Thick Exudate Research Articles

Esophageal Lichen Planus: The Efficacy and Safety of Tacrolimus in Reducing Inflammation and Need for Dilation.

Esophageal Lichen Planus (ELP) is a rare inflammatory disease most seen in middle-aged Caucasian women, manifested by sloughing mucosa, thick exudate, and proximal strictures. Most case reports and small series highlight using steroids and other immunosuppressants. To our knowledge, oral tablet tacrolimus has not been studied. We aimed to assess the change in ELP after oral tacrolimus treatment. The primary outcome was the efficacy of tacrolimus objectively through our scoring system, ELPSS. All consecutive adults with ELP who underwent more than one EGD by two esophagologists and being treated with tacrolimus or other treatment were eligible for inclusion in this retrospective cohort study. Inflammation and fibrostenotic disease were graded using the novel ELP Severity Score (ELPSS). Twenty two patients met the inclusion criteria. Half (11) received tacrolimus (dose 1-2 mg BID) and half (11) received other therapy (i.e. cyclosporine, topical steroids, or none). Mean ELPSS on first EGD, extraesophageal manifestations of disease, presenting symptoms, and baseline characteristics were similar between groups. Among patients on Tac vs No-Tac, there was a statistically significant improvement in ELPSS (mean difference 1.8 pts; 95% CI 0.25-3.38; P=0.02). Response rate was 89% with Tac vs 30% with No-Tac (P=0.025). All 22 patients underwent bougie dilation safely with a mean diameter of 16 mm achieved. Patients on Tac also required less frequent dilation. Oral tablet tacrolimus reduced the inflammatory and fibrostenotic components of ELP. Thus, low-dose oral tacrolimus is safe and should be considered in patients with more severe disease.

A Modified Approach for Preventing Anterior Glottic Web Formation Using Mitomycin C in Bilateral Vocal Fold Lesions.

Objectives: Laryngeal keel insertion, mucosal suture, application of mitomycin-C (MMC), and staged operations are approaches to prevent the anterior glottic web, but there are limitations. Our study suggests a modified approach to prevent the formation of an anterior glottic web. Methods: This retrospective single-institution tertiary center study (N = 23) involved the simultaneous removal of bilateral vocal fold lesions with topical MMC application. If exudate was identified after 4 to 6 weeks, second laryngomicroscopic surgery (LMS) was performed to remove it with topical MMC application. Extent of anterior glottic web was measured as a percentage of the total length of the membranous vocal fold. Results: After the initial surgery, 18 patients recovered without anterior web or fibrin exudate. Thick exudate was observed in 5 patients. After the second LMS, all patients showed improvement and did not develop anterior web. Conclusion: This modified method has been developed to prevent the anterior glottic web without complications.

Novel Foam Dressing With Through Holes and Negative Pressure Wound Therapy With Instillation and Dwell Time: A Retrospective Cohort Study

Background. NPWTi-d of a topical wound solution has been shown to benefit healing in a variety of wound types. This therapy has traditionally been applied via a standard ROCF-V. In 2017, a new ROCF-CC was introduced at the practice of the authors of the current manuscript for adjunctive management of patients with wounds with thick exudate and/or nonviable tissue and in cases in which surgical debridement is not available or not appropriate. Objective. To compare the efficacy of NPWTi-d with ROCF-CC dressing (treatment) vs NPWTi-d with ROCF-V dressing (control). Materials and Methods. An observational retrospective cohort study of hospital records of patients with VLUs treated with NPWTi-d who received ROCF-CC dressings (n = 11) vs standard ROCF-V dressings (n = 11) was conducted. NPWTi-d was chosen to promote wound healing in VLUs that were not fully responsive to advanced dressings and/or compression bandage. Solution dwell time was 10 minutes, followed by 2.5-hour NPWT cycles at −125 mm Hg. Dressings were changed every 72 hours. Results. Overall, mean ± SD duration of therapy and hospital length of stay were shorter in the treatment group vs the control group (duration of therapy, 8.63 days ± 7.05 vs 11.72 days ± 17.41, respectively; P = .05, and length of stay, 9.9 days ± 2.98 vs 12.81 days ± 4.26, respectively; P = .08), but these differences were not statistically significant. Mean wound area reduction was greater in the treatment group than in the control group (14.63 cm2 ± 13.24 and 10.72 cm2 ± 14.06, respectively; P = .51), but this was not significant. Conclusion. ROCF-CC dressings were a useful tool in assisting wound bed preparation and reducing time to skin graft closure in this series of complex VLUs.

