A. Onetti Muda

Autoimmune hepatitis associated with infliximab in a patient with psoriatic arthritis

We read with interest the debate about liver toxicity of infliximab in psoriatic arthritis (PsA).1,2 We describe the case of a 53 year old woman with a 4 year history of refractory PsA who developed transaminasitis during infliximab treatment. Despite combination treatment (ciclosporin 300 mg/day, fluocortolone 10 mg/day, and methotrexate (MTX)15 mg/week intramuscularly), disease activity was still high, and intravenous infliximab at 3 mg/kg was administered initially at weeks 0, 2, 6, 14 and then every 6 weeks. Ciclosporin was withdrawn. Within 3 weeks she improved, fluocortolone was gradually stopped while methotrexate (MTX) 20 mg/week intramuscularly, was continued. After the sixth infusion, she developed a mild transaminasitis and MTX, initially tapered, was stopped. After the eighth infusion transaminases continued to rise and in the absence of any other plausible cause, infliximab was withdrawn. She was admitted to our department with persistently high values of aspartate aminotransferase and alanine aminotransferase and a flare of PsA. …

Cephotaxime-associated allergic interstitial nephritis and MPO-ANCA positive vasculitis.

We report a case of reversible acute renal failure after cephotaxime treatment in a patient affected by non-Hodgkin lymphoma. Renal biopsy showed necrotizing vasculitis associated with eosinophil-rich interstitial inflammatory infiltrates and patchy infiltrates of CD20+ lymphoid cells. High serum p-ANCA titers were also detected. Drug withdrawal was closely related with recovery of renal function and disappearance of ANCA. Acute renal failure therefore represented a consequence of ANCA-mediated renal vasculitis and acute interstitial nephritis related to cephotaxime treatment.

Co-occurrence of Psoriatic Arthritis with Collagenous Colitis: Clinicopathologic findings of a Case

Abstract A 58-year-old man developed psoriatic arthritis and, after 6 months, persistent watery diarrhoea. Biopsies from the colorectal mucosa showed thickened subepithelial collagen consistent with collagenous colitis. There also was an inflammatory cell infiltration (mainly lymphocytes and monocytes) in the chorion. These findings and the parallel course of articular and bowel complaints suggest a clinicopathologic correlation between arthritis and colic involvement.

Multicentric intranodal myofibroblastoma in an infant

Introduction Interstitial haemorrhage and hemosiderin deposition were not seen. Primary spindle cell neoplasms of lymph nodes are rare. Immunohistochemistry showed intracytoplasmic They include leiomyoma’, Kaposi’s sarcoma involving positivity for vimentin and actin. Staining for damin, a lymph node2. blue naevi3, tumours of reticulum cell s-100 protein, cytokeratin and human factor VIII was derivation4” and intranodal myofibroblastoma‘-’ ’. The negative. latter is a rare neoplasm with a peak incidence in adulthood. It was first described in 19896-9 as a spindle cell lesion involving one node: recently, a recurrent and multicentric case has been reported”. We report the first case of multicentric intranodal myofibroblastoma occurring in the paediatric age group.

Freeze-drying of bone tissue: immunocytochemistry and enzyme histochemistry on paraffin embedded and low-temperature resin embedded specimens

A simple protocol of tissue preparation was sought, which would enable marker enzymes of bone cells and extracellular matrix antigens to be localized in the same tissue section with high optical resolution. For this purpose, snap-frozen samples of rat fetal skeletal tissues were dried in a FDU 010 freeze-drying unit (Balzers) for 8–12 h at −50 to −40°C and 0.02 bar. Freeze-dried tissues were either vacuum-infiltrated at 45°C and embedded undemineralized in Paraplast, or vacuum-infiltrated overnight at 4°C and embedded undemineralized in glycol methacrylate. These procedures enabled enzyme cytochemistry for alkaline phosphatase and tartrate-resistant acid phosphatase, and immunocytochemical staining for collagen types I, III, and laminin to be performed on the same sections. No pretreatment of the sections was necessary to reveal collagen antigenicity. This study reveals the possibility of complementing immunocytochemical studies of extracellular matrix with enzyme cytochemistry and, above all, with the excellent tissue preservation and high resolution afforded by plastic embedding.

