Skin manifestations of Bartonella infections.

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Gallbladder adenocarcinoma presenting as Trousseau syndrome and Virchow-Troisie’s node

Mujer de 52 años que presentó dolor y aumento de volumen en el miembro inferior derecho, adenopatía supraclavicular izquierda y anemia microcítica e hipocrómica. Se descartó pérdidas gastrointestinales por endoscopias digestivas alta y baja normales. Se realizó una tomografía de abdomen que mostró irregularidad a nivel de la vesícula biliar, cuya biopsia resultó en un adenocarcinoma. Se concluye que se trató de una paciente con una neoplasia maligna de vesícula biliar que se presentó como síndrome de Trousseau y ganglio de Virchow-Troisier.A 52-year-old female patient who presented pain and swelling in the right lower limb, a left-sided supraclavicular lymph node and microcytic hypochromic anemia. It was ruled out gastrointestinal blood loss through normal upper and lower endoscopies. The abdominal tomography showed an irregular pattern in the gallbladder, whose biopsy resulted in adenocarcinoma. It is concluded that it was a patient with a malignant neoplasm of the gallbladder who presented as a Trousseaus’s syndrome and a Virchow-Troisier’s lymph node

Regulatory T cells and IgE expression in duodenal mucosa of Strongyloides stercoralis and human T lymphotropic virus type 1 co-infected patients.

BackgroundStrongyloides stercoralis is an intestinal nematode unique in its ability to replicate in the human host, allowing ongoing cycles of autoinfection, persisting for decades within the same host. Although usually asymptomatic, overwhelming infections can occur in Strongyloides and HTLV-1 co-infected individuals (SS/HTLV-1). Regulatory T cells (Tregs) are able to blunt specific Th2 responses necessary to control the parasite. We previously reported that peripheral blood Tregs are increased in SS/HTLV-1 and correlate with low Th2 responses. We hypothesized that Tregs are also increased at the site of infection in duodenal mucosa.MethodsParaffin embedded duodenal biopsies were obtained from 10 SS/HTLV-1 patients, 3 controls with non-parasitic chronic duodenitis, and 2 healthy controls. Immunohistochemistry was performed using monoclonal antibodies against human CD3, CD8, IgE and FoxP3. The number of cells were counted using a conventional light microscope. The number of CD3+, CD8+, FoxP3+ and IgE positive cells per 0.35 mm2 was measured using ImagePro Plus software comparing areas adjacent or distant from parasite material.ResultsIn patients with SS/HTLV-1, T lymphocyte counts and CD8+ cells were lower in areas adjacent to the parasite compared to non-adjacent areas (CD3+: adjacent: 6.5 [Interquartile range (IQR: 2.8-12.3)]; non-adjacent: 24.5 [IQR: 20.9-34.4]; Mann-Whitney p = 0.0003; CD8+: adjacent: 4.5 [IQR: 2.3-11.8]; non-adjacent: 21 [IQR: 15.3-42.9]; Mann-Whitney p = 0.0011). Tregs cells in the intestines (FoxP3+ expressing cells) were increased in patients with SS/HTLV-1 compared with patients with chronic duodenitis (SS/HTLV-1: 1.5 [IQR: 0.7-2.3]; duodenitis controls: 0 [range 0-0.7]; healthy controls: 0; Mann-Whitney p = 0.034). There was also a trend towards fewer eosinophils adjacent to the parasites. Among SS/HTLV-1 patients the number of IgE expressing cells was increased for in areas not adjacent to the parasite compared to non-adjacent areas (ANOVA, p = 0.001).ConclusionsOur data shows increased Treg cell numbers localized adjacent to the parasites in the duodenum SS/HTLV-1 patients. In addition, other T lymphocytes and IgE expressing cells were decreased adjacent to the parasites, suggesting an important role for Tregs in down-regulating local parasite effector responses

Skin manifestations of Bartonella infections

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