Unusual Signs Research Articles

Refining Research Diagnostic Criteria for Catatonia Among Delirium, Medical, Affective, and Psychosis Patient Groups.

The authors proposed catatonia diagnostic criteria that require the presence of three neuropsychiatric symptom clusters, rated over 24 hours; this system differs from other symptom clustering proposals and is intended to increase diagnostic rigor over Bush-Francis Catatonia Rating Scale (BFCRS) or DSM-5 criteria. By applying new BFCRS item score thresholds, symptoms were clustered into three categories to comprise the Research Diagnostic Criteria for Catatonia (RDCC): akinesia (criterion A), unusual motor signs (criterion B), and behavioral signs (criterion C). RDCC symptom clusters were analyzed in four prospectively evaluated patient groups (delirium, medical, affective, and psychosis) (N=341). Use of the RDCC, compared with the DSM-5-TR and BFCRS, resulted in far fewer diagnoses of catatonia in the four patient groups: medical, N=1 out of 42 (2%); affective, N=1 out of 45 (2%); psychosis, N=3 out of 53 (6%); and delirium, N=0 out of 201. Permutations of the RDCC with more relaxed criteria were assessed, requiring either symptom thresholds or numbers of symptoms to meet criteria, resulting in catatonia rate gradations between those obtained with the RDCC and those obtained with current systems. The Cochrane Q test found that the DSM-5-TR was not dissimilar to the RDCC, if fulfilling numerical thresholds for criteria A-C, although any level of symptom severity was allowed. Confirmatory factor analysis with three goodness-of-fit indexes validated the RDCC. The RDCC requires akinetic symptoms on the basis of literature demonstrating their high BFCRS prevalence and exploratory factor analysis co-loadings, plus symptoms from unusual motor and behavioral signs. Compared with current lenient diagnostic approaches, having the symptoms required by the RDCC produced lower catatonia rates in the psychosis, affective, and medical groups and revealed no patients with catatonia in the delirium group. Subdividing DSM-5-TR symptoms into several different criteria may improve diagnosis. RDCC symptom clusters are both research data-based and amenable to further research for validation.

Neuromyelitis optica spectrum disorder: Exploring the diverse clinical manifestations and the need for further exploration.

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disorder characterized by inflammatory assaults on the central nervous system (CNS), particularly on the optic nerves and spinal cord. In recent years, a wider range of clinical manifestations of this complex disease have been observed, emphasizing the importance of gaining a more profound understanding beyond optic neuritis (ON) and transverse myelitis (TM). This study explores the many clinical symptoms of NMOSD, including common and uncommon presentations. Distinctive aspects of ON, TM, and diencephalic/brainstem syndromes are examined, highlighting their unique characteristics in contrast to conditions such as multiple sclerosis. We also discuss extra-CNS involvement, such as unusual signs, including muscle involvement, retinal injury, auditory impairment, and rhinological symptoms. Our study intends to highlight the wide range and complexity of NMOSD presentations, emphasizing the significance of identifying unusual symptoms for precise diagnosis and prompt management. The specific processes that contribute to the varied clinical presentation of NMOSD are not well understood despite existing information. This emphasizes the necessity for more study to clarify the mechanisms that cause different symptoms and discover new treatment targets for this complex autoimmune disorder. It is essential to acknowledge the complex and varied clinical manifestations of NMOSD to enhance diagnosis, treatment, and patient results. By enhancing our comprehension of the fundamental processes and investigating innovative therapeutic approaches, we may aim to enhance the quality of life for persons impacted by this illness.

Serological Screening of SARS-CoV-2 Infection in Several Mammalian Species in Wilhelma Zoo, Stuttgart, Germany.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) affects both humans and a wide range of mammalian species globally. Between July 2022 and January 2023, fifteen blood samples were collected from twelve different animal species during veterinary examinations, as well as for health control at Wilhelma Zoo, Germany. These samples were later analyzed for the presence of SARS-CoV-2 antibodies. The serum analysis from two gorillas indicated the presence of antibodies specific to the nucleocapsid protein of SARS-CoV-2, suggesting previous infection. These gorillas were sampled in August and September 2022, during which time they exhibited symptoms such as apathy, anorexia, vomiting, and moderate diarrhea-symptoms not typically associated with COVID-19. Given that several periods of other unusual signs have been observed in the gorillas kept in Wilhelma Zoo since the onset of the COVID-19 pandemic, it remains uncertain whether these symptoms were directly related to SARS-CoV-2 infection or if these gorillas underwent clinically inapparent infection before. Nonetheless, this study underscores the importance of ongoing animal screening in zoos to better understand the spread of SARS-CoV-2 among different animal species.

