Difficulties of hypocomplementemic urticaria vasculitis diagnostics

Urticaria vasculitis is a multisystem disease with cutaneous lesions which resemble urticaria and histologic signs of leukocytoclastic vasculitis. The article highlights the main aspects of etiology, pathogenesis, clinical and histopathological disease manifestations, and also methods of treatment. Difficulties of a diagnostic process are demonstrated by means of an example of our own follow-up of a patient with Urticaria vasculitis having a history of solar urticaria. The main trigger of episodes relapse of urticarial rash in the form of coldinduced urticaria and urticaria resulting from blood pressure, was a stress factor and hemorrhage from the duodenal bulb ulcer. The analysis of clinical data and peculiarities of disease progression was conducted for the purpose of diff erential diagnostic procedure of urticaria and urticaria vasculitis. The patient’s urticaria lasted longer than 24 hours; haemosideric staining was observed in the course of rash resolving, local oedemata resembling Quincke’s edema ailed, general symptoms were present (arthralgia, fever, abdominal pains, neurological disorders, etc.). Low effi ciency of antihistamines was reported. Laboratory examination revealed the increase in the blood sedimentation rate, lowering of the complement component 3, raise of anti-C1q and cryoglobulinemia. The essential component of the diagnostic search was biopsy of the skin which allowed to reveal signs of leukocytoclastic vasculitis. On the basis of the clinical evidence (fixed urticarial eruption), laboratory data (hypocomplementemia), histological examination of skin (leukocytoclastic vasculitis) and multisystemic pathology found (of joints, heart, GIT, nervous system), the patient has been diagnosed with a hypocomplementary urticaria vasculitis. Moreover, the article includes recommendations on sampling of pathological material due to primary importance of skin biopsy results in diagnostics of the urticarial vasculitis. Medical professionals no matter of their speciality, should know peculiarities of Urticaria vasculitis progression to reduce the likelihood of its error diagnosis as recurrent urticaria or other immunological disease.

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Artificial intelligence assisted electrocardiography for early diagnosis of thyrotoxic periodic paralysis

Journal of the Endocrine Society ◽

10.1210/jendso/bvab120 ◽

2021 ◽

Author(s):

Chin Lin ◽

Chin-Sheng Lin ◽

Ding-Jie Lee ◽

Chia-Cheng Lee ◽

Sy-Jou Chen ◽

...

Keyword(s):

Artificial Intelligence ◽

Early Diagnosis ◽

Validation Cohort ◽

Laboratory Data ◽

Diagnostic System ◽

Periodic Paralysis ◽

Medical Emergency ◽

Diagnostic Process ◽

Routine Laboratory ◽

Thyrotoxic Periodic Paralysis

Abstract CONTEXT Thyrotoxic periodic paralysis (TPP) characterized by acute weakness, hypokalemia and hyperthyroidism is a medical emergency with a great challenge in early diagnosis since most TPP patients do not have overt symptoms. OBJECTIVE To assess artificial intelligence (AI)-assisted electrocardiography (ECG) combined with routine laboratory data in the early diagnosis of TPP. METHODS A deep learning model (DLM) based on ECG12Net, an 82-layer convolutional neural network, was constructed to detect hypokalemia and hyperthyroidism. The development cohort consisted of 39 ECGs from patients with TPP and 502 ECGs of hypokalemic control; the validation cohort consisted of 11 ECGs of TPP and 36 ECGs of non-TPP with weakness. The AI-ECG based TPP diagnostic process was then consecutively evaluated in 22 male patients with TTP-like features. RESULTS In the validation cohort, the DLM-based ECG system detected all cases of hypokalemia in TPP patients with a mean absolute error of 0.26 mEq/L and diagnosed TPP with an area under curve (AUC) of ~80%, surpassing the best standard ECG parameter (AUC=0.7285 for the QR interval). Combining the AI predictions with the estimated glomerular filtration rate (eGFR) and serum chloride (Cl -) boosted the diagnostic accuracy of the algorithm to AUC 0.986. In the prospective study, the integrated AI and routine laboratory diagnostic system had a PPV of 100% and F-measure 87.5%. CONCLUSIONS An AI-ECG system reliably identifies hypokalemia in patients with paralysis and integration with routine blood chemistries provides valuable decision support for the early diagnosis of TPP.

