Exacerbation of Intimal Fibrosis and Endarteritis in a Kidney Transplant Recipient with Chronic Active Antibody-Mediated Rejection and COVID-19: A Case Report.

Kidney transplant recipients are immunocompromised hosts at risk for comorbidity and mortality due to infection. Currently, there are no established guidelines for the management of immunosuppressed transplant recipients with coronavirus disease 2019 (COVID-19). The impact of COVID-19 and its therapeutic management on chronic active antibody-mediated rejection (CAAMR) are still unclear. Here, we report a case of CAAMR exacerbation with endarteritis and intimal fibrosis after COVID-19. A 41-year-old female kidney transplant recipient with CAAMR was admitted to a local hospital with moderately severe COVID-19. Her doses of tacrolimus and mycophenolate mofetil were reduced, and she was administered methylprednisolone pulse and antiviral drugs. This resulted in a good clinical course and she was discharged in 15 days. During and after hospitalization, the immunosuppressants were gradually returned to the baseline levels. However, about 1.5 months after discharge, the serum creatinine level became elevated. An indication kidney biopsy showed CAAMR with intimal fibrosis and endarteritis in all interlobular arteries. An increase of immunosuppressant led to a decrease of the serum creatinine level. Factors contributing to CAAMR with intimal fibrosis and endarteritis may include (1) insufficient immunosuppression due to changes in the levels of immunosuppressive; (2) overlap with endothelial cell injury caused by COVID-19, and (3) an immune-activated state associated with COVID-19. COVID-19 is a life-threatening disease that can result in unexpected changes in immunological status. Possible allograft rejection should be carefully managed in such patients.

Endarteritis of coarctation of the aorta diagnosed with PET-CT.

Infective endocarditis (IE) is an infectious disease that affects the endothelium of the large intrathoracic vessels, heart valves, and intra-cardiac foreign body material. A 20-year-old woman was admitted to the cardiology department with complaints of fever and palpitations. Transthoracic echocardiography revealed a bicuspid aortic valve, aortic root enlargement, and aortic coarctation. Transesophageal echocardiography revealed a bicuspid aortic valve, but there was no vegetation. Methicillin-sensitive Staphylococcus aureus was identified on a blood culture. 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) revealed increased intensive glucose uptake on the dilated aortic segment adjacent to the distal coarctation zone. Several reports have shown promising results for radio-labelled white blood cell single-photon emission computed tomography and 18F-FDG PET-CT imaging in IE. To our knowledge, this is the first described case in which PET-CT revealed endarteritis of the descending aorta in a patient without prosthetic material.

Abiotrophia defectiva endarteritis with infective spondylodiscitis in an adult patient with patent ductus arteriosus.

Endarteritis is a major complication in patients with patent ductus arteriosus, causing significant morbidity and mortality. We report an adult patient with asymptomatic patent ductus arteriosus and endarteritis involving the main pulmonary artery and secondary infective spondylodiscitis at the L5-S1 intervertebral disc caused by Abiotrophia defectivaA. defectiva, commonly referred to as nutritionally variant streptococci, cannot be identified easily by conventional blood culture techniques from clinical specimens. Its isolation was confirmed by 16S ribosomal RNA sequencing. The patient was successfully managed with a combination of penicillin G and gentamicin, pending surgical repair of the patent ductus arteriosus.

Pulmonary hypertension in dogs with heartworm before and after the adulticide protocol recommended by the American Heartworm Society.

Pulmonary hypertension (pH) is a frequent and severe phenomenon in heartworm disease (Dirofilaria immitis). There is a lack of studies assessing the evolution of the proliferative endarteritis and pH caused by D. immitis after the death of the parasites, so this study evaluated the influence that the elimination of the worms exerts over the pulmonary pressure and therefore evolution of the endarteritis, through the evaluation of the Right Pulmonary Artery Distensibility (RPAD) Index and other echocardiographic measurements in 2D mode, M-mode and Doppler echocardiography in 34 dogs naturally infected by D. immitis on day 0, and one month after the last adulticide dose (day 120). pH, based on the determination of the RPAD Index, was present in 68% of the dogs (n=23) on day 0 and on day 120. No significant differences were observed between the RPAD Index between the two measurements, and only significant differences were found in pulmonary deceleration time, ejection time, and left ventricular internal diameter in telediastole when measurements from day 0 and day 120 were compared. There was not any worsening in the development of pH after the elimination of the parasites, independently of the parasite burden. During the adulticide treatment, the death of the worms causes thromboembolism and tends to worsen the vascular damage and presence of pH . It seems that following the adulticide protocol recommended by the American Heartworm Society with the previous elimination of Wolbachia and reduction of microfilariae followed by the stepped death of the worms did not cause a significant aggravation of the pulmonary damage of the treated dogs. Neither is present any significant improvement in the RPAD Index on day 120; probably, more time is needed before appreciating some positive changes after the elimination of the worms and Wolbachia from the vasculature and further studies are necessary.

Staphylococcus aureus bacteremia with iliac artery endarteritis in a patient receiving ustekinumab.

