Plasmocyte Infiltration Research Articles

Assessment of morphological changes in internal organs in the treatment of Aleutian mink disease with Alloferon

Nowdays, viral plasmocytosis of mink is widespread all over the world, due to the lack of effective treatments. A key role in the outcome of the disease is often played by kidney damage associated with the development of glomerulonephritis as a result of hypergammaglobulinemia. It is for this reason that the problem of finding a remedy for the treatment and prevention of Aleutian mink disease becomes urgent. The studies were carried out on mink of the sapphire breed at the age of 30 to 40 days in patients with viral plasmocytosis, confirmed by molecular genetic analysis. The experimental and control groups consisted of 20 animals each. The minks of the experimental group were injected subcutaneously twice with an interval of 6 days with alloferon at a dose of 0.5 mg per head, and the minks of the control group were injected with saline solution (NaCl 0.9%) in the same volume and multiplicity. During the study, records of fallen minks were kept. At the end of the experiment, histological studies of internal organs were carried out. The conducted experience showed that the use of alloferon led to a reduction in mortality, as well as a several-fold decrease in the intensity of plasmocytic infiltration of organs and tissues in experimental minks.

Assessment of pathomorphological characteristics of the oral mucosa in patients with HBV, HCV and HIV

Oral clinical manifestations in HBV HCV and HIV patients indicate a deterioration in general health status. The aim of the study was to assess pathomorphologic features of oral mucosa observed in patients with these diseases. The study was conducted in N1 Dental Clinic of YSMU after M. Heratsi. The total number of patients taking part in the research was 120, including HBV (n = 40), HCV (n = 40) and HIV (n = 40). After biopsy and subsequent histological examination of the oral mucosa, statistical analysis was carried out using Excel 2013 and R software. Pathomorphological examination revealed inflammatory infiltrations in all samples collected from HBV, HCV and HIV patients. These changes included microcirculatory disorders in 98.3% of samples: fibrinous-like deposits lining the surface of erosions and ulcers on the oral mucosa (1.67%), fibrosis of the mucous membrane (70%), dystrophy of squamous epithelium (93.3%) and bone sequestration (3.3%). Comparative analysis of pathomorphological characteristics revealed distinct content of infiltrates: lymphoplasmacytic infiltration in patients with HBV and HCV, while HIV patients showed neutrophils infiltration and lack of plasmocytes. There are common abnormal morphological changes in the oral mucosa typical of all patients with HBV, HCV and HIV, as well as liver diseases specific to each of them. Inflammation in the patients with HIV indicated impairment of the humoral immune system. Understanding the distinct characteristic of inflammation in the oral cavity could be useful for early differential diagnosis and management of patients with HIV, HBV and HCV.

S2044 A Rare Case of Lymphocytic Esophagitis in a Patient With Recurrent and Severe Oral Ulcers

Introduction: We describe a unique case of lymphocytic esophagitis with non-necrotizing granulomas in a patient with a three-year history of recurrent oral ulcers that did not resolve with standard medical therapy. Case Description/Methods: A 37-year-old female with a history of iron deficiency anemia presents with recurring intermittent episodes of severe oral ulcers that began after a 6-month course of antibiotics for hiradenitis suppurativa. She reported weight loss due to odynophagia and oral pain. An oral ulcer biopsy revealed dense lymphocytic and plasmocytic infiltrate with collections of histiocytic granulomas and multinucleated giant cells. Ulcer outbreaks coincided with stress and menstruation, but a gynecological etiology was unremarkable. Colonoscopy locally was non diagnostic for Crohn’s disease (CD). An obvious rheumatological etiology was not found. The patient was placed on fexofenadine once daily and a second biopsy of the oral ulcers revealed connective tissue focally surfaced by fragments of squamous epithelium, erosive lichen planus and a robust influx of mixed chronic inflammation including non-necrotizing granulomas. Further rheumatologic and dermatologic evaluation suggested an oral manifestation of Behcet’s disease. Given persistent odynophagia, esophagogastroduodenoscopy was performed. Small non-bleeding erosions in the lower third of the esophagus was found on endoscopy. Biopsies were significant for lymphocytic esophagitis with non-necrotizing granulomas and mycobacteria and fungus stains were negative. Differential diagnosis by pathology included sarcoidosis, Behcet’s disease and inflammatory bowel disease. Acid-fast and fungal stains were negative. Repeat colonoscopy including ileoscopy was negative. Management considerations by rheumatology included genetic testing for HLA-B51, steroids and colchicine. Discussion: Granulomatous esophagitis is a rare manifestation of systemic autoimmune disease including Behcet’s, Crohn’s Disease and sarcoidosis. Although only seen in 5% of CD cases, esophageal manifestations can present as granulomatous esophagitis. Pyogenic granulomatous esophagitis is typically managed with systemic corticosteroids or endoscopic resection. In our case, evaluation for Crohn’s disease was unremarkable and the presence of pathergy and involvement of non-keratinized squamous mucosa is suggestive of an oral manifestation of Behcet’s disease despite absent genital ulcers and join pain.

