scholarly journals Case Report: Necrotizing Stomatitis as a Manifestation of COVID-19-Associated Vasculopathy

2021 ◽  
Vol 9 ◽  
Author(s):  
Nina Emeršič ◽  
Tanja Tomaževič ◽  
Olga Točkova ◽  
Matjaž Kopač ◽  
Metka Volavšek ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Endothelial Cells ◽  
Case Report ◽  
Rare Complication ◽  
Endothelial Damage ◽  
Acute Onset ◽  
Systemic Resistance ◽  
Malnourished Children ◽  
Lower Jaw ◽  
Laboratory Investigations

Necrotizing stomatitis is a rare, acute-onset disease that is usually associated with severely malnourished children or diminished systemic resistance. We describe a 1-year-old girl who developed necrotizing stomatitis, vasculitic rash, skin desquamation on the fingers and toes, and persistent hypertension after serologically confirmed SARS-CoV-2 infection. Her laboratory investigations revealed positive IgG anticardiolipin and IgG anti-β2 glycoprotein antibodies, and biopsy of the mucosa of the lower jaw showed necrosis and endothelial damage with mural thrombi. Swollen endothelial cells of small veins in the upper dermis were confirmed also by electron microscopy. As illustrated by our case, necrotizing stomatitis may develop as a rare complication associated with SARS-CoV-2 infection and can be considered as a part of the clinical spectrum of COVID-19 vasculopathy. The pathogenic mechanism could involve a consequence of inflammatory events with vasculopathy, hypercoagulability, and damage of endothelial cells as a response to SARS-CoV-2 infection.

scholarly journals Pulmonary Embolism as a Rare Complication of Clomiphene Therapy: A Case Report and Literature Review

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Vinod Solipuram ◽  
Kishor Pokharel ◽  
Temple Ihedinmah
Keyword(s):  
Pulmonary Embolism ◽  
Case Report ◽  
Rare Complication ◽  
Clomiphene Citrate ◽  
Hormone Replacement ◽  
Acute Onset ◽  
Medical Emergency ◽  
Male Hypogonadism ◽  
Receptor Modulator ◽  
Male Patients

Background. Pulmonary embolism (PE) is a medical emergency. Certain medications like oral contraceptives and hormone replacement therapies have been associated with PE. Clomiphene citrate is a selective estrogen receptor modulator, approved for treating infertility in females, but is being used as an off-label therapy in treating male hypogonadism. Very rarely, clomiphene can cause pulmonary embolism. Case Report. A 56-year-old gentleman presented with acute onset shortness of breath and chest discomfort. Upon further workup, he was found to have large volume pulmonary embolism. He was prescribed clomiphene citrate (CC) 2 years ago for hypogonadism. He was started on anticoagulation with improvement in his symptoms, and clomiphene was discontinued. Conclusion. Pulmonary embolism is a rare but potential complication of clomiphene therapy. In male patients with suspected hypogonadism, the risk of serious thromboembolic complications should be discussed before prescribing CC. Patients on CC have to be carefully monitored for serious side effects.

scholarly journals Transoral migration of peritoneal end of ventriculoperitoneal shunt with perforation of gastro-esophageal junction: a case report of a rare complication

2014 ◽  
Vol 13 (4) ◽  
pp. 492-495 ◽  
Author(s):  
Rahul Gupta ◽  
Tariq Ahmed Mala ◽  
Atul Gupta ◽  
Rozy Paul ◽  
Shahaid Amin Malla ◽  
...  
Keyword(s):  
Case Report ◽  
Coming Out ◽  
English Literature ◽  
Rare Complication ◽  
Medical Science ◽  
Uneventful Recovery ◽  
Imaging Studies ◽  
Vp Shunt ◽  
Shunt Tube ◽  
Laboratory Investigations

A rare complication of ventriculoperitoneal (VP) shunt is presented. A 11-year old boy presented with a tube coming out of the mouth. He had multiple VP shunt done earlier. Clinical features, laboratory investigations and imaging studies showed that the peritoneal end had perforated the gastro-oesophageal junction and then prolapsed trans-orally. The shunt was removed and he made an uneventful recovery. Though migration of the peritoneal end of the shunt tube into various organs is known, to our knowledge, only six/seven cases have been reported in the English literature of a shunt tube coming out of the mouth and this is the next. The management of this very rare problem is discussed.DOI: http://dx.doi.org/10.3329/bjms.v13i4.20654Bangladesh Journal of Medical Science Vol.13(4) 2014 p.492-495

scholarly journals Case Report: Acute amyopathic dermatomyositis presenting with isolated facial edema