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Mycoplasmal upper respiratory infection presenting as leukocytoclastic vasculitis

Infectious Disease Reports ◽

10.4081/idr.2015.5605 ◽

2015 ◽

Vol 7 (1) ◽

Author(s):

Mana Rao ◽

Abhinav Agrawal ◽

Manan Parikh ◽

Rikka Banayat ◽

Maria Joana Thomas ◽

...

Keyword(s):

Respiratory Tract ◽

Leukocytoclastic Vasculitis ◽

Small Vessel ◽

Stevens Johnson Syndrome ◽

Small Vessel Vasculitis ◽

Upper Respiratory Tract ◽

Cutaneous Lesions ◽

Upper Respiratory Infection ◽

Mycoplasmal Infection ◽

Upper Respiratory

Mycoplasma is a virulent organism that is known to primarily infect the respiratory tract; however, affection of the skin, nervous system, kidneys, heart and bloodstream has been observed in various forms, which include Stevens Johnson syndrome, erythema multiforme, toxic epidermal necrolysis, encephalitis, renal failure, conduction system abnormalities and hemolytic anemia. Small vessel vasculitis is a lesser-known complication of mycoplasma pneumonia infection. We report a case of mycoplasmal upper respiratory tract infection with striking cutaneous lesions as the presenting symptom. Mycoplasmal infection was confirmed by serology testing, skin biopsy was suggestive of leukocytoclastic vasculitis. This case brings forth an uncommon manifestation of mycoplasmal infection with extra-pulmonary affection, namely small vessel vasculitis.

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Bringing the clinical laboratory into the strategy to advance diagnostic excellence

Diagnosis ◽

10.1515/dx-2020-0119 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Ira M. Lubin ◽

J. Rex Astles ◽

Shahram Shahangian ◽

Bereneice Madison ◽

Ritchard Parry ◽

...

Keyword(s):

Quality Management ◽

Health Care Providers ◽

Clinical Laboratory ◽

Laboratory Data ◽

Diagnostic Errors ◽

Care Quality ◽

Diagnostic Process ◽

Management Approach ◽

Care Providers ◽

Medical Diagnoses

Abstract Objectives Clinical laboratory testing provides essential data for making medical diagnoses. Generating accurate and timely test results clearly communicated to the treating clinician, and ultimately the patient, is a critical component that supports diagnostic excellence. On the other hand, failure to achieve this can lead to diagnostic errors that manifest in missed, delayed and wrong diagnoses. Content Innovations that support diagnostic excellence address: 1) test utilization, 2) leveraging clinical and laboratory data, 3) promoting the use of credible information resources, 4) enhancing communication among laboratory professionals, health care providers and the patient, and 5) advancing the use of diagnostic management teams. Integrating evidence-based laboratory and patient-care quality management approaches may provide a strategy to support diagnostic excellence. Professional societies, government agencies, and healthcare systems are actively engaged in efforts to advance diagnostic excellence. Leveraging clinical laboratory capabilities within a healthcare system can measurably improve the diagnostic process and reduce diagnostic errors. Summary An expanded quality management approach that builds on existing processes and measures can promote diagnostic excellence and provide a pathway to transition innovative concepts to practice. Outlook There are increasing opportunities for clinical laboratory professionals and organizations to be part of a strategy to improve diagnoses.

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Case Report: Acute hemorrhagic edema of infancy (Seidlmayer purpura) – a dramatic presentation for a benign disease

F1000Research ◽

10.12688/f1000research.20645.1 ◽

2019 ◽

Vol 8 ◽

pp. 1771

Author(s):

Elena Carboni ◽

Maria Scavone ◽

Ettore Stefanelli ◽

Valentina Talarico ◽

Stefania Zampogna ◽

...

