Mucopurulent Exudate Research Articles

Infections of reproductive organs in female rabbits

Symptomatic infertility is a temporary or permanent disturbance in reproductive function wherein the animal cannot become pregnant due to diseases of genital organs or systemic diseases. Since female rabbits, due to their precociousness and fertility, are often used for reproduction, the leading causes of symptomatic infertility in them are the absence of estrous cycles or their deficiency and inflammation of tissues of the reproductive system. Infertility is observed in female rabbits developing such infectious diseases as pasteurellosis, spirochetosis, and myxomatosis. It is due to these diseases that obstetric and gynecological pathology (vulvitis, vulvovaginitis, metritis, pyometra, mastitis), long-term infertility, and death of animals are recorded most often. External genitalia (vulva) and mammary glands are the main routes of infection in female rabbits. The most common microorganisms causing inflammatory processes in reproductive organs are non-specific, such as Staphylococcus and Pasteurella, and specific microbes, such as toxoplasma. Spirochetes, Listeria, and Salmonella are much less common. It has been found that on farms of different forms of ownership in the Dnipropetrovsk region, the most common infectious diseases in rabbits are myxomatosis (20 %), viral hemorrhagic disease (13 %), eimeriosis (30 %), pasarulosis (10 %), and spirochetosis (10 %). Inflammation of genital tissues, especially inflammatory processes in the uterus, is the most common disease in female rabbits. The general frequency of uterine diseases increases with age, reaching more than 50% in aged female rabbits. Endometritis was the most frequent inflammatory process diagnosed in 10 % of cases and was potentially purulent, catarrhal, lymphoplasmacytic, or enterohemorrhagic. Metritis was observed in 5 % of cases and pyometra in 3 %. Autopsy of forcibly slaughtered or dead animals revealed such uterine diseases as hydrometer and mucometer. Hydrometers and mucometers comprised 8 % of uterine diseases, and the average age of sick female rabbits was 3 years. The etiology remains unclear but is potentially related to endometrial hyperplasia or endometritis. However, in some cases, no underlying uterine disease was found. During acute infection of the organs of the reproductive system of female rabbits, a serous mucocatarrhal or mucopurulent exudate is released from the genital slit. Chronic inflammatory processes of the genital organs often occur without signs of disease or are manifested by decreased fertility or abortion.

A Case of Bilateral Conjunctivitis in a Seven-Year-Old Shih-Tzu Dog

Background: Conjunctivitis is an inflammation of the conjunctiva that is common in dog, which also known as pink eyes. Conjunctivitis can be caused by infectious agents such as bacteria, chlamydia, and virus, and can also be induced by allergies or due to trauma. Bilateral infection may indicate they are caused by an infectious agent or allergy. Purpose: This study aims to provide veterinarians with insight into the treatment of conjunctivitis cases and the factors that hinder therapy. Case: A seven-year-old female Shih-Tzu dog has had eye problems for six months since April 2023. Physical examination revealed redness in the left and right eyes with mucopurulent exudate. Laboratory examination using an impression smear followed by cytology confirmed inflammation in the eye with many neutrophil cells and coccus-shaped bacteria. The dog was diagnosed with bacterial conjunctivitis with a good prognosis. Case Management: The therapy consisted of the administration of topical antibiotics in the form of Erlamycetin plus® (chloramphenicol and dexamethasone) eye drops for five days, followed by Erlamycetin® (chloramphenicol) eye ointment. Conclusion: After 12 days of therapy, there was no redness in the dog’s eyes and only a small amount of exudate was observed. However, on day 14, the owner reported that exudates were observed in the dog’s eyes. The therapy resulted in improvements but was not optimal because the owner did not consistently follow the recommendations.