BACKGROUND: Ustekinumab (Stelara®), a human monoclonal antibody targeting the p40-subunit of interleukin (IL)-12 and IL-23, is indicated for moderate to severe plaque psoriasis and psoriatic arthritis. In large multicenter, prospective trials assessing efficacy and safety of ustekinumab increased rates of severe infections have not been observed so far. CASE PRESENTATION: Here, we report the case of a 64-year old woman presenting with chills, pain and swelling of her right foot with dark maculae at the sole, and elevated inflammatory markers. She had received a third dose of ustekinumab due to psoriatic arthritis three days before admission. Blood cultures revealed growth of Staphylococcus aureus and imaging showed a thickening of the aortic wall ventral the bifurcation above the right internal iliac artery, resembling an acute bacterial endarteritis. Without the evidence of aneurysms and in absence of foreign bodies, the decision for conservative management was made. The patient received four weeks of antibiotic therapy with intravenous flucloxacillin, followed by an oral regime with levofloxacin and rifampicin for an additional four weeks. Inflammatory markers resolved promptly and the patient was discharged in good health. CONCLUSION: To our knowledge, this is the first report of a severe S. aureus infection in a patient receiving ustekinumab. Albeit ustekinumab is generally regarded as a safe drug, severe bacterial infections should always be included in the differential diagnosis of elevated inflammatory markers in patients receiving biologicals as these might present with nonspecific symptoms and fever might be absent. Any effort to detect deep-seated or metastatic infections should be made to prevent complications and to secure appropriate treatment. Although other risk factors for an invasive staphylococcal infection like psoriasis, recent corticosteroid injection, or prior hospitalisations were present, and therefore a directive causative link between the S. aureus bacteraemia and ustekinumab can not be drawn, we considered the reporting of this case worthwhile to alert clinicians as we believe that ongoing pharmacovigilance to detect increased risks for rare but severe infections beyond phase II and phase III trials in patients treated with biologicals is essential.

[Bacteremia and endarteritis cases secondary to Campylobacter spp. in a metropolitan hospital: our experience along a quarter of a century]. / Bacteriemias e infección endovascular por Campylobacter spp: nuestra experiencia en un cuarto de siglo de historia.

Six cases of bacteremia and one of endarteritis were identified between 1986 and 2010 in a general hospital in Chile. Five of these cases occurred during the second half of this timeframe, Campylobacter fetus predominated (5 out of 7) and the majority of the infections presented during warmer months. The mean age was 32.4 years (range 19 to 63) all had comorbidities, and main clinical manifestations included fever with diarrhea. Four patients developed hypotension and two septic shock. The latter, associated to C. fetus bacteremia, died before microbiological diagnosis. Six out of 7 patients received antimicrobial therapy. During 2004 and 2010, the rates of Campylobacter spp. positive stool cultures in the same hospital increased 4 times, suggesting an emerging profile. Bacteremia and endarteritis by Campylobacter spp. can develop in vulnerable patients and manifest as fever with or without diarrhea. Finding curved or spiral shaped gram negative rods in blood cultures leads to suspect this pathogen. Species identification is of utmost importance due to antimicrobial resistance especially in C. jejuni. Prognosis is unfavorable due to host characteristics, and case-fatality rate is high.

Bacteriemias e infección endovascular por Campylobacter spp: nuestra experiencia en un cuarto de siglo de historia / Bacteremia and endarteritis cases secondary to Campylobacter spp. in a metropolitan hospital: Our experience along a quarter of a century

Six cases of bacteremia and one of endarteritis were identified between 1986 and 2010 in a general hospital in Chile. Five of these cases occurred during the second half of this timeframe, Campylobacterfetus predominated (5 out of 7) and the majority of the infections presented during warmer months. The mean age was 32.4 years (range 19 to 63) all had comorbidities, and main clinical manifestations included fever with diarrhea. Four patients developed hypotension and two septic shock. The latter, associated to C. fetus bacteremia, died before microbiological diagnosis. Six out of 7 patients received antimicrobial therapy. During 2004 and 2010, the rates of Campylobacter spp. positive stool cultures in the same hospital increased 4 times, suggesting an emerging profile. Bacteremia and endarteritis by Campylobacter spp. can develop in vulnerable patients and manifest as fever with or without diarrhea. Finding curved or spiral shaped gram negative rods in blood cultures leads to suspect this pathogen. Species identification is of utmost importance due to antimicrobial resistance especially in C. jejuni. Prognosis is unfavorable due to host characteristics, and case-fatality rate is high.