Keyword(s):

Leukocytoclastic Vasculitis ◽

Skin Lesions ◽

Rapid Onset ◽

Cutaneous Lesions ◽

Laboratory Findings ◽

Distinct Disease ◽

The Face ◽

Clinical Conditions ◽

Dramatic Presentation ◽

Schonlein Purpura

We present a case of an 11-month-old girl who was referred to our unit for an erythematous rash that appeared on the face and extremities. Personal and family history was not relevant. Laboratory tests were normal. During recovery, diameter and colour intensity of the cutaneous lesions increased, but after some weeks, lesions had a self-limited resolution without any treatment. Based on clinical and laboratory findings, a diagnosis of acute hemorrhagic edema of infancy (AHEI) was made. AHEI is a rare cutaneous leukocytoclastic vasculitis that usually affects children aged between 4 and 24 months. Etiology is unknown but almost of 75% of cases are preceded by infectious episodes, vaccinations or use of medications. In contrast to the dramatic cutaneous eruption, clinical conditions are usually optimal. Classically, AHEI is characterized by a triad of symptoms: fever, edema and purpura. Skin lesions are erythematous, annular, medallion-like, purpuric plaques that have a rapid onset and appear on the face and extremities, sparing trunk and mucosal membranes. Initially interpreted as a variant of Henoch-Schönlein purpura, now it is considered a distinct disease. In the majority of cases the disease is benign and self-limited without a visceral involvement, so a conservative approach is most often chosen.

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Biomarkers in COVID-19: An Up-To-Date Review

Frontiers in Pediatrics ◽

10.3389/fped.2020.607647 ◽

2021 ◽

Vol 8 ◽

Author(s):

Madhusudan Samprathi ◽

Muralidharan Jayashree

Keyword(s):

Patient Care ◽

Laboratory Data ◽

Healthcare Setting ◽

The Body ◽

Current Evidence ◽

Multisystem Disease ◽

Care Services ◽

Systemic Process ◽

The Individual ◽

Inflammatory Syndrome

The ongoing pandemic of coronavirus disease 2019 (COVID-19) poses several challenges to clinicians. Timely diagnosis and hospitalization, risk stratification, effective utilization of intensive care services, selection of appropriate therapies, monitoring and timely discharge are essential to save the maximum number of lives. Clinical assessment is indispensable, but laboratory markers, or biomarkers, can provide additional, objective information which can significantly impact these components of patient care. COVID-19 is not a localized respiratory infection but a multisystem disease caused by a diffuse systemic process involving a complex interplay of the immunological, inflammatory and coagulative cascades. The understanding of what the virus does to the body and how the body reacts to it has uncovered a gamut of potential biomarkers. This review discusses the different classes of biomarkers – immunological, inflammatory, coagulation, hematological, cardiac, biochemical and miscellaneous – in terms of their pathophysiological basis followed by the current evidence. Differences between children and adults are highlighted. The role of biomarkers in the diagnosis and management of Multisystem Inflammatory Syndrome in Children (MIS-C) is reviewed. The correlation of biomarkers with clinical and radiological features and the viral load, temporal evolution and the effect of treatment remain to be studied in detail. Which biomarker needs to be evaluated when and in whom, and how best this information can contribute to patient care are questions which currently lack convincing answers. With the evidence currently available broad guidelines on the rational use of available biomarkers are presented. Integrating clinical and laboratory data, monitoring trends rather than a single value, correlating with the natural course of the disease and tailoring guidelines to the individual patient and healthcare setting are essential.

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A Fatal Case of Congenital Langerhans Cell Histiocytosis with Disseminated Cutaneous Lesions in a Premature Neonate

Case Reports in Pediatrics ◽

10.1155/2016/4972180 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Michio Inoue ◽

Yoko Tomita ◽

Tsuyoshi Egawa ◽

Tomoaki Ioroi ◽

Masaaki Kugo ◽

...

Keyword(s):

Langerhans Cell Histiocytosis ◽

Fatal Case ◽

Premature Neonate ◽

Langerhans Cell ◽

Bone Lesions ◽

X Rays ◽

Cutaneous Lesions ◽

Multisystem Disease ◽

Premature Babies ◽

Hands And Feet

Background. The outcome of neonates with congenital cutaneous Langerhans cell histiocytosis (LCH) is variable. Observations. We report a case of LCH in a female premature neonate born at 33-week gestation. She had disseminated cutaneous lesions, which consisted of hemorrhagic papules and vesicles, with sparse healthy skin areas, and the hands and feet were contracted with scarring and blackened. She was in respiratory failure although no apparent pulmonary or bone lesions on X-rays were noted. Skin biopsy confirmed a diagnosis of LCH due to observation of CD1a+ Langerhans cells, which lacked expression of E-cadherin and CD56. The patient died 57 hours after birth. Conclusions. Based on this case and the literature survey, the outcome of premature babies with congenital cutaneous LCH lesions is noted to be unfavorable, with the majority of such cases suffering from multisystem disease.