Diagnosis and treatment of the otitis externa and media

Diagnosis and treatment of the otitis externa and media

Nadir Bir Kanlı Dışkılama Nedeni: Bir Olgu Sunumu

Tuberculosis, which is mainly caused by the mammalian tubercle bacilli, Mycobacterium tuberculosis complex, is life-threatening disease transmitted from human-tohuman via the airborne route. Gastrointestinal tract (GIT) tuberculosis is usually caused by swallowing infected sputum or spread of bacilli smears to the GIT. A 36-year-old male patient presented to our outpatient clinic with a one-year history of weight loss, abdominal pain, nausea, and bloody stools for the past three months. Colonoscopy revealed giant and mucopurulent exudates in the cecum, ileocecal valve, and ileum. On histopathological examination, both ileum and ascending colon biopsies showed multiple granuloma formations with caseous necrosis and multinuclear giant cells. The Ehrlich-Ziehl-Neelsen histochemical staining revealed multiple foci of acid-fast bacilli compatible with Mycobacterium tuberculosis. Chest X-ray showed bilateral infiltration of the upper zones. Acid-resistant bacilli were positive in the sputum smear test. The patient was diagnosed with GIT and pulmonary tuberculosis and appropriate treatment was initiated. This rare case highlights the importance of accurate diagnosis of tuberculosis and delayed diagnosis can cause the bacteria to infect other organs through blood, lymphatic system, or direct spread.

​Pathomorphological, Haemato-biochemical and Diagnostic Imaging Studies in Canine Pyometra

Background: Pyometra is the most common genital affections observed in bitches around the globe in-spite of advancement of disease diagnosis and treatment. Paucity of available literature regarding pyometra in canines in Odisha prompted to undertake an in-depth analysis on determinants linked to epidemiology, haemato-biochemical, clinicopathological and diagnostic imaging in pyometra bitches. Methods: During the period 2019-20, a total of 148 bitches were screened for canine pyometra in and around Bhubaneswar, Odisha on the basis of clinical signs, haematology and diagnostic imaging. Uterus was collected after ovario-hysterectomy and processed for histopathology through routine haematoxylin and eosin staining. Result: The overall incidence of pyometra was 15.54% with 4% mortality rate. Present study recorded a significant higher occurrence of pyometra in older bitches ( greater than 7 year, 78.26%), smaller breeds like Spitz (47.82%), nulliparous bitches (60.86%) and dogs in dioestrus stage (82.60%). Haematological examinations revealed anaemia with marked leucocytosis and neutrophilia. There was significant increase in AST, ALT, ALP and BUN concentrations in affected bitches. Enlarged uterus with hypo echoic tubular structures containing mostly echogenic fluids were constant findings through ultrasonography. Flabby uterine horns with thick and corrugated endometrial wall containing profuse mucopurulent exudates were seen during necropsy. Chronic inflammatory response leading to intense haemorrhages and hyperaemia were constant microscopic changes. The most common isolated pathogen in canine pyometra was Escherechia coli (67.5%).

Occurrence and Pathology of Fatal Oesophageal Spirocercosis in a Doberman Dog

Spirocercosis is an important disease affecting primarily the domestic and wild canines. The disease is caused by the nematode, Spirocerca lupi. The parasites are potentially lethal and live inside nodules formed within the oesophageal wall of dogs. This study reports the findings observed during the necropsy conducted on the carcass of a ten year old female Doberman dog at the Department of Veterinary Pathology, KNP College of Veterinary Science, Shirwal. The dog had a history of anorexia and vomition and was treated for gastritis by the local veterinarian before it succumbed. Systemic necropsy revealed a large esophageal tumour like nodule at the distal oesophageal wall. The inner cavity of the nodule had six, 2 cm to 6 cm long reddish spirally coiled nematodes embedded in muco-purulent exudate. Histopathology of the nodule showed the presence of an inflammatory reaction consisting mostly of plasma cells and hemosiderin laden macrophages. The nematodes were identified as S. lupi based on its morphological characteristics.

