compared to the NFSM treatment, whose sediment contributions from the ridge tops and the furrows at the two rainfall intensities were approximately 16.4 % and 83.6 %, respectively. In conclusion, FSM should be promoted due to its high efficiency in decreasing slope runoff and intercepting sediments. The findings of this study served as a scientific reference for effectively controlling soil erosion along slopes in the Chinese Mollisol region.

Reassessment of the enigmatic "Prestosuchus" loricatus (Archosauria: Pseudosuchia) from the Middle-Late Triassic of southern Brazil.

Our knowledge of the diversity and evolution of South American Triassic pseudosuchians has greatly improved in the past 15 years, due to new discoveries, but also to the revision of several historically important specimens. One of the earliest descriptions of pseudosuchians from the Triassic of Brazil stems from the classic work of Huene from the first half of the 20th century, who described several species, including such influential taxa as Rauisuchus tiradentes or Prestosuchus chiniquensis, which have recently been reviewed. The more poorly known proposed second species of Prestosuchus, P. loricatus, is the focus of the present work. The original material included some elements of the axial skeleton (cervical and caudal vertebrae, ribs, osteoderms) and the hindlimb (ischia, calcaneum, metatarsus), collected from the Dinodontosaurus Assemblage Zone of the Chiniquá area, west of São Pedro do Sul. "Prestosuchus" loricatus shows numerous differences to P. chiniquensis, including the shape of cervical neural spines, presence of epipophyses on the cervical vertebrae, presence of a pit in the iliac articulation of the ischium, lack of longitudinal furrows in the dorsolateral surface of the ischial shafts, the more slender calcaneal tuber and a less pronounced ventral pit in the calcaneum, and is thus referred to a new genus, Schultzsuchus gen. nov. Phylogenetic analysis indicates an early branching position within Poposauroidea for Schultzsuchus, making it the oldest known member of this clade in South America.

A retrospective real-world study on the safety and efficacy of budesonide orodispersible tablets for the induction therapy of eosinophilic oesophagitis.

An orodispersible form of budesonide has recently been approved for the targeted treatment of eosinophilic oesophagitis in the United Kingdom, Europe, Australia, Canada and the United States, following favourable results from a randomised controlled trial. This is the first dedicated real-world study exploring the safety and efficacy of budesonide orodispersible tablets for induction therapy in the treatment of eosinophilic oesophagitis while providing insights into its management. The primary objective was histologic remission, defined as less than 5 eosinophils per high-powered field. The secondary objectives included histologic response (>50% reduction in peak eosinophil count), clinical remission (complete resolution of symptoms documented on clinic letters), clinical response (improvements in symptoms as reported on clinical letters), endoscopic remission (Endoscopic Reference Score (EREFS) score = 0), and endoscopic response (improvement in EREFS score). The EREFS scores were calculated based on the severity and presence of rings, longitudinal furrows, strictures, oedema and exudates on endoscopic images. Adverse events and safety profiles were also recorded. A multicentre cohort study examining the effectiveness of 1 mg, twice daily, budesonide orodispersible tablet induction therapy for the treatment of eosinophilic oesophagitis. Ethics approval was obtained through the Western Australia Health: Governance, Evidence, Knowledge, Outcomes system for assessment of Audit and Quality Activities. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. A total of 43 patients (29 males, 14 females; median age 39) were recruited. Forty-one patients were included in the analysis. After induction therapy, 30 patients (73%) achieved histologic remission, and 35 patients (85%) demonstrated histologic response. Thirty-nine patients (95%) achieved clinical response, and 28 patients (68%) achieved clinical remission. An endoscopic response was seen in 37 patients (90%), and 16 patients (39%) achieved endoscopic remission. No significant adverse events were identified. Budesonide orodispersible tablet is an effective induction therapy for eosinophilic oesophagitis, as evidenced by its high histologic remission rate and favourable safety profile.

