Mixed Inflammation Research Articles

Lymphedematous verrucous changes simulating squamous cell carcinoma in long‐standing hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a relatively common condition marked by abscesses, sinus tracts, and scarring in intertriginous regions of the body. Lymphedema is an under-recognized consequence of chronic inflammation in the setting HS. We report five cases of patients with lymphedema resulting from long-standing HS; the patients were seen either in a specialty HS clinic or general dermatology clinic at our institution. Biopsies for histologic analysis were performed on four of the five patients reported here. Changes of lymphedema may be manifested diffusely as widespread plaques or focally as verrucous papules and nodules. The latter may be difficult to distinguish clinically from squamous cell carcinoma, another complication of chronic HS. Histopathologic features of lymphedema include dilated lymphatic channels, diffuse edema, verrucous epidermal hyperplasia, mixed inflammation, and dermal fibrosis. Lymphedema associated with chronic HS, which we also term "verrucous lymphostasis," encompasses a spectrum of clinical and histopathologic findings. Squamous cell carcinoma may mimic focal presentations of lymphedema, and biopsy may be necessary to distinguish the two.

Recurrent Inflammatory Myofibroblastic Tumor of the Heart

A previously healthy 15-year-old boy was admitted after 6 months of intermittent fevers, night sweats, and 9 kg weight loss. A systolic murmur was appreciated at the left upper sternal border. Laboratory data revealed elevated white blood cells (11 800/μL), erythrocyte sedimentation rate (75 mm/h), and C-reactive protein (10.5 mg/dL). The results of blood cultures were negative. Imaging demonstrated a hypermetabolic 2×2×4.5 cm pedunculated mass in the right ventricle, suggestive of a neoplasm with overlying thrombus (Figures 1A, 2A and 2B and online-only Data Supplement Movie I). Figure 1. Cardiac magnetic resonance imaging demonstrating the initial IMT originating from the interventricular septum near the right ventricular outflow tract ( A ) and the recurrent IMT near the tricuspid annulus ( B ). IMT indicates inflammatory myofibroblastic tumor. Figure 2. Transthoracic echocardiography before and after resection of the initial inflammatory myofibroblastic tumor. A and B , Preoperative images showed a large echogenic mass in the apex of the right ventricle extending superiorly through the right ventricular outflow tract. C and D , Postoperative echocardiography revealed no evidence of residual tumor. A4C indicates apical 4-chamber view; Ao, aorta; LA, left atrium; LV, left ventricle; PA, pulmonary artery; PSAX, parasternal short axis view; RA, right atrium; RV, right ventricle; RVOT, right ventricular outflow tract; Pre-op, preoperative; and Post-op, postoperative. Arrow denotes the tumor. At surgery, the mass was found to originate from the midportion of the interventricular septum and was covered with thrombus. …

An Unbiased Approach to Discover Novel Therapies for Liver Disease

An Unbiased Approach to Discover Novel Therapies for Liver Disease Alcoholic liver disease (ALD) represents a range of clinical and morphological changes that range from steatosis to inflammation and necrosis (alcoholic hepatitis) to progressive fibrosis (alcoholic cirrhosis). Most chronic heavy drinkers exhibit steatosis characterized by greater amount of macrovesicular fat content than microvesicular fat. In addition hepatocyte ballooning degeneration with mixed lobular inflammation is evident.

Histopathologic changes following neoadjuvant chemotherapy in various malignancies

Background:Various histopathological changes have been observed following neoadjuvant chemotherapy in individual tumors in the literature.Aims and Objectives:To observe histopathologic changes seen after neoadjuvant chemotherapy in breast malignancies, squamous cell carcinomas, adenocarcinomas, and Wilms′ tumor using breast cancer predominantly as the model.Materials and Methods:The present prospective study was carried out on 60 patients including 40 patients with carcinoma breast and 20 patients with other malignancies who received neoadjuvant chemotherapy.Results:Post neoadjuvant chemotherapy, mastectomy specimens revealed nuclear enlargement, nuclear shrinkage, necrosis, vacuolation of nucleus, vacuolation of cytoplasm, dyscohesion, and shrinkage of tumor cells with nuclear changes of nonviability like karyorrhexis, karyolysis, and pyknosis. Stromal reactions manifested as fibrosis, elastosis, collagenization, hyalinization, microcalcification, and neovascularization. Areas of necrosis included both vascular and avascular pattern. The stroma also revealed fibrinoid necrosis and mucinous change. Hyalinization of the blood vessel wall was a common finding. The most common inflammatory host response observed in the present study was lymphocytic; others included mixed inflammation, plasmacytic, prominent histiocytic, and giant cell types. Giant cell reaction was significantly correlated to all types of tumor responses (P < 0.05). Similar changes were also observed in other malignancies. A detailed review of the literature has also been done and presented.Conclusion:The tumor grade decreases and differentiation improves, in addition to the retrogressive changes and increase in stromal component, as a result of chemotherapy in carcinoma breast as well as in other malignancies.

