Eosinophilic bronchiolitis successfully treated with benralizumab

A 53-year-old non-smoking Japanese woman was admitted to our hospital with a 20-year history of wet cough and dyspnoea on exertion. Bronchial asthma (BA) had been diagnosed 20 years earlier. Although she has been treated with high-dose inhaled corticosteroid, she had experienced frequent exacerbation of BA, and short-term oral corticosteroid bursts were occasionally administered. High-resolution CT of the chest revealed diffuse centrilobular nodules with bronchial wall thickening and patchy ground-glass opacities in both lungs. Lung biopsy specimens showed widespread cellular bronchiolitis with follicle formations in the membranous and respiratory bronchioles, accompanied by marked infiltration of plasma cells and eosinophils. In addition, immunohistochemical immunoglobulin G4 (IgG4) staining revealed many IgG4-positive plasma cells, and the ratio of IgG4-positive cells to IgG-positive cells exceeded 40%. The final diagnosis was eosinophilic bronchiolitis with marked IgG4-positive plasma cell infiltration in association with BA. With benralizumab therapy, her clinical condition dramatically improved.

Pioglitazone in treatment of patients with comoribidity of psoriatic disease and alimentary obesity

An indisputable link between psoriasis and obesity has recently been proven. Alimentary obesity exacerbates systemic inflammation in patients with psoriasis, complicating the course of dermatosis, causing deterioration of the dermatological index of quality of life of patients and frequent exacerbation of psoriasis, which leads to ineffectiveness of standard treatments. PPAR-activated receptors are the link between lipids and inflammation because lipids stimulate the chronic form of systemic inflammation and are ligands that activate PPAR. Thus, PPAR can be used as the main target when choosing a treatment for this comorbidity. To date, the literature has accumulated a large number of prospective observations indicating a positive effect of pioglitazone (PG) on systemic inflammation. The mechanism of action of this drug is aimed at suppressing chronic systemic delayed inflammation of low intensity. The anti-inflammatory effect of PG is associated with its activating effect on nuclear transcription factors of PPAR. Objective — to determine the effectiveness of the inclusion of different doses of pioglitazone in the complex treatment of patients with advanced psoriasis vulgar with concomitant alimentary obesity of I—II degree. Materials and methods. Clinical and immunological study of systemic inflammation. Results and discussion. The results of the study showed the effectiveness of this method of treatment, which depended on the dose of PG and the duration of treatment. The use of PG in the complex treatment of patients with vulgar psoriasis of moderate severity with concomitant alimentary obesity of I—II degree for 26 weeks led to a decrease in inflammation both locally, according to the Psoriatic Area and Severity Index, and at the systemic level due to reduction in the level of systemic inflammation, namely the level of interleukin-33, interleukin-6 and highly sensitive C-reactive protein in the blood serum.Conclusions. Long-term use of PG can be recommended for the personalized and comprehensive treatment of patients with comorbidity of psoriasis and alimentary obesity of I—II degree.

Bronchial asthma in practice of the allergist and the pulmonologist: a comparative analysis

Aim of study. To carry out a comparative analysis of a population of patients with bronchial asthma under observation of pulmonologists and allergists. Material and methods. A total of 377 cases of bronchial asthma were studied and analysed. Th e non-interventional, observational, comparative study was carried out in the setting of actual clinical practice. Th e patient underwent medical history collection, evaluation of adherence to treatment and of the level of bronchial asthma control, physical examination, spirometry, their laboratory data and earlier treatment taken into consideration. The evaluation results were analysed via the SPSS-18 soft ware program. Results. Th e patients observed by pulmonologists had uncontrolled BA more frequently with almost 2-fold predominance of patients with severe disease progression, FEV1 was below normal values with significantly more frequent exacerbation and hospitalisation. The patients observed by allergists were more frequently male. They were younger with signifi cantly more frequent controlled bronchial asthma or bronchial asthma with mild progression, 3-fold more frequent rhinitis, a lower number of exacerbation and hospitalisation over the past year, 2-fold less frequent FEV1 below the normal values and 2-fold less frequent application of short-acting bronchodilators. Th e patients observed by pulmonologists had severe uncontrolled progression of the disease with presence of extrapulmonary concomitant diseases. Th ere was no difference between the patients in relation to the frequency of baseline therapy via inhaled glucocorticosteroids and their combinations with long-acting bronchodilators. Conclusion. Bronchial asthma is a disease, the heterogeneity of manifestations of which leads to management of patients with the same nosological entity being performed by specialists in two fi elds, which is based on the diff erences in the clinical profi le determined in this study.

