scholarly journals Gastrointestinal Cryptococcosis Associated with Intestinal Lymphangiectasia

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Fernando Naranjo-Saltos ◽  
Alejandro Hallo ◽  
Carlos Hallo ◽  
Andres Mayancela ◽  
Alejandra Rojas
Keyword(s):  
Opportunistic Infections ◽  
Lymphatic Vessels ◽  
Immunocompetent Patient ◽  
Intestinal Lumen ◽  
Histopathological Study ◽  
Intestinal Lymphangiectasia ◽  
Protein Losing Enteropathy ◽  
Unusual Association ◽  
Intestinal Involvement ◽  
Cellular Components

Intestinal lymphangiectasia is a pathological dilation of enteric lymphatic vessels resulting in lymph leakage to the intestinal lumen. This chronic lymph leakage leads to a state of immunosuppression secondary to the loss of humoral and cellular components of the immune system and represents a potential risk factor for opportunistic infections. We report a case of protein-losing enteropathy in a seemingly immunocompetent patient. An intestinal histopathological study revealed the unusual association of lymphangiectasia and intestinal cryptococcosis. Although cryptococcal infection is common in immunocompromised patients, intestinal involvement is rarely reported. We found no reports on the association of intestinal cryptococcosis in patients with lymphangiectasia. This case report is the first to describe intestinal cryptococcosis associated with intestinal lymphangiectasia.

scholarly journals Congenital intestinal lymphangiectasia

2011 ◽  
Vol 68 (3) ◽  
pp. 270-273
Author(s):  
Dusan Popovic ◽  
Milan Spuran ◽  
Tamara Alempijevic ◽  
Miodrag Krstic ◽  
Srdjan Djuranovic ◽  
...  
Keyword(s):  
Early Recognition ◽  
Clinical Manifestations ◽  
Lymphatic Vessels ◽  
High Protein Diet ◽  
Intestinal Wall ◽  
Intestinal Biopsy ◽  
Intestinal Lymphangiectasia ◽  
Laboratory Assessment ◽  
Protein Losing Enteropathy ◽  
Adequate Treatment

Background. Congenital intestinal lymphangiectasia is a disease which leads to protein losing enteropathy. Tortous, dilated lymphatic vessels in the intestinal wall and mesenterium are typical features of the disease. Clinical manifestations include malabsorption, diarrhea, steatorrhea, edema and effusions. Specific diet and medication are required for disease control. Case report. A 19-year old male patient was hospitalized due to diarrhea, abdominal swelling, weariness and fatigue. Physical examination revealed growth impairment, ascites, and lymphedema of the right hand and forearm. Laboratory assessment indicated iron deficiency anaemia, lymphopenia, malabsorption, inflammatory syndrome, and urinary infection. Enteroscopy and video capsule endoscopy demonstrated dilated lymphatic vessels in the small intestine. The diagnosis was confirmed by intestinal biopsy. The patient was put on high-protein diet containing medium-chain fatty acids, somatotropin and suportive therapy. Conclusion. Congenital intestinal lymphangiectasia is a rare disease, usually diagnosed in childhood. Early recognition of the disease and adequate treatment can prevent development of various complications.

Lymphatics in the Alimentary Tract of Children in Health and Disease: Study on Mucosal Biopsies Using the Monoclonal Antibody D2-40

2005 ◽  
Vol 8 (5) ◽  
pp. 541-549 ◽  
Author(s):  
Yiping Zeng ◽  
Fenghua Wang ◽  
Elizabeth D. Williams ◽  
Chung Wo Chow
Keyword(s):  
Clinical Features ◽  
Alimentary Tract ◽  
Lymphatic Vessels ◽  
Specific Method ◽  
Intestinal Lymphangiectasia ◽  
Histologic Diagnosis ◽  
Protein Losing Enteropathy ◽  
Negative Finding ◽  
Young Infants ◽  
Disease Study

