Presence of bronchial nodules, younger age, and heavier body weight are associated with a diagnosis of eosinophilic lung disease in dogs with cough

OBJECTIVE To describe the association between a diagnosis of eosinophilic lung disease (ELD) in dogs with signalment and bronchoscopic features and evaluate the accuracy of visualization of nodules for the diagnosis of ELD. ANIMALS 781 dogs with cough that underwent bronchoscopy between 2014 and 2016. PROCEDURES Data were extracted from the medical records of each included dog. Multivariable logistic regression was performed to investigate associations between ELD and patient characteristics. RESULTS ELD was diagnosed in 113 (14.5%) dogs. More than 3 nodular lesions of the bronchial mucosa were detected in 64 (8.2%) dogs. The odds of having ELD were greater in dogs with nodules (adjusted OR [aOR], 26.0; 95% CI, 13.0 to 52.0) and static bronchial collapse (aOR, 2.3; 95% CI, 1.1 to 4.6), and lower in dogs having focal versus diffuse inflammation (aOR, 0.05; 95% CI, 0.01 to 0.37). The odds of having ELD decreased for each 1-year increase in age (aOR, 0.86; 95% CI, 0.80 to 0.92), and increased for each 1-kg increase in weight (aOR, 1.04; 95% CI, 1.01 to 1.06). Visualization of nodules during bronchoscopy had a overall accuracy of 89.4% (95% CI, 87.0% to 91.4%), sensitivity of 41.6% (32.4% to 51.2%), and specificity of 97.5% (96.0% to 98.5%) for a diagnosis of ELD. CLINICAL RELEVANCE On the basis of high specificity and negative predictive value, lack of visualization of bronchial nodules during bronchoscopy can be used to preliminarily rule out ELD. However, visualization of bronchial nodules does not imply presence of ELD. This could be especially relevant when results of BAL cytology are available several days after the actual bronchoscopy.

Infected Cavitations, Bullae and Interstitial Lung Disease in a COVID-19 Patient in Lima, Peru

A 48-year-old Peruvian man was diagnosed with COVID-19 in December 2020. His infection resolved and he was discharged from hospital after 14 days. However, 1 week later he presented with haemoptysis, malaise, pleuritic pain, infected cavitations, bullae, extensive interstitial lung disease and pneumomediastinum. He recovered after antibiotic treatment and was discharged after 8 days. His symptoms may have been due alveolar rupture due to persistent cough during and after diffuse inflammation of the lung parenchyma caused by COVID-19 infection.

Colitis Induced by Colon-Cleansing Agent

Constipation is one of the most common functional gastrointestinal disorders and affects 20% of the general population. Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract that affects the large intestine and is characterized by chronic abdominal pain and altered bowel habits. We report a case of a 35-year-old African American man with a past medical history of IBS who presented to the clinic with a chief complaint of abdominal pain and bloody diarrhea for 1 week. The patient stated that he used a colon-cleansing agent because of persistent constipation. Computed tomography scan of the patient’s abdomen and pelvis with contrast was performed which showed diffuse contiguous segmental mural thickening and nodularity seen along the distal transverse, descending, and sigmoid colon. Colonoscopy showed moderate diffuse inflammation characterized by altered vascularity, erythema, and granularity from the rectum to the descending colon, and localized mild inflammation characterized by erythema was found at the ileocecal valve. The patient’s clinical condition improved with symptomatic management over 10 days. Patients with IBS should be advised to restrain from using a colon-cleansing agent without advice from their primary doctor as it can lead to various complications.

DOP29 The Normalization and Transition of J-Pouch Phenotype in the Chicago Classification of Pouchitis

Background Pouchitis can develop in up to 70% of patients with inflammatory bowel disease (IBD) treated by proctocolectomy with ileal pouch-anal anastomosis (IPAA). In our recent work, we proposed the “Chicago classification of pouchitis” describing 7 main pouch phenotypes with differing outcomes. In this study, we assessed the transition of pouch phenotypes in our classification. Methods This is a retrospective study of IBD patients with IPAA who subsequently underwent pouchoscopies at the University of Chicago between June 1997 and December 2019. We reviewed all available reports of pouchoscopies after ileostomy takedown and classified the pouches into 7 main phenotypes: (a) normal, (b) afferent limb (AL) involvement, (c) inlet (IL) involvement, (d) diffuse, (e) focal inflammation of the pouch body, (f) cuffitis, and (g) pouch fistulas (Figure 1). A normal pouch was defined as a pouch without any abnormal findings including fistulas. AL, IL involvement, and cuffitis were defined as any type of endoscopic inflammation in the AL, IL, and rectal cuff, respectively. Diffuse inflammation was defined as two or more endoscopic inflammatory findings in all anatomical locations of the pouch body (the tip, proximal, and distal pouch). Focal inflammation was defined as pouchitis that did not meet the criteria for diffuse inflammation. Pouch fistulas included pouches with any type of fistulas noted ≥6 months from ileostomy takedown. Using a Kaplan-Meier curve, event-free survival (EFS) was assessed from the scope date when a primary phenotype was first identified to the date when a subsequent phenotype was described. We excluded patients if a subsequent phenotype was identified before or at the scope date when a primary phenotype was initially noted. Logistic regression analysis was performed with variables with a P-value <0.05 in a Fisher’s exact test. Results We reviewed 1,359 pouchoscopies from 426 patients (90% preoperative diagnosis of ulcerative colitis). The most common subsequent inflammatory phenotype was focal inflammation (55%-88%), followed by IL involvement (31%-67%), cuffitis (33%-46%), diffuse inflammation (20%-38%), AL involvement (21%-32%), and pouch with fistulas (9%-20%). The rate of subsequent normal pouch was 6%-25% with pouch fistulas having the lowest normalization rate (6%, 5-year EFS 93%) (Table 1, Figure 2). On multivariable analysis, pouch fistulas were negatively associated with pouch normalization (OR 0.17, 95% CI 0.06–0.48) (Table 2). Conclusion We demonstrated that pouch phenotype can change over time and pouch normalization is possible. Further studies are needed to determine if pouch normalization should be a goal of treatment for IBD patients with IPAA.