Small bowel obstruction in ruptured male pelvic dermoid with situs inversus totalis: a singular case presentation

BackgroundPelvic dermoid cysts are extremely rare in males, with an even rare occurrence of rupture. Only a handful of cases of male pelvic dermoid cysts have been published with no reported case of ruptured male pelvic dermoid causing small bowel obstruction to the best of our knowledge.Case presentationHerein we report a case of ruptured pelvic dermoid presenting with intestinal obstruction in an adult male patient with situs inversus totalis.ConclusionPelvic dermoid cyst should be considered even in males the presence of classical radiological signs. Knowledge of usual and unusual imaging signs as well as the associated life-threatening complications of a ruptured dermoid cyst can help in prompt diagnosis and timely patient management.

Herpes Simplex Keratitis after PRK

Background: Herpes simplex virus (HSV) is a double stranded DNA virus that infects much of the world’s population. The World Health Organization estimates 67% of people under the age of 50 have HSV-1 and 11% of people under the age of 50 have HSV-2. While most systemic infections remain inactive and do not cause symptoms, the activation and appearance of ocular HSV can be a destructive and vision-threatening issue. HSV keratitis can be epithelial, stromal or a combination. Patients who have recently undergone photorefractive keratectomy (PRK) have a higher risk of HSV keratitis. Because of this, HSV keratitis should be considered in any PRK post-op patient that presents with unusual signs and symptoms such as decreased vision, increased IOPs, ocular pain, photophobia, iritis and corneal haze. When diagnosed in a timely manner, the prognosis is generally favorable. Current treatments for HSV keratitis include antiviral coverage as well as immunosuppression with topical steroids. Case Report: This case involves a patient that developed HSV keratitis while on topical steroid therapy following PRK. The weeks following the initial presentation were spent battling corneal haze, iritis, pain, increased IOPs and decreased visual acuity. After close monitoring and treatment changes based on each clinical presentation, the patient recovered with good vision and minimal corneal scarring. The findings and recommended treatment options are discussed. Conclusion: HSV affects much of the world’s population. Reactivation of the latent virus can lead to vision threatening corneal disease. HSV is capable of causing inflammation and pathology throughout most of the anterior segment of the eye, and therefore should be considered when managing any new or recalcitrant anterior pathology. Although the diagnosis is usually clinical, laboratory testing can be used to confirm a diagnosis. Treatment aims to decrease the viral load and to limit stromal scarring.

Herpes Simplex Keratitis after PRK

Background: Herpes simplex virus (HSV) is a double stranded DNA virus that infects much of the world’s population. The World Health Organization estimates 67% of people under the age of 50 have HSV-1 and 11% of people under the age of 50 have HSV-2. While most systemic infections remain inactive and do not cause symptoms, the activation and appearance of ocular HSV can be a destructive and vision-threatening issue. HSV keratitis can be epithelial, stromal or a combination. Patients who have recently undergone photorefractive keratectomy (PRK) have a higher risk of HSV keratitis. Because of this, HSV keratitis should be considered in any PRK post-op patient that presents with unusual signs and symptoms such as decreased vision, increased IOPs, ocular pain, photophobia, iritis and corneal haze. When diagnosed in a timely manner, the prognosis is generally favorable. Current treatments for HSV keratitis include antiviral coverage as well as immunosuppression with topical steroids. Case Report: This case involves a patient that developed HSV keratitis while on topical steroid therapy following PRK. The weeks following the initial presentation were spent battling corneal haze, iritis, pain, increased IOPs and decreased visual acuity. After close monitoring and treatment changes based on each clinical presentation, the patient recovered with good vision and minimal corneal scarring. The findings and recommended treatment options are discussed. Conclusion: HSV affects much of the world’s population. Reactivation of the latent virus can lead to vision threatening corneal disease. HSV is capable of causing inflammation and pathology throughout most of the anterior segment of the eye, and therefore should be considered when managing any new or recalcitrant anterior pathology. Although the diagnosis is usually clinical, laboratory testing can be used to confirm a diagnosis. Treatment aims to decrease the viral load and to limit stromal scarring.

