Importance of Eosinophilic Infiltration of the Colonic Mucosa in Ulcerative Colitis Patients who are Refractory to Maintenance Therapy

Eosinophilic infiltration is sometimes observed histologically in ulcerative colitis (UC), but the effect of the degree of infiltration on the treatment course for UC is not completely studied. We investigated whether short-term steroid administration in UC patients refractory to maintenance therapy, with high eosinophilic infiltration in the colonic mucosa, contributed to clinical and endoscopic improvement. Ten patients with endoscopically active and pathologically high eosinophilic infiltration, based on pathological examination using endoscopic biopsy, were examined for clinical background when starting steroid treatment; clinical and endoscopic improvement before and after steroid use were assessed prospectively. The average initial steroid dosage and duration of use were 21.0 mg and 102.7 days, respectively. The mean values before and after steroid use of clinical activity index, Mayo endoscopic subscore, and UC endoscopic index of severity were 2.4 and 1.0, 1.8 and 0.7, and 3.9 and 1.1, respectively. All these scores improved significantly after steroid use (P=0.04, P<0.01, P<0.01, respectively). Steroids were discontinued in all patients; no patients required steroid re-administration. There may be cases of UC with eosinophilic infiltration into the colonic mucosa and resistant to maintenance treatment, suggesting that short-term steroid administration may contribute to clinical and endoscopic improvements.

Cytokine Signature and Involvement in Chronic Rhinosinusitis with Nasal Polyps

Cytokines are well known to play a central role in chronic rhinosinusitis with nasal polyps (CRSwNP), particularly in maintenance of the inflammatory response and the recruitment of eosinophils. The pathophysiological concepts concerning the involvement of inflammatory cytokines in CRSwNP have gradually evolved. Although the Th2 cytokines environment associated with an eosinophilic infiltration has retained a central role in the genesis of polyps, the role of other cytokine subpopulations has also and more recently been detailed, leading to a specific and complex signature in CRSwNP. The purpose of this review is to summarize the current state of knowledge about the cytokine signature in CRSwNP, the role of cytokines in the pathogenesis of this disease and in the intercellular dialog between epithelial cells, fibroblasts and inflammatory cells. Knowledge of this precise cytokine signature in CRSwNP is fundamental in the perspective of potential targeting biotherapies.

Is there an Unnoticed Etiology of Right Atrial Aneurysm?

A 12-year-old male was referred for surgery with the diagnosis of right atrial aneurysm. Resection of the right atrial aneurysm was performed under total cardiopulmonary bypass. Besides a very thin muscular layer, histopathological evaluation of the aneurysm specimen revealed extensive eosinophilic infiltration at the epicardial side which, from place to place showed penetrations into the muscular layer. The screening tests performed for determination of the etiology of eosinophilia were indeterminate supporting the diagnosis of idiopathic right atrial aneurysm. In conclusion, although the reason for the eosinophilia could not be detected, it may have a part in the development of right atrial aneurysm that merits further investigation.

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.

221 Effects of energy drinks on inflammatory response: study in vivo in rats

In recent years, the consumption of energy drinks (EDs) has increased constantly among young people because of their capacity to enhance alertness and improve mental and physical performance, reducing fatigue. EDs are beverages containing a high and variable amount of caffeine, which exerts effects on many tissues of the cardiovascular system. In addition to caffeine, they contain several other psychoactive substances including the amino acid taurine, the glucose derivative glucuronolactone, as well as herbal extracts such as guaranà (another source of caffeine, with caffeine-like effects) and ginseng, often present in not well-known concentration. In our project we aim to evaluate whether the consumption of EDs causes alterations in the organs involved in their contact, absorption and metabolism in an animal model, i.e. the rat. We used 28 Sprague Dawley adult male rats, weighing 230–250 g and fed with a standard laboratory diet, randomly divided into four groups (N = 7). Every group received a different treatment (ED, soda-cola, sweetened coffee or water-controls-) for 5 days. All animals were anesthetized and underwent histological analysis and blood sampling at the end of the treatment. We observed eosinophilic infiltrates in gastrointestinal tract, but not in cardiovascular system. We quantified various indicators of tissue damage and cytokines in plasma, including ICAM-1, L-selectin, TIMP-1, VEGF, IL-10, IL-2, IL-4, IL-6, IL-1β, IL-13, IL-33, TNF-α, and IFN-γ. In contrast with the eosinophilic infiltration, we did not detect a systemic increase of Th2 cytokines (i.e. IL-4 and IL-13) after treatment: thus, even if the experiments evaluating the possible presence of an unbalanced Th2 response in the tissues featured by eosinophilic infiltration are still lacking, we exclude further deepening on Th2 immune responses. Interestingly, we observed a decrease of TIMP-1 in plasma from rats orally supplemented with ED, soda-cola or sweetened coffee compared to animals treated with water. TIMP-1 is a major player in preserving tissue integrity and controlling wound healing by balancing the enzymatic activity of matrix metalloproteinases (MMPs) and regulating extracellular matrix turnover. Moreover, elevated levels of the adhesion molecules ICAM-1 and L-selectin were found in plasma from rats receiving ED or soda-cola, together with a high concentration of IL-33 in animals assuming the ED. The circulating form of ICAM-1 is associated with inflammation, particularly due to endothelial damage, and L-selectin and IL-33 play an important role in inflammatory conditions as well. These observations suggest that the consumption of EDs could alter the architecture, and hence function, of the organs involved in their contact, absorption and metabolism. Indeed, the alterations we observed in the periphery could reflect the establishment of inflammation and deregulated mechanisms of damage repair locally in the target tissues.