Morphological comparison for the dorsal fin of Chrysichthys auratus, Synodontis schall, and Synodontis serratus (Teleosti: Siluriformes) collected from the Lake Nasser and the River Nile, Egypt

The anatomy, growth, and differentiation of the dorsal fin spines of three catfish species collected from the Nile River and Lake Nasser. Egyptian waters are described, and terminology is suggested for their parts. Features of the dorsal fin spine that change with growth are also described. The results showed that in all species studied, the dorsal spine is an elongate, compressed, tapered, slightly arched, osseous structure, bearing a series of retrorse dentations along the anterior and posterior surfaces and has a sharp sagittate tip. The retrorse, anterior dentations are most pronounced in the upper third of the spine and gradually alter in form until they appear as a series of distinct notches on the basal third of the spine. The anterolateral surfaces of the dorsal spine are marked by numerous short, irregular, shallow, anastomosing, longitudinal furrows. In three species (C. auratus, S. schall, S. serratus), the posterior process is poorly developed and directed laterally in young individuals and well produced and directed posteriorly in older specimens. In S. schall and S. serratus, the posterior blocking process of the large specimens has a wavy edge, while in S. serratus, it is curved in young individuals and straight in larger specimens.

Estimation of the diameter of arterial vessels of the multicameral stomach in sheep of the Edilbaev breed at different stages of postnatal ontogenesis

The multicameral stomach of sheep of the Edilbaevsky breed, as in other ruminants, according to domestic and foreign authors, has a large number of branches of the main arterial highway, which is due to the functional feature of this organ. The main arterial highway of the multicameral stomach is the abdominal artery. The hepatic artery first departs from it, and then the right cicatricial artery branches off, which goes along the right longitudinal furrow of the scar and exits to its left surface, and the splenic artery branches off the thick right cicatricial artery, and itself in the form of a thin vessel is directed to the spleen. Further, the abdominal artery smoothly passes into the left gastric artery, which goes from the right between the scar and the mesh and, having reached the book, gives the left gastro-omentum artery to the large curvature of the rennet, and the rennet itself anastomoses with the right gastric artery on the small curvature. The methods for the study were fine anatomical dissection, vasorentgenography and computed tomography of the vascular bed with the introduction of a contrasting substance. Corpses and live individuals of sheep of the Edilbaevsky breed aged from 10 days to 14 months, from a private farm in the Leningrad region, served as material for the study. According to the results of the study, it was found that the largest increase in the diameter of the vessels of the arterial bed of the multicameral stomach in sheep of the Edilbaev breed over the entire period of research was observed in the right cicatricial artery. The diameter of other vessels vascularizing this organocomplex increases uniformly at all stages of development. We associate this fact with the active growth of this organ in the first three months of life.

Eozinofilni ezofagitis

Eosinophilic esophagitis (EoE) is an inflammatory disorder characterized by intraepithelial eosinophilic infiltration followed by esophageal dysfunction. Pathophysiological mechanism of EoE is still not well understood, with several factors that may contribute, such as host immunity, environmental and genetic factors. Modern diagnostic for EoE should include: esophageal dysfunction, esophageal biopsy with at least 15 eosinophils per high power field and absence of other pathology characterized by increased number of eosinophils. The most common presenting symptoms in adults are dysphagia, heartburn, food impaction and chest pain. Children are usually presented with nausea and vomiting, anorexia, heartburn, regurgitation, chest burn and abdominal pain. Endoscopically, patients with EoE are characterized by longitudinal furrows (vertical lines, darker than surrounding mucosa), esophageal trachealization (numerous transversal rings, as in trachea), exudate (white plaques), edema (decreased mucosal vascularization), strictures and crepe-paper mucosa (mucosal friability and tearing during endoscopy). Histological features of EoE could be separated into major and minor criteria. Major criteria include: intraepithelial infiltration by eosinophils (>15 eosinophils/HPF), eosinophilic microabscesses (≥4 eosinophils in a collection), eosinophils occupying outer layer of the squamous epithelium, epithelial sloughing and eosinophil degranulation. Minor criteria include: basal zone hyperplasia, lengthening of the epithelial papillae, intracellular edema and subepithelial fibrosis. In order to set adequate diagnosis, all other conditions related to increased number of eosinophils should be excluded. The most common and the most important differential is gastroesophageal reflux disease (GERD). Treatment of the EoE encompasses: proton pump inhibitors (PPI), corticosteroids (topical and systemic), elimination diet and esophageal dilation.

Eosinophilic Gastrointestinal Diseases: The Pathogenesis, Diagnosis, and Treatment.