Pseudomembrane to nodule-gamut of ligneous conjunctivitis: A case report

Ligneous conjunctivitis is a type of chronic conjunctivitis characterized by the presence of pseudomembranes on the conjunctival surface. It can present as a part of a multisystem disease with involvement of other mucous membranes. A 1-year-old girl presented with features of conjunctivitis. Local examination revealed thick exudates in left tarsal conjunctiva, which was diagnosed as an ulcer with pseudomembrane and sterile culture. The patient presented with a nodular mass in the same site after a year, which showed a pseudomembrane along with sub- epithelial hyaline lobular deposits negative for Congo red, concurring a diagnosis of ligneous conjunctivitis. The patient was prescribed topical lubricating agents and regular follow up. Ligneous conjunctivitis is attributed to a deficiency of plasminogen, which plays a vital part in wound healing. The present case highlights the progression of pseudomembrane into a ligneous lesion in a child who was resisting medication and follows up.

Negative Pressure Wound Therapy Devices With Instillation/Irrigation: A Technologic Analysis.

The purpose of this technologic analysis was to critique technologic features of devices designed to deliver negative pressure wound therapy with instillation or irrigation (iNPWT). Published literature regarding negative pressure wound therapy (NPWT) devices with the added feature of instillation or irrigation was reviewed to provide an overview of iNPWT. Varied features of devices currently available in the United States were described based on instructions published by individual manufacturers. Safety information regarding iNPWT was derived from the Manufacturer and User Facility Device Experience (MAUDE) Database. The additional option of instillation or irrigation available with some NPWT devices may provide clinical benefits in carefully selected patients. Advantages may be related to facilitated removal of thick exudate and necrotic tissue. Devices with instillation options are indicated for inpatient settings, with ongoing monitoring of health care professionals. A simpler device with an intermittent irrigation option may be used in the home setting, with proper supervision. More research is needed to demonstrate the clinical effectiveness and cost of the therapy.

Use of Negative-Pressure Wound Therapy With Instillation and Dwell Time: An Overview.

The use of negative-pressure wound therapy (NPWT) has become an established therapy for wound management. There have been many advancements in the technology of NPWT including NPWT with instillation and dwell (NPWTi-d). NPWTi-d promotes wound healing by wound cleansing, irrigation, and nonexcisional debridement. NPWTi-d has been shown in comparative clinical studies to decrease the time to definitive wound healing and length of hospitalization. NPWTi-d-using a reticulated open-cell foam dressing with "through" holes (ROCF-CC)-has been postulated to facilitate solubilization, detachment, and elimination of infectious materials, such as slough and thick exudate, before or after operative debridement, and in cases where surgical debridement is not an option. The authors provide an overview on the use of NPWTi-d by reviewing the components of the system, proposed mechanism of action, clinical outcomes, and current consensus guidelines for its utilization.

Amebiasis in a Backyard Red-Foot Tortoise (Chelonoidis carbonaria)

