Secukinumab-induced IgA vasculitis in a patient with psoriatic arthritis

OBJECTIVES

Secukinumab (SEC) is an effective and widely used drug in psoriatic disease and axial spondyloarthritis. However, SEC has been found to be associated with inflammatory conditions and vasculitis. These inflammatory adverse effects may complicate the treatment of underlying disease, and clinicians may experience difficulties in recognizing and managing this unusual condition.

CASE REPORT

A man aged 56 years with psoriatic disease refractory to conventional disease-modifying antirheumatic drugs was given adalimumab for 6 weeks, then switched to SEC when his psoriatic lesions were exacerbated. After 3 weeks of SEC treatment, he developed systemic features of IgA vasculitis while his skin lesions and arthritis persisted.

CONCLUSIONS

Although SEC-related inflammatory adverse events, including vasculitis, are rarely encountered in clinical practice, it is essential to recognize them because they can be mistaken as a component of the underlying inflammatory disease. In addition, the dramatic improvement in many cases after the cessation of SEC underlines the importance of making an accurate diagnosis. Pathogenetically, these adverse events are likely to be paradoxical reactions, except for SEC-induced inflammatory bowel diseases. However, in many aspects, their pathogenesis is controversial and needs clarification.

The Effect of Adherence to Mediterranean Diet on Disease Activity in Patients with Inflammatory Bowel Disease

BACKGROUND/AIMS

Mediterranean diet, owing to its infla mmati on-mo dulat ory effects, is considered a beneficial dietary regimen for patients with inflammatory bowel disease. Despite promising results in the literature, studies on this subject are still limited. Therefore, the aim of this study was to evaluate adherence to the Mediterranean diet in patients with inflammatory bowel disease and examine its impact on disease activity and quality of life.

MATERIALS AND METHODS

A total of 83 patients were included in the study. Mediterranean Diet Adherence Scale was used to evaluate adherence to the Mediterranean diet. Crohn's Disease Activity Index was used to evaluate disease activity in Crohn's disease. Disease activity was determined by using the Mayo Clinic score for ulcerative colitis. Quality of Life Scale Short Form-36 was used to evaluate the quality of life of patients.

RESULTS

When the median Mediterranean Diet Adherence Scale score was 7 (1-12), only 18 patients (21.7%) showed strong adherence to the Mediterranean diet. Disease activity scores of patients with ulcerative colitis having low adherence to the Mediterranean diet were found to be higher (P < .05). In addition, some quality of life parameters were relatively higher in patients with ulcerative colitis who showed strong adherence to the Mediterranean diet (P < .05). For Crohn's disease, no significant difference was found in disease activity and quality of life with respect to adherence to the Mediterranean diet (P > .05).

CONCLUSIONS

Stronger adherence to the Mediterranean diet in patients with ulcerative colitis can help improve quality of life and modulate disease activity. However, further prospective studies are needed to investigate the potential use of the Mediterranean diet in inflammatory bowel disease management.

Factors affecting the development of complications in Crohn's disease in patients undergoing intestinal resection

Surgery is a common form of management for Crohn disease (CD) in the presence of intra-abdominal complications. In this study, we investigated the effect of various factors on the development of postoperative complications in patients who underwent surgery for complicated CD. Patients who underwent surgery between 2011 and 2018 were included in this study. Information on age, sex, presence of extraintestinal findings, operation indications, operation type, and postoperative complications was obtained. Groups with and without postoperative complications were compared according to body mass index, American Society of Anesthesiologists score, comorbidities, smoking status, preoperative drug use, presence of perianal disease, presence of a stoma, synchronous small intestine resection surgery, duration of hospital stay, and preoperative biochemical parameters. A total of 192 patients were included, of which 53.1% were female and 46.9% were male. Patients were indicated for surgery for reasons such as stricture, abscess, fistula, and tumor development. As the surgical method, patients were operated on by open or laparoscopic method (86% and 14%, respectively). Postoperative complications occurred in 30 female and 33 male patients (15.6% and 17.1%, respectively). Patient age, smoking status, steroid use, perianal disease, presence of stoma, and presence of extra intestinal findings were significantly higher in the complicated group. Surgery may be inevitable for CD in the presence of complications. In cases of patient age, smoking, steroid use, perianal disease, stoma opening, and presence of extra intestinal findings, patients with CD who undergo surgery should be followed up closely in terms of the development of complications.

