bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rare presentation of primary hepatic marginal zone B-cell lymphoma and membranous glomerulopathy in a 3-year-old boy
Authors: Alkashash A M , Saxena R , Poulos C , Phillips C L , Nassiri M , Hains D 
Published: October 2021

Abstract

Introduction/Objective
Primary hepatic marginal zone B-cell lymphoma (MZL) is a rare entity that has been described with chronic inflammatory disorders such as chronic viral hepatitides B and C and primary biliary cholangitis. We report MZL in a 3-year-old African-American boy that was discovered incidentally at autopsy.

Methods/Case Report
The patient first came to medical attention at 9-months of age with bilateral periorbital edema that progressed to generalized edema of the[PL1] face, extremities, and abdomen. Laboratory testing showed nephrotic syndrome with massive proteinuria (50-60 g/day). A percutaneous renal biopsy specimen showed membranous glomerulopathy with PLA2R detected by immunofluorescence, and granular IgG deposition along tubular basement membranes. Serum was negative for anti-PLA2R antibodies. The patient suffered recurrent upper respiratory tract infections requiring several intensive care hospitalizations. At 3 years of age, he was transported unresponsive and pulseless to the emergency department where he was pronounced dead. A brother with the infantile nephrotic syndrome had died from sepsis at 2 years of age. Suspicion of abuse led to an autopsy by the medical examiner, who discovered nodular masses in the right and left liver lobes, which histologically showed a serpiginous infiltrate of small B-lymphocytes positive for CD20, CD43 admixed with plasmacytoid cells with kappa light chain restriction. There were no extrahepatic tumors. Transmission electron microscopy of glomeruli showed membranous glomerulopathy. Kidneys showed dense reactive interstitial lymphocytic infiltrate with germinal centers

Results (if a Case Study enter NA)
NA

Conclusion
To our knowledge, this is the first reported case of MZL presenting in a pediatric patient with membranous glomerulopathy. Both diagnoses are associated with autoimmune diseases and persistent, chronic inflammation. Recurrent infections in this patient suggest an immunoregulatory disorder, setting the stage for chronic inflammation, as seen in the kidney, with progression to MZL in the liver.
Hepatic Hyaline Arteriolosclerosis in Patients with Chronic Hyperglycemia
Authors: Kilpatrick M , Lewin D 
Published: October 2021

Abstract

Introduction/Objective
Hyaline arteriolosclerosis is a common feature of diabetic microangiopathy. It results from hyperglycemia-induced endothelial cell dysfunction and can be found in many sites including the retina, kidney, and skin. This histologic finding is important because studies have shown that in the kidney it is an independent risk factor for cardiovascular complications. To our knowledge, an association between hyperglycemia and hyaline arteriolosclerosis in the liver has not be studied. We aimed to investigate whether chronic hyperglycemia is associated with this histologic finding in liver arterioles.

Methods/Case Report
The first 50 liver biopsies performed at our institution starting January 1, 2020 were scanned into a digital pathology system (Philips, Cambridge, MA). For each biopsy, the patient’s highest recorded hemoglobin A1c (HbA1c) up to one year from the date of biopsy was recorded. The biopsies were then grouped into two groups: those from patients with a HbA1c greater than 6.5%, and those with a HbA1c value less than 6.5 %. Next, the digested periodic acid Schiff (DPAS) intensity of the arteriolar vessels in each biopsy was graded 0 to 3 by a single pathology resident who was blinded to its corresponding HbA1c group. Grade 0 to 1 was considered negative staining. Grade 2 to 3 was considered positive staining and indicative of hyaline arteriolosclerosis. By the end of the data collection, each case had been given a staining category and a HbA1c group. A 2 x 2 contingency table was constructed.

Results (if a Case Study enter NA)
37 of 50 patients had a recorded HbA1c meeting the study criteria. Of these 37 patients, 11 had an HbA1c greater than 6.5 % while 26 had an HbA1c less than 6.5%. Seven of the 11 biopsies from patients with an elevated HbA1c showed positive staining. Six of the 26 biopsies from patients with an HbA1c less than 6.5% showed positive staining.

