A case of urticarial vasculitis in a female patient with lupus: Mycoplasma pneumoniae infection or lupus reactivation?

Efficacy and Influencing Factors of Sangju Cough Mixture in the Adjuvant Treatment of Adult Patients with Mycoplasma pneumoniae Infection: A Retrospective Study

Purpose

Sangju-Yin, supplemented with some drugs, has frequently demonstrated therapeutic efficacy against colds, albeit its effect on Mycoplasma pneumoniae (MP) infection remains unknown. Therefore, we aimed to elucidate the treatment efficacy and influencing factors of a Sangju cough mixture on MP infection in adults.

Patients and Methods

Between January 2021 and December 2022, 150 adult patients with MP infection at the Lishui Hospital of Traditional Chinese Medicine Affiliated with Zhejiang University of Traditional Chinese Medicine were assigned to the treatment (administered Sangju cough mixture and moxifloxacin tablets) or the control (administered moxifloxacin tablets) groups.

Results

When compared with the control group, the treatment group exhibited significantly improved traditional Chinese medicine syndrome scores, increased CD4+ T cell levels, and decreased CD8+ T cell levels (all P < 0.05). After 7 days of treatment, the negative conversion rate of the MP-specific immunoglobulin M (MP-IgM) antibody of the treatment group was not significantly different from that of the control group (P > 0.05); however, after 14 days of treatment, the rate was significantly higher in the treatment group (P < 0.05). The univariate regression analysis revealed that combined chronic respiratory disease, failure to take Sangju cough mixture, combined pneumonia, Nutritional Risk Screening 2002 (NRS 2002) score of at least 3 points, and age were associated with the negative conversion of the MP-IgM antibody (all P < 0.05). Nevertheless, the multivariate regression model revealed that the NRS 2002 score of at least 3 points was not an independent risk factor (P > 0.05).

Conclusion

Sangju cough mixture can improve symptoms, accelerate the negative conversion time of MP-IgM antibody, and promote rehabilitation of the patients.

Serum amyloid a, C-reactive protein, and procalcitonin levels in children with Mycoplasma pneumoniae infection

Background

Mycoplasma pneumoniae (MP) is a common pathogen of community‐acquired pneumonia in children. In the present study, serum amyloid A (SAA), C‐reactive protein (CRP), and procalcitonin (PCT) levels in children with MP infection were analyzed and the differential diagnoses of MP evaluated.

Methods

The study included 152 children with MP infection hospitalized in Tai’an Central Hospital in Shandong Province and 50 healthy children as controls. SAA, CRP, and PCT, as well as serum immunoglobulins and T lymphocyte subsets were analyzed during the acute and convalescent phases. Among the MP‐infected children, 30 cases were selected to monitor the SAA, immunoglobulins, and T lymphocyte subset levels for a week.

Results

The SAA, CRP, PCT, IgA, and IgM levels were significantly higher in the MP‐infected group than in the control group (F_(SAA) = 83.91, p < 0.05; F_(CRP) = 40.79, p < 0.05; F_(PCT) = 60.58, p < 0.05; F_(IgA) = 43.45, p < 0.05; F_(IgM) = 233.88, p < 0.05). In addition, the levels of these factors were significantly higher in the acute phase than in the convalescent phase (p < 0.05). However, significant difference was not observed in the IgG level between these two groups (p > 0.05). The CD3⁺ and CD4⁺ levels in the MP‐infected group were lower than in the control group ( F_(CD3+)= 60.58, P < 0.05; F_(CD4+) = 89.05, p < 0.05), and the CD8⁺ level was higher than in the control group ( F_(CD8+)= 96.96, p < 0.05). The CD3⁺, CD4⁺, and CD8⁺ levels were significantly different between the acute phase and the convalescent phase (CD3⁺: acute phase vs. convalescent phase, q = 2.79, p < 0.05; CD4⁺: acute phase vs. convalescent phase, q = 2.83, p < 0.05; CD8⁺: acute phase vs. convalescent phase, q = 3.15, p < 0.05). The changes in serum SAA levels in the MP‐infected group positively correlated with the changes in IgA, IgM, and CD8⁺ levels and negatively correlated with CD3⁺, CD4⁺, and CD4⁺/CD8⁺.

