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The primary objective was to evaluate Group A streptococcal (GAS) tests performed with a Modified Centor Criteria (MCC) Score < 3 at Urgent Care Clinics (UCC). Secondary objectives included evaluating the MCC sensitivity and specificity, antibiotics prescribed with an MCC score < 3, and association between palatal petechiae and GAS pharyngitis infections. This was a retrospective review from July 1, 2018, to June 30, 2019, of Rapid Antigen Detection Tests (RADTs) on patients with ICD codes associated with pharyngitis. Fifteen hundred patient charts were reviewed. The majority of MCC scores were < 3 at 60.0% (878/1464). Sensitivity of GAS testing (RADT/culture) slightly increased for MCC scores ≥ 3 and was better than the specificity of those scores. In comparison, MCC scores < 3, showed better specificity compared to sensitivity. Over 50% of RADTs performed were inappropriate per clinical guidelines. MCC score < 3 had higher rates of negative test results. [ABSTRACT FROM AUTHOR]

Background: Meningococcal meningitis is still a severe disease causing high mortality and morbidity rates. Early diagnosis is crucial to ensure prompt antibiotic therapy. However, identification of the pathogen can be challenging. Case presentation: A 32-year-old male patient with systemic lupus erythematosus (SLE) presented to the emergency room with fever, nausea, vomiting, headache and lower back pain as well as multiple petechial bleedings. On suspicion of meningococcal infection, the emergency doctor had already administered one dose of ceftriaxone before arrival to the clinic. Blood works showed massive inflammation due to bacterial infection. Cerebrospinal fluid (CSF) analysis showed normal cell count, protein and glucose levels but PCR was positive for Neisseria meningitis and IL-6 as well as IL-8 were elevated. On antibiotic therapy with ceftriaxone, the patient's condition improved quickly. Conclusions: We present a rare case of meningococcal infection of the CSF in a SLE patient without further CSF abnormalities. We discuss the involvement of early antibiotic treatment and the role of the patient's immune status in the normal CSF findings of this case. Moreover, this case demonstrates the importance of early antibiotic therapy in bacterial meningitis for the clinical outcome. [ABSTRACT FROM AUTHOR]

A 3-year-old boy initially presented with purpura-like rashes and nephrotic syndrome, suspected to be IgA vasculitis nephritis (IgAVN). The suggestion of kidney biopsy was rejected. Although the patient responded well to glucocorticoids, they later developed recurrent proteinuria, refractory diarrhea, and subsequent metabolic acidosis. Kidney biopsy showed membranous nephropathy with positive semaphorin 3B expression, indicative of other kidney diseases rather than IgAVN. Although his kidney responded well to glucocorticoid combined with cyclosporine A treatment regimen, enteropathy and severe food allergy still progressed afterwards as evidenced by villous atrophy on gastrointestinal endoscopy examination. Whole exome sequencing identified a heterozygous missense variant in exon 11 of FOXP3: c.1121 T > G, confirming the diagnosis of immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome. The case expanded the phenotypic spectrum of IPEX syndrome, suggesting high phenotypic heterogeneity despite similar genotypes. It also put emphasis on the significance of kidney biopsy to differentiate IgA vasculitis nephropathy from other immune disorders. [ABSTRACT FROM AUTHOR]

Gardner-Diamond syndrome (GDS) is a condition characterized by the appearance of unexplained ecchymosis on the skin. Other common symptoms include gastrointestinal complaints, such as abdominal pain and vomiting, as well as complaints about the nervous and musculocutaneous systems. We typically diagnose GDS by ruling out other potential causes, as the exact cause remains unknown. Middle-aged women mostly suffer from this disease, which is believed to have a strong psychological component in its cause. Despite the limited number of documented cases of GDS globally, our goal is to showcase four confirmed cases of the disease. [ABSTRACT FROM AUTHOR]

Background: There is limited information on the natural course of chronic ITP in children. We aimed to evaluate the clinical and demographic characteristics of children with chronic ITP in the era before the availability of eltrombopag. Methods: A total of 86 children with chronic ITP between 1978–2014 were included. Demographic findings, laboratory results, clinical signs, bleeding scores, response time and time of complete remission were recorded. Results: The male/female ratio was 1.09, and median follow-up time was 3 years (range: 1.5–17 years). The median age at diagnosis of chronic ITP was 7 years (range: 2–17), and the median initial platelet count was 10 × 109/L (range: 1–66 × 109/L). Petechiae/ecchymoses were the most common clinical sign (86%) and followed by mucosal bleeding (39.5%). Severe bleeding was seen in 5% of the patients. None of them had intracranial hemorrhage. Twenty patients underwent splenectomy, and the rate of complete remission was 70%. Spontaneous complete remission was seen in 29% of the patients, and the median time to spontaneous complete remission was 3 years. Conclusions: Our study showed that almost one-third of patients with chronic ITP experienced spontaneous complete remission in an average of 3 years, and splenectomy provided satisfactory results in severe cases. This study demonstrates the natural history of chronic ITP in childhood before the era of eltrombopag. [ABSTRACT FROM AUTHOR]