POS-485 ASSOCIATION OF AL AMYLOIDOSIS AND HEPATORENAL MULTIKYSTOSIS

Amyloidosis is a disease defined by the deposition and extracellular accumulation of a protein substance called «amyloid». AL amyloidosis results from monoclonal immunoglobulin (Ig) light chains (LC). The change in the secondary or tertiary structure of an abnormal monoclonal LC results in instable conformation, which enhances its deposition in multiple organs. It may cause various of symptoms depending on the deposit type, location and density. This is a case about a fifty-eight year old female affected by an association of AL amyloidosis and multicyctic kidney and liver. We present a case of a fifty-eight year old female, diagnosed of AL amyloidosis in 2010. The diagnosis was based on clinical, biological and histological arguments. Immunofixation of urinary and plasma proteins objective the presence of λ type IgA with a urinary concentration 0.4g/L. The myelogram showed 5 to 6% of plasmocyte infiltration. The primary injuries were in: the myocardium (a thickened septum without alteration of the ejection fraction), the liver (hepatomegaly and anicteric cholestasis), the peripheral nervous system (paresthesia and moderate axonal sensory motor neuropathy) and the kidney. Abdominal imaging didn’t show any organ morphology abnormalities. The renal injury was initially represented by a nephrotic syndrome with normal glomerular filtration rate (eGFR) and glomerular amyloidosis with light chain lambda deposits. After immunosuppressive chemotherapy based on thalidomide, melphalan and corticosteroids then Bortézomib and hematopoietic stem cell transplantation: hepatomegaly, paresthesia and proteinuria regressed and serum and urine protein immunofixation disappeared. Seven and a half year later, the serum creatinine level raised uncovering a relapse of the AL amyloidosis that resisted to a second stem cell transplantation. Abdominal CT scan objective the appearance of multiples cysts in the liver and kidneys. The eGFR decreased and the renal replacement therapy was indicated. AL amyloidosis is a multisystem disease with a poor prognosis: the life expectancy without treatment is less than 1 year. Renal location can be the main indicator for the diagnosis and the relapse and a major prognostic factor. secondary multicystic liver and kidney in association with AL amyloidosis is unusual further morphological and molecular study is necessary.

Primary sclerosing cholangitis and autoimmune hepatitis overlap syndrome associated with inflammatory bowel disease: A case report and systematic review.

BACKGROUNDA previously healthy 22-year-old woman presented with abdominal pain and jaundice. She had a reagent antinuclear factor (1:640, with a homogeneous nuclear pattern) and hypergammaglobulinemia (2.16 g/dL). Anti-smooth muscle, anti-mitochondrial and anti-liver-kidney microsomal antibody type 1 antibodies were negative. Magnetic resonance cholangiography showed a cirrhotic liver with multiple focal areas of strictures of the intrahepatic bile ducts, with associated dilations. Liver biopsy demonstrated periportal necroinflammatory activity, plasmocyte infiltration and advanced fibrosis. Colonoscopy showed ulcerative pancolitis and mild activity (Mayo score 1), with a spared rectum. Treatment with corticosteroids, azathioprine, ursodeoxycholic acid and mesalamine was initiated, with improvement in laboratory tests. The patient was referred for a liver transplantation evaluation.AIMTo report the case of a female patient with autoimmune hepatitis and primary sclerosing cholangitis (PSC) overlap syndrome associated with ulcerative colitis and to systematically review the available cases of autoimmune hepatitis and PSC overlap syndrome.METHODSIn accordance with preferred reporting items for systematic reviews and meta-analysis protocols guidelines, retrieval of studies was based on medical subject headings and health sciences descriptors, which were combined using Boolean operators. Searches were run on the electronic databases Scopus, Web of Science, MEDLINE (PubMed), Biblioteca Regional de Medicina, Latin American and Caribbean Health Sciences Literature, Cochrane Library for Systematic Reviews and Opengray.eu. Languages were restricted to English, Spanish and Portuguese. There was no date of publication restrictions. The reference lists of the studies retrieved were searched manually.RESULTSThe search strategy retrieved 3349 references. In the final analysis, 44 references were included, with a total of 109 cases reported. The most common clinical finding was jaundice and 43.5% of cases were associated with inflammatory bowel disease. Of these, 27.6% were cases of Crohn’s disease, 68% of ulcerative colitis, and 6.4% of indeterminate colitis. Most patients were treated with steroids. All-cause mortality was 3.7%.CONCLUSIONPSC and autoimmune hepatitis overlap syndrome is generally associated with inflammatory bowel disease and has low mortality and good response to treatment.