Bacterial laryngotracheobronchitis as one cause of airway obstruction in older children

Laryngitis, tracheitis and bronchitis is a common, usually self-limiting viral infection. Bacterial laryngitis, tracheitis and bronchitis is caused by secondary bacterial infection of a viral laryngeal infection leading to a mucopurulent exudate that can cause acute upper airway obstruction and eventually lead to a life-threatening condition. Bacterial tracheitis should be considered in the differential diagnosis of any child with acute upper airway obstruction. This diagnosis should also be considered in any child with viral croup that does not respond to conventional treatment. The correct way to definitively diagnose bacterial tracheitis is by direct visualisation of the trachea by bronchoscopy, but this may not be necessary in all cases. Management includes close observation and monitoring, early initiation of broad-spectrum antibiotics, pain management, and clearing the airways of lingering secretions. The decision to secure an airway by intubation or tracheotomy should be made on an individual basis depending on the severity of symptoms and the patient’s condition. If diagnosed early and treated properly, complete recovery can be expected. We present two patients diagnosed with laryngotracheobronchitis, in whom a correct diagnosis allowed successful recovery.

EQUINE UNILATERAL HETEROTOPIC POLYODONTIA: A CASE REPORT

Heterotopic polyodontia have been described in most domestic species and human. Known as a dentigerous cyst but appropriately called heterotopic polyiodontics, it rarely occurs in horses, however it is easily recognized as a congenital defect. The cysts usually associated with this condition contain part or all of dental structures. The heterotopic tooth or dental structure is usually adhered to the temporal bone and surrounded by a secretory membrane, with a accumulation of exudate and draining tract along the proximal pinna or directly over the cyst. This case report describes in a 2.5-year-old female quarter horse, weighing 430 kg, with a heterotopic polyodontia that contained two easily small’s identifiable dental structures, presented for evaluation of a chronic intermittent mucopurulent exudate discharge from the right sub-auricular region in the mastoid process of the temporal bone and a drainage tract near the right pinna. The diagnosis is established with clinical, radiographic, ultrasound and confirmed by histopathological examination of the structures removed. The cystic capsule was surgically removed, measuring approximately 3.0 x 2.3 cm in diameter, filled with mucopurulent exudate and containing two dental structures within 0.5 cm in diameter and 0.2 cm in diameter. Microscopic examination revealed a cystic area covered by stratified squamous epithelium with a lympho-histio-plasmatic cell infiltrate in the dermis, which was compatible with heterotopic polyodontia. Postoperatively, there were no neuromotor sequelae and wound healing evolved positively.

A Case Report of Cervicitis Gonorrhea

Background: Gonorrhea refers to a set of clinical conditions involving infection with the sexually acquired bacterial pathogen, Neisseria gonorrhoeae. One of the simplest gonococcal infections in women involves mucosal surfaces of the endocervix that cause cervicitis, a frequently asymptomatic inflammatory condition that results in an abnormal mucopurulent discharge and cervical friability. Purpose: To report a case of cervicitis gonorrhea in a female patient whose sexual partner had a hisstory of unprotected promiscuous intercource with multiple sex worker. Case: A 24-year-old female patient presented with increased vaginal discharge for 4 days. Her husband had a history of having sexual intercourse with a sex worker 8 days before. Physical examination revealed mucopurulent exudate in the genitalia and endocervical canal. The Gram staining showed numerous leucocytes and Gram-negative intracellular diplococci, while the result of polymerase chain reaction (PCR) examination for Chlamydia trachomatis was negative. The patient was treated with single-dose cefixime 400 mg orally and doxycycline 100 mg orally twice a day for 7 days. Discussion: The present case report showed cervicitis gonorrhea co-infected with a nonspecific genital infection that was felt asymptomatic and unintentionally found when the patient accompanied her husband to Sexually Transmitted Infection (STI) clinic. The presumptive treatment of cervicitis directed against N. gonorrhoeae and C. trachomatis in this patient leads to a complete cure of the disease. Conclusion: It is important to treat the sexual partner of a patient with urethritis gonorrhea. The empiric treatment of cervicitis that is directed against N. gonorrhoeae and also against C. trachomatis is mandatory in preventing further possible complications.

