Successful rescue of disseminated Nocardia infection with multiple abscesses in a patient with membranous nephropathy after cardiopulmonary resuscitation: A three-year follow-up.

Nocardiosis manifests as an opportunistic infection, primarily affecting individuals who are immunocompromised and susceptible to the infection. We present a case study of one patient with nephrotic syndrome and membranous nephropathy, who underwent treatment with prednisone and cyclosporine in 2016. In early 2017, the patient was diagnosed with a "fungal infection" and discontinued the use of cyclosporine. After one month of anti-infection therapy, a cranial magnetic resonance imaging scan showed multiple abscesses in the right temporal region. The diagnosis of nocardiosis was confirmed based on the presence of metastatic abscess masses, multiple lung and brain lesions, and a positive culture of Nocardia in the drainage. We changed the anti-infection therapy to a combination of trimethoprim-sulfamethoxazole (TMP-SMX), minocycline, and voriconazole. However, the patient experienced a sudden cardiac arrest and subsequently recovered after cardiopulmonary resuscitation. During the five-month follow-up period following the discharge, the patient displayed an enhanced nutritional status and stable renal function. The focal infection ultimately resolved during the subsequent three years. Neuro-infection caused by Nocardia should be considered in immunocompromised patients, and TMP-SMX is the preferred initial therapy; however, because of the high mortality rate, a long-term combination therapy with imipenem, cefotaxime, amikacin, and TMP-SMX is suggested.

Significant association of CD4+CD25+Foxp3+ regulatory T cells with clinical findings in patients with systemic lupus erythematosus.

BACKGROUND: Regulatory T (Treg) cells are one of the important mechanisms in maintaining self-tolerance and immune homeostasis. CD4+CD25+Foxp3+Treg is considered to have a role in the pathogenesis of systemic lupus erythematosus (SLE). However, the data reported is controversial, and a conclusive result has not been given thus far. The aim of the present study is to evaluate the role of CD4+Treg in SLE further. METHODS: The peripheral blood T cells (PBMCs) from patients with SLE and healthy controls were isolated, and followed by the isolation of CD3+T cells. The PBMCs were tested for the expressions of CD25 and Foxp3 molecules on the surface of CD4+T cells, and CD3+T cells were tested for their cytokine expressions including IFN-γ, TGF-ß, and IL-10, with the method of flow cytometry. The correlations of test results with clinical features of the disease were evaluated by linear correlation analysis. RESULTS: CD4+CD25+ Foxp3+Treg decreased in SLE patients and was correlated with the SLE Disease Activity Index (SLEDAI), and a few immunological abnormalities, including anti-dsDNA antibody positive, IgG increase and C3 decrease, and types of tissue damage, including leukocytopenia and kidney damage. IFN-γ+ cells in the CD4+CD25+T subset fresh-isolated from SLE patients increased slightly, but IFN-γ-producing response to stimulation in CD4+CD25+T subset of SLE decreased. The number of TGF-ß-producing cells in the CD4+CD25+T subset from SLE patients also decreased. While the percentages of CD4+CD25+IL-10+T subset in the CD3+T cells increased in SLE, however, these changes of cytokine expressions did not show any significant correlations with SLEDAI. CONCLUSIONS: There is clear and definite evidence from the present study indicating the important role of CD4+CD25+Foxp3+Treg in the pathogenesis of SLE, for the abnormalities in functional cytokine productions of the CD4+CD25+ T subset, and for the feasibility of a CD4+CD25+Foxp3+Treg- based immunotherapy in SLE.

Artery compliance in patients with rheumatoid arthritis: results from a case-control study.

Atherosclerosis is one of the most common complications of rheumatoid arthritis (RA). The objective of this study is to evaluate differences in large artery compliance (C1) and small artery compliance (C2) between RA and controls and evaluating factors associated with reduced compliance in the RA population. The profiling of large and small arterial compliance was analyzed in 185 RA patients and 88 healthy controls using Cardiovascular Profiling Instrument. The correlations of arterial compliance and the relevant clinical data were determined in these subjects. Then correlation analysis and regression analysis were performed to find whether rheumatoid arthritis patients have more risk factors than healthy controls in artery compliance and to explore the possible element involved in RA patients including traditional cardiovascular risk factors, RA disease-related factors, and the therapy. Compared with healthy controls, levels of C1 and C2 were significantly decreased in RA patients. Having adjusted the traditional risk factors associated with atherosclerosis, C1 and C2 decline was still a significant indicator in RA patients [odds ratio = 7.411(95%CI 3.275, 16.771) and 10.184(95%CI 4.546, 22.817)]. Using multi-factor regression analysis to adjust traditional risk factors for arterial compliance, we found that the levels of ESR was correlated with the abnormal large artery compliance [odds ratio = 1.021(95%CI 1.007, 1.035)]. The HAQ values and the current usage of leflunomide were correlated with the abnormal small artery compliance in RA patients [odds ratio = 1.161(95%CI 1.046, 1.289) and 6.170(95%CI 1.510, 25.215)]. The values of C1 and C2 are indicators of artery compliance in RA patients. ESR, HAQ values, and the usage of leflunomide might be possible risk factors of artery compliance. The evaluation of artery compliance could be an easy and reliable test that could help us to screen and predict cardiovascular disorders in RA patients.