Acute generalized exanthematous pustulosis (AGEP) is a sudden-onset, severe and rare adverse skin reaction characterized by nonfollicular sterile pustules tending to intertriginous localization. Lesions develop on erythematous and edematous skin. It is often triggered by drugs. This article presents a case diagnosed with AGEP due to etodolac. To the best of our knowledge, this is the second case of AGEP due to etodolac in the literature. A 47-year-old female patient presented with diffuse erythema on the extremities, a purple purpuric rash on the extensor face of both legs, and millimetric pustules on an erythematous base on the inner surface of the left arm. She stated that the reaction developed after taking 3 medications, including etodolac tablets, and gargling the throat with povidone-iodine. The patient was diagnosed with AGEP and her EuroSCAR AGEP Validation Score was calculated as 9 suggesting a definitive diagnosis of AGEP. All of the suspected drugs were discontinued. Methylprednisolone 16 mg/day, a local corticosteroid, and an oral antihistamine were started. Her symptoms resolved and laboratory abnormalities returned to normal within 2 weeks. Patch tests were performed 3 months after the reaction with the suspected drugs. The patch testing showed that only 10% etodolac at 48-, 72- and 96-hour readings were positive (++). The patient was diagnosed with AGEP due to etodolac. AGEP is often secondary reaction to drugs. The most frequent causative drugs are diltiazem, aminopenicillins, pristinamycin, terbinafine, sulphonamides, quinolones, and hydroxychloroquine. AGEP secondary to NSAIDs is very rare. Only one previous case of AGEP due to etodolac was reported in 2011. [ABSTRACT FROM AUTHOR]

Older Australians are at increased risk of skin tears with the risk not always recognised or the injury able to be prevented. This study externally validated Rayner et al. (2019) Skin Tear Risk Prediction Model in an independent aged cohort with a Fitzpatrick skin types I–IV from across multiple residential‐care sites, over a 6‐month period. A total of 362 individuals aged between 65 and 102.5 years completed the study. In all, 165‐residents sustained one or more skin tears. Logistic regression analysis was conducted of the five variables (gender, previous history of skin tears, previous history of falls, purpura and solar elastosis) identified in the skin tear model. The skin tear model provided 'good' to nearly 'very good discrimination' for correctly classifying residents at‐risk or not‐at‐risk (area under the curve of 0.799 [95% confidence interval, CI: 0.75–0.84]). The skin tear model correctly predicted 75.8% (sensitivity) of participants with skin tears and 71.6% (specificity) of residents without skin tears. The model demonstrated it could work as a screening tool to identify older individuals at risk of skin tears and would benefit clinical practice as it was easy to use, was reproducible, and had good accuracy across aged‐care residents with a Fitzpatrick skin type I–IV. [ABSTRACT FROM AUTHOR]

Ceftazidime/avibactam (CAZ/AVI) is a combination of a well‐known third‐generation, broad‐spectrum cephalosporin with a new beta‐lactamase inhibitor that has been approved for the treatment of various infectious diseases (especially multidrug‐resistant Gram‐negative bacterial infections) by the Food and Drug Administration (FDA). The current study extensively assessed CAZ/AVI‐related adverse events (AEs) in the real world through data mining of the FDA Adverse Event Reporting System (FAERS) database to better understand toxicities. The signals of CAZ/AVI‐related AEs were quantified using disproportionality analyses, including the reporting odds ratio, the proportional reporting ratio, the Bayesian confidence propagation neural network, and the multi‐item gamma Poisson shrinker algorithms. Out of 10,114,815 records retrieved from the FAERS database, 628 cases were identified, where CAZ/AVI was implicated as the primary suspect drug. A total of 61 preferred terms with significant disproportionality that simultaneously met the criteria of all four algorithms were retained. Several unexpected safety signals may also occur, including melena, hypernatremia, depressed level of consciousness, brain edema, petechiae, delirium, and shock hemorrhagic. The median onset time for AEs associated with CAZ/AVI was 4 days, with most cases occurring within 3 days after CAZ/AVI initiation. [ABSTRACT FROM AUTHOR]

The article focuses on recognizing kaposiform hemangioendothelioma (KHE) as a potential cause of a growing purpuric lesion in children, understanding the workup and management of KHE, and recognizing Kasabach-Merritt phenomenon as a lethal coagulopathy associated with rare vascular tumors, such as KHEs. It presents a case report of a 4-week-old infant with a rapidly enlarging purpuric lesion on the left leg, providing details of the clinical presentation, and physical examination findings.

