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Sang Nguyen Ngoc,1 Ha Nguyen Thai,1 Quang Vu Van,1 Lam Vu Tung,1 Rang Nguyen Ngoc,2 Hung Nguyen Van3 1Haiphong University of Medicine and Pharmacy, Hai Phong, Vietnam; 2An Giang Central General Hospital, An Giang, Vietnam; 3National Lung Hospital, Hanoi, VietnamCorrespondence: Sang Nguyen Ngoc Email nnsang@hpmu.edu.vnIntroduction: Spina Ventosa is a rare condition that is easy to misdiagnose as other diseases. We present a case of late-diagnosed Spina Ventosa, which had not only the osteoarticular tuberculosis symptoms but also some severe symptoms, including pleural effusion, ascites, and anemia. By intensive treatment, our patient recovered completely.Case Report: A 7-year-old boy was admitted with complaints of painless swelling of metacarpals, metatarsals, and phalanges of his hands and feet and a discharging sinus of the left toe. There was no family or past history of tuberculosis. His immunizations were up to date. General examination revealed that the child had pallor and was emaciated. No lymphadenopathy was detected. Investigations revealed hemoglobin: 74 g/l, and erythrocyte sedimentation rate (ESR) was 42 mm/hour. QuantiFERON-TB test was positive. The radiograph showed irregular swelling with sclerosis of the underlying bones. The right-hand x-ray showed cortical destruction, sclerosis, and cystic expansion or right second metacarpal. Chest x-ray indicated pleural effusion. Histopathological examination of specimen from the foot and lung and abdomen fluid confirmed tuberculosis. The child was treated with the first-line tuberculosis treatment regimen (Isoniazid, Rifampicin, Ethambutol, and Pyrazinamide) for two months, followed by Isoniazid, Rifampicin, and Pyrazinamide for a further four months. His lesions disappeared after six weeks of intensive treatment.Conclusion: A delay in diagnosis and treatment of tuberculosis can lead to systemic manifestations in multiple organs. Despite the delay in diagnosis, this child had a good outcome due to being treated promptly and adequately after the presentation.Keywords: spina ventosa, osteo-articular tuberculosis, children

CD47 on live cells actively engages signal-regulatory protein-α (SIRP-α) on phagocytes and delivers a negative signal that prevents their elimination. We evaluated the biological consequences of SIRP-α ligation on the dendritic cell (DC) response to maturation signals and the potential interplay with the IL-10/IL-10R inhibitory pathway. At first, CD47/SIRP-α allowed the generation of mature migratory DCs not producing IL-12, IFN-γ-inducible protein-10, and CCL19. Rather, they secreted neutrophils attracting chemokine CXCL5 and IL-1β, reflecting a partial block in functional DC maturation. Afterward, semimature DCs functionally regressed in an IL-10-independent fashion toward cells that retrieved the cardinal features of immature DCs: re-expression of CCR5, loss of DC-lysosome-associated membrane protein, high endocytosis, and impaired allostimulatory functions. The global gene expression profile of IL-10 and SIRP-α-ligated DC demonstrated two distinct molecular pathways. IL-10R and SIRP-α expression were reciprocally down-regulated by CD47 and IL-10, respectively. These results emphasize that the SIRP-α pathway might be part of the molecular machinery used by the DC to dampen or resolve an inflammatory response in an IL-10-independent manner.

Les travaux antérieurs du laboratoire ont démontré le rôle du CD47 dans la fonction des cellules dendritiques ainsi que dans l’induction des lymphocytes T régulateurs (Tregs) chez l’humain in vitro. Notre premier objectif était de déterminer le rôle de CD47 sur la fonction des DCs in vivo. Nos travaux démontrent que le CD47 contrôle sélectivement la migration des DCs au travers des vaisseaux lymphatiques et des barrières cellulaires endothéliales in vivo sans interférer avec celle des lymphocytes T et B. Des expériences de migration compétitive et d’ immunisation active avec des DCs myéloïdes démontrent que la migration des DCs est dépendante de l’expression du CD47 sur les DCs et non sur les cellules endothéliales. Ce défaut de migration est corrélé avec l’absence de DCs spléniques dans la zone marginale chez nos souris CD47-/-. Notre second objectif était de déterminer le rôle de CD47 dans l’homéostasie et la fonction des Tregs. Nous démontrons que l’expression du CD47 contrôle sélectivement l’homéostasie d’une sous-population de Tregs CD103+ à l’état de base. La proportion de cellules activées/mémoires (CD44hi CD62Llo ) Foxp3+ CD103+ augmente rapidement au cours du vieillissement chez nos souris CD47-/- comparée aux souris CD47+/+ du même âge, tandis que le pourcentage de cellules (CD44loCD62Lhi) Foxp3+ CD103- reste comparable entre les deux souches de souris. En conclusion, le CD47 inhibe la prolifération excessive des Tregs CD103+ empêchant ainsi l’accumulation de ces cellules en absence d’inflammation. Les DCs et les Tregs sont étroitement régulées de manière reciproque. Cette régulation croisée contribue au maintien d’un équilibre entre l’immunité protectrice et la tolérance. La perspective de nos travaux est d’approfondir nos connaissances sur le rôle du CD47 et de ses ligands dans la régulation des DCs par les Tregs et vice et versa. Les DCs et les Tregs étant impliqués dans la pathogenèse de multiples maladies telles que le cancer, les maladies infectieuses et les maladies auto-immunes. Par conséquent, nos études pourraient ouvrir des portes à de nouvelles stratégies thérapeutiques., Previous work in the laboratory have demonstrated the role of CD47 in the function of dendritic cells and in the induction of regulatory T cells in humans. Here, we show that the ubiquitous self-marker CD47 selectively regulates DC, but not T and B cell trafficking across lymphatic vessels and endothelial barriers in vivo. Competitive DC migration assays and active immunization with myeloid DCs demonstrate that CD47 expression is required on DCs but not on the endothelium and not vice and versa for efficient DC trafficking and T-cell responses. This migratory defect correlates with the quasi-disappearance of splenic marginal zone DCs in non manipulated CD47-deficient mice. Our data reveal that CD47 on DCs is a critical factor in controlling migration and efficient initiation of the immune response. Mutual or reciprocal regulation exists between DCs and Tregs. For instance, DCs efficiently induce Tregs in vivo. We here examine how CD47 deficiency that selectively decrease myeloid DCs impact on Treg homeostasis. We here show that CD47 expression, selectively regulated CD103+Foxp3+ Treg homeostasis. The proportion of effector/memory-like (CD44highCD62Llow) CD103+ Foxp3+ Tregs rapidly augmented with age in CD47-deficient mice (CD47-/-) as compared with age-matched control littermates. Yet, the percentage of quiescent (CD44lowCD62Lhigh) CD103-Foxp3+ Tregs remained stable. Thus, sustained CD47 expression throughout life is critical to avoid an excessive expansion of CD103+ Tregs that may overwhelmingly inhibit Ag specific T cell responses. DCs and Tregs are closely regulated to maintain the balance between protective immunity and tolerance. When that balance is broken, several diseases such as cancer, infectious diseases and autoimmune diseases may develop. Our ultimate goal is to understand how CD47 regulates DCs and Tregs function. Manipulation of the two cells types may open to the door to unexplored therapeutic avenues.