Amelanotic anorectal malignant melanoma in an ulcerative colitis patient: a rare coincidence or a rare association

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal system, known to be associated with increased risk of carcinogenesis. We report the case of a 55-year-old woman, presenting with symptoms of increased bowel frequency, per rectal bleeding and rectal pain with a background of ulcerative colitis (UC). This was presumptively managed as UC flare, with titration of her medications to control the symptoms. However, a flexible sigmoidoscopy revealed an ulceroproliferative lesion in the rectum, which was identified as an amelanotic anorectal malignant melanoma on immunohistochemistry. No local or distant metastases were noted on radiological imaging. The tumour enlarged progressively and was managed with laparotomy and defunctioning stoma followed by palliative chemotherapy and immunotherapy. This is the first such case reported in literature, highlighting the importance of endoscopic assessment and the need to consider other differential diagnosis in patients with symptoms of IBD flare.

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COVID-19 and Sarcoidosis, Readiness for Vaccination: Challenges and Opportunities

Frontiers in Medicine ◽

10.3389/fmed.2021.672028 ◽

2021 ◽

Vol 8 ◽

Author(s):

Michael Manansala ◽

Amit Chopra ◽

Robert P. Baughman ◽

Richard Novak ◽

Elyse E. Lower ◽

...

Keyword(s):

Clinical Decision ◽

Inflammatory Disorder ◽

Efficacy And Safety ◽

Risk Of Infection ◽

Decision Algorithm ◽

Chronic Inflammatory Disorder ◽

Immune Mediated ◽

Immunosuppressive Medications ◽

Increased Risk ◽

Challenges And Opportunities

Sarcoidosis is an immune mediated chronic inflammatory disorder that is best characterized by non-caseating granulomas found in one or more affected organs. The COVID-19 pandemic poses a challenge for clinicians caring for sarcoidosis patients who may be at increased risk of infection compared to the general population. With the recent availability of COVID-19 vaccines, it is expected that clinicians raise questions regarding efficacy and safety in sarcoidosis. However, studies examining safety and efficacy of vaccines in sarcoidosis are lacking. In this review, we examine the current literature regarding vaccination in immunocompromised populations and apply them to sarcoidosis patients. The available literature suggests that vaccines are safe and effective in patients with autoimmune disorders and in those taking immunosuppressive medications. We strongly recommend the administration of COVID-19 vaccines in patients with sarcoidosis. We also present a clinical decision algorithm to provide guidance on vaccination of sarcoidosis patients against COVID-19.

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A Severe Necrotizing Inflammatory Reaction of Leg Wounds Following Autologous Peripheral Blood Total Nucleated Cells Treatment in an Old Patient With Rheumatoid Arthritis and No-Option Chronic Limb-Threatening Ischemia: Is Cell Therapy Suitable for All Patients?

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734621997570 ◽

2021 ◽

pp. 153473462199757

Author(s):

Valerio Vallini ◽

Luigi Venturini ◽

Paolo Carnesecchi ◽

Roberto Andreini ◽

Simone Meini

Keyword(s):