Background: Amebiasis is a parasitic infection caused by obligate or facultative amoeboid protozoans, as well as free-living forms. The genus Entamoeba includes both pathogenic and commensal species that can affect humans and animals. Entamoeba histolytica is the most important species associated with intestinal and extraintestinal infections in humans, while Entamoeba invadens is considered the most common and serious pathogen to many reptile species, including lizards, snakes and crocodilians. The aim of this manuscript is to report a case of amebiasis in a backyard red-foot tortoise in northeastern Brazil.Case: A 10-month-old male red-foot tortoise (Chelonoidis carbonaria) was presented at the Animal Pathology Laboratory of the Veterinary Hospital of Federal University of Campina Grande for necropsy with a 1-week history of anorexia, apathy, and reluctance to move. According to the owner, the animal suffered from heat stress in the backyard, where it was housed with another male red-foot tortoise. At post-mortem examination, there were approximately 1 mL of yellowish viscous transudate in the coelomic cavity. The liver was large, with rounded edges and multifocal to coalescing yellowish areas in the subcapsular surface. When cut, the parenchyma was more friable and yellowish. At the opening of the small intestine, the mucosa was thickened, reddened, and contained many variably sized, dark red ulcers with depressed and hemorrhagic centers. Histopathology of the liver reveals diffuse macro and microvacuolar degeneration of the hepatocyte cytoplasm, often displacing the nucleus peripherally (fatty degeneration). There were extensive and multifocal areas of necrosis characterized by shrunken, hypereosinophilic and pyknotic hepatocytes. Amebic trophozoites were seen through the areas of necrosis and degeneration and the morphological features were suggestive of the genus Entamoeba. In the portal triads and slightly extending to the sinusoidal spaces, there is a moderate inflammatory infiltrate of macrophages, lymphocytes, plasma cells and rare heterophils. There were amebic trophozoites and thrombi in hepatic vessels, and mild intracanalicular cholestasis. The small intestine contained areas of transmural necrosis and ulceration associated with inflammatory infiltrate of macrophages, lymphocytes and plasma cells. The ulcers were covered by a thick fibrinonecrotic exudate mixed with a varying number of heterophils and macrophages. The submucosa contained hemorrhage and edema. Similar amebic trophozoites were found within the mucosa and submucosa, and also detected in the lumens of blood vessels at the submucosa. The amebic trophozoites, seen in the liver and intestine, were intensely Periodic acid–Schiff positive.Discussion: The diagnosis of amebiasis was based on the epidemiological, clinical and anatomopathological findings. Amebiasis is a well-recognized disease that usually is diagnosed post-mortem in numerous species of reptiles. Unfortunately, there are no scientific articles describing these cases in Brazil. In reptiles, the major pathogenic specie is Entamoeba invadens, while several other species are considered non-pathogenic, such as E. barreti, E. insolita, E. terrapinae, E. ctenosaurae, and E. knowlesi, among others. Although cultivation of E. invadens was not undertaken, the anatomopathological findings and the morphological appearance of the agent is highly suggestive of infection with this organism. In conclusion, amebiasis is a severe infectious disease that can affect young red-footed tortoises under adverse environmental conditions. Clinical signs are nonspecific and may be difficult to identify. The diagnosis is usually made post-mortem by anatomopathological findings and the morphological appearance of the agent.