Vitamin C deficiency, otherwise known as scurvy, is one the oldest known diseases. Although its prevalence has substantially diminished, certain populations such as smokers, alcoholics, elderly, and those with malabsorptive syndromes remain at risk. Deficiency presents with perifollicular hemorrhage, corkscrew hairs, and petechiae that can evolve into ecchymoses and purpura. Diagnosis starts with clinical suspicion and is confirmed with plasma and leukocyte ascorbic acid levels. Early suspicion is key. Treatment with vitamin C offers an excellent prognosis and avoids unnecessary workup for differential diagnoses. In our case, a 45-year-old male alcoholic with progressively worsening symptoms was found to have scurvy. Treatment was initiated with vitamin C supplementation, and he had remarkable improvement in his symptoms within weeks. This case demonstrates that scurvy is not a disease of history and must be considered in modern medicine, especially as homelessness with concomitant poor nutrition continues to increase. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 6-year-old child diagnosed with scurvy, evidenced by oral manifestations such as gingival overgrowth and palatal ecchymosis. Topics discussed include the patient's medical history, the role of vitamin C deficiency in the condition, and the effective treatment regimen involving vitamin C supplementation that led to a significant improvement in the child's symptoms.

In this series of articles on comments and illustrations of the World Federation for Medicine and Biology (WFUMB) guidelines on contrast-enhanced ultrasound (CEUS), the topics on very rare focal liver lesions (FLL) are discussed. This article describes the diverse changes of focal liver lesions in peliosis hepatis and the typical changes in porphyria. Although the focus is on the appearance on ultrasound and CEUS, the clinical context is always considered. While peliosis may be a surprising finding on puncture, lesions in porphyria cutanea tarda may be typical visual diagnoses that obviate the need for biopsy. If only you knew. This article aims to sharpen the clinician’s eye. It provides knowledge of the clinical presentation and US and CEUS imaging of peliosis hepatis and porphyria. [ABSTRACT FROM AUTHOR]

Advanced clinical practitioners (ACPs) encounter patients with acute dermatological presentations ranging from minor to life-threatening conditions in both primary and secondary care settings. However, ACPs often feel unprepared to assess and treat patients with dermatological emergencies. This article aims to provide guidance to trainee and qualified ACPs, whether in acute hospital settings or primary care, in understanding the essential aspects to consider when consulting with patients presenting with acute dermatological emergencies. It also emphasises appropriate referrals to relevant specialties for necessary inpatient or outpatient investigations and ensure prompt treatment. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciencias de la Salud is the property of Colegio Mayor de Nuestra Senora del Rosario and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of General Health Sciences (JGEHES) is the property of Journal of General Health Sciences (JGEHES) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

RhD alloimmunization from platelet transfusions have been documented in the literature. However, non-RhD platelet alloimmunization is much less frequent and the risk for non-RhD alloimmunization from platelets is thought to be extremely low and most associated with buffy coat pooled platelets. A 22-month-old male with acute myeloid leukemia received 99 mL apheresis platelets for thrombocytopenia. Three months later, an antibody screen, the direct antiglobulin test (DAT), and red blood cell (RBC) genotype were sent for laboratory evaluation. The antibody screen was positive, with anti-E identified. The DAT was negative and the RBC genotype of the patient was predicted to be negative for the E antigen whereas the platelet donor was predicted to be positive for E antigen. There is a risk of alloimmunization of non-RhD antigen from platelet pheresis transfusion even in a patient less than 2 years old. [ABSTRACT FROM AUTHOR]

Leptospirosis is a reemerging zooanthroponosis with a worldwide distribution, though it has a higher incidence in areas with tropical climate. A characteristic finding of the disease is its wide spectrum of symptoms and organ involvement, as it can appear either with very mild flu-like manifestations or with multiorgan failure, affecting the central nervous system (CNS) with a concomitant hepatorenal dysfunction (Weil's syndrome) and significant high mortality rate. We report herein a fatal case of a 25 years old female, previously healthy, with impaired neurological status. She had high fever and severe multiorgan failure. The clinical data and the epidemiological factors were not conclusive for the diagnosis, and the first serology test from the cerebrospinal fluid (CSF) and sera samples were negative. When the repetition of the blood test showed elevated IgM antibodies, Leptospirosis was the presumptive diagnosis. Although CNS involvement is rare, the diagnosis should be considered when there is an elevated risk of exposure. The diagnostic protocol should encompass direct evidence of the bacterium and indirect measurement of antibodies. Timely detection and management are imperative to forestall complications and fatality associated with the disease. [ABSTRACT FROM AUTHOR]