Granulomatosis with Polyangiitis Restricted to The Back Muscle: The First Case Report

Granulomatosis with polyangiitis (GPA) is an autoimmune disease which is a type of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis that frequently affects the lungs and kidneys. However, GPA limited to a single organ has also been reported. A 73-year-old man was admitted for back pain and fever. We detected elevated levels of inflammatory markers and myeloperoxidase-ANCA. Magnetic resonance imaging indicated diffuse inflammation of the back and psoas muscles. Histology showed degenerated muscle fibers and granulomatosis vasculitis with mixed lymphoplasma cell infiltration. High-dose methylprednisolone therapy improved his symptoms. A final diagnosis of GPA limited to the muscles was made.

A Case of Adult Membranous Croup Caused by Methicillin-Resistant Staphylococcus Aureus Mimicking Laryngeal Diphtheria

Membranous croup is a rare disease that is characterized by diffuse inflammation of the larynx, trachea, and bronchi with adherent or semiadherent mucopurulent membranes in the subglottic trachea and larynx. All cases have occurred in children and there has been no case of adults. The clinical signs, symptoms, progress and prognosis of membranous croup are more severe than those of ordinary croup. The detached membrane in membranous croup may cause a high degree of air way obstruction and give similar characteristics of laryngeal diphtheria, thus it is important to differentiate it from diphtheria by identifying the pathogen. Herein we report with a review of literature a rare case of adult membranous croup caused by methicillin-resistant staphylococcus aureus mimicking laryngeal diphtheria.

Diagnosis and treatment of diffuse otitis externa

The article deals with modern concepts of etiology, pathogenesis, diagnostics and treatment of inflammatory diseases of the outer ear. The problem of otitis externa flow in patients with diabetes is covered. The role of various microorganisms is discussed: Staphylococcus aureus, bacteria of Enterobacteriaceae family, fungi of Aspergillus, Candida, Penicillium, Mucor genera in the development of diffuse inflammation, variants of using local topical medications in the treatment of acute and chronic inflammatory diseases of the outer ear, as well as local therapy of otitis externa in combination with acute otitis media are considered. As the most effective and safe means the authors suggest using the local combined drug Candibiotic, which contains antibacterial, fungicidal, corticosteroid and analgesic components that affect the main pathogenesis factors of the disease.

Tropical Pyomyositis: diabetes facilitating the onset of an uncommon disease

Introduction: Tropical pyomyositis is an infectious disease that affects skeletal muscle and may appear as a diffuse inflammation or a rapidly progressive myonecrotic process. The predisposition of this disease in diabetics is already mentioned in several studies. The pathogenesis is possibly related to changes in neutrophils and the reversal of the immune response pattern that occurs in situations such as parasitic diseases. "Staphylococcus aureus" is the most common microorganism, accounting for 90% of cases of tropical pyomyositis. The diagnosis is sometimes late because patients usually do not seek care by the first symptoms, and because it is a rare disease and physicians are not very familiar with it. Case report: A 42-year-old male patient with diabetes mellitus, hypothyroidism, anemia, thrombocytopenia, and hypoalbuminemia developed tropical pyomyositis with multiple muscle abscesses in quadriceps, soleus and anterior tibial, triceps and biceps brachialis and pronator round, requiring prolonged antibiotic therapy and surgical drainage. Conclusion: Pyomyositis is a little known disease and if not diagnosed early can be fatal.

α4β7 Integrin Antagonist Vedolizumab for the Treatment of Refractory Ileitis

Background and Aims. Ulcerative colitis (UC) is a superficial diffuse inflammation restricted to the colon and rectum. Inflammation within the small bowel may occur several years after a pancolectomy. The pathogenesis is unknown and seems to be different from Crohn’s disease or other causes of diseases of the small intestine, but an association with colectomy due to UC is very likely. Methods and Results. We describe the case of a patient with a probable diagnosis of pan-UC accompanied by Sjögren’s syndrome and partial IgA deficiency, who developed enteritis after a restorative pancolectomy. For induction and maintenance of remission, the patient was successfully treated with mycofenolate mofetil (MMF) and vedolizumab (VDZ). Conclusions. We suggest that a previously refractory to standard therapy UC-related enteritis can be treated with combination MMF and VDZ.