Pseudo-Alcoholic Cirrhosis: An Interesting Case Of Amiodarone Induced Hepatotoxicity.

Amiodarone is a commonly used antiarrhythmic drug in clinical practice, despite its notoriety for causing serious adverse effects. Long-term therapy, even at low doses poses great risks to the patient. We report a case of amiodarone induced hepatotoxicity. BACKGROUND Amiodarone is a commonly used antiarrhythmic drug in clinical practice, despite its notoriety for causing serious adverse effects. Long-term therapy, even at low doses poses great risks to the patient. CASE REPORT A 77-year-old female presented with increasing abdominal distension, weakness, nausea and vomiting, lethargy and confusion. Medical history was pertinent for atrial fibrillation, treated with amiodarone 200 mg daily for four years. Patient was known to have mildly elevated liver transaminases (less than 2 times of upper limit of normal) that were monitored by semi-annual transaminases. Physical exam was remarkable for fluctuating levels of mental status, asterixis, irregular heart rhythm, abdominal distension with a positive fluid thrill. Lab studies showed Hb-11.5, platelets-112, AST-192, ALT-162, ALK PHOS-122, reversal of albumin-globulin ratio, and prolonged prothrombin time. Abdominal paracentesis revealed transudative ascites with a high serum-ascites albumin gradient. Further work up revealed negative serology for ANA, anti-smith antibody, hepatitis A, B and C virus panel, normal alpha-1 antitrypsin and ferritin levels. A transjugular needle biopsy of the liver revealed mixed inflammation with neutrophilic satellitosis, numerous Mallory hyaline bodies (figure 1), and foam cells likely representing phospholipidosis (figure 2). The wedge hepatic pressure was 40 mmHg, free hepatic pressure was 23 mmHg, and gradient was 17 mmHg consistent with portal hypertension. The hepatic and portal venous structures were patent. Figure 1 Figure 1: Tranjugular Liver biopsy showing hepatitis with Mallory’s hyaline (arrow ) and minimal macrovesicular steatosis.

A Case of Enzootic Nasal Adenocarcinoma in a Ewe

An approximately 2-year-old open Suffolk ewe presented to the North Carolina State University College of Veterinary Medicine Veterinary Health Complex for evaluation of a left nasal mass. An ultrasound-guided aspirate and core biopsies were performed. An epithelial neoplasia with mild mixed inflammation (neutrophils and plasma cells) was diagnosed on cytology and confirmed on histopathology. Immunohistochemistry (IHC), reverse transcriptase polymerase chain reaction (RT-PCR), and transmission electron microscopy were also performed. IHC and RT-PCR identified the presence of enzootic nasal tumor virus and confirmed the final diagnosis of enzootic nasal adenocarcinoma.

Severe Acute Colitis in an HIV-Positive Man Caused by Shigella flexneri

A 34-year-old human immunodeficiency virus-positive homosexual male presented with a 2-day history of worsening severe diarrhea and abdominal pain, fever, confusion, renal failure, and cardiovascular collapse. A computed tomographic scan showed edema and thickening of the entire colon, and a colectomy was performed. Gross and histologic findings of a diffusely edematous colon with mucosa showing preserved architecture, mixed inflammation in the lamina propria, attenuation and neutrophil invasion of the surface and upper gland epithelium, mucin depletion, patchy erosions, and luminal exudates were characteristic of an acute infectious colitis. Shigella flexneri was isolated from stool. Although more commonly seen in 2- to 10-year-olds and in developing countries, shigellosis is endemic in industrial countries and among adult homosexual males. Clinical manifestations are more severe in immunocompromised patients. Histologic findings are nonspecific but allow easy differentiation from idiopathic inflammatory bowel disease. Stool culture is essential to distinguish Shigella from other enteric pathogens that cause similar histologic changes and to select appropriate antibiotics.