In September 2023, the European Society of Cardiology (ESC) published new guidelines for the management of endocarditis. Infective endocarditis (IE) remains a significant life-threatening disease, concerning an increasingly younger age group, especially children with congenital heart disease (CHD) and young adults after multiple cardiac surgeries. This study's aim was to alert the medical community to the problem of increasing IE case numbers and IE course complexity. Of the eight patients who suffered from IE treated in 2023 in our department, we describe the four whose course was the most extraordinary. Afterward, we compared the number of IE patients treated over the years in our department. All cases described children with congenital heart disease suffering from IE. The IE clinical presentation in all patients was extremely diverse, necessitating the utilization of all available diagnostic methods. Each child underwent specialized treatment and subsequently qualified for cardiac surgery. While the etiology and treatment of IE are well established, it remains a formidable challenge for physicians. Pediatric patients who have undergone multiple cardiac surgeries constitute a steadily expanding group and are especially susceptible to IE throughout their lives. Currently, no recommendations exist for the management of endocarditis in pediatric patients. This gap compels pediatricians to adapt existing guidelines designed for adult patients and to rely on scientific reports, such as case studies. [ABSTRACT FROM AUTHOR]

Background: In South Korea, COVID-19 vaccination has been recommended to adolescents aged 12 − 17 since October, 2021. We aimed to assess the rate of adverse events following COVID-19 vaccination in adolescents with chronic kidney disease (CKD) in South Korea, using national cohort data. Methods: We retrieved the clinical information of adolescents 12 − 17 years old from the Korea Disease Control and Prevention Agency-COVID19-National Health Insurance Service (K-COV-N) database, to calculate incidence rates of purpura and other hemorrhagic conditions, Guillain-Barré syndrome (GBS), Kawasaki disease/multisystem inflammatory syndrome in children (MIS-C), myocarditis and/or pericarditis, and anaphylaxis in adolescents with CKD, after BNT162b2 vaccination. Results: Among the 2306 adolescents with CKD, 62.7% (n = 1446) had received the BNT-162b2 vaccine. GBS, Kawasaki disease/MIS-C, and anaphylaxis or anaphylactic shock did not occur during the observation period. Purpura and hemorrhagic conditions were more frequent in the unvaccinated group (7/860 vs. 1/1446), while myocarditis/pericarditis was observed only in the vaccinated group (0/860 vs. 1/1446). Adjusted odds ratio for any of the two adverse events was lower in vaccinated adolescents than in the unvaccinated group which did not reach statistical significance (adjusted odds ratio = 0.14, 95% confidence interval: 0.02, 1.16, P = 0.068). Conclusions: In this national cohort study of adolescents with CKD in South Korea, we observed no evidence of increased risk of adverse events following BNT162b2 vaccination. Our finding offers insights into the safety of COVID-19 vaccines, empowering adolescent patients with CKD and their caregivers to make informed decisions. [ABSTRACT FROM AUTHOR]

Peliosis hepatis (PH) and sclerosing angiomatoid nodular transformation of the spleen are uncommon benign lesions. Diagnosis can be difficult in some patients. Herein, we present the case of a 28-year-old woman referred with abdominal pain who had spleen lesions. 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography revealed multiple non-FDG avid lesions in the liver and hypermetabolic lesions in the spleen. In addition, abdominal magnetic resonance imaging was performed. Histopathology revealed sclerosing angiomatoid nodular transformation in the spleen and PH in the liver. [ABSTRACT FROM AUTHOR]