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Monitoring and diagnosis of poultry bacterial diseases in poultry farms of the Kyiv region

Naukovij vìsnik veterinarnoï medicini ◽

10.33245/2310-4902-2020-154-1-47-53 ◽

2020 ◽

pp. 47-53

Author(s):

N. Tyshkivska ◽

V. Lyasota ◽

A. Tyshkivska ◽

N. Bukalova ◽

N. Bogatko

Keyword(s):

Escherichia Coli ◽

Staphylococcus Aureus ◽

Clostridium Perfringens ◽

Upper Respiratory Tract ◽

Effi Ciency ◽

Poultry Farms ◽

Escherichia Coli Bacteria ◽

Sick Bird ◽

Pathological Material ◽

Enterococcus Cecorum

Bacterial safety in the modern poultry industry plays a key role and is one of the key factors in production eﬃ ciency. In the structure of poultry infectious pathology, the leading place is occupied by such bacteria as Escherichia coli, Clostridium perfringens, Enterococcus cecorum, Staphylococcus aureus, Gallibacterium anatis. The results of studies of samples of pathological material obtained from a sick bird are presented that indicate that most often Escherichia coli cultures were isolated from the heart (41,5 %), liver (22,0 %) and lungs (20,7 %), less often spleen (5,2 %) and kidney (2,0 %). Most isolated cultures of Escherichia coli (78 %) caused hemolysis when plating material on blood agar. The largest number of pathogenic cultures of Escherichia coli was isolated from adult chickens, signiﬁ cantly fewer chickens under the age of 20 days. The associated course of bacterioses caused by two or more pathogens was noted in 89,8 % of cases. In 38,5 % of cases, Escherichia coli, bacteria of the genus Staphylococcus and Gallibacterium anatis were isolated from pathological material, in 27,3 % – a joint course of escherichiosis, staphylococcosis and enterobacteriosis was noted, in 15,7 % – escherichiosis, salmonellosis and enterobacteriosis, in 8,3 % – pasteurellosis and enterobacteriosis. In 13,2 % of cases with pathological material from chickens (liver, joints, in chickens – blind processes of the intestine) Clostridium perfringens was isolated. Three species of bacteria of the genus Staphylococcus were identiﬁ ed: Staphylococcus aureus, Staphylococcus chromogenes, Staphylococcus pluranimalium (51,7 % from the liver, 21,7 from the lungs, 18,3 from the spleen, 5,0 % from the kidneys). Enterococcus cecorum was identiﬁ ed in 11,32 % of the studied samples from cloacal swabs, oviducts and bone marrow, and Gallibacterium anatis was identiﬁ ed in 11,32 % (from the upper respiratory tract and genitals). Key words: poultry farms, monitoring, bacterial infection, Escherichia coli, Staphylococcus aureus, Staphylococcus chromogenes, Staphylococcus pluranimalium, Enterococcus cecorum, Clostridium perfringens, Gallibacterium anatis.

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Case Report: Early Association of Vemurafenib to Standard Chemotherapy in Multisystem Langerhans Cell Histiocytosis in a Newborn: Taking a Chance for a Better Outcome?

Frontiers in Oncology ◽

10.3389/fonc.2021.794498 ◽

2021 ◽

Vol 11 ◽

Author(s):

Stefania Gaspari ◽

Valentina Di Ruscio ◽

Francesca Stocchi ◽

Roberto Carta ◽

Marco Becilli ◽

...