Rheumatoid Arthritis ◽

Cell Therapy ◽

Inflammatory Reaction ◽

Peripheral Blood ◽

Mononuclear Cells ◽

Inflammatory Diseases ◽

Inflammatory Disorder ◽

Skin Atrophy ◽

Chronic Inflammatory Disorder ◽

Increased Risk

Chronic limb-threatening ischemia (CLTI) represents an unfavorable evolution of peripheral artery disease, characterized by pain at rest, ulceration, and gangrene and also by an increased risk of cardiovascular events, amputations, and death. According to scientific literature, in almost one third of cases affected by CLTI, defined as no-option CLTI patients, revascularization strategies are not feasible. In the past decade, several studies investigated the role of therapeutic angiogenesis through cell autologous therapy, administered through intramuscular injections or multiple local intralesional and perilesional injections. In this article, we report the case of a necrotizing inflammatory reaction in a patient affected by CLTI and chronic leg wounds that occurred on the multiple injection sites after autologous peripheral blood-derived mononuclear cells (PB-TNCs) transplantation. Since the patient was affected by corticosteroid-induced skin atrophy and rheumatoid arthritis, we hypothesize that an increased skin fragility and a mechanism of immune-mediated pathergy could have been main factors leading to worsening of wounds. This case report strongly suggests the urgent need to better define the indications and contraindications of cell therapy, and further studies of adequate methodology are required to definitively assess the efficacy and safety of autologous cell therapy by local injections of PB-TNCs in patients with chronic inflammatory disorder, such as rheumatoid arthritis, especially in case of concomitant marked skin atrophy. Pending definitive evidence from literature, a strong caution is needed in patients affected by chronic systemic inflammatory diseases, since multiple injections, acting as mechanical stimulus and pathergy trigger, might exacerbate a severe and uncontrolled inflammatory response.

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Journey through Crohn’s Disease Complication: From Fistula Formation to Future Therapies

Journal of Clinical Medicine ◽

10.3390/jcm10235548 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5548

Author(s):

Federica Rubbino ◽

Luana Greco ◽

Alessio di Cristofaro ◽

Federica Gaiani ◽

Stefania Vetrano ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Perianal Fistula ◽

Fistula Formation ◽

Surgical Approaches ◽

Molecular Characteristics ◽

Inflammatory Disorder ◽

Mesenchymal Transition ◽

Chronic Inflammatory Disorder ◽

Increased Risk

Crohn’s Disease (CD) is a chronic inflammatory disorder in which up to 50% of patients develop fistula within 20 years after the initial diagnosis, and half of these patients suffer perianal fistulizing disease. The etiopathogenesis of CD-related perianal fistula is still unclear, and its phenotypical and molecular characteristics are even more indefinite. A better understanding would be crucial to develop targeted and more effective therapeutic strategies. At present, the most accredited theory for the formation of CD-related fistula identifies the epithelial-to-mesenchymal transition (EMT) as the driving force. It has been well recognized that CD carries an increased risk of malignancy, particularly mucinous adenocarcinoma is often associated with long-standing fistula in CD patients. Despite the availability of multiple treatment options, perianal fistulizing CD represents a therapeutic challenge and is associated with an important impact on patients’ quality of life. To date, the most effective management is multidisciplinary with the cooperation of gastroenterologists, surgeons, radiologists, and nutritionists and the best recommended treatment is a combination of medical and surgical approaches.

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Second-Look Endoscopy in Hospitalized Severe Ulcerative Colitis: A Retrospective Cohort Study

Inflammatory Bowel Diseases ◽

10.1093/ibd/izy282 ◽

2018 ◽

Vol 25 (4) ◽

pp. 750-755 ◽

Cited By ~ 2

Author(s):

Nienke Z Borren ◽

Hamed Khalili ◽

Jay Luther ◽

Francis P Colizzo ◽

John J Garber ◽

...

Keyword(s):

Ulcerative Colitis ◽

Rescue Therapy ◽

Independent Effect ◽

Study Cohort ◽

Severe Ulcerative Colitis ◽

Increased Risk ◽

Multivariable Regression ◽

Endoscopic Assessment ◽

Multivariable Regression Models ◽

Median Interval

Abstract Background Acute severe ulcerative colitis (ASUC) is a serious complication of ulcerative colitis (UC). Management of partial responders to steroids or rescue therapy remains challenging. Whether there is a role for re-look sigmoidoscopic evaluation in disease management is unknown. Methods Our study cohort consisted of patients who underwent 2 sigmoidoscopic procedures during the same index hospitalization for ASUC at our center. Reasons for repeat endoscopic evaluation and endoscopic and histologic severity of inflammation during both procedures were noted. Multivariable regression models were performed to identify predictors of improvement at the second endoscopic assessment and to determine the independent effect of such an improvement on in-hospital colectomy and at 3, 6, and 12 months. Results Our study included 49 patients (mean age, 42 years; 52% women). Just under one-third of patients (30%) were noted to have improved endoscopic appearance at the second sigmoidoscopy, at a median of 9 days after initial exam. None of the patients who had improvement on the second endoscopy underwent in-hospital colectomy, compared with 46% of those with worsening or persistent disease (P = 0.002). Similar differences in the improved group persisted at 3 months (P = 0.007) and 6 months (P = 0.027). Histologic severity at the first endoscopy was associated with increased risk of colectomy in-hospital (odds ratio, 3.8; 95% confidence interval, 1.02–14.21) and at 3 and 6 months. Conclusions After a median interval of 9 days, endoscopic improvement was noted in 30% of patients with ASUC undergoing a second sigmoidoscopy, which predicted lower rates of colectomy in-hospital and at 3 and 6 months.