Eosinophilic gastrointestinal diseases are delayed-type chronic allergic disorders that show gastrointestinal eosinophil dense infiltration, with an exaggerated Th2-type immune reaction considered to be an important mechanism. These diseases can be roughly divided into two types: eosinophilic esophagitis, mainly found in young and middle-aged men, and eosinophilic gastroenteritis, which is found in both genders equally. A diagnosis of eosinophilic esophagitis is suspected when characteristic endoscopic findings, including longitudinal furrows and rings, are noted. However, characteristic endoscopic abnormalities are rarely found in cases with eosinophilic gastroenteritis, so multiple biopsy sampling from the apparently normal gastrointestinal mucosal surface is important for making an accurate diagnosis. The administration of systemic glucocorticoid is the standard treatment for eosinophilic gastroenteritis, while acid inhibitors and topical glucocorticoid swallowing therapy are effective for eosinophilic esophagitis. Anti-cytokine therapies for eosinophilic gastrointestinal diseases are currently under development.

Inhibition of the NLRP3 Inflammasome by a Quercus Serrata Extract and Isolation of the Component Compounds for the Treatment of Arthritis.

Quercus serrata belongs to the Fagaceae family. There are 600 known species of Quercus worldwide. Q. serrata is distributed nationally in Korea, Japan, and China and grows to a height of 10-15 m. It exhibits a light grey bark with longitudinal furrows; the leaves are 6-12 cm long and 2.5-5 cm wide. The Quercus genus reportedly exhibits several types of bioactivity, including antioxidant, anti-inflammatory, antifungal, antimicrobial, and anticancer activity. Additionally, it has been reported that Quercus produces diverse phytochemicals, including tannins, flavonoids, and triterpenoids. Herein, we describe the column chromatographic isolation of five compounds from a Q. serrata extract. The compounds included caffeic acid (1), myricetin-3-O-cellobioside (2), phloroglucinol (3), (S)-2,3-HHDP-D-glucopyranoside (4), and pedunculagin (5). We assessed the 2,2-diphenyl-1-picryl-hydrazyl (DPPH) radical scavenging activity, antioxidant activity, NLR family pyrin domain-containing 3 (NLRP3) inflammasome (including NLRP3, ASC, and caspase-1) inhibitory effects, and collagenase inhibition activity of the Q. serrata extract and its constituent compounds. Our results indicated that the Q. serrata extract and the isolated constituent compounds showed inhibitory activity with reference to nitric oxide production, inflammasome component expression, and collagenase activity. Our findings imply that the Q. serrata extract and the isolated constituent compounds are potential candidates for the treatment of inflammatory diseases such as arthritis.

First record of Grammatodinium (Dinophyceae) for the American Eastern Pacific coast: Morphological, molecular and ecological confirmation

Grammatodinium Li & Shin is a monospecific genus described from the Tongyeong Bay area in Korea. In the current study, we describe its presence in the American Eastern Pacific coast for the first time, particularly in Acapulco Bay, Mexico, using morphological, molecular and environmental data. Sequences generated in this study with SSU and LSU formed a monophyletic group with other sequences from GenBank belonging to Gr. tongyeonginum, the only species known for the genus; however, genetic distance values between this species and our specimens (8.5% SSU; 2.8% LSU) were equivalent or even greater than those reported in other genera of dinoflagellates. Our phylogeny clearly showed the relationship of Grammatodinium with the families Pyrocystaceae and Gonyaulacaceae. In our specimens, cells appeared individually and in colonies of up to 16 cells, which were observed mainly during the dry season, so they could be confused with Gymnodinium catenatum, a common dinoflagellate in Acapulco with which they can coexist and share their general appearance, but they are clearly differentiated by the presence of longitudinal furrows throughout the body and a yellowish-green coloration, both absent in Gymnodinium catenatum. Although our evidence strongly suggests the presence of a new species for the region, more detailed morphological examinations are needed to confirm this statement.

S2371 Ripped by Chips: A Case Report of Esophageal Perforation After Consumption of Chips