Primary intestinal lymphangiectasia and intestinal lymphatic hypoplasia are 2 causes of protein-losing enteropathy in children and share many common clinical features. For the diagnosis of lymphatic hypoplasia on endoscopic biopsies of the intestine, i.e., based on a negative finding in a small specimen, a very sensitive and specific method for identifying lymphatics is essential. In the present study, lymphatic vessels were labelled using D2-40 immunostaining in mucosal biopsy specimens of the alimentary tract of children in whom no histologic abnormality was noted and of those who had different relatively common pediatric conditions, including inflammatory and neoplastic diseases. Using this method, lymphatic vessels were well visualized even in young infants and not destroyed by diseases. The presence of the muscularis mucosae in specimens was important for adequate assessment. In the duodenum and esophagus, lymphatics were observed in every single section; in the stomach, ileum, and colon, they were less regular and several sections were sometimes required. The extreme sensitivity of this method for demonstrating lymphatic vessels in the duodenum makes it ideal for the histologic diagnosis of intestinal lymphatic hypoplasia. In 4 patients who were considered to have this diagnosis based on clinical features, full-thickness intestinal biopsies and electron microscopy, D2-40 immunostaining confirmed the absence or marked paucity of lymphatics.

scholarly journals A case of primary intestinal lymphangiectasia with non-Hodgkin lymphoma

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Doudou Hu ◽  
Xianghua Cui ◽  
Wanlei Ren ◽  
Jian Zhang ◽  
Xin Guan ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Ileocecal Valve ◽  
Abdominal Distension ◽  
Intestinal Lumen ◽  
Intestinal Lymphangiectasia ◽  
Protein Losing Enteropathy ◽  
Non Hodgkin Lymphoma ◽  
Limb Edema ◽  
History Of ◽  
Biopsy Examination

Abstract Background Primary intestinal lymphangiectasia (PIL) is a rare protein-losing enteropathy characterized by the loss of proteins, lymphocytes, and immunoglobulins into the intestinal lumen. Increasing evidence has demonstrated an association between PIL and lymphoma. Case presentation A 54-year-old man with a 20-year history of abdominal distension and bilateral lower limb edema was admitted. Laboratory investigations revealed lymphopenia, hypoalbuminemia, decreased triglyceride and cholesterol level. Colonoscopy showed multiple smooth pseudo polyps in the ileocecal valve and terminal ileum and histological examination showed conspicuous dilation of the lymphatic channels in the mucosa and submucosa. A diagnosis of PIL was made. Three years later colonoscopy of the patient showed an intraluminal proliferative mass in the ascending colon and biopsy examination confirmed a malignant non-Hodgkin lymphoma. Then the patient was been underwent chemotherapy, and his clinical condition is satisfactory. Conclusion Our report supports the hypothesis that PIL is associated with lymphoma development.

Abstract 321: Lymphatic derived HDL Is an Effective Donor for the Trans-Intestinal Cholesterol Efflux Pathway That Is Impaired During Insulin Resistance

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Rabban Mangat ◽  
Faye Borthwick ◽  
Donna F Vine ◽  
Spencer D Proctor
Keyword(s):  
Insulin Resistance ◽  
Basolateral Membrane ◽  
Lymphatic Vessels ◽  
Intestinal Lumen ◽  
Cholesterol Diet ◽  
High Fat ◽  
Ussing Chambers ◽  
Mesenteric Lymph ◽  
Proximal Small Intestine ◽  
Specific Permeability