Enterobius vermicularis Infestation Mimicking Rectal Malignancy

Enterobius vermicularis is a common intestinal nematode of humans that can be considered relatively harmless. A polypoid lesion mimicking malignancy was detected in the rectum of a 66-year-old female patient who had been operated for sigmoid colon adenocarcinoma in the past. Histopathological examination of the lesion revealed no malignancy but there was adult E. vermicularis nematodes and eggs. In this case report, we aimed to present an enterobiasis infestation that produces non-necrotizing granuloma tissue in the rectum.

Comparison of new and classical point mutations associated with clarithromycin resistance in Helicobacter pylori strains isolated from dyspeptic patients and their effects on phenotypic clarithromycin resistance

PURPOSE

We aimed to investigate the presence of three recently identified point mutations (A2115G, G2141A and A2144T) of the 23 S rRNA gene and compare them with the three most frequently encountered point mutations (A2142G, A2142C and A2143G) in Helicobacter pylori strains in Turkey.

METHODOLOGY

A total of 63 patients (mean 47.08±12.27) were included. The E-test method (for clarithromycin) was used for the clarithromycin antimicrobial susceptibility test of isolated H. pylori strains. Real-time PCR was used to detect the point mutations.

RESULTS

A total of 24 out of 63 H. pylori strains (38.1%) were detected as clarithromycin resistant (>0.5 mg l^-1 ). The new A2115G (n:6, 25%), A2144T (n:7, 29.1%) and G2141A, 8 (n:8, 33.3%) mutations and the classical A2142G (n:8, 33.3%) and A2143G (n:11, 45.8%) point mutations were detected in the 24 clarithromycin-resistant strains. The A2144T point mutation had the highest median MIC value (3 mg l^-1 ) amongst the new mutations, but the classical mutations (A2142G and A2143G) had the highest median MIC values (256 mg l^-1 ) overall. The presence of the A2115G (OR:31.66), A2144T (OR:36.92) or G2141A (OR:28.16) mutations increased the likelihood of clarithromycin resistance in H. pylori strains by 31.66-, 36.92- and 28.16-fold (ORs), respectively, according to the binary logistic regression analysis.

CONCLUSION

We concluded that classical mutations of the 23 S rRNA gene resulted in higher clarithromycin MIC values than new mutations. These new point mutations caused moderate elevations in the MIC values of clarithromycin-resistant H. pylori strains.

Patterns of EPIYA motifs among cagA-positive Helicobacter pylori strains: a case-control study in a Turkish population with Eurasian geographical features

Geographical variation in the frequency of various gastroduodenal pathologies was shown to be related to the geographical diversity of H. pylori CagA Glu-Pro-Ile-Tyr-Ala (EPIYA) patterns. We examined the EPIYA patterns of H. pylori and the association of EPIYA patterns with gastric cancer (GC) for the first time, to the best of our knowledge, in Turkey. The patient group (PG) contained 60 patients [38 GC and 22 duodenal ulcer (DU) patients]. The control group (CG) was 110 individuals [94 gastritis patients and 16 persons with a normal gastrointestinal system (NGIS)]. Specific primers were used for the detection of cagA including empty-site-positive and EPIYA-A, -B, -C, -D PCR. Bands of EPIYA-A, -B, -C were confirmed by DNA sequencing. One hundred and forty-two (83.5 %) strains [60 in the PG (38 GC, 22 DU), 82 in the CG (72 gastritis, 10 NGIS)] were positive for the cagA gene. EPIYA-C with multiple repeats was detected in 34 (23.9 %) strains, and 22 (64.7 %) were from GC patients. EPIYA-C with one repeat was detected in 89 (62.7 %) strains, and 54 (60.7 %) were from gastritis patients. EPIYT was detected in 10 strains, and EPIYA-D was not detected. The number of EPIYA-C with multiple repeats was significantly higher for the PG than for the CG (P < 0.0001). In GC patients, the number of EPIYA-C with multiple repeats was significantly higher than one repeat (P < 0.0001). In conclusion, our study showed that multiple EPIYA-C repeats increases the GC risk by 30.6-fold and the DU risk by 8.9-fold versus the CG. This indicates that Western-type H. pylori strains in Turkey have similar EPIYA motifs to those of neighbouring countries and Western populations.