Se presentan seis casos de bacteriemia y uno de infección vascular por Campylobacter spp, observados en 25 años, con el fin de describir sus características clínicas. Cinco de ellos se registraron en la segunda mitad del período, en concomitancia con el incremento de este agente en el porcentaje de coprocultivos, lo que sugiere un perfil emergente. Las infecciones fueron más frecuentes en los meses cálidos, asociadas principalmente a C. fetus (5 de 7) y a co-morbilidad. La edad promedio de los pacientes fue de 32,4 años (rango 19 a 63 años) y todos tenían comorbilidades. Las manifestaciones clínicas más frecuentes fueron diarrea y fiebre (5 de 7 casos) y dos pacientes cursaron con shock séptico (28,6 por ciento). La evolución fue favorable en cinco pacientes pero los dos que presentaron shock asociado a C. fetus fallecieron (28,6 por ciento). Las bacteriemias o infecciones vasculares por Campylobacter spp., aunque infrecuentes, pueden presentarse en pacientes vulnerables y debutar como cuadros febriles, en presencia o ausencia de diarrea. La identificación de la especie involucrada es de suma importancia debido a la escasa actividad terapéutica de cefalosporinas de tercera generación y quinolonas. El pronóstico de estas bacteriemias es grave debido a las características del hospedero y a su elevada letalidad.

Neonatal infective endarteritis complicating patent ductus arteriosus.

UNLABELLED: Infective endarteritis complicating patent ductus arteriosus (PDA) is a rare occurrence. Most cases are reported in older children and adults, and there are little published data describing this condition in the preterm neonate. We outline the presentation, clinical course, management and outcome of two affected infants born at less than 27 weeks of gestation. CONCLUSION: This report highlights the importance of a detailed cardiac evaluation in a neonate with persisting bacteraemia. An increasing awareness of neonatal ductal endarteritis combined with the wider availability of more sensitive echocardiography has implications for local neonatal service delivery.

Unusual complication of coarctation of the aorta.

The majority of older patients with uncorrected coarctation of the aorta die before the age of 50 years from many complications. We report our experience in treating this type of congenital malformation in a 40-year-old man who developed aortic endarteritis as a rare complication.

Septic endarteritis following percutaneous transluminal coronary angioplasty.

We report a case of bacterial arteritis of the external iliac artery complicated by mycotic aneurysm following coronary angioplasty. To our knowledge, this is the first reported instance of arterial wall infection caused by coronary angioplasty at a distance from the insertion site equal to the length of the sheath.

[Ways to enhance the efficacy of treating patients with the terminal stage of arterial ischemia of the lower extremities]. / Puti povysheniia éffektivnosti lecheniia bol'nykh s terminal'noi stadiei arterial'noi ishemii nizhnikh konechnostei.

Experience with treatment of 410 patients with obliterating diseases of lower extremities arteries with the terminal stage of ischemia and occlusions of the femoro-popliteal segment have shown that successful results of small amputations can be obtained but against the background of complex treatment based on a thorough and comprehensive examination of the patient, and aimed at the recovery of adequate blood supply of distal parts of the extremity by operations of direct and indirect revascularization, normalization of microcirculation and struggle against infection. It allows performing amputation distal to the knee joint in 79.5% of cases, and to reduce the amount of postoperative complications in 38.8% of cases.

[Use of vazaprostan in the treatment of multifocal peripheral obliterating lesions of arteries of the lower limbs]. / Primenenie vazaprostana pri lechenii mul'tifokal'nykh i perifericheskikh obliteriruiushchikh porazhenii arterii nizhnikh konechnostei.

Vazaprostan was prescribed to 13 patients with the lower limbs obliterating atherosclerosis and the coronary arteries atherosclerotic lesion (first group) and in 17--with obliterating atherosclerosis and endarteritis of the lower limbs vessels (second group). The treatment was found to be effective one in all of the patients of the first group and in 13--of the second. The authors consider vazaprostan application to be expedient in patients with the lower limbs obliterating lesions as a supplement to operative intervention and also in coincidence of this pathology with the ischemic heart disease.

[Effectiveness of pathogenetic treatment of arterial obliterative diseases of the extremities]. / Vozmozhnosti patogeneticheskogo lecheniia obliteriruiushchikh zabolevanii arterii konechnostei.

The authors studied the activity of blood serum amine oxidase in patients with atherosclerosis obliterans and endarteritis obliterans. It was found that amine oxidase activity exceeded the normal value. 2.6 times in patients with stage 1-2 atherosclerosis obliterans and was reduced by more than 12 times in patients with stage 3-4 of the disease. The activity of the enzyme was absent in patients with endarteritis obliterans, whatever the stage of limb ischemia. On the basis of the obtained facts, the authors voice a new opinion on the nature of hypercatecholaminemia in obliterative diseases and suggest a new trend in the treatment of chronic ischemia of the limbs-activation of the processes of catabolism of vasoconstrictive biogenic amines.

[The use of emakor in arterial ischemia of the lower extremities in outpatient practice]. / Primenenie émakora pri arterial'noi ishemii nizhnikh konechnostei v ambulatornoi praktike.

Overall 43 outpatients with arterial ischemia of the lower limbs were treated by emakor, a new Soviet drug that exerts a concomitant alpha- and beta-blocking action. The treatment resulted in a remarkable positive effect which manifested itself in amelioration of circulation in the lower limbs, positive time-course of changes in peripheral hemodynamics and in computer-aided tomography data. The use of emakor is contraindicated in exacerbation of gastrointestinal diseases, chronic pulmonary diseases associated with the obstructive syndrome, and marked signs of venous outflow obstruction in the lower limbs.