Introduction: Emerging evidence shows that the proximal small intestine secretes cholesterol into the intestinal lumen via the trans-intestinal cholesterol excretion (TICE) pathway. It is thought TICE can contribute up to 30-40% of fecal neutral sterol excretion. Plasma apoB containing lipoproteins are known to donate cholesterol to the TICE pathway whilst conflicting evidence exists on the role for plasma HDL. Due to the anatomical proximity of lymphatic vessels to the basolateral membrane of enterocytes, it may serve as a candidate donor to TICE, but to date this has not been tested. Objective: To determine if HDL derived from mesenteric lymph can act as cholesterol donor for TICE in JCR:LA cp rats as a model of insulin resistance (IR). Methods: Mesenteric lymph was collected following intralipid infusion via lymphatic cannulation from control rats. Lymph HDL was isolated using ultra-density centrifugation and labeled with H3 cholesterol. Jejunal explants were obtained from control and IR rats (as a model of reduced TICE) fed chow or a high fat/cholesterol diet. TICE was measured with Ussing Chambers as appearance of H3-cholesterol labeled lymph HDL using micelles as acceptors. Results: Relative to free cholesterol [FC; used as marker of non-specific lipid permeability], lymph derived HDL TICE was 77% higher in control tissue (n=5, p<0.05) under chow fed conditions, suggestive of an effective donor for TICE. Lymph HDL TICE was also reduced (89%, p<0.05) in IR rats compared to control. Furthermore SR-B1 mRNA was reduced (-65%) in enterocytes from IR rats compared to control, and may explain reduced TICE by lymph HDL in IR. Under conditions of high fat/cholesterol fed diet, TICE from FC [and mannitol as a marker of paracellular transport] was increased in both control and IR rats, suggesting an elevated non-specific permeability of lipids by the basolateral membrane. Conclusions: Consistent with evidence that the lymphatics have a role in reverse cholesterol transport, this data supports that lymph HDL is an effective donor for TICE possibly by the SR-B1 pathway. While we have shown that the lymph HDL TICE pathway may be impaired during insulin resistance, a high fat/cholesterol diet may exacerbate lipid permeability via non-specific efflux pathways.

scholarly journals Resolution of longstanding protein-losing enteropathy in a patient with intestinal lymphangiectasia after treatment for malignant lymphoma

1981 ◽  
Vol 80 (1) ◽  
pp. 166-168 ◽  
Author(s):  
Samuel Broder ◽  
Thomas R. Callihan ◽  
Elaine S. Jaffe ◽  
Vincent T. DeVita ◽  
Warren Strober ◽  
...  
Keyword(s):  
Malignant Lymphoma ◽  
Intestinal Lymphangiectasia ◽  
Protein Losing Enteropathy

Recurrent and Opportunistic Infections in Children With Primary Intestinal Lymphangiectasia

2007 ◽  
Vol 44 (3) ◽  
pp. 382-385 ◽  
Author(s):  
Miranda P Dierselhuis ◽  
Jaap Jan Boelens ◽  
Florens GA Versteegh ◽  
Corry Weemaes ◽  
Nico M Wulffraat
Keyword(s):  
Opportunistic Infections ◽  
Intestinal Lymphangiectasia

A Case of Protein-Losing Enteropathy Caused by Intestinal Lymphangiectasia in a Preterm Infant

PEDIATRICS ◽  
2001 ◽  
Vol 107 (2) ◽  
pp. 416-417 ◽  
Author(s):  
G. Salvia ◽  
C. F. Cascioli ◽  
F. Ciccimarra ◽  
G. Terrin ◽  
S. Cucchiara
Keyword(s):  
Preterm Infant ◽  
Intestinal Lymphangiectasia ◽  
Protein Losing Enteropathy

scholarly journals Case report: Medullary cryptococcosis in a immunocompetent patient

2021 ◽  
Author(s):  
Joao Paste Silva ◽  
Catarina Secundino ◽  
Tiago Timotio ◽  
Aurea Angelica Paste
Keyword(s):  
Case Report ◽  
Pulmonary Infection ◽  
Opportunistic Infections ◽  
Spinal Tuberculosis ◽  
Memory Loss ◽  
Immunocompetent Patient ◽  
Unusual Manifestation ◽  
Meningeal Irritation ◽  
Cranial Neuropathies ◽  
One Year