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 60
Author(s):  
Efthymia Pappa ◽  
Marina Gkeka ◽  
Asimina Protogerou ◽  
Leonidas Marinos ◽  
Chariclia Loupa ◽  
...  
Keyword(s):  
Case Report ◽  
Corticosteroid Treatment ◽  
Acute Onset ◽  
Facial Skin ◽  
Amyopathic Dermatomyositis ◽  
Muscle Enzyme ◽  
Cutaneous Manifestations ◽  
Facial Edema ◽  
Laboratory Investigations ◽  
High Level

A 45-year-old Asian man presented with acute-onset periorbital and facial edema associated with pyrexia. Muscle weakness was absent. Initial laboratory investigations showed an inflammatory reaction, while screening for infections was negative. Serum muscle enzyme levels were normal. He was hospitalized and treated empirically with antibiotics and corticosteroids, pending the result of facial skin and muscle biopsy. He showed a good clinical and laboratory response but an attempt to discontinue corticosteroids led to a prompt relapse of facial edema and pyrexia, associated with rising laboratory indices of inflammation. Biopsy findings were typical of dermatomyositis. Reintroduction of corticosteroid treatment resulted in complete clinical and laboratory remission. Facial edema as the sole clinical manifestation of dermatomyositis is extremely rare. There have been no previous reports of isolated facial edema in the setting of acute amyopathic dermatomyositis. A high level of suspicion is required to make the diagnosis in the absence of myopathy and the hallmark cutaneous manifestations of the disease (heliotrope rash, Gottron papules).

scholarly journals Primary-localized-cutaneous-amyloidosis: Lichen amyloidosus

2004 ◽  
Vol 61 (1) ◽  
pp. 83-87
Author(s):  
Dragan Mikic ◽  
Slobodan Forcan ◽  
Milos Kostov ◽  
Lidija Popovic ◽  
Goran Brajuskovic
Keyword(s):  
Electron Microscopy ◽  
Case Report ◽  
Female Patient ◽  
Final Diagnosis ◽  
Keratin Filaments ◽  
Laboratory Investigations ◽  
Lichen Amyloidosus

This case report presented a female patient with primary-localized-cutaneous--amyloidosis in the form of lichen amyloidosus. Primary-localized-cutaneous--amyloidosis is a rare idiopathic dermatosis caused by abnormal deposition of amyloid composed primarily of degenerated keratin filaments. In order to establish the final diagnosis, detailed clinical and laboratory investigations were performed, with a particular emphasis on pathohistological analysis of skin specimens, special stains, and electron microscopy.

Complex Vesicles, Microtubules, and Cytoplasmic Filaments in the Endothelial Cells of Normal Dog Aorta

1968 ◽  
Vol 26 ◽  
pp. 172-173
Author(s):  
C. N. Sun ◽  
J. J. Ghidoni
Keyword(s):  
Electron Microscopy ◽  
Endothelial Cells ◽  
Cross Sections ◽  
Functional Significance ◽  
Tubular Structures ◽  
Aldehyde Fixation ◽  
Cytoplasmic Filaments

Endothelial cells in longitudinal and cross sections of aortas from 3 randomly selected “normal” mongrel dogs were studied by electron microscopy. Segments of aorta were distended with cold cacodylate buffered 5% glutaraldehyde for 10 minutes prior to being cut into small, well oriented tissue blocks. After an additional 1-1/2 hour period in glutaraldehyde, the tissue blocks were well rinsed in buffer and post-fixed in OsO4. After dehydration they were embedded in a mixture of Maraglas, D.E.R. 732, and DDSA.Aldehyde fixation preserves the filamentous and tubular structures (300 Å and less) for adequate demonstration and study. The functional significance of filaments and microtubules has been recently discussed by Buckley and Porter; the precise roles of these cytoplasmic components remains problematic. Endothelial cells in canine aortas contained an abundance of both types of structures.