36-YEAR-OLD MAN WITH ACUTE INFLUENZA AND SECONDARY BACTERIAL PNEUMONIA COMPLICATED BY HERPES VIRUS INFECTION

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Herpes Simplex Virus (HSV) pneumonia is rare in immunocompetent individuals. It has been described in young to middle aged patients with flu-like symptoms [1]. It should be suspected in patients with clinical deterioration despite antimicrobial therapy [2]. Diagnosis is made by PCR, culture, cytopathology and response to acyclovir therapy. Active infection is controversial since HSV-1 is commonly identified in the respiratory tract mucosa of critically ill patients [1-3]. CASE PRESENTATION: Patient is a 36 year-old male with history of bronchial asthma presented to an outside hospital with acute onset dyspnea, productive cough and worsening of hemoptysis for one week prior to admission. Exposures include sand blasting and cotton processing. He presented with fever, bilateral pulmonary infiltrates, and respiratory failure that required intubation with mechanical ventilation. Multifocal consolidative changes with air bronchograms and ground glass opacities were seen on CT Chest. Influenza A/H1 was diagnosed by PCR and treated with oseltamivir as well as antibacterial antibiotics for superimposed bacterial infection. Initial bronchoscopy with BAL did not show fungal or bacterial growth. Autoimmune panel and HIV were negative. Despite appropriate antibiotic coverage, he failed he failed to improve. On hospital day 7, he developed fever and a rash. His antibiotics were changed to vancomycin and meropenem. Repeat bronchoscopy was performed. Erythematous bronchial mucosa with mucopurulent exudate were seen. BAL cultures were negative for bacteria, fungi or PJP. DFA was positive for HSV1 with a positive viral culture. Antibiotics were discontinued, and he was started on acyclovir. Patient’s ventilator requirements decreased and chest imaging improved. He was successfully extubated on day 16th DISCUSSION: Pathogenic mechanisms for HSV pneumonia include stress induced by mechanical ventilation, systemic inflammation and respiratory distress which contribute to viral reactivation in the lower respiratory tract [1-3]. Chronic lung disease can also be an important factor as illustrated in our case. There are no established diagnostic criteria for HSV pneumonia and guidelines on its treatment with acyclovir are sparse. HSV diagnosis is a challenge, and it should be considered after excluding other infection sources, inflammatory and autoimmune causes. CONCLUSIONS: HSV pneumonia can be suspected in patients with prolonged mechanical ventilation. It requires a high index of suspicion. HSV pneumonia is associated with worse outcomes and longer hospital stays. Reference #1: Ishihara T, Yanagi H, Ozawa H, et al. Case report: Severe herpes simplex virus pneumonia in an elderly, immunocompetent patient. BMJ Case Rep (2018) 18 July 2018: 1- 4. Reference #2: Linssen CF, Jacobs JA, Stelma FF, et al. Herpes simplex virus load in bronchoalveolar lavage fluid is related to poor outcome in critically ill patients. Intensive Care Med 2008;34:2202–9. Reference #3: Simoons-Smit AM, Kraan EM, Beishuizen A, et al. Herpes simplex virus type 1 and respiratory disease in critically-ill patients: Real pathogen or innocent bystander? Clin Microbiol Infect 2006;12:1050–9. DISCLOSURES: No relevant relationships by Mohamed Elmassry, source=Web Response No relevant relationships by John Makram, source=Web Response No relevant relationships by Barbara Mantilla, source=Web Response No relevant relationships by Arunee Motes, source=Web Response No relevant relationships by Victor Test, source=Web Response No relevant relationships by Myrian Vinan Vega, source=Web Response No relevant relationships by Wasawat Vutthikraivit, source=Web Response

Differential expression of endometrial toll-like receptors (TLRs) and antimicrobial peptides (AMPs) in the buffalo (Bubalus bubalis) with endometritis.

