Anaphylactic shock with pulmonary eosinophilic infiltration due to honeybee attack in a donkey: case report

ABSTRACT A case of a donkey attacked by Africanized honeybee is reported here with clinical signs of agitation, dehydration, congestion of the ocular mucous membranes, tongue edema, tachycardia and inspiratory dyspnea, and progression to death. At necropsy, diffuse, severe subcutaneous edema at face and cervical regions and severe diffuse pulmonary hyperemia with abundant edema without parenchymal collapse were observed. Microscopically, marked, diffuse deep dermis and panniculus carnosus edema and marked diffuse alveolar edema, with moderate population of eosinophils predominantly around larger caliber vessels were noted. The final diagnosis of anaphylactic shock was supported by history, clinical signs, and anatomic pathology findings. This is the first report of a honeybee attack with pulmonary eosinophilic infiltration in a mammal.

Chronic pyrrolizidine alkaloid toxicosis in a heifer

This heifer came from a group of cattle with chronic diarrhea and emaciation. Some of the animals also had neurological signs, predominantly aggressiveness. Two animals had already died spontaneously after worsening of the clinical signs. The farmer had kept these animals on native pasture during the winter, and he reported that the vegetation had been scarce in that period. On clinical exam, the animals were in bad body condition, with some presenting dyspnea, subcutaneous edema mainly affecting the dewlap, and abdominal distention.

Severe azotemia in a young breeding ram following to acute urethral obstruction by throughout intra-luminal blood clots

Urethral obstruction is a very important problem in small ruminants` flocks, as it affects breeding rams and so invaluable genetic reserves of the population. A three-years-old breeding ram referred to the teaching hospital with the owner`s compliant of lack of urination in previous two days. The ram was the only one in the flock which it had unlimited access to fat-tailed ewes. The other signs consisted of anorexia, reluctance to walking and final lateral recumbency. Severe depression, anuria, dribbling of blood drops from the glans and firmness of the enlarged penis in palpation were detected in the clinical examination. But noticeably there was no local subcutaneous edema and even swelling outside of the penis as it could be usually observed in urolithiasis. It was noticeable that the animal had remarkable bleeding tendency. An obvious splashing sound was heard using stethoscope auscultation on the right flank along. Abdominal paracentesis demonstrated a blood-tinged peritoneal fluid. Ultrasonography showed a completely distended urinary bladder. The animal died because of severe obstructive azotemia. The distended urinary bladder was opened and large amounts of blood-tinged urine flashed out. The urethra was incised but no urinary stones were detected in the lumen. Otherwise, an intra-luminal blood clotting at full length was detected following to the proximal internal hemorrhage. Obviously, this complex case may be confused with urolithiasis and should be exactly differentiated. There is no available reported data concerning the entity in literature. This case report is discussing the matter.

Crotalaria spectabilis poisoning in a horse

Plant poisoning is an important cause of death in horses and cattle in Brazil. Crotalaria sp. has stood out in this scenario due to its toxic potential caused by monocrotaline, a pyrrolizidine alkaloid found throughout the plant, mainly in seeds. Here is reported a case of Crotalaria spectabilis poisoning a horse. A horse consumed oats contaminated with Crotalaria spectabilis seed and presented clinical signs of toxicosis characterized by jaundice, progressive weight loss, hemoglobinuria, subcutaneous edema in the pectoral region and neurological symptoms typical of hepatic encephalopathy. In the serum evaluation, there was an increase in the activity of the enzymes alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT) and aspartate transaminase (AST), urea, creatinine and creatine phosphokinase (CPK). At necropsy, the main macroscopic findings were opaque and congested liver with capsular irregularity and accentuated the lobular pattern, trachea with foamy and pinkish fluid and congested and edematous pulmonary lobes. The main histopathological findings were hepatic fibrosis, periportal ductal hyperplasia, centrilobular necrosis, megalocytosis and binucleated hepatocytes. The brain parenchyma showed perivascular edema and Alzheimer type II astrocytes. Crotalaria sp. is among the main plants that cause acute or chronic mortality after exposure to the toxic compound in horses and farm animals.

