Generalized erythematous scaly rash after glucocorticoids

A 65-years-old woman with a medical history of idiopathic throm- bocytopenic purpura and psoriasis in treatment with topical glucocor- ticoids presented with a three-month history of burning, generalized erythematous, scaly rash, and chills. A few weeks before the rash, the patient presented petechiae on her thighs due to a low platelet count (28.000 platelets per microliter), for which she started treatment with prednisone 25 mg/week. The rash was initially treated with topical ointments including clobetasol, urea, salicylic acid, ammonium lactate, and propylene glycol without improvement. The physical examination showed generalized erythroderma (Fig. 1A) from neck to feet (Fig. 1B), with thick silvery desquamation respecting the face and back of the legs (Fig. 1C), involving more than 90% of the patient’s body surface area and erythematous scaly plaques on the scalp. Laboratory test results were normal. A punch biopsy specimen obtained from an arm area showed increased keratinization at the level of the corneal layer with compact parakeratosis with abundant polymorphonuclear cells. The epidermis presented psoriasiform hyperplasia with significant spongio- sis. What is the diagnosis

Pneumatocele formation following COVID-19 pneumonia

A 61-year-old man with no significant medical history presented to the emergency department with worsening dyspnea a week after close con-tact with someonewhohad COVID-19. Hewas unvaccinated. He washypoxemic, and the chest radiograph showed bilateralopacities consistent withCOVID-19 pneumonia and tested positive for RNA from SARS-CoV-2. Blood tests showed raised inflammatory markers. Computed tomography (CT)of the chest demonstrated bilateralground-glass opacities. Thepatient washospitalized andtreated with high-flow nasaloxygentherapy, dexameth-asone, and sarilumab. His clinical status improved, and hewas discharged home after 1 week of hospitalization.Three weekslater, hepresented againwith worsening dyspnea, fever, and pleuritic chest pain. A CT pulmonary angiography ruled out pulmonary embolism (Fig. 1A, B) but demonstrated athin-walled cystic lesion with an air–fluid level (Fig. 1A, arrowheads) that suggested an infected pneumatocele. The patient was managed conserva-tively with amoxicillin/clavulanic acid for 3 weeks. During the follow-up, the patient reported the disappearance of symptomatology

LESIONES GÁSTRICAS, HEPÁTICAS Y RENALES EN EL SÍNDROME DE ÚLCERAS GÁSTRICAS EN EQUINOS PURA SANGRE DE CARRERA.

The aim of this study was to describe gastric, hepatic, and renal lesions inThoroughbred Racing horses associated to the equine gastric ulcer syndrome. Thirtyhorses with a history of gastric ulcer syndrome and recurrent colic during 2006 to 2007 atthe Race Track «La Rinconada», Caracas, Venezuela were evaluated. Horses were euthanized and the necropsy was conducted. Tissue samples were collected from stomach,liver and kidney, and processed by conventional histological methods. In the stomach,the mucosa was intact but areas of hyperaemia and hyperkeratosis were observed in 6cases, multifocal small erosions or ulcers in 6 cases, multifocal large ulcers with areas ofextensive erosion in 12 cases and extensive areas of ulceration with exposure of thesubmucosa in 6 cases. The macroscopic evaluation of the liver showed evidenthepatomegaly in 22 cases and lobular pattern in 18 cases. The kidneys showed severecongestion in all cases, loss of cortico-medullar ratio in 20 cases, cortical necrosis in 18cases, acute tubular necrosis in all cases, papillary necrosis in 6 cases, and adherence ofthe capsule with interstitial fibroplasia in 4 cases. Lesions in the gastric mucosa, liver andkidney were associated with extended treatment with non-steroidal anti-inflammatorydrugsEl objetivo del estudio fue describir lesiones gástricas, hepáticas y renales en caballos Pura Sangre de Carreras enmarcadas en el síndrome ulceroso gástrico equino. Se trabajó con 30 ejemplares Pura Sangre de Carrera con historia de síndrome ulceroso gástrico y cólico recurrentes entre 2006 y 2007, en el Hipódromo «La Rinconada», Caracas, Venezuela. A los animales se les practicó la eutanasia y se colectó nuestras de tejido gástrico, hepático y renal. Las muestras fueron procesadas por los métodos histológicos convencionales. En el estómago se observó mucosa intacta, pero con áreas de hiperemia y/o hiperqueratosis en 6 casos, pequeñas erosiones multifocales o úlceras en 30 casos, úlceras grandes multifocales con regiones extensas de erosión en 12 casos, y úlceras extensivas con áreas de exposición de la submucosa en 6 casos. La evaluación macroscópica del hígado evidenció icteria en 22 casos, así como hepatomegalia y patrón lobulillar en 18 casos. Los riñones mostraron congestión severa en todos los casos, pérdida de la relación córtico medular en 20 casos, necrosis cortical 18 casos, necrosis tubular aguda en todos los casos, necrosis papilar confluente en 6 casos y adherencia de la cápsula con fibroplasia intersticial en 4 casos. Las lesiones observadas en la mucosa gástrica, hígado y riñón estuvieron asociadas con terapéuticas prolongadas con antiinflamatorios no esteroideos