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Roles of IL-17A and IL-23 in the Pathogenesis of Ulcerative Colitis and Crohn’s Disease

Iraqi Journal of Science ◽

10.24996/ijs.2021.62.8.5 ◽

2021 ◽

pp. 2526-2535

Author(s):

Sarah S. Abdul-Hussein ◽

Ekhlass N. Ali ◽

Nawal M. F. Alkhalidi ◽

Neihaya H. Zaki ◽

Ali H. Ad'hiah

Keyword(s):

Ulcerative Colitis ◽

Crohn’S Disease ◽

Family History ◽

Crohn's Disease ◽

Smoking Status ◽

Serum Levels ◽

Inflammatory Disorder ◽

Chronic Inflammatory Disorder ◽

History Of ◽

Disease Extension

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder, the etiology and pathogenesis of which have been suggested to be influenced by cytokines. Two main clinical types of IBD are recognized, namely ulcerative colitis (UC) and Crohn's disease (CD). The present study examined serum levels of two cytokines (IL-17A and IL-23) in 60 IBD patients (30 UC and 30 CD) and 30 healthy controls. The levels were correlated with age, gender, cigarette-smoking status, disease duration, family history, disease extension, symptoms, extra-intestinal manifestations, and medication. The results depicted that IL-17A level was significantly higher in UC and CD patients compared to control (45.2 ± 23.3 and 47.5 ± 34.4 vs. 15.6 ± 7.5 pg/ml, respectively; p < 0.001). Serum level of IL-23 was similarly increased in UC and CD patients compared to control (64.1± 23.7 and 62.5 ± 27.3 vs. 25.2 ± 11.1 pg/ml, respectively). However, the level of both cytokines showed no significant variation between UC and CD patients (p = 0.713 and 0.777, respectively). Distributing UC and CD patients into subgroups according to some characteristics revealed that IL-17A level was significantly increased in UC male compared to female patients (57.3 ± 18.2 vs. 34.5 ± 22.5 pg/ml; p = 0.005). It was also significantly increased in smoker UC patients compared with non-smoker patients (51.9 ± 19.4 vs. 31.6 ± 25.5 pg/ml; p = 0.022). Smoker CD patients also showed a significantly increased level of IL-23 compared to non-smoker patients (72.7 ± 28.5 vs. 52.2 ± 22.6 pg/ml; p = 0.038). In the case of family history, IL-23 level was significantly decreased in UC patients with a family history of IBD compared to CD patients with a family history (84.5 ± 24.3 vs. 50.4 ± 17.0 pg/ml.; p = 0.042). In conclusion, the present data suggest a role for IL-17A and IL-23 in the etiology and pathogenesis of UC and CD.

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Secukinumab and Apremilast Combination Therapy for Recalcitrant Psoriasis

Journal of Psoriasis and Psoriatic Arthritis ◽

10.1177/247553031700200203 ◽

2017 ◽

Vol 2 (2) ◽

pp. 59-61 ◽

Cited By ~ 2

Author(s):

Ali Hadi ◽

Mark Lebwohl

Keyword(s):

Coronary Artery Disease ◽

Metabolic Syndrome ◽

Psoriatic Arthritis ◽

Th17 Cells ◽

Treatment Options ◽

Inflammatory Disorder ◽

Combination Therapies ◽

Chronic Inflammatory Disorder ◽

Increased Risk ◽

Artery Disease

Psoriasis is a chronic inflammatory disorder of the skin and joints mediated by aberrant activity of Th1 and Th17 cells. It also has been shown to be associated with an increased risk of coronary artery disease and metabolic syndrome, highlighting the associated systemic inflammation. Despite the multitude of treatment options available, some cases are still refractory to the available agents, necessitating innovative combination therapies for management. Here we report the second case of plaque psoriasis and psoriatic arthritis treated successfully with a combination of apremilast and secukinumab.