Toll like receptors (TLRs) and β-defensins expressed in the endometrium are part of the innate uterine defense mechanism (UDM). In the present study, transcriptional profile of TLRs (1-3, 6-8, 10, and) and β-defensins such as lingual antimicrobial peptide (LAP), tracheal antimicrobial peptide (TAP) and bovine neutrophil beta-defensin 4 (BNBD4) were studied. Bubaline genitalia were collected from abattoir and the endometrium was categorized into one of the following seven groups (n = 7/group) based on cyclicity and endometritis: follicular non-endometritis (FNE), luteal non-endometritis (LNE), follicular cytological endometritis (FCE), luteal cytological endometritis (LCE), follicular purulent endometritis (FPE), luteal purulent endometritis (LPE) and acyclic non-endometritis (ANE). Cytological endometritis (CE) was diagnosed by uterine cytology while purulent endometritis (PE) was diagnosed by the presence of purulent or mucopurulent exudate in the uterine lumen. Real time PCR was performed and the relative fold change was analysed. TLR1 and BNBD4 transcripts were not found in the buffalo endometrium. Of all the innate immune genes studied, upregulation of TLR and β-defensins was mostly contributed by the inflammatory status of endometrium. Further, there was a prominent upregulation of TAP in buffaloes with endometritis. However, no association could be found between the inflammatory status of the endometrium and phase of estrous cycle with respect to the expression of TLRs and β-defensins.

Karakteristik Pasteurella multocida Penyebab Pasteurellosis pada Babi di Kota Kupang Provinsi Nusa Tengggara Timur

The number of commercial pigs in East Nusa Tenggara has grown fast with a population of 1,739,481, and has become more potential. However, the mixed farming model has become one of the factor of potentially high in the transmission of disease-causing pathogenic microorganisms. One of the microorganism is Pasteurella multocida which causes pasteurellosis, has been identified in 25% of slaughtered pigs (Maes et al., 2001). One of the clinical symptom due to pasteurellosis in pigs is the occurrence of bronchopneumonia in pulmo and inflammation in various visceral organs, such as the heart and kidneys. the phenotypic characteristization of this bacteria, will be very helpful in designing a comprehensive prevention and treatment programs of pig pasteurellosis.
 The aim of the research was to determine the characteristics of P. multocida related to pasteurellosis and recording of the disease in Kupang, NTT. This research also find out the phenotipyc characteristics of P. multocida species from pigs and the possibility of transmission among sensitive species.
 A total of 30 swine lung samples of pulmo were obtained from slaughterhouse in Kupang to carry out this study. Pulmo taken from slaughtered pigs that showed clinical respiratoric symptoms such as dyspnoea and the presence of serous to mucopurulent nasal exudates, and the specific lesions of gray hepatization in pulmo. The collected samples were then processed for histopathological and microbiological studies.
 Out of the total 30 sample, 15 samples were found to be suspected for pasteurellosis, and 3 samples were successfully confirmed to be positive for Pasteurella multocida. Varied macroscopic changes showed pathognomonic lesions as multifocal hemorrhage and congestion of the pulmonary lobes. Serous to mucopurulent exudate were found in lumen bronchus. Multi lobes grayed hepatization and multifocal hemorrhage were observed in the pulmo. Histopatologic analysis showed three types of pneumonia that were multifocal suppurative bronchopneumonia with neutrophil infiltration into alveoli and bronchioles; non-suppurative pneumonia as fibrinous bronchopneumonia with severe congestion, and chronic bronchiolitis with infiltration of mononuclear cell and thickening of fibrous tissue on bronchioles. Bacterial culture from the samples showed circular, convex and non hemolytic colony on blood agar base. Gram staining’s showed Gram negative microorganism with coccoid bipolar structure, which are some of the characteristic of the microorganism..
 It was concluded that the samples is having P. multocida infection. Although, some isolate on MacConkey showed lactose fermentation and tolerance to bile salts that were not the nature of the microorganism, isolation and identification from other organs needed to be done, for example from the heart and kidneys, are needed.

A specific laryngeal finding in dogs with bronchial vegetal foreign bodies: a retrospective study of 63 cases.

Grass awns commonly cause respiratory disease in dogs; when located in the trachea or bronchi, they cause severe bronchial inflammation and sepsis. The interplay of cough, bronchoconstriction, and mucus secretion can result in a less effective expulsive cough phase, especially when the causal factor persists. The bronchial exudate could consequently become trapped in the upper respiratory tracts of dogs with bronchial vegetal foreign bodies. We retrospectively reviewed endoscopic findings of the upper respiratory tract in dogs that underwent bronchoscopy in our hospital and correlated these findings with the presence of bronchial grass awns. Muco-purulent exudate in the ventral larynx region, between the vocal cords and laryngeal ventricles, was frequently associated with the presence of bronchial grass awns. This laryngeal finding could be secondary to an altered response to grass awn localization in the bronchi. These results should be carefully considered, particularly in countries where grass awns are commonly found.