Epidermolysis Bullosa of the Dowling‐Meara Type: Clinical and Ultrastructural Findings in Five Patients

Abstract: Clinical and pathologic features of five cases of epidermolysis bullosa simplex, Dowling‐Meara type (EBS‐DM), are described. Four patients were children, and two were related (father and daughter). Clinical history revealed blistering at birth in three patients; in all of them the signs and symptoms improved with age. Histopathologic and ultrastructural examinations showed cytolysis of the basal cells and clumping of the tonofilaments within the cytoplasm of keratinocytes. Two distinct types of clumps were observed: round (3 patients) and whisklike (2 patients). Two patients had both types of clumps. The presence of both types in the same patient suggests that subtyping of the disease is still premature.

Infantile Condylomata of the Oral Cavity

A child had condylomata acuminata localized to the oral cavity. Main points of interest were this exclusive localization, the extremely high number of papillary lesions, not reported in the literature until now, and the excellent response to interferon and local applications of podophyllin. Histologic, ultrastructural, and in situ molecular hybridization techniques were performed to make a correct diagnosis. Transmission of the etiolgic agent and therapeutic approaches are discussed.

THU0172 The role of T regulatory lymphocytes in lupus nephritis

Background Regulatory T cells (Tregs) play a key role in the maintenance of immune tolerance and in the development of autoimmune diseases. Expression of Foxp3, a member of forkheadbox family of transcription factors, is specific for Treg cells and can be used for the identification of these cells. Systemic Lupus Erythematosus (SLE) is a prototype autoimmune disease characterized by dysregulated activation of T and B lymphocytes, causing multiple organ damage. There is a high incidence of renal involvement during the course of the disease with varied pathologic and clinical features. Several studies describe a quantitative and/or qualitative abnormalities of peripheral Tregs in SLE. However, the role of Tregs in lupus nephritis (LN) is still unclear. Objectives Aim of the study:The study aims to investigate the variations of Tregs Foxp3+ in the kidney biopsies inflammatory infiltrate of different LN classes (according to ISN/RPS 2003 criteria) compared to that of ANCA associated crescentic glomerulonephritis (ANCA- CrGN), acute tubulointerstitial nephritis (ATIN) and nephroangiosclerosis (NAS). Methods Investigation was carried out on renal biopsy samples of 27 patients with histologically proven LN classified according to the ISN/RPS 2003 criteria (class III: 3 patients, class IV: 17 patients, class V: 7 patients), 3 patients with ANCA-CrGN, 6 patients with ATIN, and 2 patients with NAS. Sections of paraffin embedded tissue have been stained by immunohistochemistry with anti-CD3 and anti-FoxP3 antibodies, performed separately on consecutive sections. The number of FoxP3 positive cells and CD3 positive per mm2 was counted after digitalization of slides and application of a dedicated image analysis software. Results Amount of CD3+ cells was higher in ATIN (5713/mm2) and in ANCA-CrGN (5121/mm2) than in LN-IV (3558/mm2), LN-III (2491/mm2), NAS (2379/mm2) and LN-V (2220/mm2). Instead, we found that the ratio of FoxP3+/CD3+ cells was significantly lower in patients with LN-IV (1,6) and, although less significantly, in patients with CrGN (3) than in course of NAS (3,9), ATN (4), and LN-V (4,5). Conclusions The data presented herein, demostrate a decrease of Foxp3+ Treg cells in the inflammatory infiltrate of lupus nephritis. These results, although preliminary, suggest an important role of Tregs in the pathogenesis of autoimmune diseases, particularly during the most active phases of LN, as observed in LN-IV class. Disclosure of Interest None Declared