027 Plasma Cell Mucositis of the Vagina and Cervix

In 1952, Professor Johannes Jacobus Zoon described Zoon’s balanitis, an inflammatory condition which causes increased plasmocytic infiltrate of the penis and prepuce (1,2). Zoon’s vulvitis, commonly referred to as plasma cell vulvitis (PCV) or vulvitis circumscripta plasmacellularis, was first documented by Garnier in 1954 (1,2,3). PCV is a rare, chronic inflammatory disease characterized by erythematous plaques with a red, orange hue and increased plasma cells affecting the vulva. PCV predominantly affects the vulvar vestibule, but may extend to the labia minora and majora.

The effect of chronic restraint stress on esophageal visceral sensitivity and significance of stress-induced esophageal inflammation and oxidative stress in a murine model

Objective: To discuss the effect of chronic restraint stress (CRS) on esophageal hypersensitivity and inflammation, as well as the impact of oxidative stress in a murine model. Methods: 20 male SPF mice were randomly divided into two groups, CRS and normal control(NC) group. Then the mice in CRS group were submitted to 2 h per day of restraint stress for a period of 14 days. For the rest of the time, mice in both groups were given free drinking and eating in the same environment. Histopathological changes of esophageal tissue were observed using HE staining and analyzed by histological damaging score. The esophageal expression levels of transient receptor potential vanilloid (TRPV-1) and nicotinamide adenine dinucleotide phosphate oxidase 4(NOX-4) were detected by immunohistochemical staining. Further more, protein expression level of TRPV-1 was also observed by Western blotting. In addition, mRNA expression levels of TRPV-1, oxidant/antioxidant enzymes and related cytokines in esophageal tissues were detected by real time PCR. Results: HE staining for esophageal tissues revealed that histopathological changes including basal cell hyperplasia, infiltration of neutrophils and plasmocytes were observed in stressed mice, while there was no distinct changes observed in non-stressed mice. Histological damaging scores for epithelial damage and submucosal inflammatory cells were higher in CRS group, and the differences were statistically significant(all P<0.05). Immunohistochemical staining revealed that positive cells for TRPV-1 and NOX-4 were observed in majority of samples, but the number of positive cells and density were higher in CRS mice. Western blotting showed that the expression levels of TRPV-1 protein in CRS mice was higher than that of NC mice (1.0±0.0 vs 1.6±0.2; t=-7.06, P<0.001). RT-PCR showed that mRNA expression levels of TRPV1 and NOX-4 in CRS group were higher than those in NC group (1.0±0.0 vs 2.0±0.2, 1.0±0.0 vs 2.0±0.2; t=-13.44, -14.32, all P<0.001). Moreover, mRNA expression levels of antioxidant enzymes, such as Mn-SOD and Cu Zn-SOD, were higher in stressed mice (1.0±0.0 vs 0.7±0.1, 1.0±0.0 vs 0.7±0.1), and the differences were statistically significant (t=8.39,7.36, all P<0.05). The mRNA expression levels of important cytokines, such as MCP-1, IL-8, TNF-α, in stressed mice were overexpressed comparing to non-stressed mice (1.0±0.0 vs 2.4±0.4, 1.0±0.0 vs 1.8±0.2, 1.0±0.0 vs 2.5±0.4), and the differences were statistically significant (t=-10.06, -13.24, -12.40, all P<0.001). Conclusions: Chronic stress may result in esophageal hypersensitivity through activation of TRPV1, and may also cause esophageal inflammation. Stress-induced oxidative stress may contribute to the formation of esophageal hypersensitivity.

Monoclonal Gammopathy of Undetermined Significance (MGUS)Monoclonal Gammopathy of Undetermined Significance (MGUS).