TB PLEURAL EFFUSION WITH MODEST ELEVATION OF ADENOSINE DEAMINASE

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Tuberculous pleural effusion (TBPE) occurs in 4% of all tuberculosis cases in the United States. Pleural fluid adenosine deaminase (pfADA) can help distinguish TBPE from other etiologies of pleural effusion. We present a case of TBPE with modest elevation of pfADA. CASE PRESENTATION: A 40 year old African American male with no past medical history, remote history of incarceration, presented with 4 days of fever and nonproductive cough. He denied any night sweats, chills or recent weight loss. Vitals on presentation: temperature 101.6○F, heart rate 115 bpm, blood pressure 129/84 mmHg, respiratory rate 20 breaths/min, pulse oximetry 96% on room air. On exam, he was tachypneic with left lower lung zone rhonchi. Initial investigations revealed leukocyte count of 8.2 (X10ˆ3/μL), elevated CRP at 129 mg/L and normal basic metabolic panel. A chest radiograph showed a large left pleural effusion. Vancomycin and levofloxacin were empirically initiated for suspected left sided pneumonia with parapneumonic effusion. Thoracentesis yielded 1800cc of clear yellow pleural fluid. Analysis revealed a lymphocyte-predominant exudate. (pH of 7.34, neutrophil count 3340, LDH 1551, Protein 4.8). CT of the chest on day 2 of admission demonstrated a new loculated inferior and lateral left base pleural fluid collection. Despite antibiotic therapy, patient continued to be febrile during days 3 and 4. Testing for influenza, HIV, Histoplasma, ANCA and ANA was negative. During a video-assisted thoracoscopy on Day 5, he was found to have fibrinous thick exudates indicating an early empyema with adhesions. Empyema was drained and decorticated, with complete re-expansion of the lung. Pathology of pleural biopsies revealed caseating granulomas indicative of tuberculosis. A quantiferon GOLD test returned positive. pfADA was mildly elevated at 20.5 units/L (normal: 0.0 – 9.4). He was started on treatment for presumptive pleural tuberculosis. Due to nonproductive nature of cough, patient underwent bronchoscopy for a BAL sample on Day 9, and subsequent AFB stain and culture was negative. He was discharged on INH, Rifampin and Pyrazinamide with vitamin B for 2 months, and continued on INH and Rifampin for a further 4 months. DISCUSSION: Measurement of pfADA may be useful to establish a presumptive diagnosis of TBPE relatively expeditiously when AFB stain and culture are negative. Based on several meta-analyses, pfADA levels >45 to 60 units/L is thought to be 97 percent specific for TBPE. Definitive diagnosis is often by the identification of M. Tuberculosis or necrotizing granulomas in pleural tissue or pleural fluid. In the presented case, despite a mildly elevated pfADA level, the diagnosis was clinched with histopathological evidence of tuberculous granulomas. CONCLUSIONS: While pfADA may have a supplementary role in the investigation of AFB-negative pleural effusion, pleural biopsy remains necessary for diagnosis of TBPE. Reference #1: 1. Klimiuk J1, Krenke R, Safianowska A, Korczynski P, Chazan R. 2015. Adv Exp Med Biol. 852:21-30. https://doi.org/10.1007/5584_2014_105 Reference #2: 2. Porcel JM. 2009. Tuberculous pleural effusion. Lung 187:263–270. https://doi.org/10.1007/s00408-009-9165-3. Reference #3: 3. Bays AM, Pierson DJ. Tuberculous Pleural effusion. Respiratory Care Oct 2012, 57 (10) 1682-1684; https://doi.org/10.4187/respcare.01443 DISCLOSURES: No relevant relationships by Dhruv Desai, source=Web Response No relevant relationships by Nikky Keer, source=Web Response No relevant relationships by Ngozika ORJIOKE, source=Web Response

1461 Pseudomembranous Colitis, Bowel Ischemia, and Phentermine: A Case Report

INTRODUCTION: Pseudomembranous colitis, though classically associated with Clostridium difficile infection, can be a consequence of other disease processes including severe ischemic colitis. Several drugs have been proposed to predispose to colonic ischemia including the appetite suppressant phentermine. We present a case of pseudomembranous colitis from severe bowel ischemia that likely was compounded by concomitant phentermine use. CASE DESCRIPTION/METHODS: A 55-year-old obese Caucasian female with hypertension presented with a week of abdominal pain and progressively worsening diarrhea that had subsequently turned bloody. She was a former smoker. Medication history was significant for using a family member's weight loss medication Phentermine 37.5 mg daily for several days prior to developing gastrointestinal symptoms. At presentation she was mildly hypotensive needing fluid resuscitation and brief vasopressor support. Laboratory profile was significant for acute kidney injury with creatinine 8.86 mg/dl, lactic acid 3.2 mmol/L and white blood cell count 12.3 k/uL. A non-contrast CT abdomen showed findings suggestive of acute colitis involving the splenic flexure and descending colon (Figure 1). Supportive care and broad-spectrum antibiotics were continued. Multiple stool studies were negative for clostridium difficile infection, bacterial cultures, and assays for ova and parasites. Antineutrophil antibodies and antineutrophil cytoplasmic antibodies were negative as well. Flexible sigmoidoscopy revealed severe ulcerations covered by thick exudate of the rectum and sigmoid colon (Figure 2). Histopathology of biopsy specimens showed colonic mucosa with fibrinopurulent surface adherent exudate with abundant neutrophils consistent with pseudomembranous colitis (Figure 3). Patient recovered with supportive care alone and was subsequently discharged with instructions not to use Phentermine again. DISCUSSION: Our patient, with risks for vascular disease, had several days of abdominal pain with diarrhea. At the time of her initial hospital presentation, she was hypotensive likely from gastrointestinal volume loss. The inciting event for her colonic ischemia is unclear. Possibilities include Phentermine induced colonic ischemia that was further compounded by volume loss vs prodrome of gastroenteritis leading to volume loss and hypovolemia with subsequent colonic ischemia compounded by patient's Phentermine use. Phentermine use in this patient would have been contraindicated secondary to her vascular risk factors.