Bupivacaine Induced Hepatotoxicity after Continuous Infusion for Pain Control

Purpose: Background: Bupivacaine is increasingly used as a local anesthetic. Hepatotoxicity from this medication is not well recognized. We present a case report of drug-induced liver injury from bupivacaine use. Case: 51 year old white male without a significant PMH except dyslipidemia was admitted to the hospital for an elective hernia repair with mesh placement. Prior to hospital admission he was taking simvastatin 20 mg for about 10 years without clinical or laboratory side effects. He denied alcohol use. On admission, complete blood cell count, basic metabolic panel and liver function tests were within normal range. A Q-pump with continuous bupivacaine infusion was placed at the site of surgery and continued for 3 days to control pain. A total dose of 770 mg was received. After discharge, the patient experienced dizziness, diaphoresis and hypotension. Symptoms resolved after the Q-pump was stopped. Ten days after, he presents with increasing fatigue, pruritus, dark urine and acholic stools. CBC and LFTs were abnormal (Table). Simvastatin was discontinued. Liver ultrasound and CT scan plus serologic markers for acute viral hepatitis were negative. Symptoms and LFTs continued to worsen (Table). Additional work up for chronic liver disease was negative. A liver biopsy showed mild mixed portal inflammation, low grade ductular reaction, hepatocanalicular cholestasis and mild portal and periportal fibrosis. Repeat LFTs returned to normal at 7 weeks and symptoms resolved. Discussion: Bupivacaine hydrochloride is a local anesthetic, increasingly used in ambulatory operative anesthesia and in the treatment of chronic pain due to low incidence of transient neurological syndrome and improved analgesic effect. It is metabolized in the liver via conjugation with glucuronic acid. We present a case of bupivacaine induced hepatotoxicity based on the temporal association of symptoms with the introduction of bupivacaine, the exclusion of other risk factors for hepatotoxicity, and the improvement with withdrawal of the medication. Lack of laboratory or clinical side effects to simvastatin prior to surgery and the laboratory pattern of cholestatic hepatitis makes simvastatin an unlikely cause of this liver injury. Development of dizziness, hypotension and esoinophilia suggest an allergic mechanism. Local infiltration of the medication in the wound area may explain its prolonged toxicity. Competitive inhibition of CYP3A4 may account for bupivacaine-simvastatin interaction and enhanced toxicity. A previous case report of cholestatic hepatitis from continuous epidural block with bupivacaine suggest that bupivacaine causes cholestatic hepatitis pattern of liver injury when used locally and epidurally.Table 1: Liver function test at 3 weeks and 4 weeks post bupivacaine infusion

The effects of rosuvastatin alone or in combination with fenofibrate or omega 3 fatty acids on inflammation and oxidative stress in patients with mixed dyslipidemia

Objective:Mixed dyslipidemia, oxidative stress and inflammation are related to a high risk for cardiovascular events. The aim of this open-label randomized study was to compare the effects of high-dose rosuvastatin, low-dose rosuvastatin plus fenofibrate and low-dose rosuvastatin plus omega 3 fatty acids on inflammation and oxidative stress indices in patients with mixed dyslipidemia.Methods:Ninety patients with mixed dyslipidemia participated in the study. Patients were randomly allocated to receive rosuvastatin 40 mg (n = 30, group R), rosuvastatin 10 mg plus fenofibrate 200 mg (n = 30, group RF) or rosuvastatin 10 mg plus omega 3 fatty acids 2 g daily (n = 30, group RΩ). Plasma and high-density lipoprotein (HDL)-associated lipoprotein-associated phospholipase A2 (LpPLA2) activities, high-sensitivity C reactive protein (hsCRP), plasma isoprostane and paraoxonase (PON1) activities were measured at baseline and after 3 months of treatment.Results:Serum concentrations of non-HDL cholesterol and low-density lipoprotein cholesterol (LDL-C) were significantly reduced in all study groups. However, these changes were more pronounced in the rosuvastatin monotherapy group. In all treatment groups a significant reduction in total plasma LpPLA2 activity was observed (by 41, 38 and 30% for groups R, RF and RΩ, respectively). This decrease was greater in the R and RF groups compared with the RΩ combination (p < 0.05). HDL-LpPLA2 activity was increased more in the RF group (+43%) compared with the R and RΩ groups (+ 18% and + 35%, respectively; p < 0.05 for both comparisons). In all treatment groups there was a nonsignificant reduction in plasma 8-iso-PGF2α levels. A 53% reduction of hsCRP levels was observed in the R group, while in the RF and RΩ groups the reduction was 28 and 23%, respectively (p < 0.05 and p < 0.01 for the comparisons of group R with groups RF and RΩ, respectively). No significant changes were observed in PON activities in all treatment groups.Conclusion:The greater non-HDL-C- and LDL-C-lowering efficiency of rosuvastatin monotherapy along with its more potent effect on LpPLA2 activity and hsCRP levels indicate that this regimen is a better treatment option for patients with mixed dyslipidemia.

