ABSTRACT
BACKGROUND: Thrombotic cutaneous gangrene is a rare extra-intestinal manifestation of ulcerative colitis with a severe prognosis. CASE REPORT: A 35-year-old woman with a 7-year history of ulcerative colitis presented with extensive ecchymotic lesions that began a few hours earlier. On examination, she was febrile with multiple necrotic lesions. Skin biopsy showed multiple microthrombi in the dermal vessels. A diagnosis of thrombotic cutaneous gangrene was established. The patient was treated with heparin and systemic corticosteroids. The majority of cutaneous lesions showed improvement after 1 month. Thrombophlebitis of the left lower limb occurred subsequently. CONCLUSION: Thrombotic cutaneous gangrene is attributed to microvascular thrombosis, which arises from the hypercoagulability observed in ulcerative colitis. Complete blood and coagulation tests must be performed and early anticoagulation with heparin must be considered in order to prevent the progression of cutaneous infarction.
Subject(s)
Colitis, Ulcerative/diagnosis , Colitis, Ulcerative/pathology , Skin/pathology , Thrombosis/diagnosis , Thrombosis/pathology , Adrenal Cortex Hormones/therapeutic use , Adult , Biopsy , Colitis, Ulcerative/drug therapy , Drug Therapy, Combination , Female , Gangrene/diagnosis , Gangrene/drug therapy , Gangrene/pathology , Heparin/therapeutic use , Humans , Necrosis , Skin/blood supply , Skin/drug effects , Thrombosis/drug therapyABSTRACT
The abdominal actinomycosis (AA) is a rare and often unrecognised suppurative chronic illness. It is caused by an anaerobic Gram positive bacteria, Actinomyces israelii. Abdominal actinomycosis is responsible for pseudotumoral syndrome often leading, to a large and mutilating surgery whereas a prolonged treatment by antibiotics would have permitted to cure the disease. The diagnosis is obtained generally from anatomopathologic exam. We report four cases of abdominal actinomycosis being revealed by a pseudotumoral syndrome. The diagnosis was only made after surgery. In spite of an active treatment by antibiotics during several months, two of our patients had a relapse of the infectious process. These four observations confirm the diagnostic and therapeutic difficulties previously reported by other authors.
Subject(s)
Abdominal Abscess/microbiology , Abdominal Wall , Actinomyces , Actinomycosis/complications , Pelvic Inflammatory Disease/microbiology , Abdominal Abscess/diagnosis , Abdominal Abscess/drug therapy , Abdominal Abscess/surgery , Actinomyces/isolation & purification , Actinomycosis/diagnosis , Actinomycosis/drug therapy , Actinomycosis/surgery , Aged , Anti-Bacterial Agents/therapeutic use , Cholecystectomy/adverse effects , Female , Humans , Intrauterine Devices/adverse effects , Middle Aged , Pelvic Inflammatory Disease/diagnosis , Pelvic Inflammatory Disease/drug therapy , Pelvic Inflammatory Disease/surgery , Rectus Abdominis/surgery , Round Ligament of Uterus/surgery , Treatment OutcomeABSTRACT
AIMS: The objective of our study was, in one hand, to determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ELISA and dot blot assay to investigate IgG M2 antimitochondrial antibodies (M2 AMA) and, on the other hand, to compare these results with those of indirect immunofluorescence technique (IIF). METHODS: Sera from patients suffering from primary biliary cirrhosis (PBC) (n=55), systemic lupus erythematosus (n=21), celiac disease (n=30) and blood donors (n=75) were analyzed. M2 AMA were detected by ELISA and dot blot using pyruvate dehydrogenase purified from porcine heart and by IIF on cryostat sections of rat liver-kidney-stomach. RESULTS: IIF was more sensitive (98%) than ELISA (93%) and dot blot (91%). The specificity of AMA for PBC using IIF, ELISA and dot blot reached 100%, 92% and 100%, respectively. The PPV of IIF, ELISA and dot blot was 100%, 93% and 100%, respectively. The NPV was 98% for IIF, 92% for ELISA and 91% for dot blot. CONCLUSION: Dot blot, using purified pyruvate dehydrogenase, had a higher specificity than ELISA and may be useful in confirming the specificity of AMA in cases of doubt with IIF.
