ABSTRACT
Case report Background: Mutations in the PLCG2 gene can cause PLCG2-associated antibody deficiency and immune dysregulation (PLAID) or auto-inflammation with PLCG2-associated antibody deficiency and immune dysregulation (APLAID). PLAID is characterized by urticarial eruptions triggered by evaporative cooling along with cutaneous granulomas. APLAID may present with early-onset skin inflammation and non-infectious granulomas, uveitis, and colitis. Method(s): Case report and literature review. We performed in silico analysis for variants of uncertain significance (VUS). Result(s): A 29-day-old boy presented to emergency department for failure to thrive. He was found to be SARS-CoV2 positive, had an E. coli UTI in the setting of bilateral perinephric masses which subsequently resolved. He also had a perianal soft tissue abscess measuring 4cm in diameter. Mom reported a similar infection when she was age 2. She also reported intermittent diffuse urticaria triggered following perspiration evaporation.Abscess wall histology showed diffuse neutrophil and lymphocytic infiltration, with cultures growing polymicrobial enteric flora. His serum immunoglobulins G, A, M, and E were within reference range. Naive and memory CD4, CD8, CD19 lymphocyte subsets (including NK cells) were also within age-appropriate reference range. He had a normal neutrophil oxidative burst measured using dihydrorhodamine (DHR) flow cytometry following PMA stimulation, which ruled out a diagnosis of chronic granulomatous disease. On evaporative cooling, the patient had a 2mm wheal with surrounding erythema which resolved rapidly with warming. A targeted primary immunodeficiency panel showed a heterozygous VUS in PLCG2, c.688C > G (p.Leu230Val). The variant was absent from major databases and had a calculated CADD score of 17.77. He had symptomatic resolution after completing 3 weeks of ceftriaxone and metronidazole antimicrobials. Given the concern for PLCG2-associated very early-onset inflammatory bowel disease (VEO-IBD), a fecal calprotectin was obtained at 3 months and found to be elevated (157 mcg/g [ < = 49 mcg/g]). However, he had no symptomatic or macroscopic evidence for VEO-IBD. Conclusion(s): Presence of very early onset abscesses has not been previously described in patients with heterozygous PLCG2 deficiency. This case adds to the expanding variable phenotype of PLCG-2-associated immune dysregulation.
ABSTRACT
Introduction & Objectives: More evidence is emerging with regards to the low sepsis rate in relation to Local Anaesthesia Transperineal (LATP) prostate biopsy. The acceptable rate for sepsis is 2% in relation to prostate biopsy procedure in general. LATP biopsy upon latest systematic reviews and peer evidence has a sepsis rate of 0.16 percent which is relatively low which allows for conversion of this procedure into forgoing the use of prophylactic antibiotics. We present our study, a retrospective analysis of outcome of selected low risk patients who has had LATP prostate biopsy initiated in the BHRUT trust without the need for antibiotics prophylactically in line with the antibiotic stewardship initiative of the Urology department during Covid era. Materials & Methods: Data from 23.12.2020 to 10.05.2021 was collected from electronic medical recordings of 160 consecutive LATPs without antibiotics using PrecisionPoint™ Transperineal Access System performed under local anaesthesia in King George Hospital Goodmayes, London. Various parameters like PSA, pain score, number of cores, MRI findings, histology findings, MDT outcome and complications, focusing more on infection rates were analysed. Results: Of the 160 consecutive LATPs without antibiotics, the mean for age, PSA, cores and average visual analog scale scores were 65 years, 10.9ng/mL, 26 cores and 1.6, respectively. The overall cancer detection rate was 58%, and for Likert scores 3-5, the cancer detection rates were 40%, 79%, and 95%, respectively. Complication rates of sepsis, acute urinary retention, clot retention, and perianal abscess were 0%(0/160), 1%(1/ 160), 1.25%(2/160) and 0%(0/160) respectively. Conclusions: Our study group of patients undergoing TP biopsy under local anaesthesia without antibiotic administrations has no complications of post biopsy sepsis. So, is it safe to perform LATP in a selected group of low risk patient without prophylactic antibiotics with implementation of antibiotic stewardship. With rising antibiotics resistance LATP may avoid use of antibiotics.
ABSTRACT
Purpose: Early in the coronavirus pandemic, guidelines and consensus have been proposed for the management of various general surgical emergencies to help surgeons serve the best interests of patients during an unprecedented time. There has been an agreement that certain conditions such as acute appendicitis should be managed conservatively with antibiotics whereas strong emphasis was put on the importance of timely surgical intervention on perianal and other superficial abscesses. Methods: Using ICD-10 codes, we investigated the impact of COVID-19 on surgical admissions due to perianal, pilonidal abscesses and acute appendicitis as comparison between March and November in 2020 and compared it to the same period in 2019. Results: The total number of surgical admissions due to perianal and pilonidal abscesses decreased by 22.5 and 31.7%, respectively, compared to the same period in 2019. Most of the decline was noted during the first wave, from March to July. Whereas acute appendicitis admissions remained comparatively constant between 2019 and 2020. Conclusion: Despite guidance regarding operative management of abscesses during the pandemic, the total number of surgical admissions due to perianal and pilonidal abscesses was reduced in comparison to the same period in 2019. Most of the decline was noted during the first wave, from March to July. This might result in higher rate of complications presenting at a later time.