The cytokine response in THP-1 (monocyte) and HL-60 (neutrophil-differentiated) cells infected with different genotypes of Helicobacter pylori strains

BACKGROUND/AIMS

Helicobacter pylori (H. pylori) is a microaerophilic bacterium related with peptic ulcer and gastric cancer. Its virulence factors include cytotoxin-associated gene A (CagA) and vacuolating cytotoxin gene A (VacA) proteins. Cytokine release inducted by H. pylori colonization has an important role in pathogenesis of H. pylori. The severity of gastric pathologies depends on the H. pylori genotypes found in different geographical regions. We aimed to determine the relationship between different H. pylori genotypes and their effects on the cytokine release levels.

MATERIALS AND METHODS

ureC, cagA, vacAs1/s2, vacAm1/m2, and blood group antigen-binding adhesion protein A2 (babA2) virulence related genes were investigated in 21 H. pylori strains. Genotyping of 21 strains were made due to the presence of cagA, vacAs1/s2, vacAm1/m2, and babA2 genes. The H. pylori strains were cultured together with THP-1 and neutrophil-differentiated Human promyelocytic leukemia cells (HL-60) cells. The levels of cytokines interleukin (IL)-1β, IL-6, IL-8, IL-12, tumor necrosis factor-alpha (TNF-α), and IL-10 in these cells were measured after co-culturing with H. pylori strains.

RESULTS

The following five different genotypes were detected: Genotype1: cagA and vacAs1m2; Genotype2: cagA and vacAs1m1; Genotype3: cagA, vacAs1m2, and babA2; Genotype4: vacAs2m2; and Genotype5: cagA and vacAs2m2. All these genotypes significantly induced the levels of IL-1β, IL-6, IL-8, IL 10, and TNF-α in THP-1 cells. Genotype 5 caused higher amounts of IL-1β, IL-6, TNF-α, and IL-10, whereas genotype 1 induced the highest levels of IL-8. In neutrophil-differentiated HL-60 cells, genotype 4 increased IL-6 levels and genotype 3 and 4 elevated IL-8 levels significantly.

CONCLUSION

These results suggested that cytokine response of the host varies depending on the specific immune response of the host against different H. pylori strains.

Bone marrow transplantation for Behçet's disease: a case report and systematic review of the literature

OBJECTIVES

Behçet's disease (BD) can be life threatening and may be refractory to corticosteroids and immunosuppressives. There has been some experience with haematopoietic stem cell transplantation (HSCT) in BD either for severe, refractory disease or for a haematological condition. The objectives of this study were to describe a BD patient undergoing HSCT and to evaluate the outcomes of BD patients who underwent HSCT.

METHODS

We report a BD patient with refractory gastrointestinal (GI) involvement who had HSCT for concomitant myelodysplastic syndrome (MDS). We also performed a systematic literature search regarding HSCT for either refractory disease or concomitant haematological conditions in BD patients.

RESULTS

A 30-year-old woman with refractory GI BD involvement with trisomy 8 MDS underwent a successful myeloablative allogeneic HSCT resulting in complete resolution of both BD and MDS. Additionally we identified 14 manuscripts providing data on 19 patients with BD who had HSCT. Among these 20 patients, including ours, refractory disease was the indication of transplantation in 9, while 11 patients were transplanted because of accompanying haematological conditions. Transplant indications for the nine patients (four male, five female) with refractory BD were neurological involvement in five, pulmonary artery aneurysm in two, GI disease in one and not reported in one patient. Three patients with neurological disease, both patients with pulmonary artery aneurysm and the patient with intestinal involvement achieved complete remission of their disease. Six patients transplanted for haematological conditions, including the presented case, also had GI involvement of BD. All of these patients achieved complete remission of GI findings after HSCT.

CONCLUSION

When considering HSCT, the potential adverse events and complications, which can be fatal, need to be kept in mind.