Context: Cryptococcosis is an important fungal infection that, after AIDS development globally, became more common, being an important cause of opportunistic infections. The pathogen normally gets in through the lungs, causes pulmonary infection and then spreads to another systems, particularly the nervous system in most cases. Along the clinical manifestation there was headache, fever, cranial neuropathies, altered mentation, lethargy, memory loss, and signals of meningeal irritation. Case-Report: A 48-year-old male patient with a one-year story of paraparesis in both legs, associated with pain, paresthesia, and progressive worsening to complete walking incapability, seeks medical consultation. Cerebrospinal fluid was turbid appearance, yellow colored, presence of RBC (1.239 cel/mm³) and leukocytes (149 cel/mm³ - 5% neutrophils, 91% lymphocytes and 4% monocytes), glucose of 23 mg/dL, chlorine of 96 mmol/L, and Cryptococcus neoformans was isolated. Immunosuppressive disease wasn´t found. In MRI, there were nodular images in the intradural and extradural sites through T11-T12 levels, compressing the spinal cord. Local biopsy revealed chronic granulomatous inflammatory process, consistent with the cryptococcosis suspect. Conclusions: The case represents an unusual manifestation of cryptococcosis, with an uncommon topography and profile, once it´s manifestation medullary and in a healthy individual is rare. The main differential diagnosis was spinal tuberculosis, an also rare disease yet with similar symptoms and relevant local epidemiology. To reach the diagnosis, laboratory study was necessary. The treatment was the same of cryptococcosis in general.

scholarly journals H3K4me3 Histone ChIP-Seq Analysis Reveals Molecular Mechanisms Responsible for Neutrophil Dysfunction in HIV-Infected Individuals

2021 ◽  
Vol 12 ◽  
Author(s):  
Paweł Piatek ◽  
Maciej Tarkowski ◽  
Magdalena Namiecinska ◽  
Agostino Riva ◽  
Marek Wieczorek ◽  
...  
Keyword(s):  
Cell Activation ◽  
Molecular Mechanisms ◽  
Opportunistic Infections ◽  
Bioinformatic Analysis ◽  
Activation Pathway ◽  
Tlr4 Mrna ◽  
Canonical Pathways ◽  
Chromatin Immunoprecipitation Sequencing ◽  
Cellular Components ◽  
Neutrophil Dysfunction

Peripheral neutrophils in HIV-infected individuals are characterized by impairment of chemotaxis, phagocytosis, bactericidal activity, and oxidative burst ability regardless of whether patients are receiving antiretroviral therapy or not. Neutrophil dysfunction leads not only to increased susceptibility to opportunistic infections but also to tissue damage through the release of reactive oxygen species (ROS), proteases, and other potentially harmful effector molecules contributing to AIDS progression. In this study, we demonstrated high levels of histone H3 lysine K4 trimethylated (H3K4me3) and dysregulation of DNA transcription in circulating neutrophils of HIV-infected subjects. This dysregulation was accompanied by a deficient response of neutrophils to LPS, impaired cytokine/chemokine/growth factor synthesis, and increased apoptosis. Chromatin immunoprecipitation sequencing (ChIPseq) H3K4me3 histone analysis revealed that the most spectacular abnormalities were observed in the exons, introns, and promoter-TSS regions. Bioinformatic analysis of Gene Ontology, including biological processes, molecular function, and cellular components, demonstrated that the main changes were related to the genes responsible for cell activation, cytokine production, adhesive molecule expression, histone remodeling via upregulation of methyltransferase process, and downregulation of NF-κB transcription factor in canonical pathways. Abnormalities within H3K4me3 implicated LPS-mediated NF-κB canonical activation pathway that was a result of low amounts of κB DNA sites within histone H3K4me3, low NF-κB (p65 RelA) and TLR4 mRNA expression, and reduced free NF-κB (p65 RelA) accumulation in the nucleus. Genome-wide survey of H3K4me3 provided evidence that chromatin modifications lead to an impairment within the canonical NF-κB cell activation pathway causing the neutrophil dysfunction observed in HIV-infected individuals.

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