Background: In this study, it was aimed to evaluate the demographic characteristics and etiologic causes of patients admitted to our Pediatric Emergency Clinic with a history of bleeding. Materials and Methods: The files of 331 patients admitted to the emergency outpatient clinic of Dicle University Children's Hospital between January 2010 and December 2012 with a history of bleeding were retrospectively analyzed. Age, presenting complaints, examination findings, gender, time of presentation, season of presentation and etiology of bleeding were recorded. Results: The patient group in the study consisted of a total of 331 patients, of whom 133 were female and 198 were male. The age range of the patients in the study was between 1-92 months. Patients applied to the pediatric emergency outpatient clinic were most frequently applied due to nasal and oral bleeding, and least frequently because of infectious thrombocytopenia. Other etiologic causes were immune thrombocytopenic purpura, gastrointestinal bleeding, factor deficiency, Henoch Schonlein Purpura and Glanzmann thrombasthenia. There was a statistical significance between the etiology of bleeding and gender (p<0,05), and it was observed that it was more common in boys than girls. Considering the examination findings, bleeding (mouth, nose) was found in 40.8% of the patients, and ecchymosis was found in 20.8% of the patients. In addition, the most common etiologic cause was immune thrombocytopenic purpura in patients presenting with petechiae and ecchymosis, Henoch Schonlein purpura in patients presenting with purpura, factor deficiency in patients presenting with hemarthrosis and hematoma, and gastrointestinal system bleeding in patients presenting with pallor. A statistical significance was found between the examination findings and the bleeding etiology. It was determined that the month and/or season had a significant effect on the diseases, especially in patients diagnosed with infectious thrombocytopenia, Glanzmann's thrombasthenia, and Henoch Schonlein purpura. Conclusions: It is important to determine the demographic characteristics and etiologies of patients presenting to the Pediatric Emergency Outpatient Clinic with a history of bleeding in order to determine the clinical conditions requiring urgent examination and treatment, and to reach the correct diagnosis quickly. As a result, early recognition of risky patients and treatment planning may be guiding in reducing both morbidity and mortality. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciencias de la Salud is the property of Colegio Mayor de Nuestra Senora del Rosario and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pigmented purpuric dermatosis (PPD) comprises a group of skin conditions characterized by flat, nonpalpable petechiae and purpura as a result of capillaritis. Although the precise cause of PPD is as yet unknown, increased vascular permeability and capillary fragility are key factors in its pathophysiology. PPD has diverse clinical presentations, but the histopathology of all these variants essentially remains the same. The initial purpuric lesions develop a golden-brown hue owing to hemosiderin absorption and eventually progress to chronic pigmentary changes. These lesions, which often affect the lower limbs, are either asymptomatic or accompanied by moderate pruritus, and can be difficult to diagnose and treat. There are several subtypes of clinical presentations that have been documented over the years. In order to accurately diagnose PPD, a thorough clinical evaluation and, occasionally, a biopsy may be required. It is essential to identify the condition and reassure patients of its benign nature. Treatment is usually necessary due to the chronic nature of the condition, its consequences on physical and mental well-being, and the presence of significant lesions or itching. In this review, we outline the various prevalent PPDs and discuss their etiopathogenesis, clinical features, and diagnostic and treatment modalities. [ABSTRACT FROM AUTHOR]

Summary: We report the case of a woman who developed post‐transfusion purpura following complicated cardiac surgery requiring multiple blood product transfusions and extracorporeal life support. This case highlights the challenges of managing thrombocytopenia in patients supported with prolonged mechanical cardiovascular and renal support with ongoing blood product transfusion requirements. The differential diagnoses are broad, varied and may overlap. Whilst post‐transfusion purpura is very rare, clinical signs may prompt consideration and further specific diagnostic testing. Once confirmed, management is then specific, with some aspects which are at direct variance with standard intensive care and extracorporeal life support guidelines for the management of non‐specific thrombocytopenia. Consideration of the diagnosis of post‐transfusion purpura early in the clinical course could help anticipate and prevent a vicious cycle of bleeding, transfusion and autoimmune‐mediated platelet disruption, and may improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to determine whether there is a relationship between the age at diagnosis and the clinical, laboratory, and prognostic features in pediatric immunoglobulin A vasculitis (IgAV) patients. Patients and methods: In this study, 539 pediatric IgAV patients (298 males, 241 females; mean age: 7.74±3.36 years; range, 1 to 17.8 years) were retrospectively evaluated between January 2005 and July 2020. The relationship between clinical findings and age at diagnosis was analyzed by univariate logistic regression analysis. Factors associated with renal involvement, steroid-dependent or refractory disease, and recurrence were examined. Results: The median age of diagnosis was 7.1 (1-17.8) years in all patients. At the time of admission, purpura, abdominal pain, and arthritis were the most common clinical findings. At the time of diagnosis, there was a positive association between age and purpura and an inverse association with the presence of arthritis. There were associations between renal involvement and age at diagnosis (odds ratio=1.22, 95% confidence interval 1.13-1.31, p<0.001), follow-up time (p<0.001), no history of previous infection (p<0.001), and presence of gastrointestinal (GI) involvement (p=0.003). Significant relationships were found between the age at diagnosis, follow-up time, GI involvement, renal involvement, scrotal involvement, the C-reactive protein value at the time of diagnosis, and the presence of steroid-dependent disease. An association was found between recurrence and GI involvement. All refractory patients had renal involvement. Age at diagnosis (p<0.001) and follow-up time (p<0.001) was found to be associated with refractory disease. Conclusion: Age at diagnosis and follow-up time may be associated with renal involvement and refractory and steroid-dependent disease in IgAV. In addition, there may be a relationship between steroid-dependent disease and renal, GI, and scrotal involvement and between GI involvement and recurrence. [ABSTRACT FROM AUTHOR]