Effect of Postural Drainage and Effective Cough After Nebulizer Intervention to in Oxygen Saturation Among Children with Bronchopneumonia

Bronchopneumonia is a disease that occurs at the distal end of the bronchioles, where this portion of the bronchiole is blocked by mucopurulent exudate. One of the main problems of children with bronchopneumonia is an increase in excessive sputum secretion that will affect the process of oxygen exchange, which ultimately can reduce the oxygen saturation in the blood of the patients. The purpose of this study was to determine the differences between postural drainage and effective cough exercises in nebulizer intervention on oxygen saturation changes in children aged 3-5 years with bronchopneumonia. Analytical quasi-experimental study design with pre- and post-test approach among 30 children in a hospital was utilized. Sampling was done with non-probability sampling technique. The methods used were postural drainage and effective cough. The result was analyzed using t-Test. The mean difference in oxygen saturation value in the postural drainage group was higher (4.53 %) than in the effective cough group (3.64 %). Result of unpaired t-Test indicated a p = 0.343. Thus, there is no difference in postural drainage and effective cough exercises in nebulizer intervention to oxygen saturation change in bronchopneumonia. Future studies can be done on the effects of these methods when applied before nebulizer intervention.

Data on the epidemiology and pathology of anatipestifer disease in Hungary (2010-2014).

Anatipestifer disease is a contagious disease caused by Riemerella anatipestifer, affecting primarily ducks, geese and turkeys, and characterised by listlessness, diarrhoea, sneezing, nasal discharge, and nervous signs. Sporadically, it occurs in a wide range of other domesticated and wild birds as well. The incidence and characteristics of the disease seen in the three main host species are summarised based on birds submitted for routine laboratory investigation in Hungary over the period 2010-2014. The infection was diagnosed in a higher percentage in geese (9.9%) and ducks (7.5%). It occurred in 5-day-old to 17-week-old geese and 3- to 6.5-week-old ducks, respectively. The pathological lesions were comparable in these two species: enlarged spleen, serofibrinous pericarditis, perihepatitis, airsacculitis, catarrhal enteritis, subcutaneous oedema and hyperaemia over the cranium, mucopurulent exudate in the nasal cavity and occasionally pneumonia, conjunctivitis, purulent arthritis and caseous salpingitis. In some cases, R. anatipestifer produced only secondary lesions, which complicated other diseases such as circovirus infection, mycotoxicosis, mycoplasmosis, or Derzsy's disease. In turkeys, the disease occurred rarely (0.5%) and at an older age (12 to 19 weeks). The lesions most frequently seen were purulent osteomyelitis of the cranium and seropurulent meningitis. Purulent osteomyelitis in the cranium caused by R. anatipestifer infection had not been reported in turkeys previously. To various extents, other local lesions such as serofibrinous pericarditis, airsacculitis, arthritis, and in one case septicaemia were also observed. The high incidence of the disease in waterfowl underlines the importance of appropriate treatment and prevention that should be based on accurate diagnosis and antimicrobial susceptibility testing, proper biosecurity and vaccination with regard to the serotype(s) present on the farm.

Pyoderma Gangrenosum of the Preauricular Area with Ulcerative Colitis: A Case Report and Review.

Pyoderma gangrenosum (PG) is primarily, a sterile, inflammatory, neutrophilic dermatosis, characterized by recurrent cutaneous ulceration with mucopurulent or hemorrhagic exudate. The incidence of PG is uncertain, but it is estimated to be about 3-10 patients per million per year. It occurs most commonly on the lower legs, but has been reported at other sites of the body as well. The causes of PG are unknown, but about 50-70% of cases are associated with other diseases, mainly inflammatory bowel disease. We hereby report a case of PG in a 21-year-old male, with a history of ulcerative colitis (UC). After appropriate diagnostic methods including biopsy for pathologic confirmation, sigmoidoscopy and computed tomography, we excluded other diseases and the lesion was diagnosed as PG. We then carried out regular dressing of the wound, while UC was treated with steroid and immunosuppressant medication, with inputs from the department of gastroenterology during the hospital stay. There occurred recurrence of the skin lesion, 7 months after discharge, after which they improved. UC has been in the remission state as per the follow-up, since 2 years.