Introduction: Eosinophilic esophagitis (EoE) is an uncommon condition defined as a chronic, immune-mediated, esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation.1 Patients typically present with esophageal dysphagia and food impaction. We present a unique and rare case presentation of a young male patient who presents with pneumomediastinum in the setting of undiagnosed EoE. Case Description/Methods: A 31-year-old male with no significant past medical history presents to the emergency department with lower neck pain. He reports sudden onset of pain after consuming a sandwich containing potato chips. This was followed by 2 immediate episodes of hematemesis. Vital signs were within normal limits. Physical exam was significant for bilateral crepitus on exam. CT Chest with contrast was significant for extensive pneumomediastinum around the esophagus suggestive of an esophageal perforation. CT neck was significant for extensive emphysema in the neck and pneumomediastinum with esophageal wall emphysema suggestive of esophageal rupture (Figure). An esophagram revealed no evidence of gross esophageal leak suggesting a contained micro perforation, so he was managed conservatively with IV pain medications, initial period of nil by mouth followed by slow escalation to a liquid diet. His diet was slowly escalated, and he was discharged home in stable condition. Two months later at an outpatient gastroenterology follow up, an esophagogastroduodenoscopy was significant for ringed esophagus, longitudinal furrows, white plaques and white specks throughout the entire esophagus. Biopsies were consistent with eosinophilic esophagitis with increase eosinophil count in the proximal esophagus. He was started on a daily proton pump inhibitor with ongoing follow up. Discussion: The incidence of EoE appears to be increasing, in part due to rising recognition of the disorder. It is important for physicians to identify its features early to prevent further complications. Esophageal perforation is a rare but serious complication of eosinophilic esophagitis, occurring in ∼2% of cases.2 Ongoing inflammation from longstanding untreated EoE has previously been reported to have led to esophageal perforation but rarely in such a dramatic fashion.3Figure 1.: 1. Significant emphysema in the neck and pneumomediastinum with thinning of the posterolateral aspect of esophagus concerning for esophageal rupture.

Mucosal color changes on narrow-band imaging in esophageal eosinophilic infiltration.

This study aimed to examine the range of beige colored mucosa (BCM) in patients with esophageal eosinophilic infiltration (EEI) using narrow-band imaging (NBI).In this retrospective study, EEI was confirmed histologically in 12 consecutive patients from January 2014 to December 2017. The BCM tone on NBI without magnifying endoscopy was evaluated, and red, green, and blue (RGB) values of BCM and normal mucosa were measured. BCM was macroscopically classified into 2 groups (bright and dark) using cluster analysis. Histopathological analysis was performed in 1 patient who underwent biopsy for both normal mucosa and BCM.All 12 patients presented with BCM. Endoscopy revealed fixed rings, longitudinal furrows, mucosal edema, and exudate in 3, 12, 10, and 8 patients, respectively. Strictures were absent. Five patients had findings suggestive of gastroesophageal reflux disease. In the cluster analysis, 5 and 7 patients had bright and dark BCM, respectively. Consistent results were noted when we categorized patients according to their macroscopic characteristics. RGB values of the BCM and normal mucosa were measured—normal mucosa: R: 99.8 ± 16.5, G: 121.7 ± 23.1, and B: 93.4 ± 19.2; BCM: R: 152.0 ± 31.3, G: 123.9 ± 35.0, and B: 97.5 ± 29.5. BCM had significantly higher R values than normal mucosa (P = .0001). All parameters were significantly lower in the dark BCM group than in the bright BCM group (P < .001). Histopathological analysis revealed expansion of the epithelial intercellular space, eosinophilic infiltration, and basal cell hyperplasia at the BCM sites.BCM was observed in all cases of EEI. RGB values differed between bright and dark BCM. Assessing BCM tone using NBI is a potentially novel diagnostic method for EEI.

Generalized lichenification sparing the nose

A 76-year-old man presented with a 1-year history of generalized itching, accompanied by darkening of the skin, with significant weight loss and intermittent swelling of the legs. On examination, there was diffused, uniform, gray-brown colored pigmentation with lichenification of the skin accompanied by fine, semiadherent scales and generalized lymphadenopathy (Figs 1 to 3). The facial appearance was striking with exaggeration of the longitudinal and transverse furrows, supraciliary madarosis, and clear sparing of the nose (Fig 1).

Ultrastructural tegumental changes of Trichinella spiralis adult and larval stages after in vitro exposure to Allium sativum

Albendazole (ALB) is the most used therapeutic drug for trichinellosis treatment, but it has many drawbacks. Hence, the search for alternative natural compounds is a goal for researchers. The present work aimed to test the in vitro anthelmintic effect of Tomex (Allium sativum) against adult and muscular larva of Trichinella spiralis (T. spiralis). We incubated adult forms and muscular larvae of T. spiralis with Tomex at concentrations 10, 50, and 100 μg/mL to evaluate the changes that happened on the cuticle using a scanning electron microscopy (SEM). Although ALB was very effective, Tomex also affected motility and the tegumental structure of T. spiralis, which was in proportion to its concentration and incubation time, as Tomex started the mortality of muscular larvae and adult stages after 4 h at 50 μg/mL, and after 6 h at10 μg/mL. A 50% mortality rate of muscular larvae was recorded after 6 h at 100 μg/mL. However, a 50% mortality rate was recorded after 12 h at 10 μg/mL for the adult stage. Adult worms and muscular larvae of T. spiralis incubated with 100 μg/mL of Tomex displayed loss of normal annulations and creases of the cuticle, multiple vesicles, widening of longitudinal furrow space, and multiple minor loss blebs. Our results suggested that Tomex can be a therapeutic agent against adults and larvae stages of T. spiralis.