Detection of Pattern of Some Unusual Signs and Symptoms of Multiple Sclerosis

Detection of Pattern of Some Unusual Signs and Symptoms of Multiple Sclerosis

Congenital duodenal web causing partial obstruction with recurrent vomiting and abdominal distention in a toddler boy: a case report

BackgroundThe duodenal web is a thin, elongated, web-like structure that is one of the factors contributing to duodenal obstruction. Only 100 cases have been reported in the literature. We present a 2.5-year-old cachectic Afghan child who did not have any overt signs and symptoms of intestinal obstruction, like recurrent vomiting, abdominal distention, and weight loss. The web was discovered near the intersection of the third and fourth portions, which is an uncommon location for the duodenal web. The late presentation of congenital duodenal web with partial obstruction is rare but well-known and has been reported in this case.Case presentationA 2.5-year-old cachectic Afghan child who had recurrent vomiting and experienced abdominal distention was brought to Maiwand Teaching Hospital from the Jabelsuraj region of Parwan province. The patient was suffering from unusual signs and symptoms like recurrent vomiting, abdominal distention, weight loss, and constipation. The diagnosis of these anomalies was established by a detailed history, clinical features, and abdominal CT scan. In the computerized tomography scanning (CT-Scan) image reported, there was a web with stenosis and partial obstruction in the distal aspect of the third-to-fourth portion of the duodenum. After preoperative stabilization, the child was taken for surgery. The abdomen was opened by a right upper abdominal transverse incision. After web resection and duodenoplasty, the patient was shifted to the recovery room in satisfactory condition. The child was allowed to feed after 8 days, which he tolerated well.ConclusionCongenital duodenal web with partial obstruction is typically observed in the second and third years of life. It is suspected in patients with recurrent vomiting, abdominal distention, weight loss, and constipation. Partial obstruction may not have an overt presentation, making it a challenging diagnosis for general practitioners. Abdomen X-ray and CT scan usually confirm the diagnosis, and successful surgical intervention is recommended.

Solitary occipital bone plasmacytoma with unusual ocular signs

Solitary occipital bone plasmacytoma at the level of the confluence of sinuses is a rare condition. We report a case of an unusual combination of occipital bone plasmacytoma, ocular motility abnormalities, and papilledema. To the best of our knowledge, no case has been reported in the literature on such a combination of nosology, location and clinical course.

Non-Multisystem Inflammatory Syndrome in Children—Postacute Sequelae of Paediatric COVID-19: Autoimmune or Autoinflammatory? A Systematic Review of the Reported Cases

Three years after its emergence, coronavirus disease 2019 (COVID-19) continues to be a leading cause of worldwide morbidity and mortality. This systematic review comprises relevant case reports that discuss non-multisystem inflammatory syndrome in children (non-MIS-C) and postacute sequalae of COVID-19 (PASC) in the paediatric population, also known as long COVID syndrome. The study aims to highlight the prevalent time interval between COVID-19 and the development of non-MIS-C post-infectious sequalae (PIS). Databases were searched for studies that met our inclusion and exclusion criteria. The final screening revealed an equal sex distribution where the commonest age intervals were school-age and adolescence, with 38% of the patients being older than six years. Interestingly, hospital admission during the course of COVID-19 was not a predictor of the subsequent PASC; forty-nine patients (44.9%) were hospitalized while sixty patients (55.1%) were not hospitalized. Moreover, the most predominant time interval between COVID-19 and the developing PASC was within 14 days from the start of COVID-19 infection (61%). These findings suggest a crucial link between COVID-19 and immune PIS in the paediatric population, especially those older than six years. Accordingly, follow-up and management are encouraged in case of unusual symptoms and signs following COVID-19 infection, regardless of the COVID-19 infection severity.