Immunological Biomarkers of Fatal COVID-19: A Study of 868 Patients

Information on the immunopathobiology of coronavirus disease 2019 (COVID-19) is rapidly increasing; however, there remains a need to identify immune features predictive of fatal outcome. This large-scale study characterized immune responses to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection using multidimensional flow cytometry, with the aim of identifying high-risk immune biomarkers. Holistic and unbiased analyses of 17 immune cell-types were conducted on 1,075 peripheral blood samples obtained from 868 COVID-19 patients and on samples from 24 patients presenting with non-SARS-CoV-2 infections and 36 healthy donors. Immune profiles of COVID-19 patients were significantly different from those of age-matched healthy donors but generally similar to those of patients with non-SARS-CoV-2 infections. Unsupervised clustering analysis revealed three immunotypes during SARS-CoV-2 infection; immunotype 1 (14% of patients) was characterized by significantly lower percentages of all immune cell-types except neutrophils and circulating plasma cells, and was significantly associated with severe disease. Reduced B-cell percentage was most strongly associated with risk of death. On multivariate analysis incorporating age and comorbidities, B-cell and non-classical monocyte percentages were independent prognostic factors for survival in training (n=513) and validation (n=355) cohorts. Therefore, reduced percentages of B-cells and non-classical monocytes are high-risk immune biomarkers for risk-stratification of COVID-19 patients

ESTUDIO SEROLÓGICO E HISTOPATOLÓGICO DE LA INFECCIÓN POR TOXOPLASMA GONDII EN CERDOS DEL ESTADO ARAGUA-VENEZUELA

El cerdo, al igual que otras especies de interés zootécnico como los bovinos y caprinos, se considera factor de riesgo epidemiológico en la diseminación del Toxoplasma gondii al humano. El consumo de carne fresca o subproductos porcinos insuficientemente cocidos o la contaminación del agua o alimento con formas infectivas del parásito es la forma de infección más común. Esta investigación se planteó como objetivo determinar la seroprevalencia y el estudio histopatológico de los casos seropositivos a Toxoplasma gondii en cerdos destinados al consumo humano en el estado Aragua, Venezuela. Se realizó un estudio de cohorte transversal tomando 425 muestras sanguíneas de cerdos previos al beneficio; Posterior al sacrificio, se tomaron muestras de tejido músculo-esquelético (n=425). Se utilizó la prueba de hemoaglutinación indirecta (HAl) para el análisis serológico y para el estudio histopatológico de los casos seropositivos, se realizaron  coloraciones de rutina y especiales.La tasa de seroprevalencia general fue 9,41%,  no evidenciándose diferencias estadísticas significativas entre  hembras y machos. La titulación de anticuerpos fue de 1/64 hasta 1/1024 sin la utilización de 2- Mercaptoetanol (2-ME), indicando la exposición al protozoario, el curso de una posible infección. Bajo la titulación con 2-ME, se obtuvo 12,5% de seroreaccionantes que presentaron  IgM característica de la infección aguda, sin evidencia clínica de enfermedad, indicando que el contacto con el parásito se adquirió en las etapas finales del ciclo productivo. No se evidenciaron formas parasitarias libres ni intracelulares u organizaciones quisticas o pseudoquisticas. Los cambios histológicos más frecuentes fueron degeneración miofibrilar, fragmentación miofibrilar, fibrosis perivascular e infiltrado inflamatorio linfocítico en  músculo del diafragma, semitendinoso, recto adbominal e intercostal; con grado de lesión de leve a moderado. La titulación de anticuerpos no expresa la evidencia de formas parasitarias en tejidos, lo cual podría depender del grado de infestación o exposición/dosis parasitarias; epizootiología del agente; higiene de la producción y método de muestreo. Es fundamental establecer un programa integral de control epidemiológico, basado en medidas básicas de bioseguridad, control de gatos y roedores, monitoreo serológico en granjas y medidas higiénico-sanitarias. (Palabras clave:  Toxoplasma gondii; histopatología; inmunodiagnostico; morbosidad; Aragua; Venezuela)Abstract Pigs, as well as cattle and sheep are considered at epidemiological risk in the dissemination of Toxoplasma gondii to humans. The consumption of raw meat and pork by-products insufficiently cooked, or the contamination of water or food with the infective forms of the parasite are the means of infection. The aims of this investigation were two-fold: to determine the seroprevalence and to study the histopathology of Toxoplasma gondii in pigs for human consumption in the Aragua State, Venezuela. A cross-sectional study was undertaken. A total of 425 blood samples from pigs prior to slaughter were collected. Post mortem samples (n = 450) of skeletal muscle were also taken. For the serological analysis of positive cases, the indirect haemoagglutination test (IHA) was used. Hematoxilin-Eosin (H-E) and Periodic Acid of Schiff (PAS) stains were used for the histopathology study of seropositive cases. The results show an overall seroprevalence rate of 9.41%. No significant differences by gender were found. Antibody titration ranged from 1/64 to 1/1024 in samples non-treated with 2-mercaptoethanol (2-ME), indicating a potential exposure of the host to the protozoan infestation. Five (12.5%) of the serum samples treated with 2-ME, evidenced the presence of IgM, typical of an acute infection without clinical evidence of the disease. This finding suggests that the infection was acquired during the final stages of the parasite’s reproductive cycle. There was no histopathological confirmation of free parasites, intracellular forms, cystic or pseudocystic organizations. The most frequent histological changes were: myofibrilar degeneration, myofibrilar fragmentation, perivascular fibrosis, and lymphocytic inflammatory infiltration of the diaphragm, semitendinous, abdominal rectus, and intercostal muscles, with mild to moderate degrees of lesions. The antibodies titration does not necessarily reveal the presence of parasitic forms in a particular organ or tissue, which could depend on several factors such as: the degree of infestation, exposure to a parasite load, epizooty of the agent, health measures in the farm, epidemiologic conditions, and sampling methods. In conclusion, it is fundamental to establish a complete epidemiologic control program, based on biosecurity measures, pest (cats and rodents) control, and both serological screening and health measures of farms. (Key words: Swine, Toxoplasma gondii; histopathology; inmunodiagnosis; morbidity; Aragua; Venezuela