Monoclonal gammopathy of undetermined significance (MGUS) is one of the most prevalent premalignant conditions associated with a risk of malignant transformation to multiple myeloma (MM) or other forms of lymphoproliferative disorders with risk of progression of approximately 1% per year. IgG and IgA MGUS are precursor conditions of multiple myeloma (MM), whereas light-chain MGUS is a precursor condition of light chain MM. IgM MGUS is a precursor condition of Waldenström macroglobulinemia (MW) or other lymphoproliferative diseases. Assessment of the risk of progression of patients with asymptomatic monoclonal gammopathies (MG) is based on various factors, including the serum paraprotein (M protein) concentration, isotype of M protein, serum free light chain ratio, infiltration of bone marrow plasmocytes, reduction of one or two noninvolved immunoglobulin subtype levels (immunoparesis), evolving and non-evolving subtype of MGUS, ratio of normal/abnormal plasma cells in bone marrow identified by multiparametric flow cytometry techniques and number of circulating plasma cells in peripheral blood. Three risk stratification models have been constructed that are useful in daily practice for predicting risk of progression of MGUS into malignant forms of monoclonal gammopathy - MAYO, PETHEMA and CMG model. The goal of all three models is to identify correctly prognostic markers that can divide patients into low-risk MGUS and high-risk MGUS groups. This review provides a look at the definition, pathogenesis, diagnostic algorithm, clinical significance and stratification of MGUS patients, followed by recommendations for patient risk dispensarisation intervals.

Gastric Syphilis Mimicking Neoplasm: A Case Report

1. Abstract 1.1. <span style=font-size:10.0pt;font-family: times= new= roman,serif=>Introduction: <span style=font-size:10.0pt; font-family: times= new= roman,serif=> Gastric syphilis is a rare and challenging diagnosis in clinical practice. Due to decreasing incidence of syphilis, the encounterment with the diagnosis became exceptionally rare. Kaunas regional Biomedical Research Ethics Committee approved the presentation of this case report (protocol no. BEC-LSMUC(R )-26). 1.2. <span style=font-size:10.0pt;font-family: times= new= roman,serif=>Case Presentation: <span style=font-size: 10.0pt;font-family: times= new= roman,serif=> A 46 -year -old Caucasian female with a 3 months history of mild epigastric pain, followed by vomiting, weight loss, and early satiety. The symptoms and findings of instrumental examinations led to initial diagnosis of gastric cancer. Partial distal gastrectomy and D2 lymphadenectomy was performed and histological examination showed active chronic gastritis with dense lymphocytic and plasmocytic infiltration -alterations were in line the diagnosis of syphilis, which was further confirmed by serological tests. 1.3. <span style=font-size:10.0pt;font-family: times= new= roman,serif=>Conclusion: <span style=font-size:10.0pt; font-family: times= new= roman,serif=> Epigastric pain, anorexia, vomiting, weight loss, together with radiological, endoscopic and microscopic appearance of gastric syphilis may easily be confused with gastric lymphoma or carcinoma. Furthermore, endoscopic gastric biopsies show non-specific histological alterations. We suggest that in all patients with gastric symptoms mimicking neoplasm with nonspecific endoscopic or histological findings, VDRL and TPHA tests should be performed. 2. Keywords: Gastric Syphilis; Gastrectomy; Plasmocytic Infiltration

Cutaneous Complications Related to Tattoos: 31 Cases from Finland

Background: Cutaneous complications related to permanent tattoos affect 2-30% of those patients who have tattooed their skin. Little is known about the cases of tattoo complications in Finland. Objective: The aim of this study was to conduct a retrospective review of a series of Finnish patients with cutaneous tattoo reactions. Methods: We collected cases of tattoo reactions from the Department of Dermatology at Helsinki University Central Hospital, from members of the Finnish dermatological society and from various other sources (author's private practice, tattooists, professional internet forum). We analysed the demographics, clinical presentation, diagnosis, and microscopic findings on the skin biopsies, and evaluated the therapeutic outcome. Results: Thirty-one patients (16 men and 15 women, mean age 37.8) were included from 9 cities, mainly from Helsinki. Fifty-two percent (16/31) presented with an allergic tattoo reaction mainly against the red colour (75%, 12/16). Reactions were clinically polymorph ranging from scattered papules or nodules to complete infiltration of a colour. Lesions were itchy and sometimes painful. The reactions were lichenoid, granulomatous, pseudolymphomatous or less specific with a dermal lympho-histiocytic or plasmocytic infiltrate. Other diagnoses included tattoo blow-out (13%), melanoma within a tattoo, naevi within a tattoo (10% each), lichen planus (6%), granulomatous reaction with uveitis, sarcoidosis and dermatofibroma (3% each). Allergic tattoo reactions were mainly treated with local corticosteroid (CS) ointments, CS infiltration or surgical removal. Conclusion: This review is the largest series of tattoo complications in the Baltic area. It illustrates the wide spectrum of complications. Prospective, controlled therapeutic studies are necessary to assess the best treatment protocols for tattoo allergies and tattoo reaction management in general.