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Vitamin D Increases CTLA-4 Gene Expression in Patients with Mild to Moderate Ulcerative Colitis

Middle East Journal of Digestive Diseases ◽

10.15171/mejdd.2019.149 ◽

2019 ◽

Vol 11 (4) ◽

pp. 199-204

Author(s):

Amrollah Sharifi ◽

Homayoon Vahedi ◽

Mohammad Reza Honarvar ◽

Behnam Alipoor ◽

Zeinab Nikniaz ◽

...

Keyword(s):

Gene Expression ◽

Ulcerative Colitis ◽

Vitamin D ◽

Cytotoxic T Lymphocyte ◽

Serum Vitamin ◽

Immunoglobulin Superfamily ◽

Inflammatory Disorder ◽

Chronic Inflammatory Disorder ◽

Serum Vitamin D ◽

Antigen Presenting

BACKGROUND Ulcerative colitis (UC) is a chronic inflammatory disorder of the large intestine. Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) is a member of the immunoglobulin superfamily, which binds B7-1 and B7-2 on APCs (antigen-presenting cells), and induces APCs to produce an inhibitory signal to T cells. The aim of this study was to investigate the effect of vitamin D on CTLA-4 gene expression in whole blood samples of patients with UC. METHODS 90 patients with mild to moderate UC were randomized to receive either a single injection of 7.5 mg vitamin D3 or 1 mL normal saline. 90 days following the intervention fold changes in CTLA-4 mRNA expression were determined and statistical comparisons between the two groups were performed. RESULTS Serum vitamin D increased significantly only in the vitamin D group. CTLA-4 fold changes were significantly higher in the vitamin D group compared with the placebo group (median ± IQR: 1.21 ± 2.3 vs. 1.00 ± 1.5, respectively; p = 0.007). CONCLUSION The results of this study revealed that vitamin D administration in patients with UC enhances the CTLA-4 gene expression.

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Survivin and Programmed Death Ligand-1 as Possible Players in the Pathogenesis of Ulcerative Colitis: An Immunohistochemical Study

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.4868 ◽

2020 ◽

Vol 8 (A) ◽

pp. 646-651

Author(s):

Reham Shehab El Nemr Esmail ◽

Eman Hassan Abdelbary

Keyword(s):

Ulcerative Colitis ◽

Lamina Propria ◽

Immunohistochemical Study ◽

Control Group ◽

Inflammatory Disorder ◽

Immunohistochemical Expression ◽

Chronic Inflammatory Disorder ◽

Programmed Death ◽

Mucosal Cells ◽

Inflammatory Bowel

BACKGROUND: Ulcerative colitis (UC) is a relapsing chronic inflammatory disorder, with many catastrophic complications. The pathogenesis of UC is not yet well understood. Exploring the exact immunologic pathogenesis of UC may eventually offer new therapeutic options. AIM OF THE WORK: In this study, we proposed that survivin and programmed death ligand (PDL1) may have roles in the pathogenesis of UC. MATERIALS AND METHODS: The study examined the immunohistochemical expression of both markers in the colonic epithelial cells and lamina propria in 43 cases of UC and 43 cases of non-specific chronic colitis (non-inflammatory bowel disease colitis). RESULTS: The results uncovered that both survivin and PDL1 expression were significantly expressed in the colonic lamina propria cells in UC cases in comparison to colitis cases (p < 0.001). On the other hand, the expression of PDL1 was shown to be lost in the colonic mucosal cells in UC cases when compared to cases of the control group (p < 0.05). CONCLUSION: The study, therefore, concluded that both survivin and PDL1 may play an important role in the UC pathogenesis and hence may be a novel interest in new therapeutic trends.

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