Conclusion
We hypothesized that patients living with hyperglycemia may be more likely to exhibit hepatic hyaline arteriolosclerosis. A chi-squared test of independence was performed to examine the association between a liver biopsy’s HbA1c group and staining category. The relation between these variables was significant at p = &lt; .05, χ 2 (2, N= 36) = 5.57, p = .0182, indicating liver biopsies with a HbA1c greater than 6.5 % are more likely to have this histologic finding. Future studies are needed to characterize diabetic hepatopathy, and its relatedness to macrovascular complications.
Porto-Sinusoidal Vascular Disease and Focal Nodular Hyperplasia-like Nodules in a Patient with Neurofibromatosis and Non-Cirrhotic Portal Hypertension
Authors: Alkashash A M , Khan S , Saxena R , Nephew L , Kubal C 
Published: October 2021

Abstract

Introduction/Objective
Non-cirrhotic portal hypertension (NCPH) is uncommon. The underlying pathophysiology appears to lie at the level of intrahepatic portal veins and sinusoids, hence the term “porto-sinusoidal vascular disease” (PSVD). We report a rare case of PSVD with focal nodular hyperplasia (FNH)-like nodules in a patient with neurofibromatosis type 2 (NF2).

Methods/Case Report
A 57-year-old male with NF2 and type 2 diabetes, presented with a large variceal bleed requiring blood transfusion and subsequent transjugular intrahepatic portosystemic shunt (TIPS). Imaging showed a nodular liver, presumed to be cirrhosis due to non-alcoholic liver disease. Liver biopsy was not done. Thereafter, he had several episodes of hepatic encephalopathy and TIPS was downsized to prevent recurrences. The patient required liver transplantation for intractable portal hypertension and severe hepatic encephalopathy; his liver synthetic function was near normal and MELD was 11. Portal vein was patent. The explanted liver was micronodular, soft and weighed 946 grams. Unencapsulated nodules, a few mm to 1 cm in size, were present. Microscopically, there was diffuse nodularity in the absence of bridging fibrosis. Thin, incomplete curvilinear fibrous septa were present. There were aberrant veins, hypervascular portal tracts, herniated portal veins and rare occluded portal veins. Trichrome and reticulin stains confirmed architectural abnormalities including nodularity, lack of bridging fibrosis and approximation of portal tracts. Immunohistochemistry for glutamine synthetase accentuated architectural distortion and revealed nodules with FNH-like geographic areas of staining.

Results (if a Case Study enter NA)
NA

Conclusion
This is a rare case of NCPH due to PSVD in a patient with NF2. Microscopy suggested incomplete septal cirrhosis (ISC), a pattern associated with both PSVD and regression of fibrosis in a cirrhotic liver. Isolated portal hypertension without loss of synthetic function favors primary PSVD over regression of fibrosis. FNH-like nodules are consistent with regenerative changes caused by localized abnormalities of blood flow.
Comparison of Saliva and Nasopharyngeal Swabs for SARS-CoV-2 Detection in an Emergency Department and Ambulatory Testing Locations
Authors: Attaway C , El-Sharkawy Navarro F , Richard-Greenblatt M , Herlihy S , Gentile C , Glaser L , Morris B , Abella B , Collman R 
Published: October 2021

Abstract

Introduction/Objective
Nasopharyngeal (NP) swabs have been the traditional specimen source used for testing for respiratory viruses. However, at the start of the COVID-19 pandemic, several studies suggested that saliva could also be used as a specimen source for testing for SARS-CoV-2. Despite potential benefits, there was limited data on the characteristics of this specimen type and few commercial assays with FDA emergency use authorization allowed saliva as a specimen source. In order to explore the feasibility and validate using saliva as a specimen source for ambulatory and emergency department patients we designed a study to compare saliva to NP swabs for SARS-CoV-2 testing.

Methods/Case Report
Specimens were collected in the emergency department and ambulatory testing sites between May 6, 2020-July 7, 2020. Nasopharyngeal swabs were collected as part of routine clinical practice and patients were given written instructions to self-collect 1mL of saliva into a sterile specimen cup with or without a straw. SARS-CoV-2 testing was performed in parallel with both specimen types using the TaqPath COVID-19 Combo Kit (Thermo Fisher Waltham, MA). Saliva was diluted 1:1 in saline prior to testing. Specimens were transported to the lab at 4C and frozen at -80C prior to testing.

Results (if a Case Study enter NA)
Seventy-four patients had both an NP swab and saliva tested in this study. Thirty of the 74 patients (41%) were unable to produce the full 1mL of saliva requested, but all samples had sufficient volume for testing after dilution. There were 34 positive samples obtained with an 82% positive agreement between the NP swabs and saliva. In 6 cases, the NP swab was positive, and the paired saliva was negative. In 1 case, only the saliva was positive. The average Ct of the positive NP swabs with a paired negative saliva sample was 39.6. There was only a single invalid test for one of the saliva samples.