Fistulized Crohn’ Disease Mimicking Sigmoid Cancer: A Case Report

Crohn’s disease is an inflammatory bowel disease of unknown etiology, progressing with frequent exacerbation periods that can involve any part of the gastrointestinal tract. Although, it can manifest itself with complaints from the entire gastrointestinal tract; abdominal pain, diarrhea, nausea, weight loss and fever are the most important clinical symptoms. In this presentation, a 41-year-old male patient with known Crohn’s disease was presented to our hospital with the help of operation images.

Features of the formation of professional allergodermatoses at the present stage

Introduction. All over the world, the great socio-economic importance of occupational skin diseases is recognized, among which occupational allergic dermatoses account for a significant share. An important factor affecting the effectiveness of preventive measures is the identification of groups and risk factors for the development of the disease. In this regard, the importance of measures aimed at reducing the incidence of pro-allergic dermatoses is obvious. The aim of study is to characterize the severity of the clinical course in patients with occupational eczema, depending on the influence of concomitant pathologies (atopy, mycoses). Materials and methods. The data of the results of examinations of 70 patients who were hospitalized in the clinic department of dermatology of Izmerov Research Institute of Occupational Health for the last 3 years are provided. Results. In patients with a history of atopy and concomitant mycotic infection, the clinical picture is widespread with pronounced inflammatory manifestations, there is a more frequent exacerbation and torpidity to the therapy. The time of manifestation from the beginning of work with industrial allergens is reduced. Conclusions. Identification of patients with atopy (pollinosis, bronchial asthma, atopic dermatitis), patients with mycotic infections as risk groups for the development of occupational allergodermatoses and their inclusion in preventive programs can improve the effectiveness of medical examinations and prevent them from developing severe forms of occupational skin pathology, reduce the disability of patients.

A high-risk airway mycobiome is associated with frequent exacerbation and mortality in COPD

IntroductionThe COPD bacteriome associates with disease severity, exacerbations, and mortality. While COPD patients are susceptible to fungal sensitisation, the role of the fungal mycobiome remains uncertain.MethodsWe report the largest multicenter evaluation of the COPD airway mycobiome to date including participants from Asia (Singapore and Malaysia) and the United Kingdom (Scotland) when stable (n=337) and during exacerbations (n=66) as well as non-diseased controls (n=47). Longitudinal mycobiome analyses performed during and following COPD exacerbations (n=34) were examined in terms of exacerbation frequency, two-year mortality, and the occurrence of serum specific-IgE against selected fungi.ResultsA distinct mycobiome profile is observed in COPD compared to controls evidenced by increased alpha diversity (Shannon-index) (p<0.001). Significant airway mycobiome differences including greater inter-fungal interaction (by co-occurrence) characterise very frequent COPD exacerbators (≥3 exacerbations per year) (PERMANOVA, adjusted p<0.001). Longitudinal analyses during exacerbations and following treatment with antibiotics and corticosteroids did not reveal any significant change in airway mycobiome profile. Unsupervised clustering resulted in two clinically distinct COPD groups, (1) with increased symptoms (CAT score) and Saccharomyces dominance and (2) with very frequent exacerbations and higher mortality characterised by Aspergillus, Penicillium and Curvularia with a concomitant increase in serum specific IgE levels against the same fungi. During acute exacerbations of COPD, lower fungal diversity associates with higher two-year mortality.ConclusionThe airway mycobiome in COPD is characterised by specific fungal genera associated with exacerbations and increased mortality.