Eosinophilic enteritis – case report of a rare manifestation and review of updates

Eosinophilic enteritis is one of the eosinophilic gastrointestinal disorders characterised by various clinical symptoms. Histopathologic proof of dense eosinophilic infiltration is the cornerstone for the diagnosis. There is no consensus on how dense the infiltration should be, and cut-off values of the eosinophilic count in HPF have not been defined yet. Therapy for eosinophilic enteritis is based on an elimination diet and corticosteroid treatment. Herein the authors report a case of 14-year-old boy who suffered from acute abdominal pain. Computer tomography of the abdomen revealed a thickening of the duodenal wall mimicking a tumour, which seemed to infiltrate the gallbladder and omentum. Histopathological examination of samples taken during laparoscopy showed eosinophilic infiltration and sclerotic changes of the gallbladder and duodenum. Follow-up endoscopy proved extensive eosinophilic infiltration of the gastrointestinal tract: eosinophilic esophagitis, duodenal ulcer with dense eosinophilic presence and eosinophilic proctitis. The patient recovered after dietary restrictions and prednisone.

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Eosinophilic gastritis-a rare diagnosis

Case Reports in Internal Medicine ◽

10.5430/crim.v7n3p7 ◽

2020 ◽

Vol 7 (3) ◽

pp. 7

Author(s):

Sana Ali ◽

Joel B. Yednock

Keyword(s):

Abdominal Pain ◽

Failure To Thrive ◽

Elimination Diet ◽

Eosinophilic Gastritis ◽

Abdominal Symptoms ◽

Dietary Restrictions ◽

Minimal Improvement ◽

Food Elimination ◽

Eosinophilic Gastrointestinal Disorders ◽

Rare Diagnosis

Introduction: Eosinophilic Gastritis (EG), one of the less common amongst Eosinophilic Gastrointestinal Disorders (EGID),with a prevalence of 6.3 cases/100.000, is an uncommon cause of unspecific abdominal symptoms, including epigastric pain.Case: A 23-year-old female, was admitted with recurrent episodes of nausea, vomiting, abdominal pain and weight loss. She was discharged one week previously after being treated for similar symptoms. The patient had failed an outpatient treatment with a Proton Pump Inhibitor (PPI). During her re-admission, Esophagogastroduodenoscopy (EGD) was performed, and results were significant for gastritis without ulcers or esophagitis. While awaiting biopsy results, the patient experienced a minimal improvement in her symptoms with intravenous fluids and PPI. Extensive workup remained negative except of eosinophilia in peripheral blood. Gastric mucosal biopsy revealed eosinophilic infiltrates in Lamina Propria, confirming the diagnosis of Eosinophilic Gastritis. Helicobacter pylori on immunohistochemistry was negative. The patient was counseled regarding the Six Food Elimination Diet for the management of this condition. Her symptoms began to improve under dietary restrictions. Repeated EGD with biopsy at 12 weeks showed resolved eosinophilic infiltrates.Discussion: EG remains a rare diagnosis, and it should be included as a differential diagnosis in every patient with refractory symptoms of nausea, vomiting, abdominal pain, and failure to thrive. Diagnosis of EGID is established after the exclusion of other causes of eosinophilia in the gastrointestinal tract.

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Spectrum of Surgical Presentation of Eosinophilic Enteritis

Case Reports in Surgery ◽

10.1155/2015/691904 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5

Author(s):

Spoorthy Sudhakar Shetty ◽

Charan Kishor Shetty

Keyword(s):

Histopathological Examination ◽

Past History ◽

Case Series ◽

Antitubercular Drugs ◽

History Of ◽

Subacute Intestinal Obstruction ◽

Clinical Dilemma ◽

One Year ◽

Eosinophilic Gastrointestinal Disorders

Eosinophilic enteritis is a rare disorder presenting mostly with diarrhea, malabsorption, abdominal pain, weight loss, and hypersensitivity. Surgical manifestation of eosinophilic gastrointestinal disorders depends on the site and extent of involvement. In our case series of four patients two of them had ileocaecal masses with recurrent subacute intestinal obstruction with past history of intake of antitubercular drugs for 9 months. On histopathological examination both of them proved to have eosinophilic enterocolitis. Thus it is a clinical dilemma to differentiate between these two conditions. The other two patients presented as acute abdomen with perforation and intussusception. All four patients were treated surgically. Postoperatively they recovered well with no symptoms on one year follow-up. In Indian setup tuberculosis being rampant there may be under reporting or wrongly diagnosed cases of eosinophilic enteritis. Thus a strong clinical suspicion and awareness of this clinical entity are essential among surgical community.