Fibrinolysis in Decidual Spiral Arteries in Late Pregnancy

1978 ◽  
Vol 39 (03) ◽  
pp. 751-758 ◽  
Author(s):  
B L Sheppard ◽  
J Bonnar
Keyword(s):  
Electron Microscopy ◽  
Endothelial Cells ◽  
Fibrinolytic Activity ◽  
Physiological Mechanism ◽  
Late Pregnancy ◽  
Full Term ◽  
Fibrin Deposition ◽  
Placental Villi ◽  
The Media ◽  
Slide Technique

SummaryThe fibrinolytic activity of the intimal cells of decidual spiral arteries and the syncytium of placental villi was studied by electron microscopy in ten normal full-term human pregnancies using a modification of the fibrin slide technique. Endothelial cells lining the intima of the decidual spiral arteries showed a considerably greater fibrinolytic activity than intimal cytotrophoblast and the syncytiotrophoblast showed no activity.The replacement of endothelial cells by an intimal lining of cytotrophoblast, and the presence of cytotrophoblast in the media, appears to play an important role in the reduction of the fibrinolytic activity of the vessel. This inhibition of fibrinolytic activity in the utero-placental arteries may be the physiological mechanism which controls fibrin deposition in these vessels and on the placental villi.

Neutrophil Derived Cathepsin G Induces Potentially Thrombogenic Changes in Human Endothelial Cells: a Scanning Electron Microscopy Study in Static and Dynamic Conditions

1994 ◽  
Vol 72 (01) ◽  
pp. 140-145 ◽  
Author(s):  
Valeri Kolpakov ◽  
Maria Cristina D'Adamo ◽  
Lorena Salvatore ◽  
Concetta Amore ◽  
Alexander Mironov ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Scanning Electron Microscopy ◽  
Extracellular Matrix ◽  
Endothelial Cells ◽  
Thrombus Formation ◽  
Cathepsin G ◽  
Arterial Segment ◽  
Dynamic Conditions ◽  
Activated Neutrophils ◽  
Scanning Electron

SummaryActivated neutrophils may promote thrombus formation by releasing proteases which may activate platelets, impair the fibrinolytic balance and injure the endothelial monolayer.We have investigated the morphological correlates of damage induced by activated neutrophils on the vascular wall, in particular the vascular injury induced by released cathepsin G in both static and dynamic conditions.Human umbilical vein endothelial cells were studied both in a cell culture system and in a model of perfused umbilical veins. At scanning electron microscopy, progressive alterations of the cell monolayer resulted in cell contraction, disruption of the intercellular contacts, formation of gaps and cell detachment.Contraction was associated with shape change of the endothelial cells, that appeared star-like, while the underlying extracellular matrix, a potentially thrombogenic surface, was exposed. Comparable cellular response was observed in an “in vivo” model of perfused rat arterial segment. Interestingly, cathepsin G was active at lower concentrations in perfused vessels than in culture systems. Restoration of blood flow in the arterial segment previously damaged by cathepsin G caused adhesion and spreading of platelets on the surface of the exposed extracellular matrix. The subsequent deposition of a fibrin network among adherent platelets, could be at least partially ascribed to the inhibition by cathepsin G of the vascular fibrinolytic potential.This study supports the suggestion that the release of cathepsin G by activated neutrophils, f.i. during inflammation, may contribute to thrombus formation by inducing extensive vascular damage.

An Electron Microscopic Study of Platelet Thrombus Formation in the Rabbit with Particular Regard to 5-Hydroxytryptamine Release

1967 ◽  
Vol 18 (03/04) ◽  
pp. 592-604 ◽  
Author(s):  
H. R Baumgartner ◽  
J. P Tranzer ◽  
A Studer
Keyword(s):  
Endothelial Cells ◽  
Endothelial Cell ◽  
Vessel Wall ◽  
Thrombus Formation ◽  
Endothelial Damage ◽  
Electron Microscopic ◽  
Rabbit Ear ◽  
Basement Lamina ◽  
Platelet Thrombus

SummaryElectron microscopic and histologic examination of rabbit ear vein segments 4 and 30 min after slight endothelial damage have yielded the following findings :1. Platelets do not adhere to damaged endothelial cells.2. If the vessel wall is denuded of the whole endothelial cell, platelets adhere to the intimai basement lamina as do endothelial cells.3. The distance between adherent platelets as well as endothelial cells and intimai basement lamina measures 10 to 20 mµ, whereas the distance between aggregated platelets is 30 to 60 mµ.4. 5-hydroxytryptamine (5-HT) is released from platelets during viscous metamorphosis at least in part as 5-HT organelles.It should be noted that the presence of collagen fibers is not necessary for platelet thrombus formation in vivo.

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