Background: Oxaliplatin-based regimens are commonly used as adjuvant chemotherapy following surgery for colorectal cancer. Adverse events associated with oxaliplatin include blue liver, which is caused by sinusoidal dilation and diffuse peliosis hepatis. We report herein a case of localized peliosis hepatis closely resembling a metastatic liver tumor. Case presentation: The patient, a 50-year-old male, underwent a robotically assisted colectomy for rectosigmoid colon cancer, which was discovered when hematochezia occurred. The patient received a diagnosis of pStage IIIb and was treated with four courses of CAPOX as adjuvant chemotherapy starting at postoperative month 1. At postoperative month 4, contrast-enhanced computed tomography (CT) of the abdomen revealed a 20-mm, low-density area with heterogeneous internal structure in S6/7 of the liver. Abdominal ultrasound and gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) findings led to a diagnosis of metastatic liver tumor, for which a laparoscopic partial hepatectomy was performed. The resected lesion was a dark reddish-brown nodule with indistinct margins that appeared to be continuous with the surrounding area. Histopathological analysis revealed severe, localized dilatation of the sinusoids and congestion consistent with the gross nodule. Based on these findings, localized peliosis hepatis associated with oxaliplatin-induced sinusoidal damage was diagnosed. Conclusions: Localized peliosis hepatis associated with oxaliplatin use can be difficult to distinguish from a metastatic liver tumor on imaging studies. [ABSTRACT FROM AUTHOR]

Background: Peliosis hepatis (PH) is a rare benign condition, characterized by hepatic sinusoidal dilatation and blood‐filled cystic cavities, often found incidentally, with still challenging diagnosis by imaging due to polymorphic appearance. Purpose: Based on a retrospective analysis of our series (12 patients) and systematic literature review (1990–2022), to organize data about PH and identify features to improve characterization. Study Type: Retrospective case series and systematic review. Population: Twelve patients (mean age 48 years, 55% female) with pathology‐proven PH and 49 patients (mean age 52 years, 67% female) identified in 33 studies from the literature (1990–2022). Field Strength/Sequence: 1,5‐T; T1‐weighted (T1W), T2‐weighted (T2W), diffusion‐weighted (DW), contrast‐enhanced (CE) T1W imaging. Assessment: We compared our series and literature data in terms of demographic (gender/age/ethnicity), clinical characteristics (symptoms/physical examination/liver test), associated conditions (malignancies/infectious/hematologic/genetic or chronic disorders/drugs or toxic exposure) percentage. On magnetic resonance imaging lesion numbers/shape/mean maximum diameter/location/mass effect/signal intensity were compared. PH pathological type/proposed imaging diagnosis/patient follow‐up were also considered. Statistical Tests: Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports/Series quality assessment. Intraclass correlation and Cohen's kappa coefficients for levels of inter/intrareader agreement in our experience. Results: Patients were mainly asymptomatic (92% vs. 70% in our study and literature) with associated conditions (83% vs. 80%). Lesions showed homogeneous T1W‐hypointensity (58% vs. 65%) and T2W‐hyperintensity (58% vs. 66%). Heterogeneous nonspecific (25% vs. 51%), centrifugal (34% vs. 8%), or rim‐like centripetal (25% vs. 23%) patterns of enhancement were most frequent, with hypointensity on the hepatobiliary phase (HBP), without restricted diffusivity. Good inter‐ and intrareader agreement was observed in our experience. Concerning JBI Checklist, 19 out of 31 case reports met at least 7 out of 8 criteria, whereas 2 case series fulfilled 5 and 6 out of 10 items respectively. Data Conclusion: A homogeneous, not well‐demarcated T1W‐hypointense and T2W‐hyperintense mass, with heterogeneous nonspecific or rim‐like centripetal or centrifugal pattern of enhancement, and hypointensity on HBP, may be helpful for PH diagnosis. Among associated conditions, malignancies and drug exposures were the most frequent. Level of Evidence: 4 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Vasculitis is a multisystemic disease that affects vessels of different sizes. Its presentation can vary widely depending on the system involved. It may present with constitutional symptoms or with specific features of end‐organ involvement. The diagnosis is built on a compatible pattern of clinical features supported by specific serological or radiological investigations and confirmatory biopsy. Tissue biopsy is vital to confirm the diagnosis of vasculitis; however, this should not delay treatment when presentation strongly suggests vasculitis. We describe a case of a 72‐year‐old man treated with steroids, plasma exchange, and rituximab for suspected granulomatosis with polyangiitis (GPA) given his clinical presentation including suspected scleritis of the right eye, hearing changes, sinusitis, diffuse alveolar hemorrhage, pulmonary lesions, kidney failure, palpable purpura, and radiological evidence of pansinusitis and pulmonary lesions without waiting for serology or tissue confirmation. This case highlights the importance of recognizing the clinical features of GPA to initiate prompt treatment as it can progress rapidly and be fatal. [ABSTRACT FROM AUTHOR]