Histopathological study of non neoplastic lesion in cervix at Birat Medical College Teaching Hospital Nepal

Introduction: Like in other developing countries non –neoplastic region of cervix in pap smear is most common findings. In Nepal... In Nepal cervical pap-smear screening is not done my most of woman due to lack of aware­ness. The objective of this study is to find the prevalence of non-neoplastic lesion of cervix. 
 Methods: This was a retrospective study of 486 conventional cervical Pap smears reported from the Department of Pathology. The time period was from March 2015 to May 2018. We used Bethesda system to report our all our slides. All the cases were reviewed by consultant pathologist of Birat medical college. This research is done according to rule of BMCTH. 
 Results: Total cases were 486 in two years period in which 456 cases were satisfactory for evaluation and 30 cases were unsatisfactory for evaluation which is due to thick neutrophilic exudates, mucous, degen­erative cells and hemorrhage. The age of the patients ranged from 20 to 80 years with an average age of 35.5 years. Non specific inflammatory smear is 440 that is 90.53%, Bacterial vaginosis is 10 that is 2.05%, Candidiasis is 04 that is 0.82% and trichomonas vagenalis is 02 that is 0.41%. 
 Conclusion: Simple screening test like cervical papanicolaou smear (Pap)can detect the non-neoplastic lesion of cervix. If non-neoplatic lesion of cervix is not treated as soon as possible than the chances of being infertility, salpingitis and even neoplasia is more. So non-neoplastic lesion of cervix is as important as neoplastic lesion of cervix.

Marshall Syndrome or PFAPA (Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenopathy) Syndrome

Marshall Syndrome PFAPA (Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis) Syndrome is a chronic condition, typically starting 2-5 years old, in which fever occurs periodically (lasts for 3-7 days), accompanied by aphthous-like ulcers, pharyngitis and/or cervical adenitis. The patients have no clinical symptoms between episodes and it is required to exclude all other diseases before confirming the diagnosis. The dramatic response to treatment with steroid helps diagnosing PFAPA. We are presenting the case of an 8 years male patient, with the history of recurrent episodes of fever (onset at the age of two), oral ulcer and difficulty in deglutition who constantly received antibiotic therapy and or antifungal prescribed by different doctors. Clinically the patient was febrile, mildly pale, cervical lymphadenopathy, aphthous ulcers in the tongue with inflamed tonsils, covered with thick exudates and pharyngeal wall was inflamed and folliculated. There was just palpable liver. Laboratory investigations performed but it was without serological confirmation. Throat swab culture was negative. The child received steroid (Prednisolone) with favorable outcome. Subsequently, the patient presented with similar episodes of fever which disappeared within 24 hours of single dose of prednisolone. After Ranitidine (H2 blocker) prophylaxis the patient remains asymptomatic for about one and half years. With our best knowledge this is the first case report of Marshall Syndrome or PFAPA Syndrome in Bangladesh.J Bangladesh Coll Phys Surg 2016; 34(4): 222-224

Initial Experience Using a Novel Reticulated Open Cell Foam Dressing with Through Holes during Negative Pressure Wound Therapy with Instillation for Management of Pressure Ulcers