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Nasal supratip pilonidal sinus: a rare manifestation

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20193890 ◽

2019 ◽

Vol 5 (5) ◽

pp. 1394

Author(s):

Firamir Bin Zulkifli ◽

Farah Dayana Bintin Zahedi ◽

Ahmad Bin Nordin ◽

Yong Doh Jeing

Keyword(s):

Computed Tomography ◽

Pilonidal Sinus ◽

Squamous Epithelium ◽

Middle Age ◽

Histopathological Examination ◽

Sinus Tract ◽

Rare Manifestation ◽

Stratified Squamous Epithelium ◽

External Rhinoplasty

<p>Pilonidal sinus is widely associated with disease involving the gluteal cleft. Derived from the Latin word (Pilus=hair; nidus=nest), it was first described by Herbert Mayo in 1833. The pathognomonic finding of the pilonidal sinus is the presence of loose hairs in the sinus tract or cavity. We report a case of a fit middle age policeman who developed an unusual chronic discharging sinus over the tip of the nose. A computed tomography (CT) sinogram showed a localized blind subcutaneous tract over the nose. The course of management is discussed with reference to other reported works of literature. The patient was diagnosed to have a subcutaneous sinus over the tip of the nose with the aid of CT sinogram. Surgery was performed to excised the sinus tract through external rhinoplasty approached. Histopathological examination confirmed a sinus tract lined by keratinized stratified squamous epithelium with a tuft of hair. Patient was follow up for another year with no evidence of recurrence.</p>

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Scoring System for the Diagnosis of COVID-19

The Open Public Health Journal ◽

10.2174/1874944502013010413 ◽

2020 ◽

Vol 13 (1) ◽

pp. 413-414 ◽

Cited By ~ 1

Author(s):

Mohamed Farouk Allam

Keyword(s):

Scoring System ◽

Clinical Symptoms ◽

False Negative ◽

Nasopharyngeal Swab ◽

Rt Pcr ◽

Pcr Assay ◽

Negative Results ◽

False Negative Results ◽

Symptoms And Signs

Due to the international spread of COVID-19, the difficulty of collecting nasopharyngeal swab specimen from all suspected patients, the costs of RT-PCR and CT, and the false negative results of RT-PCR assay in 41% of COVID-19 patients, a scoring system is needed to classify the suspected patients in order to determine the need for follow-up, home isolation, quarantine or the conduction of further investigations. A scoring system is proposed as a diagnostic tool for suspected patients. It includes Epidemiological Evidence of Exposure, Clinical Symptoms and Signs, and Investigations (if available). This scoring system is simple, could be calculated in a few minutes, and incorporates the main possible data/findings of any patient.

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Chinese Herbal Medicine Dingji Fumai Decoction for Ventricular Premature Contraction: A Real-World Trial

BioMed Research International ◽

10.1155/2020/5358467 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Bo Liang ◽

Fei-Hu Zou ◽

Ling Fu ◽

Hui-Ling Liao

Keyword(s):

Herbal Medicine ◽

Chinese Herbal Medicine ◽

Clinical Symptoms ◽

Medication Compliance ◽

Controlled Trial ◽

Ventricular Premature Contraction ◽

Traditional Chinese Medicine Syndrome ◽

Chinese Herbal ◽

Double Blinded

Background. Chinese herbal medicine Dingji Fumai Decoction (DFD) is widely clinically used for ventricular premature contraction (VPC). This real-word trial was designed to assess the safety and effectiveness of DFD for VPC. Methods. This was a double-blinded, randomized placebo-controlled trial. Patients with VPC were randomized (1 : 1) to treatment with DFD combined with metoprolol (DFD arm) or metoprolol combined with placebo (MET arm). A primary end point was a composite of clinical symptoms and signs determined by the traditionalChinese medicine syndrome score and the number of VPC determined by the Holter examination. Second outcomes were adverse events, medication compliance, and laboratory examination. Results. 144 patients were randomized to DFD arm (76 patients) or MET arm (68 patients), and 136 cases (71 in DFD arm and 65 in MET arm) finally completed this trial. After a 12-week follow-up, DFD arm significantly decreased traditional Chinese medicine syndrome score and the number of VPC compared with MET arm (P=0.003 and 0.034, respectively). There was no adverse drug effect and patient medication compliance was good. Conclusions. Superiority with DFD arm for VPC was demonstrated over MET arm for both the safety and effectiveness end points.