Effects of Fibrin, Thrombin, and Blood on Breast Capsule Formation in a Preclinical Model

The root cause of capsular contracture (CC) associated with breast implants is unknown. Recent evidence points to the possible role of fibrin and bacteria in CC formation. The authors sought to determine whether fibrin, thrombin, and blood modulated the histological and microbiological outcomes of breast implant capsule formation in a rabbit model. The authors carried out a case-control study to assess the influence of fibrin, thrombin, and blood on capsule wound healing in a rabbit model. Eighteen New Zealand white rabbits received four tissue expanders. One expander acted as a control, whereas the other expander pockets received one of the following: fibrin glue, rabbit blood, or thrombin sealant. Intracapsular pressure/volume curves were compared among the groups, and histological and microbiological evaluations were performed (capsules, tissue expanders, rabbit skin, and air). The rabbits were euthanized at two or four weeks. At four weeks, the fibrin and thrombin expanders demonstrated significantly decreased intracapsular pressure compared to the control group. In the control and fibrin groups, mixed inflammation correlated with decreased intracapsular pressure, whereas mononuclear inflammation correlated with increased intracapsular pressure. The predominant isolate in the capsules, tissue expanders, and rabbit skin was coagulase-negative staphylococci. For fibrin and thrombin, both cultures that showed an organism other than staphylococci and cultures that were negative were associated with decreased intracapsular pressure, whereas cultures positive for staphylococci were associated with increased intracapsular pressure. Fibrin application during breast implantation may reduce rates of CC, but the presence of staphylococci is associated with increased capsule pressure even in the presence of fibrin, so care should be taken to avoid bacterial contamination.

Storage alters feline bronchoalveolar lavage fluid cytological analysis

Bronchoalveolar lavage fluid (BALF) collection is a valuable respiratory diagnostic procedure in cats. This study evaluated effects of BALF storage on total nucleated cell counts (TNCCs) and differential cell counts (DCC), cell morphology, and cytological diagnosis. Forty-five research cats with neutrophilic, eosinophilic, and mixed inflammation, and healthy controls were enrolled. BALF samples were processed within 1h (baseline) or stored at 4°C (4C24) or room temperature (RT24) for 24h, or 4°C (4C48) or room temperature (RT48) for 48h before processing. Stored BALF at RT48 had decreased TNCC compared to baseline. The RT24 and RT48 samples had greater eosinophil % and the RT24, 4C48, and RT48 samples had decreased neutrophil % compared with baseline. Cellular morphology deteriorated in all stored samples. Storage resulted in a change in cytological diagnosis in up to 57% of stored samples. We conclude that cytological analysis of BALF in cats should be performed promptly for optimal results.

Canine bronchomalacia: A clinicopathological study of 18 cases diagnosed by endoscopy

Canine bronchomalacia (BM) is characterized by weakness leading to collapse of the bronchial wall. A prospective study of 18 affected dogs (age range: 1-15 years) was undertaken to characterize the clinicopathological and histological features of BM. Poodles and Yorkshire terriers were commonly affected. Half of the dogs were overweight or obese. The clinical presentation was a mild, wheezing, chronic cough and pulmonary crackles were heard in 28% of the dogs. Compatible radiographic changes were present in 61% of the dogs. Using bronchoscopy, both lungs were affected in half of the animals, whereas in the others the disease appeared to affect predominantly the left lung. Analysis of bronchoalveolar lavage fluid and biopsies of bronchial mucosa revealed pure or mixed neutrophilic inflammation. Underlying infectious bronchitis was considered possible in 56% of the dogs. It was concluded that canine BM may present as an isolated clinical entity associated with infection and/or inflammation.