Background: Primary Sjögren syndrome (PSS) is a chronic, autoimmune, and lymphoproliferative disease of the connective tissue. In patients with PSS, the risk of developing B-cell non-Hodgkin lymphoma (NHL) increases dramatically, with a prevalence of approximately 5%. The 14-3-3 protein isoforms are phospho-serin/phospho-threonine binding proteins associated with many malignant diseases. This study aimed to evaluate the relationship between disease activity parameters and markers predicting lymphoma development in patients with PSS and 14-3-3η proteins. Methods: This study was designed as an analytical case-control study. A total of 57 PSS patients and 54 healthy volunteers were included in the study. The European League Against Rheumatism (EULAR) Sjögren syndrome disease activity index (ESSDAI) was used to assess systemic disease activity in PSS. Receiver operating characteristic (ROC) analysis was used to test the diagnostic accuracy measures of the analytical results. Multivariable linear regression analysis was used to evaluate the effects of independent variables on the 14-3-3η protein. Results: The 14-3-3η protein serum levels were found to be significantly higher in PSS (2.72 [2.04-4.07]) than healthy controls (1.73 [1.41-2.43]) (P < 0.0001). A significant relationship was found between 14-3-3η protein levels and ESSDAI group (β = 0.385, 95%CI = 0.318-1.651, P = 0.005), hypocomplementemia (C3 or C4) (β = 0.223, 95% CI = 0.09-1.983, P = 0.048) and purpura (β = 0.252, 95% CI = 0.335-4.903, P = 0.022), which are accepted as lymphoma predictors. A significant correlation was found between PSS disease activity score ESSDAI and 14-33η protein (β = 0.496, 95% CI = 0.079-0.244, P = 0.0002). Conclusion: 14-3-3η proteins are potential candidates for diagnostic marker, marker of disease activity, and predictor of lymphoma in PSS patients. [ABSTRACT FROM AUTHOR]

The article describes the case of Raynaud's phenomenon (RP), digital ischaemia, and paradoxical arthritis as a result of ixekizumab treatment and discusses the potential pathogenesis of these suspected adverse events. Topics include her symptoms that developed after taking ixekizumab, reason for prescribing anticoagulation with low-molecular weight heparin, and proposed hypothesis to explain the underlying mechanisms of paradoxical reactions like arthritis and psoriasis.

Background: Human immunodeficiency virus (HIV) has a protean clinical picture, in rare instances manifesting as systemic autoimmune disorders such as vasculitides. HIV-induced autoimmune diseases often do not respond well to systemic immunosuppressive therapy. Opportunistic infections may occur in patients with either acquired immunodeficiency syndrome (AIDS) or heavy immunosuppressive treatment, and can further complicate the clinical presentation. Case presentation: A patient presenting with immunoglobulin A (IgA) vasculitis (IgAV) with treatment-refractory purpuric skin rash and suspect intestinal vasculitis was discovered to have AIDS. HIV was the trigger of IgAV, and cytomegalovirus (CMV) colitis mimicked intestinal vasculitis. Antiretroviral treatment improved both CMV colitis and the control of the autoimmune disease. Conclusions: An autoimmune disease relapsing despite adequate immunosuppressive treatment and/or the presence of recurrent severe opportunistic infections may be clues to an underlying HIV infection. [ABSTRACT FROM AUTHOR]

Psychogenic purpura is a rare but interesting psychosomatic condition where there are transient dermatohematological manifestations in response to antecedent psychological disturbances most commonly depression, whose pathophysiology is still an enigma. The objective of this case series is finding out the missing link between antecedent psychological disturbances and resultant purpura through psychoimmunologic exploration. In all four cases, patients were female, aged between third–fifth decade with depression being the common diagnosis, where transient painful bruising appeared only during antecedent stressful conditions. Immune-cytokine work-up in all the patients showed type 1/type 2 cytokine shift during bruises. With psychiatric treatment, there was not only improvement in depression and bruises, cytokine alterations were also normalized. Rise in pro-inflammatory cytokines with type 1/type 2 shift during stresses may cause these bruises by increasing the vascular permeability. [ABSTRACT FROM AUTHOR]