Conclusion

SAA, CRP, and PCT were specific markers for diagnosing early MP infection in children. These findings are important in the differential diagnosis of MP infection and clinical guidance for MP treatment.

A case report of a boy suffering from type 1 diabetes mellitus and familial Mediterranean fever

BACKGROUND

Type 1 diabetes mellitus could be associated with other autoimmune diseases, such as autoimmune thyroid disease, celiac disease, but the association with Familial Mediterranean Fever is rare, we describe a case of a boy with type 1 Diabetes Mellitus associated with Familial Mediterranean Fever (FMF).

CASE PRESENTATION

A 13 year old boy already suffering from Diabetes Mellitus type 1 since the age of 4 years, came to our attention because of periodic fever associated with abdominal pain, chest pain and arthralgia. The fever appeared every 15-30 days with peaks that reached 40 °C and lasted 24-48 h. Laboratory investigation, were normal between febrile episodes, but during the attacks revealed an increase in inflammatory markers. Suspecting Familial Mediterranean Fever molecular analysis of MEFV gene, was performed. The genetic analysis showed homozygous E148Q mutation. So Familial Mediterranean Fever was diagnosed and colchicine treatment was started with good response.

CONCLUSION

Familial Mediterranean Fever could be associated with other autoimmune diseases such as Ankylosing Spondylitis, Rheumatoid Arthritis, Polyarteritis Nodosa, Behcet disease, Systemic Lupus, Henoch-Schönlein Purpura, and Hashimoto's Thyroiditis. Association of type 1 Diabetes Mellitus and Familial Mediterranean Fever has been newly reported in the medical literature, this is the third association of these two diseases described in the medical literature so far.

Atypical Bacterial Pathogens and Small-Vessel Leukocytoclastic Vasculitis of the Skin in Children: Systematic Literature Review

Leukocytoclastic small-vessel vasculitis of the skin (with or without systemic involvement) is often preceded by infections such as common cold, tonsillopharyngitis, or otitis media. Our purpose was to document pediatric (≤18 years) cases preceded by a symptomatic disease caused by an atypical bacterial pathogen. We performed a literature search following the Preferred Reporting of Systematic Reviews and Meta-Analyses guidelines. We retained 19 reports including 22 cases (13 females and 9 males, 1.0 to 17, median 6.3 years of age) associated with a Mycoplasma pneumoniae infection. We did not find any case linked to Chlamydophila pneumoniae, Chlamydophila psittaci, Coxiella burnetii, Francisella tularensis, or Legionella pneumophila. Patients with a systemic vasculitis (N = 14) and with a skin-limited (N = 8) vasculitis did not significantly differ with respect to gender and age. The time to recovery was ≤12 weeks in all patients with this information. In conclusion, a cutaneous small-vessel vasculitis with or without systemic involvement may occur in childhood after an infection caused by the atypical bacterial pathogen Mycoplasma pneumoniae. The clinical picture and the course of cases preceded by recognized triggers and by this atypical pathogen are indistinguishable.

Vasculitis in Juvenile-Onset Systemic Lupus Erythematosus

Juvenile-onset systemic lupus erythematosus (JSLE) is a rare, heterogeneous multisystem autoimmune disease that can affect any organ, and present with diverse clinical and serological manifestations. Vasculitis can be a feature of JSLE. It more commonly presents as cutaneous vasculitis than visceral vasculitis, which can affect the central nervous system, peripheral nervous system, lungs, gut, kidneys, heart, and large vessels. The incidence and prevalence of vasculitis in JSLE has not been well described to date. Symptoms of vasculitis can be non-specific and overlap with other features of JSLE, requiring careful consideration for the diagnosis to be achieved and promptly treated. Biopsies are often required to make a definitive diagnosis and differentiate JSLE related vasculitis from other manifestations of JSLE, vasculopathies, and JSLE related antiphospholipid syndrome. Visceral vasculitis can be life threatening, and its presence at the time of JSLE diagnosis is associated with permanent organ damage, which further highlights the importance of prompt recognition and treatment. This review will focus on the presentation, diagnosis, management and outcomes of vasculitis in JSLE, highlighting gaps in the current evidence base.