Clinicopathologic analysis of extranodal Rosai-Dorfman disease of breast: a report of 12 cases

To investigate the clinicopathologic features, diagnosis and differential diagnosis of extranodal Rosai-Dorfman disease(RDD)of the breast. Twelve cases of extranodal RDD of the breast were analyzed using hematoxylin-eosin stain and immunohistochemical staining.The morphological features and immunophenotype were observed by light microscopy, accompanied with a review of the literature. Twelve cases of extranodal RDD of the breast are presented. The patients were women and their ages ranged from 15 to 55 years (mean =37 years). Except one patient with involvement of the right breast and ipsilateral axillary lymph nodes, other eleven patients' disease confined to the breast. Seven cases located in the right breast, the other five cases in the left breast. Microscopically, it showed a typical morphology, characterized by diffuse infiltration of large histiocytes, lymphocytes and plasmocytes that formed irregular nodular structure with light and dark appearance under microscope. Spindling of histiocytosis often arranged in a vague storiform with prominent fibrosis, accumulation of foamy histiocytes and scattered atypical nuclei. The characteristic histocytes and emperipolesis could not be seen obviously in extranodal RDD of the breast.Immunohistochemical staining showed histocytes were strongly positive for S-100 protein, CD68 and CD163, while negative for CD1a. Extranodal RDD of the breast is very rare. Because of unconspicuous emperipolesis and lack of specificity in clinic and images, extranodal RDD of the breast is easy to be misdiagnosed as other histiocytosis. The microscopic differential diagnosis includes idiopathic granulomatous mastitis, infective granulomas, langerhans cell histiocytosis, IgG4 related sclerosing disease, Erdheim-Chester disease, benign fibrous histiocytoma, malignant fibrous histiocytoma and Hodgkin Lymphoma. Light and dark appearance under microscope is the important clue in diagnosis of extranodal RDD in breast. Immunohistochemistry is also helpful.

A case of IgG4-related disease seemingly presenting as a T-cell lymphoma

IgG4-related disease (IgG4-RD) is an immune-mediated disorder hallmarked with lymphoplasmacytic tissues infiltrated with abundant IgG4-positive plasma cells, which has various clinical features and easily to be misdiagnosed. Here, we described a case with symptoms of body weight loss and multiple lymph node enlargements in a patient’s groin, axilla, mediastinum, and retroperitoneum at the first admission. Both F-fluorodeoxyglucose (FDG)-position emission tomography (PET) and lymph node biopsies supported the possible diagnosis of this case as a T-cell lymphoma, but no TCR gene rearrangement observed. Further examinations showed that serum IgG4 level of the patient was elevated and large amount of IgG4+ plasmocyte infiltration was detected in the involved lymph nodes, indicating this case as a possible IgG4-RD. However, the possibility of this disease as a T-cell lymphoma still could not be excluded. Tentatively, the patient was first treated as IgG4-RD with oral prednisone combined with methotrexate to avoid the unnecessary side effect of chemotherapy and economy burden. After three weeks treatment, the serum IgG4 level of the patient is evidently decreased and the enlarged lymph nodes disappeared as well. Eventually, we characterized this case as an atypical IgG4-related lymphadenopathy with 20 months’ follow-up.

