Irina Ivanova

Desmoid abdominal tumour: A clinical case report and brief literature review

Desmoid tumours are unique mesenchymal neoplasm. They are able to spread to proximal tissues but tend not to metastasize. Our case presents a 66-year-old female referred for evaluation of the prominent, palpable mass located into the left abdomen. Imaging studies revealed a tumour up to 22 cm, extending below the diaphragm to the retroperitoneal and intra-abdominal cavity. Contrast enhanced ultrasound showed strong inhomogeneous arterial hyper-enhancement followed by persistent enhancement in a venous phase. Histology obtained with tru-cut needle biopsy established desmoid tumour, with overall proliferating activity (Ki-67 expression) of 20%. The lesion had been identified as sporadic and ‘unresectable’. During the patient’s follow-up a slow but continuous elevation of serum creatinine was registered eventually led to anuria, requiring emergent haemodialysis. The non-obstructing nephropathy is an unusual complication of the disease course, therefore we briefly reviewed the published data on abdominal desmoid tumours and critically analysed the relation with kidney injury.

Chronic Hepatitis Due to Gluten Enteropathy – a Case Report

Abstract Background: Celiac disease is an immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals. Case description: A 45-year-old Caucasian woman presented with severe iron-deficient anemia and mild elevation of liver enzymes. Upper endoscopy was done in the context of evaluation of anemia, which revealed reduced duodenal folds and mosaic pattern of the mucosa, but also grade II esophageal varices and portal hypertensive gastropathy. Duodenal biopsy showed total villous atrophy, diffuse mainly lymphocytic infiltrate, presence of intra-epithelial lymphocytes. Serology test confirmed celiac disease by the typical pattern of high titer positive IgA and IgG antibodies to tissue transglutaminase. Liver biopsy was performed for staging and etiological evaluation, because laboratory screening ruled out common viral, metabolic and autoimmune liver disease. Liver morphology was consistent with chronic hepatitis without findings for extensive fibrosis. Our patient had poor dietary compliance, so we failed to established improvement of liver enzymes and resolution of anemia during follow-up. Conclusions: We would like to stress on the diverse clinical manifestations of celiac disease and the importance of serologic screening with antibodies to tissue transglutaminase in differential diagnosis of chronic liver disease.

A Rare Comorbidity: Dermatitis Herpetiformis and Sarcoidosis - A Case Report

Sarcoidosis is an enigmatic, multisystem granulomatous disease of unknown etiology and wide range of clinical presentations. Case report: A 54-year-old female presented with facial rash: polymorphic, round, infiltrated erythematous plaques, 1 3 cm in size, disseminated on several areas of the face. The medical history was consistent with dermatitis herpetiformis and persistent intrahepatic cholestasis. The laboratory test results suggested celiac disease (strong positivity of IgA anti-tissue transglutaminase antibodies) but upper endoscopy was not performed to confirm it. The skin biopsy revealed noncaseating epithelioid-cell granulomas, and negative direct immunofluorescence showed IgA deposits in the dermis. Sarcoidosis with cutaneous and hepatic involvement was established based on compatible clinical findings and supportive histology. The period between manifestations of Duhring disease and skin manifestations of sarcoidosis was 20 years. Conclusion: Our clinical case supports the hypothesis for common immune pathogenic factors in gluten-sensitive diseases and sarcoidosis. The simultaneous occurrence of celiac disease and sarcoidosis is rare, but should not be under recognized.

Serum level of the human antimicrobial cathelicidin (hCAP18/LL-37) in patients with psoriasis vulgaris

Introduction : Psoriasis is a chronic immune-mediated inflammatory disease. Human cathelicidin (hCAP18/LL37) has been elucidated recently as a modulator of inflammation in the affected skin. Vitamin D may induce expression of this antimicrobial peptide. Our trial aimed to study the circulating level of hCAP18/LL-37 and to explore its relationship with the severity of psoriasis. Material and Methods : 79 patients with moderate to severe psoriasis (PASI >10) were included in a retrospective analysis. Stored serum samples were used for assessment of 25-hydroxyvitamin D - 25(OH)D and to measure the circulating human cathelicidin (LL-37). Results : In a study group of 79 patients we assessed mean level of 25(OH)D of 30.25 nmol/l (95% CI 25.87 – 34.62 nmol/l). Mean circulating cathelicidin was 27.17 ng/ml (95% CI 21.52 – 32.83 ng/ml). Only 8.9% of patients had LL-37 level > 54 ng/ml. Although circulating LL-37 was lower in severe psoriasis than in moderate psoriasis (24.33 ng/ml vs. 31.14 ng/ml), the variation is nonsignificant. We further evaluated the association of LL-37 with both PASI score and 25(OH)D concentration in the subgroup of patients with vitamin D deficiency (n=39). It was interesting to find a significant correlation between the level of LL-37 and 25(OH)D (r=0.38, p=0.017) and inverse association between the level of LL-37 and PASI (r= -0.30, p=0.06). Conclusion : In this pilot trial we assessed low serum levels of cathelicidin antimicrobial peptide in the patients with psoriasis. LL-37 may be discussed as related to PASI and 25(OH)D in a subgroup of psoriatic patients with vitamin D deficiency.