Cutaneous non-tuberculous Mycobacterial infections: a clinical and histopathological study of 17 cases from Lebanon

Only a few studies characterized cutaneous non-tuberculous Mycobacterium (NTM) infections in this region of the world. Objective The aim of this study was to describe the epidemiological, clinical and histological findings of cutaneous NTM infections in Lebanon. Retrospective study of 17 patients (19 histological specimens) diagnosed with cutaneous NTM infections and confirmed by culture-based partial sequencing of the 16S rRNA gene at the American University of Beirut Medical Center between 2005 and 2008. Of 17 cases, 14 were caused by Mycobacterium marinum. All patients were immunocompetent except for one. Clinically, the most common presentation was multiple sporotrichoid lesions over an extremity (8/17). Many patients had peculiar presentations including bruise-like patches, herpetiform lesions, annular ulcerated plaques, symmetrical nodules over the buttocks and locally disseminated lesions with surrounding pale halo. Almost all patients cleared their infection on either minocycline or clarithromycin monotherapies. Histologically, a dermal small vessel proliferation with mixed inflammation (granulation tissue-like changes) was identified in 58% of specimens. The most common type of granulomatous inflammation was the suppurative (47%) followed by the tuberculoid (30%), sarcoidal (11%), and palisading (5%) types. Lichenoid granulomatous dermatitis was noted in 42% of cases. Special staining highlighted mycobacteria in only two specimens. The incidence of cutaneous NTM infections is high in our area. Many patients had peculiar clinical presentations. Our study is the second to report the common presence of granulation tissue-like changes as a good histological indicator of cutaneous NTM infections. Minocycline and clarithromycin remain the drugs of choice in our area.

Morphologic Findings in Upper Gastrointestinal Biopsies of Patients With Ulcerative Colitis

Upper gastrointestinal involvement, both gastric and duodenal, is known to occur in both Crohn disease and ulcerative colitis (UC). However, the frequency and types of inflammation in upper gastrointestinal biopsies in patients with UC has not been well studied, especially in a controlled study. Twenty-four esophageal, 59 gastric, and 40 duodenal biopsies from 69 UC patients were reviewed. These were compared with 35 esophageal, 66 gastric, and 46 duodenal biopsies from a control group of 97 consecutive patients of similar age and sex distribution. The pattern and extent of inflammation were noted in each biopsy. There were 3 types of gastric inflammation that occurred more in UC patients than in controls, and the differences were statistically significant. The most common was an intense focal gastritis, present in 29% of UC gastric biospies, compared with 9% of controls. Twenty-two percent of UC patients had a basal mixed inflammation compared with 8% of controls, and 20% of the UC patients had superficial plasmacytosis compared with 6% of controls. There were no esophageal inflammations that occurred more commonly in UC than controls. Four UC patients and no controls had diffuse chronic duodenitis, also a statistically significant difference. All 4 UC-duodenitis patients were among the 10 with previous colectomies, and all 4 patients had pouchitis. Only 1 of the 4 UC-colectomy patients without duodenitis developed pouchitis. Most UC patients have no upper gastrointestinal inflammation in biopsies, and most of the inflammations they have are not unique. The most common upper gastrointestinal inflammatory pattern in patients with UC is focal gastritis, followed by gastric basal mixed inflammation and superficial plasmacytosis. The one unique upper gastrointestinal inflammation in UC patients is diffuse chronic duodenitis, present in 10% of patients who had duodenal biopsies, and in 40% of UC patients who had colectomy and all of these patients had pouchitis. This association strongly suggests that diffuse chronic duodenitis in UC patients who have colectomy is a strong predictor of pouchitis.