Conclusion
Saliva was a straightforward sample to collect and test for SARS-CoV-2. Challenges included obtaining sufficient sample and a less predictable matrix that required dilution to ensure proper pipeting. In this study, NP swabs were more sensitive for detection of SARS-CoV-2. Paired saliva was more often negative in patients shedding small amounts of SARS-CoV-2 based on a high Ct of the positive NP sample.
Correlation Of Pcr Ct Values With Symptom Onset Across Diagnostic Platforms For Sars-Cov-2
Authors: Zia S Q , Mehrotra H , Tibbetts R J , Samuel L 
Published: October 2021

Abstract

Introduction/Objective
Following the definition of SARS-CoV2 outbreak as a pandemic by WHO, FDA gave EUA approval to the CDC real time polymerase chain reaction (PCR) assay and soon to other vendors to increase test availability. Most of testing platforms are PCR based, which test for multiple gene targets. We aimed to compare distribution of crossing threshold (cT) values of Diasorin (DIA), NeuMoDX (NDX) and Cepheid GenXpert (GX) for symptomatic and asymptomatic patients and assess performance of individual gene targets within the assays. We also correlated cT values with time from symptom onset.

Methods/Case Report
Retrospective review of medical and laboratory records of patients who tested positive for SARS-CoV2 between 08/01/2020 and 10/10/2020 on DIA, NDX, and GX platforms.

Results (if a Case Study enter NA)
We included 212 patients in our study. Days since symptom onset included 1 to 16 days. For DIA, mean Ct values for 46 symptomatic patients were 21.75 (S gene) and 22.74 (ORF1 gene); whereas 23.49 (S gene) and 25.49 (ORF1 gene) for 12 asymptomatic patients. Similarly, on NDX mean was 22.21 (N gene) and 23.13 (NSP2 gene) for 69 symptomatic, though 28.09 (N gene) and 28.61 (NSP2 gene) for 35 asymptomatic patients. GX manifested mean Ct value of 27.13 (E gene) and 31.22 (N2 gene) for 19 symptomatic; while 33.85 (E gene) and 36.42 (N2 gene) for 31 asymptomatic patients. Correlation coefficient for cT values versus days since symptom onset are DIA (r2 0.19), NDX (r2 0.22), and GX (r2 0.02).

Conclusion
The difference in cT values was statistically significant for symptomatic versus asymptomatic patients. There was positive correlation between days since symptom onset and cT values for DIA and NDX but not for GX, which may be due to difference in population tested in these platforms. These observations may be used to predict viral load and thus infectivity of patients who test positive for SARS-CoV2.
Novel discovery of Extended Spectrum β-lactamase (ESBL) Pluralibacter gergoviae in acute urinary tract infection and urolithiasis
Authors: Coate E , Merchen T , Cybulski R , Collier R , Mc Gann P , Mills E 
Published: October 2021

Abstract

Introduction/Objective
This case study describes the diagnosis, treatment, whole genome sequencing (WGS) and antibiotic resistance characterization from the ESBL-producing Pluralibacter gergoviae, a multi-drug resistant organism (MDRO) with a previously-documented presence in foodstuffs and cosmetics.

Methods/Case Report
A 39-year-old Hispanic American woman was admitted to the emergency department (ED) for fever, suprapubic tenderness, and pyuria. Three days prior to admission, patient underwent elective bilateral lithotripsy for retained nephrolithiasis. Seven days prior to ED admission, patient had an “Orgasm Shot” (O-Shot) which consists of platelet rich plasma that is drawn from the patient and injected into her vulvar area and around her clitoris to increase stimulation potential during orgasm. The patient was started on broad spectrum antibiotics, receiving Vancomycin and Ceftriaxone 1 gram 1 gram IV every 12 hours, intravenously. Urine cultures yielded two organisms, including a lactose fermenting as well as a non-lactose fermenting Gram negative rod. Mass spectrometry-based identification was successful in identifying the non-lactose fermenting colony as Pseudomonas aeruginosa, which also identified from a blood culture collected from the patient upon presentation to the ED. The lactose fermenting colony resulted in no identification by mass spectrometry but was identified using biochemical methods as Pluralibacter gergoviae, a recently-reclassified taxonomy previously identified as Enterobacter gergoviae. The P. gergoviae isolate was submitted to the Multidrug-Resistant Organism Repository (MRSN) at Walter Reed Army Institute of Research (WARIR) for WGS on Illumina Miseq. Sequencing and phenotypic/ genotypic data on isolate confirmed this as an ESBL P. gergoviae organism.