Atypical form of cystic fibrosis in early childhood

Introduction: Cystic fibrosis (CF) is an autosomal recessive genetic disorder, more prevalent in the Caucasian population. The disease is the result of mutations in a gene that codifies a chloride channel called CFTR (cystic fibrosis transmembrane conductance regulator) at affects most critically the lungs, pancreas, sweat glands and wolffian ducts. The variety of mutations in the CFTR gene is in some way responsible for the clinical variations by having and presentation in its atypical forms. Other factors, such as environmental factors and other genetic modifiers, affect the clinical variability of the disease. Aim: The purpose of the case presentation is to show that CF is also presented with unusual signs and symptoms of the disease, causing it to be diagnosed late in time. Case report: An 8 years old child A.D. admitted to the University Hospital Center of Tirana with a history of hypertransaminasemia, hypergammaglobulinemia and hepatomegaly which were found after a routine check. From the laboratory tests which were normal, causes such as: HIV, Viral Hepatitis, CMV infection, Toxoplasmosis and Rubeola are excluded as causes of increased transaminases and hepatomegaly. Antibodies for autoimmunity and liver-specific antibodies were normal, so autoimmune pathologies were excluded as their cause. Based on the history, the girl had repeated history of pulmonary infections, defecation with a heavy and greasy smell, poor weight gain, mother with a history of two spontaneous abortions, so the cystic fibrosis was suspected. Also, changes with an inflammatory aspect were found in chest radiography. Two sweat tests were performed, which were positive within a period of two weeks. The positive fecal elastase test confirmed pancreatic insufficiency. The child was started therapy with vitamine ADEK and ursodeoxycholic acid and an improvement was observed in the laboratory values ​​of the examinations. Conclusion: Continue neonatal screening for cystic fibrosis. Since we have cases with atypical clinical presentation that are diagnosed late in time when we have cases with hepatic manifestations and the child has a history of repeated respiratory infections, steatorrhea, poor weight gain according to age, a differential diagnosis of hepatic pathologies should be made with Cystic Fibrosis. Since hepatic involvement can be the first manifestation that leads to the diagnosis of cystic fibrosis in its atypical forms.

Sporadic small intestinal hamartomatous polyp: Causative element for obscure gastrointestinal bleeding and iron deficiency anemia: A case report

The term “obscure gastrointestinal bleeding” (OGIB) refers to gastrointestinal (GI) bleeding that is persistent or recurring and that cannot be distinguished by upper or lower GI endoscopy as a standard diagnostic procedure. There is a rare clinical disorder known as hamartomatous polyp (HP) which is characterized by a tumor-like development made up of mature cells and normal tissue that is distributed or numbered abnormally. The Peutz–Jeghers syndrome, juvenile polyposis syndrome (JPS), and phosphatase and tensin homologue deleted on chromosome 10 (PTEN) hamartoma tumor syndromes are the collection of genetic illnesses. In this case report, a 59-year-old man reported with sporadic hamartomatous jejunal polyp and unusual signs of recurrent gastrointestinal bleeding manifested by melena. The patient was diagnosed with capsule endoscopy and the treatment to the patient was given. So, it is recommended to go through careful endoscopic examination followed by endoscopic removal of polyps to reduce the risk of complications such as bleeding, degeneration, and the risk of surgery.

Prevalence and Characteristics of Radiographic Radiolucencies Associated with Class II Composite Restorations

Bitewing radiographic examination of the Class II composite restorations is commonly performed for diagnosis and preoperative planning of posterior teeth. The purpose of this study was to describe the prevalence; location; and characteristics of radiolucency findings associated with proximal class II composite restorations. Bitewing radiographs of proximal composite restorations of healthy adult patients (18 to 88 years old) who underwent restorative care at predoctoral clinics at the University of Maryland School of Dentistry from August 2016 to July 2019 were identified. Atypical radiographic features were categorized by location and associated material (adhesive or composite). In addition, demographic and clinical details (tooth position; restored surface) were recorded. Out of the 669 radiographically examined bitewings of restorations; 16.5% of radiographs showed no atypical findings; and 83.5% had unusual radiographic signs. The atypical radiographic findings were distributed as 16.5% internal voids; 3% overhang; 7.8% interlayer lines; 12.6% secondary caries; 20.7% interfacial gaps; and 23.1% multiple atypical findings. Class II composite restorations have a high prevalence of atypical radiolucency; particularly in the body of the composite; premolars; and disto-occlusal restorations. The information reported here emphasizes the clinical challenge of ascertaining an appropriate diagnosis of the radiolucencies underneath composite restorations.