Generalized erythematous scaly rash after glucocorticoids

A 65-years-old woman with a medical history of idiopathic throm- bocytopenic purpura and psoriasis in treatment with topical glucocor- ticoids presented with a three-month history of burning, generalized erythematous, scaly rash, and chills. A few weeks before the rash, the patient presented petechiae on her thighs due to a low platelet count (28.000 platelets per microliter), for which she started treatment with prednisone 25 mg/week. The rash was initially treated with topical ointments including clobetasol, urea, salicylic acid, ammonium lactate, and propylene glycol without improvement. The physical examination showed generalized erythroderma (Fig. 1A) from neck to feet (Fig. 1B), with thick silvery desquamation respecting the face and back of the legs (Fig. 1C), involving more than 90% of the patient’s body surface area and erythematous scaly plaques on the scalp. Laboratory test results were normal. A punch biopsy specimen obtained from an arm area showed increased keratinization at the level of the corneal layer with compact parakeratosis with abundant polymorphonuclear cells. The epidermis presented psoriasiform hyperplasia with significant spongio- sis. What is the diagnosis

ESTUDIO RETROSPECTIVO DE NEOPLASIAS DE PIEL EN CANINOS, CON REFERENCIA PARTICULAR A SU EDAD, RAZA, SEXO Y LOCALIZACIÓN

Se estudiaron 244 tumores de piel y subcutis, procedentes del Servicio de Diagnóstico Anatomopatológico de la Facultad de Ciencias Veterinarias de la UCV, desde 1992 a 2002; durante este período se recibieron 526 biopsias, de las cuales, 379 casos fueron diagnosticados como neoplasias. Se reseñaron 53 tipos de tumores distintos, consistiendo en mayor número de neoplasias malignasque las benignas. El más común fue el Tumor de células mastocíticas, seguido en orden de frecuencia por el histiocitoma cutáneo canino. La región ventral del cuerpo fue la localización mas frecuente. Los caninos reseñados como mestizosrepresentaron un número importante de la muestra; de las razas puras, el Bóxer fue la que registró la mayor casuística, seguida de Pastor alemán, Cocker spaniel y Dobermann Pinscher. El rango etario fue de 4 meses a 20 años, con una media de 6 a 7 años de edad.Skin Neoplasms in Canine, Retrospective Study with Particular Reference of Age, Breed, Sex and LocationAbstractTwo hundreds and forty four tumors of canine skin and subcutaneous tissues were studied at the Pathology Department, Veterinary School, Universidad Central de Venezuela, from 1992 to 2002. During this period 526 biopsies were submitted to histopathological study, 379 were diagnosed as tumors. Fifty three different types of neoplasm were registered, being the number of malignant tumors cases larger than benign tumors. The most frequent neoplasm was Mast cell tumor, followed by Canine cutaneous histiocytoma. Body ventral region was the most frequent tumor location. Crossbred dogs represented an important number of the sample; the boxer was the most common pure-bred dogs, followed by German Shepherd, Cocker Spaniel and Doberman Pinscher. Age range was between 4 months and 20 years, with a statistical average of 6 to 7 years