Observation of Ultrastructure in Nasal Mucosa on Allergic Perennial Rhinitis Cases before and after the Operations

Objective: The partial inferior turbinectomy and septoplasty was applied to treat the allergic perennial rhinitis (APR), and to observe the ultrastructure changes of the nasal mucosa before and after the operations. Methods: For 36 cases of research objects diagnosed with APR, the partial inferior turbinectomy and septoplasty was administered. For 6 APR cases among them, the pre- and postoperative observation of anterior nasal mucosa of the inferior turbinate on the same side under the electron microscope was conducted for one year respectively. In addition, their pathological alterations of tissues were also conducted. Results: In the pre-operative observation under the electron microscope, it was found that the nasal mucosae epithelium cells were nude without cilia. The lamina propria had edema, and mesenchyme presented the infiltration of substantial eosinophilic granulocytes, basophilic granulocytes, plasmacytes and mast cells. Additionally, abundant degranulation and vacuolation of cytoplasts were observed. The plentiful glands, duct ectasia, edema and structural changes were also found. Some gland cells had degenerated. After the operation, it was found that the epithelium nudity still existed and the deficiency of cilia was not improved. Only a very small amount of microvilli existed. The edema of lamina propria was improved and eosinophilic granulocytes were rarely observed in mesenchyme. However, the infiltration of basophilic granulocytes, plasmocytes and mast cells was still observed. The particle structure was generally stable and the central crystal was clear without degranulation. Meanwhile, the amount of glands was reduced and the tissue structure tended to be recovered. Overall, the nasal mucosa showed changes as chronic inflammation. Conclusions: For the treatment of APR with the methods presented by our research institution, in one year before and after the operation, ultrastructural changes of inferior turbinate mucosa tissues were observed from the preoperatively pathological changes of typical APR to the chronic inflammation with the primary infiltration of neutrophilic granulocyte and mast cells.

IgG4-related retroperitoneal fibrosis: A case report and literature review

Clinical data of one patient diagnosed as IgG4-related retroperitoneal fibrosis was analyzed.IgG4andretroperitoneal fibrosiswere used as the key words to search literatures from PubMed and Wanfang Database. Clinical data of 27 cases with IgG4 retroperitoneal fibrosis, including clinical manifestation, diagnostic basis, therapeutic method and prognosis, which were retrieved through literatures, were analyzed. A 82-year-old male patient presented with urinary tract obstruction and renal insufficiency. Imaging examination revealed a retroperitoneal irregular lump shadow, and showed chronic inflammation of soft tissues in posterior peritoneum with fibrosis by biopsy pathology. The IgG4-positive plasmocyte infiltration was found by immunohistochemical method. The serum level of IgG4 was significantly increased, which was in accord with IgG4-related retroperitoneal fibrosis. After treatment with methylprednisolone, retroperitoneal lump shadow was obviously dissipated. The serum level of IgG4 became normal. 27 cases with IgG4-related retroperitoneal fibrosis were searched through literature retrieval, with 19 confirmed cases, 3 suspected cases, and 5 suspicious cases. Male accounted for 92.6% (25/27), and the average age was 67.6 years old. The cases with the involvement of extraperitoneal organs accounted for 37.0% (10/27). The misdiagnosis rate was 55.6% (15/27). 23 cases took effective therapy with glucocorticoids.IgG4-related retroperitoneal fibrosis is an orphan disease, which can be misdiagnosed easily. The diagnosis is made with histopathological examination and determination on the serum level of IgG4. The therapy with glucocorticoids is effective. Key words: Retroperitoneal fibrosis; Immunoglobulin G

A Case of Over-the-Counter, Drug-Induced Autoimmune Hepatitis: Immunohistochemical and Electron Microscopic Studies

Introduction: In daily clinical practice, drug-induced liver injury(DILI) can always be a cause of liver injury in patients taking medications. Over-the-counter(OTC) drug: Pabron has been purchasing at the pharmacy in Japan, Thailand, Malaysia, and Chinese Taipei as a multi-component cold medicine. We desribed a case of DI-autoimmune hepatitis(AIH) from OTCdrug: Pabron gold®. Case description: A 64-year-old man sought treatment for common cold and was admitted for general fatigue and liver dysfunction. Blood test results included total bilirubin (T-bil), 2.4 mg/dL; direct bilirubin (D-bil), 1.4 mg/dL; AST, 1,244 IU/L; ALT 1,455 IU/L; ALP 1,242 IU/L; and γ-GTP 599, IU/L. Viral hepatitis serology was negative. Other relevant data included IgG level, 1,907 mg/dL; IgM, 95 mg/dL; ANA x80 (cut-off, < x40); ASMA x20 (cut-off, OTC, namely Pabron Gold®, prior to disease onset which was suspected as the cause of liver injury. A DI lymphocyte stimulation test for Pabron Gold® was positive, 2,447 cpm (503%) (< 179%). The liver biopsy revealed spotty necrosis and the accumulation of ceroid pigment in Kupffer cells around central vein, and piecemeal necrosis with multiple plasma cells around portal tracts. Moreover, the plasmocytic infiltration showed positive CD79a staining while negative CD20 staining. Ultrastructually, “cart-wheel” chromatin configuration in the nucleus was observed in some of plasma cells packing with a lot of rough-surfaced endoplasmic reticulum. Moreover, the characteristic granular osmiophilic materials and lipid droplet were observed in Kupffer cell. HLA typing test was HLA-DR4 positive. The score based on simplified criteria for autoimmune hepatitis diagnosis was 6, probable. With a persistent rise in aminotransaminase levels, the patient was started on steroids with predonine prescribed to control the hepatic inflammation. Discussion: This report is the first to describe a case of DI-AIH following the use of an over-the-counter drug. In fact, DI-AIH diagnosis represents a challenge to the clinician because neither histological nor clinical pathognomonic features of AIH exist. We described a case of OTC Pabron gold®-associated liver injury, diagnosed as DI-AIH, calling for caution in the use of OTC.