Intravenous administration of anakinra in children with macrophage activation syndrome

Background Subcutaneous anakinra is an interleukin-1 inhibitor used to treat juvenile idiopathic arthritis. Recent reports suggest anakinra can be a valuable addition to the treatment of COVID-19 associated cytokine storm syndrome and the related multisystem inflammatory syndrome (MIS-C) in children. Herein, we describe our experience with intravenously administered anakinra. Findings 19 Patients (9 male) received intravenous (IV) anakinra for treatment of macrophage activation syndrome (MAS) secondary to systemic lupus erythematosus (SLE), systemic JIA (SJIA) or secondary hemophagocytic lymphohistiocytosis (sHLH). In most cases the general trend of the fibrinogen, ferritin, AST, and platelet count (Ravelli criteria) improved after initiation of IV anakinra. There were no reports of anaphylaxis or reactions associated with administration of IV anakinra. Conclusion Intravenous administration of anakinra is an important therapeutic option for critically ill patients with MAS/HLH. It is also beneficial for those with thrombocytopenia, subcutaneous edema, neurological dysfunction, or very young, hospitalized patients who need multiple painful subcutaneous injections.

Early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments

Objective Peripheral intravenous catheter (PIVC) failure occurs frequently, but the underlying mechanisms of failure are poorly understood. We aim to identify ultrasonographic factors that predict impending PIVC failure prior to clinical exam. Methods We conducted a single site prospective observational investigation at an academic tertiary care center. Adult emergency department (ED) patients who underwent traditional PIVC placement in the ED and required admission with an anticipated hospital length of stay greater than 48 hours were included. Ongoing daily PIVC assessments included clinical and ultrasonographic evaluations. The primary objective was to identify ultrasonographic PIVC site findings associated with an increased risk of PIVC failure. The secondary outcome was to determine if ultrasonographic indicators of PIVC failure occurred earlier than clinical recognition of PIVC failure. Results In July and August of 2020, 62 PIVCs were enrolled. PIVC failure occurred in 24 (38.71%) participants. Multivariate logistic regression demonstrated that the presence of ultrasonographic subcutaneous edema [AOR 7.37 (1.91, 27.6) p = 0.0030] was associated with an increased likelihood of premature PIVC failure. Overall, 6 (9.67%) patients had subcutaneous edema present on clinical exam, while 35 (56.45%) had subcutaneous edema identified on ultrasound. Among patients with PIVC failure, average time to edema detectable on ultrasound was 46 hours and average time to clinical recognition of failure was 67 hours (P = < 0.0001). Conclusions Presence of subcutaneous edema on ultrasound is a strong predictor of PIVC failure. Subclinical subcutaneous edema occurs early and often in the course of the PIVC lifecycle with a predictive impact on PIVC failure that is inadequately captured on clinical examination of the PIVC site. The early timing of this ultrasonographic finding provides the clinician with key information to better anticipate the patient’s vascular access needs. Further research investigating interventions to enhance PIVC survival once sonographic subcutaneous edema is present is needed.

RS3PE and the role of ultrasound. A case report and brief review of the literature

Remitting seronegative symmetric synovitis with pitting edema (RS3PE) is a rare syndrome characterised by acute onset of symmetrical distal synovitis and tenosynovitis, associated with severe pitting edema of the dorsum of the hands and feet, seronegativity for autoimmunity and dramatic response to glucocorticoids. First described by McCarty et al. in 1985, RS3PE is reported mostly in elderly males, but it can also rarely occur in young people. Although it was initially regarded as a form of rheumatoid arthritis (RA), it is now considered a clinical distinct entity that can be associated with other rheumatologic conditions or be secondary to underlying diseases, such as cancer. As revealed by magnetic resonance imaging (MRI), the typical landmark of RS3PE is extensor tenosynovitis. Due to extensive subcutaneous edema of the extremities, the clinical assessment of synovitis and tenosynovitis is difficult. On the other hand, the use of MRI is expensive, time-consuming and requires experienced staffs. Musculoskeletal ultrasound (MSUS) may be a viable, reliable and cost-effective tool for evaluation of RS3PE patients. We hereby report the case of an 84 year-old woman presenting with bilateral hand and wrist swelling and morning stiffness. Clinical examination, laboratory tests and imaging led to a diagnosis of RS3PE. The aim of this report is to discuss the role of MSUS in RS3PE for the purpose of diagnosis and differential diagnosis compared with other rheumatologic conditions.