Neuropsychiatric presentation of Wernicke’s Encephalopathy occurs to a pregnant Woman: A case report

IntroductionWernicke’s encephalopathy (WE) is a severe neuropsychiatric syndrome resulting from thiamine deficiency (vit B1) wich is often associated with chronic alcoholism. The classical presentation is characterized by ophtalmoplegia, ataxia and confusion.Unfortunately, WE is still underdiagnosed because it may not always show up with a classical presentation in one hand, and could also be seen in other non alcoholic condition in an other hand which delay diagnosis and managment of early proper treatementObjectivesThis case highlights the importance of considering atypical presentations of Wernicke’s encephalopathy, it’s medical etiologies and the importance of improving diagnosis to manage early treatementMethodsWe reported a case of a pregnant women who consulted for alterated mental status , asthenia and occurs to have Wernicke’s encephalopathy due to hyperemesis gravidarumResultsMrs X is a 35-year-old pregnant women with a past medical history of a cesarian, an hospitalisation in third month of this pregnancy for vomits, no known psychiatric illness or history of substance abuse. She was brought to the gynecology emergency department for asthenia and altered mental status. MRS X, was lethargic, had not eaten for several days, vomiting for more than a month. On the medical evaluation she appeared confused, disoriented, and unresponsive to verbal or manual redirection and prompting. She had also ataxia and gait incoordination. Laboratory testing was remarkable for lactic acidosis (blood lactate concentration lipasemia and normal electrolyte levels, cerebrospinal fluid (CSF) culture was unremarkable.A brain MRI was done and showed FLAIR signal abnormalities around the third ventricle and periaqueductal, suggesting Gayet-Wernicke encephalopathy. Thiamine (vit B1) 500mg thrice a day was administrated for the next days in associtation with vitamin B6.ConclusionsWernicke encephalopathy (WE) is an acute reaction to thiamine deficiency which usually presents with a classical triad. However, Clinicians tend to ignore WE in other non-alcoholic clinical settings and the diagnosis becomes even more difficult when thiamine deficiency presents with unusual neuropsychiatric signs and symptoms like catatonia. This case highlights the importance of considering atypical presentations of WE, it’s medical etiologies and the necessity of a complete medical evaluation and appropriate investigations to make prompt diagnosis and early management.Disclosure of InterestNone Declared

COVID Vaccination and Myocarditis, Is it real?

Introduction: SARS-CoV-2 first emerged during the coronavirus pandemic in Wuhan, China. The period from outbreak to aftermath was December 21, 2019, the first case occurred with association of seafood marketplace. The maximum not unusual place signs and symptoms are dyspnea, fever and cough. The novel COVID-19 disease has been also linked to cardiovascular disease. Myocarditis is an inflammation of cardiac muscle which can arise due to microorganism infection, publicity to poisonous substances, and stimulation of the immunity system. Many pharmacological establishments and academic foundations from everywhere in our world are working together to develop a vaccine for the new coronavirus infection. Aim of the work: Study the prevalence of myocarditis in healthy subjects after COVID vaccination due to an increase with inside a variety of cases. Materials and Methods: A retrospective scientific work of the predominance of myocarditis after vaccination against COVID-19 in Tobruk. The study included medical archives of all patients treated for myocarditis in the ICU and CCU of Tobruk Medical Center, including gender and age group from 17 to 64 years. Samples were collected. From January 1, 2020 to December 31, 2021, the total number of cases was 63. All necessary basic information and data were obtained from medical documents. Excel was used for data collection and descriptive analysis. Results: Our study included 63 patients. Of these, 51 (81%) were male and 12 (19%) were female. Male gender is predominant on female gender as ratio 1.6:1. Ages of patients tested in this study ranged from 17 to 64 years (mean age; 49 years). Highest age group observed to have a higher incidence of myocarditis after COVID-19 vaccination was 20-29 years (34.9%). According to the data, all patients (63 patients, 100%) experienced palpitations, 52 patients (82.5%) experienced mild fatigue, and 46 patients (73%) experienced shortness of breath. Our patients were taken Pfizer-BioNTech COVID vaccination (mRNA vaccine). Myocarditis occurred in 56 patients (89%) after second dose and 7 patients (11%) after first dose. Echocardiograms of all these patients showed no irregularities with conserved left ventricular ejection fraction. All recovered within 6 days of onset. Conclusion: Cardiac symptoms in the form of myocarditis occur after COVID-19 vaccination and require further investigation to determine the actual mechanism and appropriate treatment.