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Macrolide-Resistant and Macrolide-Sensitive Mycoplasma pneumoniae Pneumonia in Children Treated Using Early Corticosteroids

Journal of Clinical Medicine ◽

10.3390/jcm10061309 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1309

Author(s):

Hye Young Han ◽

Ki Cheol Park ◽

Eun-Ae Yang ◽

Kyung-Yil Lee

Keyword(s):

Mycoplasma Pneumoniae ◽

Serological Test ◽

Corticosteroid Treatment ◽

23S Rrna ◽

Laboratory Parameters ◽

The Mean ◽

Domain V ◽

Positive Results ◽

Mycoplasma Pneumoniae Pneumonia

We have found that early corticosteroid therapy was effective for reducing morbidity during five Korea-wide epidemics. We evaluated the clinical and laboratory parameters of 56 children who received early corticosteroid treatment for pneumonia that was caused by macrolide-resistant Mycoplasma pneumoniae (M. pneumoniae) or macrolide-sensitive M. pneumoniae between July 2019 and February 2020. All subjects had dual positive results from a PCR assay and serological test, and received corticosteroids within 24–36 h after admission. Point mutation of residues 2063, 2064, and 2067 was identified in domain V of 23S rRNA. The mean age was 6.8 years and the male:female ratio was 1.2:1 (31:25 patients). Most of the subjects had macrolide-resistant M. pneumoniae (73%), and all mutated strains had the A2063G transition. No significant differences in clinical and laboratory parameters were observed between macrolide-resistant and macrolide-sensitive M. pneumoniae groups that were treated with early dose-adjusted corticosteroids. Higher-dose steroid treatment may be needed for patients who have fever that persists for >48 h or increased biomarkers such as lactate dehydrogenase concentration at follow-up despite a usual dose of steroid therapy.

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Treatment and therapeutic strategies for pituitary apoplexy in pregnancy: a case series

Journal of Medical Case Reports ◽

10.1186/s13256-021-02892-5 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Yuya Kato ◽

Yoshikazu Ogawa ◽

Teiji Tominaga

Keyword(s):

Pituitary Apoplexy ◽

Clinical Symptoms ◽

Case Series ◽

Optimal Timing ◽

Presenting Symptoms ◽

Pathological Evaluation ◽

Mother And Child ◽

Life Threatening ◽

In Pregnancy

Abstract Background Pregnancy is a known risk factor for pituitary apoplexy, which is life threatening for both mother and child. However, very few clinical interventions have been proposed for managing pituitary apoplexy in pregnancy. Case presentation We describe the management of three cases of pituitary apoplexy during pregnancy and review available literature. Presenting symptoms in our case series were headache and/or visual disturbances, and the etiology in all cases was hemorrhage. Conservative therapy was followed until 34 weeks of gestation, after which babies were delivered by cesarean section with prophylactic bolus hydrocortisone supplementation. Tumor removal was only electively performed after delivery using the transsphenoidal approach. All three patients and their babies had a good clinical course, and postoperative pathological evaluation revealed that all tumors were functional and that they secreted prolactin. Conclusions Although the mechanism of pituitary apoplexy occurrence remains unknown, the most important treatment strategy for pituitary apoplexy in pregnancy remains adequate hydrocortisone supplementation and frequent hormonal investigation. Radiological follow-up should be performed only if clinical symptoms deteriorate, and optimal timing for surgical resection should be discussed by a multidisciplinary team that includes obstetricians and neonatologists.

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Non-Invasive Dengue Diagnostics—The Use of Saliva and Urine for Different Stages of the Illness

Diagnostics ◽

10.3390/diagnostics11081345 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1345

Author(s):

Mahathir Humaidi ◽

Wei Ping Tien ◽

Grace Yap ◽

Choon Rong Chua ◽

Lee Ching Ng

Keyword(s):

Clinical Symptoms ◽

Detection Algorithm ◽

Acute Stage ◽

Serum Samples ◽

Non Invasive ◽

Fever Onset ◽

Dengue Transmission ◽

Dengue Diagnostics ◽

Potential Tool

Dengue diagnosis is largely dependent on clinical symptoms and routinely confirmed with laboratory detection of dengue virus in patient serum samples collected via phlebotomy. This presents a challenge to patients not amenable to venipuncture. Non-invasive methods of dengue diagnosis have the potential to enhance the current dengue detection algorithm. In this study, samples from dengue infected patients were collected between January 2012 until September 2012 and September 2013 until December 2013 in two different setups. Panel A samples (blood, urine, and saliva) were collected daily when the 39 patients were hospitalised and during their follow-up visits while Panel B samples (saliva) were collected from 23 patients during the acute stage of dengue. Using DENV PCR on Panel A, from day 2 to day 4 post fever onset, serum showed the best overall positivity followed by saliva and urine (100%/82.1%/67.9%). From day 5 until day 10 post fever onset, serum and urine had similar positivity (67.4%/61.2%), followed by saliva (51.3%). Beyond day 10 post fever onset, DENV was undetectable in sera, but urine and saliva showed 56.8% and 28.6% positivity, respectively. DENV in urine was detectable up until 32 days post fever. Panel B results showed overall sensitivity of 32.4%/36% (RNA/NS1) for DENV detection in saliva. Our results suggest that the urine-based detection method is useful especially for late dengue detection, where DENV is undetected in sera but still detectable in urine. This provides a potential tool for the physician to pick up new cases in an area where there is ongoing dengue transmission and subsequently prompt for intensified vector control activities.