Keyword(s):

Langerhans Cell Histiocytosis ◽

Laboratory Data ◽

Langerhans Cell ◽

Braf V600e ◽

Line Treatment ◽

First Line ◽

Standard Chemotherapy ◽

Multisystem Disease ◽

Response To Chemotherapy ◽

First Line Treatment

Langerhans cell histiocytosis (LCH) is due to aberrant monoclonal proliferation and accumulation of dendritic cells, ranging from a self-limiting local condition to a rapidly progressive multisystem disease with poor prognosis. Pathogenic cells originate from a myeloid-derived precursor characterized by an activation of the MAPK/ERK signaling pathway in about 70% of cases. In particular, BRAF V600E mutation is usually associated with a more severe clinical course and poor response to chemotherapy. We report on a newborn with multisystem LCH in life-threatening medical conditions. At diagnosis, the patient was successfully treated with the early association of BRAF inhibitor Vemurafenib to standard chemotherapy representing a new approach in first-line treatment. A rapid clinical improvement with a prompt fever regression from day 2 and complete resolution of skin lesions by week 2 were observed; laboratory data normalized as well. Vemurafenib was discontinued after 12 months of treatment. No signs of relapse occurred after 12 months of discontinuation. This case indicates that early combination of target therapy with standard treatment may induce rapid response and prolonged disease remission without significant toxicities in infants. This approach represents a valid and safe option as first-line treatment in multisystem disease, especially in high-risk patients.

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Cutaneous lesions and finger clubbing uncovering hypocomplementemic urticarial vasculitis and hepatitis C with mixed cryoglobulinemia

Anais Brasileiros de Dermatologia ◽

10.1590/abd1806-4841.20132776 ◽

2013 ◽

Vol 88 (6) ◽

pp. 973-976 ◽

Cited By ~ 2

Author(s):

Teresa Pinto-Almeida ◽

Mónica Caetano ◽

Rosário Alves ◽

Manuela Selores

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Leukocytoclastic Vasculitis ◽

Symptomatic Treatment ◽

Mixed Cryoglobulinemia ◽

Skin Condition ◽

Cutaneous Lesions ◽

Urticarial Vasculitis ◽

Hypocomplementemic Urticarial Vasculitis

Urticarial vasculitis is a rare clinicopathologic entity characterized by urticarial lesions that persist for more than 24 hours and histologic features of leukocytoclastic vasculitis. Patients can be divided into normocomplementemic or hypocomplementemic. The authors report the case of a healthy 49-year-old woman with a 1-year history of highly pruritic generalized cutaneous lesions and finger clubbing. Laboratory tests together with histopathologic examination allowed the diagnosis of hypocomplementemic urticarial vasculitis, chronic hepatitis C and type II mixed cryoglobulinemia. The patient started symptomatic treatment and was referred to a gastroenterologist for management of the hepatitis C, with progressive improvement of the skin condition. The development of hypocomplementemic urticarial vasculitis in the context of chronic hepatitis C is exceedingly rare and possible pathogenic mechanisms are discussed.

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INTELLIGENT SYSTEM FOR DIAGNOSING THE PARAMETERS OF THE TECHNICAL CONDITION OF TRACTORS

AGRICULTURAL ENGINEERING ◽

10.26897/2687-1149-2021-1-45-50 ◽

2021 ◽

pp. 45-50

Author(s):

MIKHAIL N. EROKHIN ◽

Keyword(s):

Intelligent Systems ◽

Intelligent System ◽

Diagnostic System ◽

Technical Condition ◽

Diagnostic Process ◽

Agricultural Machinery ◽

Online Mode ◽

Effi Ciency ◽

Agricultural Tractors

Research aimed at the development and implementation of new digital methods and intelligent systems that allow improving the diagnostic process, increasing the reliability of determining the functional characteristics of agricultural tractors in an online mode is an important and relevant component of technologies and tools for servicing agricultural machinery. The paper presents the results on the justifi cation and development of an intelligent system for diagnosing machines based on the interaction of a neural network. The advantage of this diagnostic system is the ability to maintain the working condition of agricultural machinery, in case the processes of diagnosis and analysis of the obtained data are automated. The use of an intelligent tractor diagnostic system provides for the determination of not only the cause of failure by the controlled parameters, but also the effi ciency evaluation of the machine as a whole. It is established that one of the ways to increase the effi ciency of using agricultural machinery is the non-contact determination of the parameters of the technical condition of equipment through the modernization of the technology for monitoring the technical condition of machines and the quality of work on the basis of the introduction of modern intelligent and telemetric systems.

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