ПРЕДВАРИТЕЛЬНЫЕ ИТОГИ ИЗУЧЕНИЯ КЕРАМИКИ МОГИЛЬНИКА АНДРОНОВСКОЙ (ФЕДОРОВСКОЙ) КУЛЬТУРЫ ЧЕКАНОВСКИЙ ЛОГ-10

This article is devoted to the study of the Andronovo ceramic complex of the Chekanovsky Log-10 burial ground, one of the largest necropolises in the Altai Foothills and the entire Ob-Irtysh interfluve. Both a general morphological analysis of ceramics was carried out, including consideration of the shapes of vessels, methods of surface treatment, ornamentation techniques and decorative stylistics, as well as a technical and technological analysis, which made it possible to identify the traditions of selecting the original materials and composing pottery paste. As a result, eight groups of vessels were identifi ed, differing in the composition of the natural structure and parameters of general proportionality. It was found that most of the vessels had average proportions. When making ceramics, potters gave preference to medium-ferruginous clays containing natural inclusions of minerals. 10 recipes for pottery paste were identified. The leading one at the site was the tradition of using chamotte as a mineral admixture; organic additives were mainly used solutions and squeeze of manure. The correlation of all the data obtained during the analysis revealed that the greatest dependence can be traced between morphological groups, the method of surface treatment and the ornamentation of the vessels. The relationship of morphological groups with the raw materials of vessels and recipes for their manufacture is visible to a lesser extent. A number of vessels had a non-standard shape and decoration (vessels with grooves, a ledge on the shoulder, a drawn comb stamp). The identifi ed unusual signs may be associated with contacts with the population of other territories (presumably with the Alakul population from the Urals or Kazakhstan), since they are not typical for the Andronovo (Fedorovо) culture. A comparison of the obtained results of technical and technological analysis with data from other Andronovo complexes indicates that the ceramics of the Chekanovsky Log-10 burial ground have greater similarities in the ceramics manufacturing technology with the monuments of the Altai plain zone. At the same time, the features of the morphology and ornamentation of the dishes indicate a general similarity with ceramics from the Andronovo sites not only in Altai, but also in the Upper Irtysh region.

Clinical phenotypes of five patients with psychotic disorders carrying rare schizophrenia-associated loss-of-function variants

The Schizophrenia Exome Meta-Analysis (SCHEMA) consortium identified 10 genes in which loss-of-function (LoF) variants are highly associated with schizophrenia (SZ). In a well-characterized sample of 988 patients with psychotic disorders, we investigated whether patients bearing a SCHEMA variant presented with unusual or unique signs, symptoms, or course of illness. We identified 5 patients who carried a LoF variant in a SCHEMA gene, each in a different gene. None of the patients with a SCHEMA variant had unique symptoms. However, compared to the average of patients in the sample, all of the patients with a SCHEMA variant had earlier onset of any mental illness and more hospitalizations. Also, among SCHEMA carriers, 80 % were treated with clozapine, 60 % with ECT, all with either clozapine or ECT and 40 % with both clozapine and ECT, compared to only 2 % treated with clozapine and 18 % treated with ECT in the comparison group of patients without SCHEMA variants. All 5 patients with a SCHEMA variant had polysubstance abuse, and all had attempted suicide. Fewer than half had such presentations in the group without SCHEMA variants. In this small sample, SCHEMA variants appear to be associated with earlier onset, less favorable response to standard first-line treatments, and more severe illness, but not unique presentations of illness.