Background: Peliosis is a rare condition with anatomopathological characteristics that affect the liver. However, splenic peliosis is even more unique and rare. Patients with such abnormality usually exhibit no symptoms. Moreover, this is a lethal condition due to the high probability of splenic rupture accompanied by shock. Case presentation: We present a case of a 29-year-old Arab female who was admitted to the hospital with severe upper abdominal pain that started 1 week from the date of admission, associated with nausea, anorexia, low-grade fever, and vomiting, with no past medical history or comorbidities. A computerized tomography scan with contrast showed intraperitoneal free fluid along with multiple hypodense splenic cysts. Hence, an emergent exploratory laparotomy with splenectomy was performed. Splenic peliosis was confirmed by the histopathological examination. Conclusion: Further investigations are warranted if peliosis is confirmed in one organ, for example, the liver, to detect its presence in any other potential organs that can be affected by peliosis. Splenic peliosis is extraordinarily rare. Furthermore, such a disease has no established management plan. Definitive treatment is surgical. Many aspects of splenic peliosis remain puzzling requiring more research in the near future. [ABSTRACT FROM AUTHOR]

Introduction: Psychogenic purpura, also known as autoerythrocyte sensitization syndrome, is a rare condition which is characterized by spontaneous development of painful purpura, or ecchymoses. Skin lesions are usually preceded by stress and emotional trauma. It is usually a diagnosis of exclusion after ruling out history of trauma, drug intake and other bleeding disorders. Autoerythrocyte sensitization test (AEST) and a psychiatric evaluation helps in the diagnosis and treatment. Objective: To demonstrate the importance of AEST in diagnosing the patient of Gardner Diamond syndrome. Materials and Methods: Five suspected cases of autoerythrocyte sensitization syndrome underwent AEST after ruling out other causes of bleeding. Results: Four out of five patients were positive for AEST while one patient was negative. Psychiatric complaints were present in three patients. One patient was lost to follow up. Rest all patients responded well to vitamin C supplementation. Conclusion: Autoerythrocyte sensitization syndrome is a rare disorder and is a diagnosis of exclusion, so a thorough workup of the patient to rule out common causes of bruising is essential. A high index of suspicion on the clinician's part and a simple OPD-based AEST may help in the diagnosis. Psychiatric consultation is important to find out the stress factor and timely management. [ABSTRACT FROM AUTHOR]

Various clinical manifestations of SARS-CoV-2 infections and adverse reactions to COVID-19 vaccination have been described in children. The present narrative review aimed to collect and synthesize reported findings on oral lesions detected in SARS-CoV-2-positive subjects following COVID-19 EMA-authorized and WHO Emergency Use Listing-approved vaccine administration in the pediatric population to detail their clinical features and highlight possible pathogenic aspects of those lesions based on current evidence. Few and incomplete reports were retrieved from the literature, probably because most lesions belonged to a broad spectrum of systemic diseases and syndromes and were nonspecific or inaccurately described. The most common oral lesions in pediatric SARS-CoV-2-positive patients were erosive–ulcerative lesions and macules/petechiae, primarily erythematous. In the context of COVID-19 vaccination, oral adverse reactions were rare and typically presented as erosive–ulcerative lesions, with EM-like or unspecified patterns. Future studies should investigate oral lesions in SARS-CoV-2-positive subjects and after COVID-19 vaccination in the pediatric population, taking into account viral variants and newly developed vaccines. Deeper insight into oral lesions detectable in pediatric SARS-CoV-2-positive subjects and after COVID-19 vaccination may increase clinicians' ability to improve multidisciplinary pediatric oral and general care. [ABSTRACT FROM AUTHOR]

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A 23-month-old healthy boy presented to the emergency department with a purpuric rash, fever and edema of the extremities. There were no recent vaccinations or drug intake. The skin showed round purpuric lesions dispersed. Complete blood count, inflammatory markers, plasma creatinine and urea levels, coagulation tests and urinalysis were normal. Different differential diagnoses can be listed and different approaches should be considered depending on the diagnosis. Some of these require urgent medical attention and may be life-threatening. This case reports a typical presentation of acute hemorrhagic edema in infancy, with very peculiar and detailed images of the skin that also show edema of the extremities. This case report aimed to explore this worrisome rash that has a benign course to alert pediatricians with different purpura diagnoses. The authors believe that the images presented are unique and might increase knowledge about the variety of cutaneous presentations of this under-recognized disease. [ABSTRACT FROM AUTHOR]

Purpura fulminans is a rare, albeit a life-threatening emergency which has been reportedly triggered by infections, congenital disorders of protein C or S deficiencies, as well as drugs. Here we report a case of a previously healthy 17 year old male who developed purpura fulminans after fever, sore throat and then getting injection diclofenac. Blood cultures grew Staph. aureus. This case is the first to report two causative etiologies in a single patient. [ABSTRACT FROM AUTHOR]