Fibrosarcoma arising at the site of a retained surgical sponge in a cat

An 8-year-old female spayed domestic shorthair cat had an abdominal mass palpated as an incidental finding on physical examination. Cytologic findings in ultrasound-guided fine-needle aspirates of the mass were most compatible with a sarcoma, with abundant mineralized material and mixed inflammation. The mass was removed surgically and on gross examination was white-tan, firm, associated with the mesentery, and when transected contained a gauze sponge in its center. On histopathologic examination, an area of central necrosis with mineralization and numerous refractile fibers consistent with sponge material was surrounded by dense fibrous connective tissue (gossypiboma). Within the connective tissue was a population of highly pleomorphic spindle cells consistent with a fibrosarcoma. Immunohistochemically, most neoplastic cells stained strongly positive for vimentin and a low number of cells were positive for smooth muscle actin. The results were consistent with a fibrosarcoma arising at the site of a retained surgical sponge. At a follow-up visit 2 months postoperatively, ultrasonographic and cytologic evidence of metastasis was found in the spleen and mesentery. To our knowledge, this is the first report of malignant transformation at the site of a retained surgical sponge in a cat and the first report of a fibrosarcoma arising within a gossypiboma in a domestic animal.

Abstract 1677: Epithelial hyperplasia induced by a selective B-Raf inhibitor, WYE-130600

Abstract The Raf-MEK-ERK signaling pathway is critical for cell survival, growth, proliferation and tumorigenesis. The RAF kinases, ARAF, BRAF and CRAF, are essential signaling serine-threonine kinase proteins in the cascade. B-Raf mutations are frequent in human cancers suggesting small molecule B-Raf kinase inhibitors represent potential therapeutics for treatment of various cancers. The tolerability and limited safety of WYE-130600, a potent and highly selective inhibitor of B-Raf, was evaluated in investigative preclinical studies in dogs and rats. In dogs, a single dose of 10 mg/kg or 4 daily doses of 1 or 3 mg/kg WYE-130600 were administered orally, followed by a 7 day drug-free observation period after the last dose at 1 mg/kg. Clinical observations, body weight, food consumption, plasma concentrations, and clinical pathology were assessed at each dosage; limited microscopic examinations were conducted at 1 and 3 mg/kg. Dose-related dermal effects were observed at all dosages and progressed in severity; described as red discoloration (flushing) of the entire body, followed by swelling and subsequent dryness and desquamation of the dermis of the ears, eyelids, muzzle, prepuce, and anus. Alterations in clinical pathology parameters (increased neutrophils, monocytes and fibrinogen) consistent with an inflammatory response were observed. Microscopic cutaneous changes correlating to the clinical WYE-130600-related dermal effects included epidermal and hair follicle hyperplasia, hyperkeratosis, squamous metaplasia of the sebaceous glands, mixed cell inflammation and prominent dermal vessels in the haired skin. Partial recovery was evident at 1 mg/kg at the end of the 7-day observation period, when microscopic changes were limited to epithelial hyperplasia and mixed cell inflammation in the skin. In rats, WYE-130600 was administered orally at dosages of 15, 50 and 150 mg/kg, once daily for 4 days, followed by a 5-day observation period after the last dose. Evaluations for compound-related effects were based on clinical observations, body weight, food consumption and limited microscopic examinations. Clinical dermal effects at ≥50 mg/kg were limited to the skin of the feet. At 150 mg/kg, red discoloration of the skin of the feet progressed, as was noted in the dog, to swelling and a dry, scaly appearance. At 50 mg/kg, only dry, scaly skin of the feet were noted. Microscopically, epithelial hyperplasia and hyperkeratosis with mixed cell inflammation of the foot pads correlated with the clinical presentation. Atrophy of the hair follicles of the skin and inflammation/ hyperplasia of the nonglandular stomach were also noted at 150 mg/kg. In summary, epithelial hyperplasia occurred in rats and dogs and was attributed to this selective B-Raf inhibitor. The commonality of this lesion in both species suggests a potential for similar effects in humans. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1677.

Protective effects of the Alisma orientalis extract on the experimental nonalcoholic fatty liver disease

The aim of this investigation was to evaluate the efficacy of Alisma orientalis methanolic extract (AOME) on the experimental nonalcoholic fatty liver disease (NAFLD) induced by high-fat diet. Rats were fed with high-fat diet for six weeks and then gavaged the AOME for another six weeks. Typical pathological symptoms of NAFLD occurred in the high-fat diet rats. Administration with the AOME (150,300 and 600 mg kg (-1)) markedly decreased the serum and liver lipids; the high level of fasting serum glucose was reduced and insulin resistance was improved. The AOME treatment was also helpful in preventing the oxidative stress by lessening lipid peroxidation and activating antioxidant enzymes. Markers of the liver injury, aminotransferase abnormalities and hepatomegaly were improved and morphological changes, such as liver steatosis, mixed inflammation and collagen deposition, were lessened in rats treated with the AOME. These results suggested that the AOME showed hepatoprotective effects on NAFLD and may be a potential clinical application for treatment of this chronic liver disease.

