Clinical Analysis of Chronic Active EBV Infection Involving Gastrointestinal Tract

Objective This study aimed to analyze the clinical manifestation, prognosis, and risk factors of pediatric chronic active Epstein-Barr virus infection (CAEBV) associated with gastrointestinal tract involvement.Methods This retrospective case series study included pediatric CAEBV associated with gastrointestinal tract involvement treated at Beijing Children’s Hospital, Capital Medical University from June 2017 to Jun 2021. The control group was consisted of Children with CAEBV without gastrointestinal involvement. The clinical manifestations, laboratory and ultrasound examinations, treatment and prognosis of the children were observed.Results There were 15 children with CAEBV combined with gastrointestinal involvement, including 11 males and 4 females, accounting for 20.8% (15/72) of CAEBV patients in the same period, with an onset median age of 3.71 (0.64-14.47) years. The most common clinical manifestation at onset was diarrhea (13/15). Gastrointestinal ultrasound showed air accumulation accompanied by intestinal wall swelling and thickening, mild to moderate swelling of the surrounding mesentery and omentum, and enhanced echo. The endoscopic features were hyperemia, edema, and ulcers of variable morphological characteristics. Pathological examination showed lymphocyte infiltration with EBER (+), and the common involvement locations were the colon (n=6) and gastric antrum (n=3). The median follow-up time was 13.26 (0.31-51.89) months. Ten patients survived, and 5 patients died (including one patient who died of intestinal perforation due to necrotizing enterocolitis). Compared with the control group, the case group had higher levels of alanine aminotransferase, aspartate aminotransferase and whole blood EBV-DNA copies (P=0.038, 0.040 and < 0.001) and lower NK cell activity (P < 0.001). The 3-year overall survival rate of the case group was significantly lower than that of the control group (59.3%±12.9% vs. 79.4%±4.9%, P=0.021).Conclusion The incidence of CAEBV with gastrointestinal tract involvement was low. The most common involvement location was colon. CAEBV with gastrointestinal involvement had poor prognosis. Patients who had high whole blood EBV-DNA copy levels early in their illness were more likely to develop gastrointestinal involvement.

SARS-CoV-2 precipitated Kasabach-Merritt syndrome in a child with angioma infantile and acute lymphoblastic leukemia: Case Report

Background: We describe an 8-month-old boy with leukemia and SARS-CoV-2 infection who developed Kasabach-Merritt phenomenon. He had a positive SARS-COV-2 RT-PCR sample. Hematologic tests showed coagulopathy and intestinal involvement. She was managed in emergency receiving transfusion support and in hospitalization with social isolation measures, she started propanolol and corticotherapy as initial treatment of infantile angiomas. She presented with symptoms of intestinal obstruction and underwent surgery and evidence of hemorrhagic infarction with foci of intestinal ischemic necrosis, ending in ileostomy. We tried to understand a pathophysiological explanation of the dermatologic and gastrointestinal tract involvement by the virus and the atypical form of COVID-19. Given the emerging evidence of endothelial and vascular involvement in COVID-19, the development of tests to detect vascular lesions may be critical to guide the use of new therapeutic strategies.

Clinical Picture and Risk Factors of Severe Respiratory Symptoms in COVID-19 in Children

Children with COVID-19 develop moderate symptoms in most cases. Thus, a proportion of children requires hospital admission. The study aimed to assess the history, clinical and laboratory parameters in children with COVID-19 concerning the severity of respiratory symptoms. The study included 332 children (median age 57 months) with COVID-19. History data, clinical findings, laboratory parameters, treatment, and outcome, were evaluated. Children were compared in the groups that varied in the severity of symptoms of respiratory tract involvement. Children who required oxygen therapy represented 8.73%, and intensive care 1.5% of the whole cohort. Comorbidities were present in 126 patients (37.95%). Factors increasing the risk of oxygen therapy included comorbidities (odds ratio (OR) = 92.39; 95% confidence interval (95% CI) = (4.19; 2036.90); p < 0.00001), dyspnea (OR = 45.81; 95% CI (4.05; 518.21); p < 0.00001), auscultation abnormalities (OR = 34.33; 95% CI (2.59; 454.64); p < 0.00001). Lactate dehydrogenase (LDH) > 280 IU/L and creatinine kinase > 192 IU/L were parameters with a good area under the curve (0.804-LDH) and a positive predictive value (42.9%-CK). The clinical course of COVID-19 was mild to moderate in most patients. Children with comorbidities, dyspnea, or abnormalities on auscultation are at risk of oxygen therapy. Laboratory parameters potentially useful in patients evaluated for the severe course are LDH > 200 IU/L and CK > 192 IU/L.

Gastrointestinal tract involvement in hepatocellular carcinoma: two cases illustrating duodenal and oesophageal invasion

We present here two hepatocellular carcinoma (HCC) patients with gastrointestinal tract involvement (GITI). Hemorrhage due to duodenal involvement was the inaugural event of the HCC for the first patient. Dysphagia due to HCC recurrence in the oesophagus four years after left hepatectomy was the call symptom for the second. As incidence of HCC increases, and overall survival improves, incidence of GITI in HCC patients is expected to increase.

Orofacial Granulomatosis Associated with Crohn’s Disease: a Multicentre Case Series

Background Orofacial granulomatosis [OFG] is a rare syndrome that may be associated with Crohn’s disease [CD]. We aimed to characterise this relationship and the management options in the biologic era. Methods This multicentre case series was supported by the European Crohn’s and Colitis Organisation [ECCO], and performed as part of the Collaborative Network of Exceptionally Rare case reports [CONFER] project. Clinical data were recorded in a standardised collection form. Results This report includes 28 patients with OFG associated with CD: 14 males (mean age of 32 years, ±12.4 standard deviation [SD]) and 14 females [40.3 years, ±21.0 SD]. Non-oral upper gastrointestinal tract involvement was seen in six cases and perianal disease in 11. The diagnosis of OFG was made before CD diagnosis in two patients, concurrently in eight, and after CD diagnosis in 18. The distribution of OFG involved the lips in 16 cases and buccal mucosa in 18. Pain was present in 25 cases, with impaired swallowing or speaking in six. Remission was achieved in 23 patients, notably with the use of anti-tumour necrosis factors [TNFs] in nine patients, vedolizumab in one, ustekinumab in one, and thalidomide in two. A further five cases were resistant to therapies including anti-TNFs. Conclusions OFG associated with CD may occur before, concurrently with, or after the diagnosis of CD. Perianal and upper gastrointestinal [UGI] disease are common associations and there is a significant symptom burden in many. Remission can be obtained with a variety of immunosuppressive treatments, including several biologics approved for CD.