Several published reviews and recommendations exist for the use of negative pressure wound therapy (NPWT) with instillation and a dwell time (NPWTi-d) in acute and chronic wounds. Specific dressings for use with NPWTi-d have also been developed, including a reticulated open cell foam dressing with through holes (ROCF-CC) that assists in removing thick wound exudate and infectious materials. ROCF-CC is especially helpful for wound cleansing when debridement is not possible or appropriate in patients. We report our initial experiences in using NPWTi-d with ROCF-CC in patients with pressure ulcers. An algorithmic approach was used to determine appropriate treatment to reach the goals of therapy (i.e., wound bed preparation, granulation tissue formation, and removal of infectious materials). Previous therapies included honey and gauze soaked in Dakin’s solution. All patients received antibiotics and debridement when possible. Five patients (3 females and 2 males) received NPWTi-d with ROCF-CC (instillation of saline or a hypochlorous solution with a dwell time of 10 minutes, followed by 2-3 hours of -125 mmHg NPWT). Patient comorbidities included obesity, diabetes mellitus, hypertension, and peripheral artery disease. Mean age of patients was 65.2 years (range: 50-82 years). After an average of 6 days of therapy (range 2-9 days), all wounds treated with NPWTi-d with ROCFCC showed rapid granulation tissue formation. We also noted improved removal of devitalized tissue and subsequent granulation tissue formation in patients receiving hypochlorous solution compared to patients receiving saline during NPWTi-d with ROCF-CC. All patients were eventually transferred to a skilled nursing facility. In our clinical practice, NPWTi-d with ROCF-CC provided effective and rapid removal of the thick exudate and infectious materials and promoted excellent development of underlying granulation tissue.

A Novel Herbomineral Formulation Sahaj Vati as Shelf Life Enhancer of Nutraceuticals Based on Aflatoxin Inhibitory and Antioxidant Activity

The present investigation deals with chemical standardization and aflatoxin inhibitory and antioxidant activity of a herbomineral formulation, sahaj vati prepared in two batches (batch I and II) by mixing shilajeet (thick exudates of the mountain during summer season), guggul (Commiphora mukul (stocks) hook.), haridra (Curcuma longa L) and chitrak (Plumbago zealanica L) with levigation of Agnimantha kwatha (Premna mucronata L). Batch I was prepared by mixing shilajeet, guggul, haridra and chitrak in equal proportion (25% each by weight) while batch II comprised shilajeet (44.7%), guggul (44.7%), haridra (4.8%) and chitrak (5.8%) by weight. Sahaj vati II showed highest (96%) inhibition of aflatoxin production at concentration of 10 000 µg/ml. Suddha guggul exhibited strong antioxidant activity showing lowest IC50 at concentration of 20.56 µg/ml. Based on these findings, the newly formulated herbomineral formulation could be recommended for value addition of nutraceuticals by enhancing their shelf life against lipid per oxidation and aflatoxin contamination.

Effect of <i>Haematostaphis barteri</i> (blood plum) leaf extracts on histopathalogical parameters of albino rats

Haematostaphis barteri has been extensively used as food supplement and in the treatment of haemorrhoids, stomach aches and vomiting. The present study is aimed at assessing the effects of the aqueous, ethanol and methanol leaf extracts of Haematostaphis barteri on the histopathological parameters in rats. The fresh leaves of Haematostaphis barteri were collected, dried, powdered and extracted using water, 95% ethanol and methanol. Graded doses of 25, 50, 75 and 100 mg/kg of the extracts administered for four weeks were used to evaluate the histopathological parameters in rats. Histopathological findings due to the subchronic administration of the extracts showed villous atrophy, goblet cell hyperplasia and presence of thick mucus exudates in the small intestines. There was severe glomerular and tubular degeneration of the kidneys and moderate pulmonary congestion and thickening of the interalveolar septae. Therefore, the use of Haematostaphis barteri plant part especially the leaves for either food supplement or medicinal purposes for long period has to be with caution because of its effect on the lungs, gastrointestinal tract and kidneys. Keywords: Haematostaphis barteri ; Leaves; Extracts; Histopathology

Effectively managing wound exudate.

The management of wound exudate remains a clinical challenge despite technological advances in products with better exudate-handling capacities. This clinical challenge is occasionally encountered when thick exudate (viscous exudate) is present, and when most modern dressings do not possess the capabilities to manage the viscosity while enabling exudate absorption. Maceration to the peri-wound area poses another challenge, irrespective of the number of topical barrier application products on the market and the innovation of dressing products that lock exudate away or those that encourage vertical wicking. In addition to all the above, in clinical practice, the assessment and documentation of wound exudate remains sporadic, leading to the challenges of effective wound exudate dressing selection and cost-effective dressings.

The thickness of exudate: does it matter?