Early Ordovician Seleneceme (Trilobita) in Ziyang Fauna, South China

ABSTRACT Ziyang Fauna is a significant early Ordovician Floian fossil Lagerstätte, recovered from blackish-grey mud limestone and calcareous mudstone of possible slope facies in the Yangtze platform in Ziyang County, Shaanxi Province, China, distinguished by predominate trilobites, accompanied with graptolites, brachiopods, arthropods and some trace fossils. It is marked by high abundance of exceptionally preserved Seleneceme (Trilobita). Two trilobite species named Caputrotundum bashanense and C. ziyangensis, are reassigned here to Seleneceme based on a detailed study of more than one hundred well-preserved specimens. The taxonomic generic and ontogeny characters of Seleneceme are as follows: cephalon semicircular in outline, with axial spine and genal spines; without eye lobes; glabella subcircular in outline, with deep longitudinal glabellar furrows; thorax and pygidium with much parallel segments. The morphological variation during ontogeny of Seleneceme is characterised by the gradual increase of the length/width ratio (L/W) of the body, but with a constant width/length ratio (W/L) of the cephalon, and also a faster growth rate in the pygidium than in the thorax.

A New Protocruzia Species (Ciliophora: Protocruziida) Isolated From the Mariana Trench Area.

A new species of Protocruzia, isolated from the deep-sea Pacific Ocean (>3,000-m depth) in the vicinity of the Mariana Trench, is described based on morphological and molecular data. The systematic status of the ciliate genus Protocruzia has long been highly ambiguous, and Protocruzia species have been assigned to an independent class until recently. In the present study, we described Protocruzia marianaensis sp. n. as a small (25–32 × 14–17 μm in vivo) drop-shaped ciliate, with longitudinal furrows along the ciliary rows on the right side, six adoral membranelles, eight somatic kineties, and one macronucleus comprising 7–11 nuclear globules. Phylogenetic analyses inferred from small subunit rRNA gene sequences revealed that seven Protocruzia species in the phylogenetic tree formed a fully supported clade representing an independent class. Protocruzia marianaensis sp. n. was established to be most closely related to Protocruzia adhaerens, with a sequence similarity of 96.64%, and was found to be able to survive at both atmospheric pressure and hydrostatic pressure of 320 bar, thereby indicating effective barotolerance.

S3547 Lymphocytic Esophagitis: An Unlikely Mimicker of Gastroesophageal Reflux Disease in the COVID-19 Era

Introduction: Lymphocytic esophagitis (LE) is a recently-recognized disease entity characterized by peripapillary chronic inflammation with an endoscopic appearance resembling Eosinophilic esophagitis (EoE). The condition is characterized by esophageal intraepithelial lymphocytosis accompanied by low granulocyte count and spongiosis. Rarely observed in clinical patients, testing for LE is seldom performed and its pathology remains poorly-understood. We present a case report of a patient with prior normal endoscopic appearance who developed severe LE 6 months post SARS-CoV-2 (COVID-19) infection. Additionally, the goal of this case report is to contribute to the limited information about LE with regards to symptoms, signs and endoscopic appearance. Case Description/Methods: A 60-year-old African American gentleman with a history of gastroesophageal reflux disease (GERD), well managed on pantoprazole 40 mg once daily for 3 years who presented with worsening reflux symptoms and regurgitation six months post SARS-CoV-2 infection. He did not have severe respiratory illness secondary to COVID-19 infection. An Esophagogastroduodenoscopy (EGD) was performed, and revealed longitudinal furrowing and white plaque throughout the esophagus suggestive of EoE. These results differed from the normal EGD performed 2 years prior. Esophageal pathology from the mid and distal esophagus displayed lymphocytosis coupled with decreased neutrophil and eosinophil counts consistent with severe lymphocytic esophagitis. Spongiosis was also observed and no fungal components or malignancies were reported. Patient was advised to increase proton pump inhibitors (PPI) twice daily for treatment, and symptoms continue to be monitored. Discussion: LE is a rare disease with limited available knowledge. While the patient’s older age aligns with the established range for this condition, his race and sex deviate from the white, female demographic predominantly associated with LE. We raise the possibility of COVID-19 triggering manifestation of lymphocytic infiltration in the esophagus causing GI symptoms in this patient. The symptoms for this occurrence remained subtle and were confined to the patient’s complaints of heartburn. SARS-CoV-2 changed how we practice medicine in many ways. This case highlights the need to be more vigilant and keep LE in the differential diagnosis even for common diseases like GERD. Our patient did well by increasing PPI to twice daily for two months in this setting.Figure 1.: A. Pre-COVID-19 EGD showing normal Esophagus B & C. Post-COVID-19 EGD showing longitudinal furrows & microabscesses D, E, & F. Post-COVID-19 pathology showing lymphocytic infiltration and spongiosis throughout.