Atypical Dermatophilus Congolensis Infection in a Three-Year-Old Pony

Dermatophilosis caused by Dermatophilus congolensis causes exudative dermatitis in a variety of species. The infection is generally limited to the cutaneous tissues, where infection is acquired from the environment and bacteria penetrate into keratinized epithelium through epithelial disruption. A 3-year-old pony filly was examined for enlarging mandibular lymph nodes during the preceding 10 months. Biopsy of the node revealed mixed and granulomatous inflammation and thick, filamentous Gram-positive bacteria. Dermatophilus congolensis, confirmed by biochemical testing and sequencing of the ribosomal RNA gene, was cultured from a sample aspirated from the infected site. Dermatophilus congolensis should be considered as a possible etiologic agent associated with lymphadenopathy and granulomatous inflammation in the horse.

A Case of Esophageal Crohnʼs Disease

Purpose: A 60 year old female presented with a 3 week history of dysphagia and odynophagia preceded by abdominal cramping, non-bloody diarrhea, and a 30 pound weight loss. She had no significant past history of diarrhea or family history of IBD. Her physical exam was notable for oral apthous ulcers and lower abdominal tenderness. Admission labs: WBC 10.9, Hb 10.0, CRP 11.4, Alb 2.8 and normal TTG. Abdominal CT showed noncontinous wall thickening involving the colon. Stool studies were negative. Endoscopy revealed multiple, discrete, superficial, non-bleeding ulcers with raised margins seen in the mid and lower esophagus. Stomach and duodenal exam was normal. Histopathology of the esophagus showed ulceration, granulation tissue with mixed inflammation without granulomas. Viral cultures for HSV and CMV were negative. Colonoscopy to the TI was notable for multiple, deep, irregular ulcers from the rectum to ascending colon with intervening normal appearing mucosa. Colonic biopsies showed ulceration with mixed inflammation and cryptitis. A diagnosis of Crohn's disease (CD) was made. The patient responded to IV steroids. After discharge on a prednisone taper, mesalamine and a PPI, she had significant improvement. On follow-up she was placed on 6-MP 50mg/d and has remained in remission. CD involving the esophagus is rare (incidence 0.3-2%). The diagnosis is made by the presence of esophageal symptoms, endoscopy, histologic findings, and co-existing extra-esophageal disease. Symptoms include dysphagia, odynophagia, heartburn, and apthous ulcers. There are no pathonomonic findings on EGD or histology. Endoscopy may show inflammatory, stricturing or fistulizing changes. The lower esophagus is most commonly involved. Histologic findings include an acute and/or chronic inflammation and a lymphocytic infiltrate in the lamina propria. Granulomas may not be present. Therapies include steroids, 5-ASA's, PPI's, biologics, 6-MP and rarely surgery. This case illustrates that diagnosing CD of the esophagus often requires a high index of suspicion when both esophageal and lower GI tract symptoms are present.Figure: Endoscopy showing ulcerations in the mid-esophagus.

An outbreak of Mycobacterium chelonae infections in tattoos

Nontuberculous mycobacteria infections may occur after cutaneous procedures. Review of the medical records of patients who developed a rash within a tattoo revealed 6 patients with skin infections caused by Mycobacterium chelonae after receiving tattoos by one artist at a single tattoo establishment. The interval between tattoo placement and the skin findings was 1 to 2 weeks. All patients received alternate diagnoses before mycobacterial infection was identified. Skin findings included pink, red, or purple papules; papules with scale; pustules; granulomatous papules; and lichenoid papules and plaques. Histopathologic examination revealed granuloma, lymphohistiocytic infiltrate, or mixed inflammation; acid-fast bacilli stains produced negative results. Diagnosis was made by culture in 3 patients, histopathology in two patients, and clinical/epidemiologic association in one patient. The M chelonae isolates were clarithromycin susceptible, and the infections responded to macrolide antibiotics. Physicians should consider mycobacterial infections in patients with skin findings within a new tattoo.