The majority of chronic wounds are managed in the community by the district nursing team. With increasing constraints on the health-care budget, it can be tempting to manage exudate by focusing solely on the exudate-handling capability of some of the more absorbent dressings available. However, exudate levels and viscosity can change depending on the patient and the wound, with exudate being a marker of potential infection. Ongoing assessment of the wound, the exudate and the patient is pivotal to effective wound management, with timely and appropriate intervention being key. This article discusses this management, with particular focus on dealing with thick exudate.

Feline Infectious Peritonitis with Distinct Ocular Involvement in a Cat in Turkey

An approximately 2-year old domestic short hair female cat weighting 2.750g was presented to Firat University Veterinary Teaching Hospital with a history of depression, anorexia and weight loss for the last 15 days. Clinical examination revealed incoordination, hyperaesthesia, circling, head tilt, posterior paraparesis, absence of the pupillary reflex in both eyes, opisthotonus and anisocoria. Blood samples were examined for hematological, RT-PCR and biochemical analyses. The cat died without any improvement of clinical findings although symptomatic treatment was made. Necropsy revealed that distinct ocular lesions such as hyphema and thick proteinous exudate accumulation in vitreous in both eyes. Microscopically; there was pyogranulomatous vasculitis in meninges, sclera, corpus ciliare choroid, retina was partially detached in the right eye with retinal epithelial hypertrophy. The kidneys contained focal subcapsular, gray to yellow raised nodules varying from 3 to 10 mm in diameter, and there was discrete fatty degeneration in the liver. The RT-PCR revealed that RNA for FCoV was positive in the blood sample. As a result; the non-effusive form of FIP with distinct ocular involvement was diagnosed through clinical, pathological and polymerase chain reaction (PCR) findings.

MRI appearances of tuberculous meningitis in HIV-infected children: a paradoxically protective mechanism?

Immune suppression predisposes HIV-infected children to opportunistic infections including Mycobacterium tuberculosis. HIV infection increases the risk of progression to active disease and also increases the risk for extrapulmonary involvement, including tuberculous meningitis (TBM). Brain injury in TBM is the consequence of an immune-mediated vasculopathy. HIV-related immune dysfunction prevents the production of thick exudates that cause parenchymal infarctions and cerebrospinal fluid flow obstruction. It could be postulated that HIV may be ‘protective’ from some of the common complications related to TBM. The aim of this paper is to highlight the ‘protective’ features of HIV-related immune suppression observed on MRI in children with TBM and promote the use of MRI for detecting subtle and atypical meningeal enhancement in HIV and TBM coinfected children.

Proliferative and necrotizing otitis externa in four cats

Proliferative and necrotizing feline otitis externa is a rare disorder of unknown aetiology. This condition was diagnosed by skin biopsy in three adult domestic shorthair cats (3-5 years old) and one kitten (6 months old). The affected cats had large tan to dark brown-black coalescing plaques covering the concave surface of the pinnae and external ear canals. Friable material from the plaques and a thick exudate occluded the ear canals. The cats had a secondary bacterial and/or yeast otitis. Prior to the histopathological diagnosis, all cats received numerous otic preparations as well as oral antibiotics and corticosteroids without resolution. Histologically, all cases had strikingly similar changes; acanthosis with pronounced hair follicle outer root sheath hyperplasia and neutrophilic luminal folliculitis, follicular keratosis and individually necrotic keratinocytes in the outer root sheath of hair follicles. One case was documented via skin biopsy to have persisted for 4 years. The adult cats were treated with topical 0.1% tacrolimus and all showed marked improvement although one cat was lost to follow up. The lesions completely resolved with topical tacrolimus alone in one cat and topical tacrolimus in addition to oral prednisolone in another cat.

Inhalational anthrax with acute respiratory distress syndrome

A 10-year-old boy presented with facial swelling, thick exudates in the nasal cavities with membranes covering the nasopharynx, shock and respiratory distress. X-ray of the paranasal sinuses showed opacification of both maxillary sinuses. Nasal diphtheria was suspected but culture of the membranes grew Bacillus anthracis. Chest X-ray showed mediastinal widening and extensive pulmonary infiltrates compatible with respiratory anthrax.