Research Progress on IgG4-Related Hashimoto’s Thyroiditis

AbstractIgG4-related disease is a systemic autoimmune disease with unknown cause and involves multiple organs and tissues. This disease became one of research hotspots in the last ten years. IgG4-related Hashimoto’s thyroiditis (HT) exhibits unique clinical pathological characteristics: serum-free thyroxine reduction and increases in thyroid peroxidase antibody and IgG4; massive IgG4-positive plasmocyte infiltration in tissues; significant matrix fibrosis; and severe degeneration of thyroid follicular epithelium. IgG4-related HT is a subtype of HT; it presents relatively good therapeutic effect after thyroxine treatment. Cortical hormones can be used for IgG4 HT patients who may suffer from hypothyroidism with significant thyroid injury during early stage to constrain immune injury. This thesis summarizes clinical and pathological histology of IgG4-related HT based on its characteristics.

A case of tertiary syphilis manifested with multiple skin gummas

The tertiary cutaneous syphilis has become extremely rare as a result of the effective treatment of early syphilis with penicillin and occasional antibiotic therapy for concomitant infections. We report a case of tertiary gummatous syphilis associated with asymptomatic neurosyphilis that was initially misdiagnosed as basal cell carcinoma of the skin. A 67-year-old woman presented with the 18-month history of multiple, firm, bluish-red asymptomatic nodes on the parietal scalp, chin and lateral part of the trunk that had developed without preceding trauma. One node on the trunk had small central ulceration covered with dry yellowish crust. On the left retroauricular area the brownish-purple atrophic scar was observed. Blood tests revealed reactive VDRL, ELISA and TPHA assays. Skin biopsy has showed endarteritis with endothelial swelling and caseating granulomas along with plasmocytic infiltrate in the dermis and subcutaneous tissue. Increased lymphocyte count and the positive VDRL test with cerebrospinal fluid have confirmed the diagnosis of asymptomatic syphilitic meningitis in this patient. The treatment with aqueous penicillin intravenously has lead to resolution of the skin infiltrates and progressive more than 4-fold reduction of follow-up serum VDRL titers. This case is reported as a reminder of the possibility of tertiary syphilis with misleading clinical patterns in patients infected during the epidemics of 1995-2000. We would like to emphasize the necessity to perform timely serological and pathomorphological study to prevent misdiagnosis and mistreatment.

Therapeutic effect of Captopril on rheumatoid arthritis in rats.