Results (if a Case Study enter NA)
NA

Conclusion
Summary data on possible epidemiological associations, antibiotic susceptibility testing, antibiotic resistance genes identified, and information on the antibiotic resistance plasmids will be presented. These findings from the WGS data, antibiotic susceptibilities will provide a lessons-learned for other clinical microbiology labs on how to identify unusual organisms such as P. gergoviae.
A rare case of Pneumocystis jirovecii and cytomegalovirus coinfection in the small bowel
Authors: Broder K , Geller R L , Del Rio C , Bhamidipati D 
Published: October 2021

Abstract

Introduction/Objective
Infection with Pneumocystis jirovecii remains a common cause of pneumonia in patients with Acquired Immune Deficiency Syndrome (AIDS). Extrapulmonary manifestations, however, are exceedingly rare. We describe a rare case of coinfection of the small bowel by Pneumocystis jirovecii and cytomegalovirus (CMV).

Methods/Case Report
A 48-year-old female with a history of HIV/AIDS, remote history of Pneumocystis jirovecii pneumonia, and previous non-compliance with HAART, presented to the emergency department with right lower quadrant abdominal pain, fever, and chills for 1 week. Her recent medical history included a hospital admission 1 month prior for community-acquired pneumonia with CD4 count and viral load of 12 cells/mcl and &gt;680,000 copies/mL, respectively; upon discharge she restarted HAART. When she presented to the emergency department in our case, she demonstrated leukocytosis (14.3 K/mcl), tachycardia (131 bpm), and hypotension (87/58 mmHg). An abdominal CT scan showed free air with concern for perforated viscus and multi-station lymphadenopathy with gastrohepatic and retrocaval nodes &gt;2 cm. A chest x-ray showed nodular and cavitary lesions, stable from prior imaging. The differential diagnoses in an AIDS patient with a gastrointestinal mass includes Kaposi’s sarcoma, lymphoproliferative process, or infection. The surgeons were concerned for tuberculosis as well, due to the hospital’s patient population, her bulky lymphadenopathy, and immune-compromised status. An exploratory laparotomy was performed and found jejunal perforations, mesenteric lymphadenopathy, and 3L of fluid in the abdomen. Pathology received 4 soft lymph nodes and a 57 cm segment of thickened small bowel with purulent perforation but no discrete mass. Microscopic examination showed a perforating pseudotumor and acute serositis extending to the margins of the specimen. Lymph node flow cytometry was negative for clonal populations. GMS stains highlighted innumerable “crushed-ping-pong-ball”-like fungal forms consistent with Pneumocystis in the jejunum and all 4 lymph nodes. A CMV immunohistochemical stain highlighted infected cells with nuclear enlargement and nuclear inclusions in the jejunum.

Results (if a Case Study enter NA)
NA

Conclusion
Extrapulmonary Pneumocystis infection is rare but clinicians, pathologists, and microbiologists must keep it in the differential of HIV patients, especially those who are not controlled on antiretroviral therapy.
Public health risk of Giardia and Cryptosporidium infection from urban wildlife
Authors: Leu-Burke G , Charoonsophonsak T , Madsen J 
Published: October 2021

Abstract

Introduction/Objective
The dedication of large areas in Anchorage for urban park environments encouraged increased interaction between migrating Canadian geese, approximately 1500 moose and humans. Urban wildlife inhabiting public establishments such as parking lots, creeks, playgrounds, and suburban backyards results in significant environmental fecal contamination. Previous studies found varying potential for zoonotic transmission of parasites through direct fecal contact or water contamination. With a significant number of vulnerable unsheltered individuals in Anchorage using public green belts, there is risk of asymptomatic, under diagnosed, parasitic infection due to exposure to fecal contamination.

Methods/Case Report
To assess environmental risk of parasitic zoonosis from urban wildlife, we surveyed fourteen high impact exposure areas including waterways and green spaces throughout Anchorage with ground collection of 106 fecal samples from moose (n=76) and geese (n=30). Using standard rapid antigen immunoassay detection method, we identified preserved samples for the presence of Cryptosporidium or Giardia.