Scleromyxedema.

A 52-year-old man presented to our outpatient clinic with a 6-month history of generalized asymptomatic eruptions. Physical examination revealed multiple 0.1–0.3-cm firm, waxy, and closely spaced papules with partial confluence on the dorsal hands, forearms, scalp, face, neck, and upper back (Fig. 1, Panels A-1 and A-2). On the dorsal part of the proximal interphalangeal joints, a central depression was surrounded by an elevated rim, which presented a donut-like appearance (Fig. 1, Panel A-1). The skin of the glabella, upper back, and proximal arms was thickened and indurated with deep, longitudinal furrows, presenting typical characteristics of a ‘leonine face’ (Fig. 1, Panel A-3) and ‘Shar-Pei sign’ (Fig. 1, Panel A-4). Skin biopsy revealed scleromyxedema, which is a sclerotic variant of lichen or popular mucinosis in which lichenoid papules and scleroderma-like features are both present [1]. It is a rare mucinous deposition disorder that shares clinical features with scleroderma but has important distinguishing features in clinical presentation and major organ complications that should be recognized [2]. Laboratory tests of the patient revealed normal thyroid function. Serum protein immunoelectrophoresis and immunofixation revealed IgG monoclonal gammopathy. Six months after monthly cyclic treatment of 2 g/kg intravenous immunoglobulin, the skin eruptions improved considerably (Fig. 1, Panels B-1–B-4).

173 CATERPILLAR SIGN: NOVEL ENDOSCOPIC FINDING IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS

Abstract Pathological identification of esophageal eosinophilia (EE) is considered to be most important and critical step for diagnosis of eosinophilic esophagitis (EoE). Although several endoscopic findings related with EoE have been reported, it is still difficult to exclude other causes of EE, such as gastroesophageal reflux disease. Here, we noted a novel endoscopic finding related with EoE termed ‘Caterpillar sign’. The aim of this study was to evaluate its clinical significance for the diagnosis of EoE. Methods One hundred and seventy-four patients who were endoscopically suspected with EoE at our hospital and affiliated institutions were enrolled. EoE was defined clinically by symptoms of esophageal dysfunction and histologically by the presence of EE [≧15 eosinophils/high power field (HPF)]. Endoscopic findings at baseline were retrospectively reviewed. ‘Caterpillar sign’ was defined as a stair-like, fragile, slight mucosal protruded lesion sandwiched between longitudinal furrows, such as the Caterpillar traces remaining on the ground (Figure). Furthermore, the clinicopathological features of patients having ‘Caterpillar sign’ were evaluated. Results One hundred and seventy-four patients (92 males, 82 females with mean age of 49.7) suspected with EoE were evaluated, of whom 60 (34.5%) was finally diagnosed as EoE. ‘Caterpillar sign’ was found in 48 patients (80.0%). Sensitivity and Specificity of ‘Caterpillar sign’ for the diagnosis of EoE was 0.80 (95% confidence interval [CI] 0.72–0.85) and 0.94 (95% CI 0.90–0.97), respectively. Furthermore, the presence of ‘Caterpillar sign’ was associated with degree of eosinophil infiltration (Caterpillar sign positive: 42.9 ± 49.3/HPF vs. Caterpillar sign negative: 6.7 ± 24.4/HPF, p &amp;lt; 0.0001). Conclusion This novel finding termed ‘Caterpillar sign’ was clinically useful for the definitive diagnosis of EoE and associated with degree of eosinophil infiltration.