To investigate the therapeutic effect of the intervention treatment with different doses of Captopril on TNF-αcontents in serum of rheumatoid arthritis (RA) rats, and to provide the theoretical proofs for clinical application of Captopril in treatments of rheumatoid diseases. Fifty Wistar rats were randomly divided into 5 groups, namely, Group A, Group B, Group C, Group D, Group E with 10 rats in each group. Injection of Freund's complete adjuvant was employed to establish adjuvant-induced arthritis model in rats. Group A was model group; after model establishment, rats were treated with 20 mL normal saline as placebo (ip.). Rats in Group B were treated with 8 mg/kg cyclophosphamide (ip.). Rats in Group C, D and E were intraperitoneally injected with 30 mg/kg, 100 mg/kg and 300 mg/kg Captopril respectively. Rats in each group were subjected to continuous treatment for 3 weeks, and then sacrificed. Eyeballs of rats were excised and blood was collected. TNF-αcontent in serum were detected using ELISA; each group rats were compared for the hind legs arthrocele. Right ankle tissues of rats were collected to prepare section, and microscopic observation of pathological changes was performed. TNF-αcontent in serum of Group A rats was significantly higher than that of rats in other 4 groups (P<0.05). TNF-αcontent in serum of Group B rats was significantly lower compared with that of rats in Groups C, D and E. The highest TNF-αcontent in serum of rats treated with Captopril was found in Group C, followed by Groups D and E (P<0.05). Right ankle arthrocele of rats in Groups B, C, D and E in early stage showed no statistical difference compared with that of Group A rats (P>0.05). From Day 8, ankle arthrocele of rats in Groups B, C, D and E was obviously relieved compared with that of Group A rats; the anti-inflammatory effects were gradually enhanced with the extension of medication time. Treatments of Groups C, D and E showed significant activities against tardive arthrocele; the degree of ankle arthrocele in rats of these three groups was lower than that of Group A rats (P<0.01). Histological observation showed that large amount of inflammatory cells and plasmocyte infiltration was found in ankle synovial tissues of Group A rats. Relief of hyperaemia and edema of right ankle synovial tissues as well as significant decrease in synoviocyte layer hyperplasia, intra-articular inflammatory cells infiltration and cartilago articularis damage degree etc. were observed in Groups B, C, D and E. Intervention treatment with Captopril can effectively reduce the TNF-αcontent in serum of rheumatoid arthritis rats and inhibit the generation of inflammatory factors, so as to achieve the therapeutic effect.

PO-0106 Sclerosing Cholangitis In Childhood Report Of 3 Cases

Backgrounds and aims Sclerosing cholangitis (SC) is a chronic cholestatic liver disease characterised by inflammation and progressive bile duct fibrosis. Our purpose was to describe characteristics of SC in childhood. Methods We performed a retrospective study of 3 childrens with SC followed in the paediatric department of Sfax (2008–2013). Results There are 2 boys and 1 girl. The mean age at diagnosis was 6 years. Clinical features at presentation were jaundice (1 case) and hepatosplenomegaly (2 cases). Autoantibodies (anti-nuclear antibody, smooth muscle antibody, and perinuclear antineutrophil cytoplasmic antibodies) were detected in 1 case. Magnetic resonance cholangiography revealed irregularities with strictures, dilatations and pruning of bile ducts. Histological examination of liver biopsy showed signs of CS stage I (1 case), stage III (1 case) and portal inflammation with infiltration of lymphocytes and plasmocytes and periductal fibrosis (1case). Search histiocytosis was negative in 3 cases. Colonoscopy with mucosal biopsies revealed no specific inflammatory colitis in one case. The diagnosis of overlap syndrome was made in one case and primary SC (2 cases). All patients were treated with ursodeoxycholic acid and the patient with overlap syndrome received immunosuppressive therapy. After a mean follow-up of 3 years, remission was noted in 2 cases and one patient progressed to cirrhosis and liver failure. Conclusion SC is a rare cause of chronic cholestasis. Ursodesoxycholic acid is the treatment of choice for all forms of SC but without proof of its effectiveness in preventing progression to secondary biliary cirrhosis.

Saccharomyces boulardii prevention of the hepatic injury induced by Salmonella Enteritidis infection.

Salmonella enterica subsp. enterica serovar Enteritidis (Salmonella Enteritidis) is the predominant cause of serovar-associated food-borne outbreaks in many countries and causes significant clinical symptoms of liver injury, enteritis, and diarrheal diseases. Saccharomyces boulardii is used in clinical application for prophylaxis and the treatment of a variety of diseases caused by bacterial infection. We used a mouse model of Salmonella Enteritidis infection, which included pretreatment with S. boulardii, to reveal the protection mechanisms of S. boulardii against Salmonella Enteritidis infection, including the translocation of Salmonella Enteritidis to the liver 10 days after Salmonella Enteritidis challenge, and the colonisation of Salmonella Enteritidis and the formation of hepatic tissue lesions in mice after Salmonella Enteritidis challenge on the 10th day. Compared with Salmonella Enteritidis infection in mice, S. boulardii decreased Salmonella Enteritidis translocation to the liver by 96%, and 99% of Salmonella Enteritidis colonised the cecum on the 10th day. Saccharomyces boulardii also abated hepatic tissue injury caused by the infiltration of neutrophilic granulocytes, lymphocytes, and plasmocytes by decreasing the translocation of Salmonella to the liver. These findings demonstrated that S. boulardii is an effective agent in the prevention of the hepatic injury induced by Salmonella Enteritidis infection in a mouse model.