Síndroma de Stevens-Johnson: a importância do reconhecimento pelo médico de família

Introduction: Children are often affected by infectious diseases, not only because their most vulnerable epidemiological context, but also from their immaturity immune system. The rash illnesses are common at this stage of life, imposing to the family physician a high diagnostic difficulty to skin diseases. The purpose of this report is relates the importance of the family physician recognize skin diseases more severe, to behave as dermatologic emergencies. Case description: Female child, five years old without a history of relief. In August 2015, she appealed to general practice by fever, malaise and with two erythematous and ulcerated lower lip injuries. This was seen as chickenpox. Two days later it was complicated by similar lesions on the vaginal mucosa, palpebral edema and bilateral ocular mucopurulent exudates. Because total food refusal, she turned to a private emergency service, where she was hospitalized. Given the lack of improvement, she was transferred to the hospital of her home area three days later, prostrate with multiple aphthous lesions on the oral and vaginal mucosa, dispersed subconjunctival hemorrhages and keratitis. She was admitted to the pediatric service. Given the clinical picture of ulcerative stomatitis, purulent conjunctivitis and vulvoganite, the clinical diagnosis of Stevens-Johnson syndrome was assumed. Comments: Stevens-Johnson syndrome is characterized by a delayed hypersensitivity skin reaction, which affects the skin and mucous membranes. It constitutes a dermatological emergency with high potential for morbidity and mortality, difficult to diagnose in clinical practice of the family physician. Family physician need to pay special attention to the skin lesions or mucous membranes which are associated with drugs, viral infections, cancer or just injuries that concern some degree of suspicion should not be delayed urgent hospital referral.

Anorectal Lymphogranuloma Venereum in Madrid: A Persistent Emerging Problem in Men Who Have Sex With Men.

Since 2003, outbreaks of lymphogranuloma venereum (LGV) with anorectal syndrome have been increasingly recognized in many Western countries. All of them have been classified as LGV serovar L2b, mainly occurring in human immunodeficiency virus (HIV)-infected men who have had sex with men (MSM). We describe a series of 26 diagnosed cases of LGV proctitis in downtown Madrid, Spain, in 2014, after implementing routine diagnostic procedures for this disease in symptomatic MSM. We conducted an observational study of patients with symptomatic proctitis attending an outpatient infectious diseases clinic in Madrid, Spain during calendar year 2014. Clinical, epidemiological, laboratory, and therapeutic data were gathered and analyzed. Twenty-six patients were included in the analysis. All were MSM, and 24 of them were HIV-positive. All patients reported having acute proctitis symptoms including tenesmus (85%), pain (88%), constipation (62%), or anal discharge (96%). Proctoscopy showed mucopurulent exudate (25 patients [96%]), and rectal bleeding, with mucosal erythema and/or oedema in all cases. Rectal swabs were obtained from all patients, and LGV serovar L2 was confirmed in all of them. The cure rate was 100% after standard treatments with doxycycline 100 mg twice per day for 3 weeks. Simultaneous rectal infections with other sexually transmitted pathogens (gonorrhoea, herpes simplex virus, Mycoplasma genitalium) and systemic sexually transmitted diseases (STDs) (syphilis, acute HIV, and hepatitis C infections) were also documented in 12 patients (46%), but these co-infections did not appear to influence the clinical manifestations of LGV. Anorectal LGV is a common cause of acute proctitis and proctocolitis among HIV-infected MSM who practice unprotected anal sex, and it is frequently associated with other rectal STDs. The implementation of routine screening and prompt diagnosis of these rectal infections should be mandatory in all clinical settings attended by HIV and STD patients.