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Endoscopically controlled surgery with open hemilaminectomy for the treatment of intradural extramedullary tumors: an operative technique and short-term outcomes of 20 consecutive cases

Chinese Neurosurgical Journal ◽

10.1186/s41016-020-00222-0 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Xiaorong Yan ◽

Huiqing Wang ◽

Cai Li ◽

Yuanxiang Lin ◽

Lin Lin ◽

...

Keyword(s):

Surgical Technique ◽

Spinal Deformity ◽

Tumor Recurrence ◽

Clinical Symptoms ◽

Short Term ◽

Before And After ◽

Intradural Extramedullary ◽

Controlled Surgery

Abstract Background To present a surgical technique for the treatment of intradural extramedullary (IDEM) tumors by using endoscopically controlled surgery with open hemilaminectomy technique. Methods In this study, 20 patients with 22 IDEM tumors were enrolled. An endoscopically controlled surgery with open hemilaminectomy was employed to remove the tumors. Data related to clinical symptoms and medical images before and after surgery were collected for perioperative evaluation and follow-up analysis. Results All the tumors in 20 patients were well removed. The clinical symptoms were significantly reduced in all the patients as well. The short-term follow-up data showed that there was no tumor recurrence or spinal deformity. Conclusion The endoscopically controlled surgery with open hemilaminectomy technique provided favorable exposure and satisfactory resection to the IDEM tumors. It may be an effective surgical method for treating IDEM tumors. Larger samples and longer follow-up data are needed to verify its long-term effectiveness.

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Concentrations of canine prostate specific esterase, CPSE, at baseline are associated with the relative size of the prostate at three-year follow-up

BMC Veterinary Research ◽

10.1186/s12917-021-02874-1 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Bodil S. Holst ◽

Sofia Carlin ◽

Virginie Fouriez-Lablée ◽

Sofia Hanås ◽

Sofie Ödling ◽

...

Keyword(s):

Clinical Symptoms ◽

Specific Antigen ◽

Relative Size ◽

Clinical Signs ◽

Serum Concentrations ◽

Prostatic Disease ◽

Follow Up Study ◽

Prostate Size ◽

Prostate Growth

Abstract Background Enlargement of the prostate is associated with prostatic diseases in dogs, and an estimation of prostatic size is a central part in the diagnostic workup. Ultrasonography is often the method of choice, but biomarkers constitute an alternative. Canine prostate specific esterase (CPSE) shares many characteristics with human prostate specific antigen (PSA) and is related to prostate size. In men with clinical symptoms of prostatic disease, PSA concentrations are related to prostate growth. The aims of the present follow-up study were to evaluate if the concentration of CPSE is associated with future growth of the prostate, and if analysis of a panel of 16 steroids gives further information on prostatic growth. Owners of dogs included in a previous study were 3 years later contacted for a follow-up study that included an interview and a clinical examination. The prostate was examined by ultrasonography. Serum concentrations of CPSE were measured, as was a panel of steroids. Results Of the 79 dogs included at baseline, owners of 77 dogs (97%) were reached for an interview, and 22 were available for a follow-up examination. Six of the 79 dogs had clinical signs of prostatic disease at baseline, and eight of the remaining 73 dogs (11%) developed clinical signs between baseline and follow-up, information was lacking for two dogs. Development of clinical signs was significantly more common in dogs with a relative prostate size of ≥2.5 at baseline (n = 20) than in dogs with smaller prostates (n = 51). Serum concentrations of CPSE at baseline were not associated with the change in prostatic size between baseline and follow-up. Serum concentrations of CPSE at baseline and at follow-up were positively associated with the relative prostatic size (Srel) at follow-up. Concentrations of corticosterone (P = 0.024), and the class corticosteroids (P = 0.0035) were positively associated with the difference in Srel between baseline and follow-up. Conclusions The results support the use of CPSE for estimating present and future prostatic size in dogs ≥4 years, and the clinical usefulness of prostatic size for predicting development of clinical signs of prostatic disease in the dog. The association between corticosteroids and prostate growth warrants further investigation.

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