Results (if a Case Study enter NA)
Overall evaluation of fecal samples found 23.6% positive for parasitic colonization in 87% of collection sites. Giardia was identified in 10.4% and Cryptosporidium in 13.2%. Comparative evaluation of each species found geese with a higher percentage of Cryptosporidium isolated (30%) when compared to moose (6%). Giardia was predominately found in moose (13%) with very few geese colonized.

Conclusion
Considering the high population of outdoor enthusiasts and a significant number of unsheltered individuals in Anchorage, discovering nearly a quarter of urban moose and geese colonized with Giardia and/or Cryptosporidium identifies a significant public health risk. Often using creeks and lagoons as their water source Anchorage’s vulnerable population includes a large number of immunocompromised HIV positive individuals in which parasitic infection, especially Cryptosporidium, can cause overall poor health and reduced quality of life. Therefore, active surveillance of parasitic colonization in urban wildlife is essential and continued evaluation necessary to determine public health risk.
Bacillus cereus Bacteremia: An Unusual Case Following Food Poisoning
Authors: Sabri A , Cavalieri S , Ahmad F , Martin S , Abushattal A 
Published: October 2021

Abstract

Introduction/Objective
Bacillus cereus is a spore-forming, gram-positive rod, well known for causing food poisoning. In addition, this bacterium often presents as a contaminant of blood cultures. Differentiating true bacteremia from contamination of blood samples is important as it has treatment implications. Early recognition is necessary, as it can cause septic shock if untreated. We present a challenging case of food poisoning with concomitant bacteremia in a young patient with a history of diabetes mellitus (DM), celiac disease, and new-onset chronic kidney disease (CKD).

Methods/Case Report
A 23-year-old adult male with a history of DM, new-onset CKD, and celiac disease presented with nausea, intermittent vomiting, and lower abdominal pain for 2 weeks. On initial evaluation, he had normal blood pressure but tachypnea and tachycardia. Physical examination was significant for left lower quadrant and flank tenderness. The symptoms were persistent and progressed to point that he could not tolerate meals due to vomiting. Two weeks earlier, he presented with similar complaints along with dysuria and was treated for suspected urinary tract infection with Co-trimoxazole. This time, further workup revealed normal white blood cell count (11.8 k/µL) with 81% neutrophils, elevated creatinine (3.56 mg/dL), blood urea nitrogen (49 mg/dL), and procalcitonin (0.39 ng/mL), with abnormal urinalysis showing increased turbidity, pyuria, and nitrituria. He was started on ceftriaxone, fluids, antiemetics and was admitted to the hospital for further management. The urine culture had no bacterial growth. Two sets of peripheral blood cultures (different sites at different times) had gram-positive rods which eventually turned out to be B. cereus, identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Levofloxacin was started, and he reported improvement in nausea and vomiting by the next day of admission and was discharged.

Results (if a Case Study enter NA)
NA

Conclusion
Differentiating true B. cereus bacteremia from blood sample contamination is important. Additionally, no symptoms are specific for B. cereus-associated food poisoning, and the presence of risk factors doesn’t always favor this entity over other entities, hence adding difficulty to the diagnosis. A high index of suspicion is needed, as early intervention can prevent the development of life-threatening complications.
Practical Approach to the Pathologic Diagnosis of Mixed Filamentous Fungal Infections in Burn Wounds: A Case Series
Authors: Pyden A D , Solomon I , Laga Canales A 
Published: October 2021

Abstract

Introduction/Objective
Opportunistic infections by fungi are a major source of morbidity and mortality in patients suffering from extensive burn wounds. Here we review a series of cases of infections by multiple fungi in burn wounds as diagnosed by histopathology and outline the key features for the pathologist to include in the report.

Methods/Case Report
Biopsies from patients with more than one fungal species identified in the laboratory in a concurrent culture or by PCR were included in this study. Three cases are presented with multiple fungi identified. Each case had yeast and at least one different hyaline mold species present on pathology; two cases additionally had mucormycetes present, with angioinvasion in one case. All organisms requiried microbiologic cultures and variably required molecular testing for full identification.

Results (if a Case Study enter NA)
N/A

Conclusion
Pathologists should be aware of the possibility of infection by multiple fungal species in burn wounds. Fungal morphology in tissue sections should allow for detection and distinction of mucormyctes and other hyaline molds. Histopathologic correlation with culture and/or PCR results is essential to distinguish potential contaminants from true infection.