Diffuse Large B-Cell Lymphoma of Recto-Sigmoid Colon

Primary colorectal lymphoma (PCL) is a rare malignancy accounting for 3% of all GI lymphomas and 0.1-0.5% of all colorectal malignancies. The most frequent colonic location is the cecum followed by the rectum and ascending colon. Although several cases of PCL have been reported in the literature the recto-sigmoid junction as an origin has rarely been reported. We present a rare case of diffuse large B- cell lymphoma (DLBCL) in a patient presenting with anemia, weight loss and change in bowel habits. A 79 year old male with a past medical history significant for adenocarcinoma of the prostate status post (s/p) radiation, coronary artery disease s/p CABG, chronic kidney disease admitted to Dartmouth Hitchcock Medical Center (DHMC) with complaints 30 pound weight loss, intermittent lower abdominal pain with alternating diarrhea and constipation. Of note, one month prior to admission, he underwent colonoscopy at an outside hospital due to changes in his bowel habits. Biopsies taken at the time revealed non-specific acute inflammation thought to be related to ischemic colitis. During his admission at DHMC he underwent CT scan abdomen and pelvis which revealed thickening of the recto-sigmoid colon. Subsequent colonoscopy showed a colonic mucosa characterized by circumferential ulcerations with mucopurulent exudate that extended from rectum to sigmoid colon (Figure 1). The appearance was suggestive of ischemic colitis, but rectal involvement seemed atypical. Biopsies taken were stained for hematoxylin and eosin and immunohistochemistry to reveal diffuse DLBCL of the colon.Figure 1A PET-CT scan showed hypermetabolic activity involving lung, kidney, sigmoid and rectum. This was consistent with stage IVB DLBCL with extra-nodal involvement and 4 year survival of 40-50%. The patient underwent treatment with R-CHOP (Rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) however did not tolerate treatment due to worsening kidney and functional decline. He was transitioned to hospice care per family wishes and died one month later. The most common histological subtype of colorectal lymphoma is DLCBL. The etiology of DLBCL is unknown. Patient may present with variety of clinical symptoms that include abdominal pain, anorexia, weight loss, fatigue, anemia, fever, constipation and/or diarrhea. However, due to the nonspecific presentation diagnosis maybe delayed as seen in our patient. One should consider PCL in patient presenting with the above symptoms or with risk factors including HIV, organ transplant, inflammatory bowel disease and immunosuppressant agents. Endoscopists should think of a broader differential diagnosis when proctitis or colitis is seen during colonoscopy. Biopsies should be taken and reviewed by an expert GI pathologist.Figure 2

Allergic Rhinitis in Adults with Chronic Suppurative Otitis Media.

Chronic suppurative otitis media (CSOM) is considered one of the most common causes of acquired hearing impairment in developing countries. CSOM is a multifactorial persistent inflammatory disease of the middle ear. A distinct pathophysiologic mechanism linking allergic rhinitis (AR) and CSOM remains to evolve. The purpose of this study was to investigate the association between AR and CSOM in adults.This was a case-control study. The subjects were 62 adults (23 male, 39 female) with established CSOM and 61 healthy controls. CSOM was diagnosed when there was a history of chronic (persisting for at least 3 months) otorrhea, accumulation of mucopurulent exudates in the external auditory canal or middle ear and/or perforated tympanic membrane on otoscopy. All participants were evaluated for the presence of AR by clinical evaluation of allergic symptoms, and underwent a skin-prick test for 23 common regional allergens. Statistical analysis was performed using SPSS version 16. The prevalence of clinical rhinitis (allergic and non-allergic) was significantly higher among the cases compared with controls (62.5% vs. 37.5%, P=0.02). The prevalence of AR (proven by positive skin-prick test) was also significantly higher among affected adults than controls (24.6% and 13.8%, respectively). Adjusting for age, a logistic regression model showed that there was a significant difference between the two groups. Patients with AR and non-AR were at 3.27- (95% CI=1.15-9.29; P=0.036) and 2.57-(95% CI=1.01-6.57; P=0.048) fold increased risk of developing CSOM, respectively, compared with healthy individuals. The study showed a higher prevalence of AR in CSOM patients than in controls. It may be valuable to evaluate and control this factor in these patients.