An unusual case of a gallbladder polyp

A 63-year old female patient with a medical history of hypereosinophilic syndrome with neurological and pulmonary involvement presented for a routine follow-up. The patient was asymptomatic but a routine scheduled ultrasound showed a gallbladder polyp of 19mm. One month later this polyp had grown to 36 mm. On magnetic resonance imaging of the liver there was a suspicion of gallbladder cancer and for this reason cholecystectomy was performed. Pathology however showed eosinophilic infiltration. Serum analysis showed an increase in her eosinophil count. The diagnosis of hypereosinophilic syndrome with eosinophilic infiltration of the gallbladder was made. The dose of corticosteroids was augmented and she recovered completely post-operatively with no residual flares of other organ damage during follow up.

Mucosal eosinophilic infiltration may be a characteristic of human intestinal spirochetosis

Background Human intestinal spirochetosis (HIS) is an infectious disease of large intestines caused by Brachyspira species, and most HIS cases are asymptomatic or exhibit mild intestinal symptoms. The host reaction to HIS remains unclear, and we examined HIS-related mucosal inflammatory features histologically. Methods From the archival HIS cases in a single medical center, 24 endoscopically taken specimens from 14 HIS cases (male:female = 10:4; 28–73 yrs) were selected as not containing polypoid or neoplastic lesions. Stromal neutrophils, eosinophils, and mast cells, and intraepithelial neutrophils and eosinophils, (sNeu, sEo, sMast, iNeu, and iEo, respectively) were counted, and the presence or absence of lymphoid follicles/aggregates (LFs) was also examined. Association of the above inflammation parameters and spirochetal infection parameters (such as degrees of characteristic fringe distribution, of spirochetal cryptal invasion, and of spirochetal intraepithelial invasion) were also analysed. Results iNeu was observed in 29.2%, iEo in 58.3%, and LFs in 50.0% of the specimens. Maximal counts of sNeu, sEo, sMast, iNeu, and iEo averaged 8.4, 21.5, 6.0, 0.5 and 1.5, respectively. Strong correlation between the maximum counts of iNeu and iEo (p < 0.001, r = 0.81), and correlations between those of iEo and sNeu (p = 0.0012, r = 0.62) and between those of iEo and sEo (p = 0.026, r = 0.45) were observed. iNeu was influenced by fringe formation (p < 0.05) and spirochetal crypt involvement (p < 0.05). Conclusions HIS was accompanied by inflammatory reactions, and among these, mucosal eosinophilic infiltration may be a central indicator and host reaction of HIS.

Eosinophilic Gastroenteritis: A Rare Digestive Disorder

Eosinophilic gastroenteritis is a rare digestive disorder in children and adults characterized by eosinophilic infiltration of the gastrointestinal tract. The symptoms are nonspecific and vary, depending on the site and layer of the bowel wall infiltrated by eosinophils. Unlike eosinophilic oesophagitis, the management of eosinophilic gastroenteritis is not consensual. The course of this pathology is variable and spontaneous remission is possible. In some patients, recurrent symptoms have been reported after corticosteroid interruption.