Colonic perforation presenting as retroperitoneal abscess: case report and brief review of literature

Retroperitoneal colonic perforation is a rare cause of retroperitoneal abscess. It presents more frequently in frail elderly patients with heterogeneous signs and symptoms which make it difficult to diagnose clinically. Subcutaneous emphysema with pneumomediastinum and iliopsoas muscle abscess are unusual signs. Abscess formation occurs in 0.3 to 0.4% and is the second most common complication of perforated lesions. Acute appendicitis may also present with retroperitoneal abscess which is a life threatening complication.

Atypical Lesions in Canine Leishmaniosis: Description of New Cases.

Simple SummaryCanine leishmaniosis is a zoonotic disease caused mainly by the protozoan Leishmania infantum that is endemic in the Mediterranean basin. The clinical signs and pathological characteristics have been extensively described; however, atypical lesions leading to clinical and pathological misdiagnosis have been sporadically reported. This study presents three cases of dogs experimentally infected with Leishmania infantum that showed gross lesions considered atypical of canine leishmaniosis and not previously reported. Macroscopic lesions were observed in the liver, spleen, and peritoneal cavity that corresponded to tan to whitish nodular lesions in all organs and multifocal irregular and linear whitish lesions in one of the livers that mimicked tumors. Microscopically, a marked granulomatous inflammation with a relative scarcity of parasites was observed in all the organs. In conclusion, microscopic and parasitological studies should be performed on atypical lesions observed in Leishmania-infected and non-infected dogs, especially in endemic regions. In addition, due to its zoonotic importance, leishmaniosis should be considered when atypical nodular lesions are observed in dogs from non-endemic regions with a history of travel to endemic regions.Pathological characteristics are well described in canine leishmaniosis (CanL). However, atypical lesions that can be confused with other pathologies or trigger unusual clinical signs are sporadically reported. Atypical lesions were observed during routine postmortem examination in three Leishmania-infected dogs and samples were taken for histopathological and immunohistochemical studies. Clinical signs, biochemical parameters, level of antibodies, and parasite detection by PCR were also evaluated. Atypical lesions were found in the peritoneal cavity, liver, and spleen. Splenomegalia and hepatomegalia were observed in all dogs. In addition, multifocal dark to white nodules of variable size were observed in the peritoneal cavity, liver, and spleen of one dog and in the spleen of the other two dogs. One dog presented diffuse irregular whitish lines with a threadlike appearance and another an intense fibrotic depression in the intermediate lobe. Microscopically, an intense granulomatous inflammation with abundant macrophages, a variable number of lymphocytes, and a low to moderate number of parasites was observed. This study represents the first description of granulomatous peritonitis associated with Leishmania in dogs. It also shows atypical macroscopic expression of hepatitis in CanL. In the absence of an adequate clinical history and laboratory analyses, certain lesions observed in CanL could admit alternative diagnoses.

A fatal SARS-coronavirus-2 induced bone marrow aplasia complicated with invasive fungal infection and severe neutropenic enterocolitis

BackgroundImmunization against the coronavirus disease 2019 (COVID-19) began in January 2021 in Iran; nonetheless, due to a lack of vaccination among children under 12, this age group is still at risk of SARS-CoV-2 infection and its complications.Case presentationSARS-CoV-2 infection was diagnosed in a 6-year-old girl who had previously been healthy but had developed a fever and pancytopenia. The bone marrow aspiration/biopsy demonstrated just hypocellular marrow without signs of leukemia. She was worked up for primary and secondary causes of pancytopenia. Except for a repeated reactive HIV antibody/Ag P24 assay, all test results were inconclusive. After a thorough diagnostic investigation, the cross-reactivity of the HIV antibody/Ag P24 test with SARS-CoV-2 antibodies was confirmed. The patient did not develop any COVID-19-related signs and symptoms, but she did get a severe invasive fungal infection and neutropenic enterocolitis. She died as a result of disseminated intravascular coagulopathy.ConclusionIt is critical to recognize children infected with SARS-CoV-2 who exhibit atypical clinical manifestations of COVID-19, such as persistent pancytopenia. SARS-CoV-2 infection can cause severe and deadly consequences in children; thus, pediatricians should be aware of COVID-19’s unusual signs and symptoms mimicking other conditions such as aplastic anemia.