IgA Vasculitis with scrotal involvement - a rare presentation in adults

IgA vasculitis (IgAV) is a small-vessel vasculitis common in children but rare in adults. It is usually an auto-limited disease in children but has a more severe course and worse prognosis in adults. The classical manifestations are non-thrombocytopenic purpura, arthralgias, gastrointestinal involvement and renal involvement. Herein we report a case of a 39-year-old man with a rash of the lower limbs associated with testicular and lower abdominal pain. The initial study revealed increased inflammatory biomarkers and enlarged left testis with bilateral ischemic areas on doppler ultrasound. A cutaneous biopsy later revealed leukocytoclastic vasculitis, confirming the diagnosis of IgAV with scrotal involvement. The patient started prednisolone, with improvement in the first week and sustained remission after two years of follow-up. This case report describes an adult with IgAV and scrotal involvement, which is rarely reported in adults and appears to be different from the one in children. The prevalence of scrotal involvement is presumably underestimated. In all men with IgAV, a scrotal examination should be performed and ultrasonography accordingly since it affects the treatment and follow-up. Recommendations for IgAV diagnosis and treatment in adults are still lacking and more research is needed.

Effects of gastroesophageal reflux on esophageal motility

Esophageal characteristics during swallowing in individuals with reflux are not well known. This study aimed to compare manometric esophageal characteristics between a group of individuals with gastroesophageal reflux and a group without these symptoms.

METHODS

A stationary esophageal manometry and a questionnaire of gastrointestinal symptoms were performed on 41 individuals, of whom 13 (31.7%) complained of gastroesophageal reflux.

RESULTS

The following data were obtained in cases of non-reflux vs. reflux: mean wave amplitude, 53.4 +/- 17.9 mm Hg vs. 48.6 +/- 11.8 mm Hg; similar mean upstroke; and lower esophageal sphincter pressure of 16.7 +/- 6.4 mm Hg vs. 17.9 +/- 4.9 mm Hg (p = 0.5). The relaxing degree and duration were similar. In the analysis according to the severity of the symptoms, we verified the following differences between cases of slight and severe reflux: amplitude in proximal esophagus, 40.75 +/- 13.1 mm Hg sec vs. 23.0 +/- 9.2 mm Hg sec (p = 0.02); mean average upstroke, 36.6 +/- 8.2 mm Hg sec vs. 24.8 +/- 7.3 mm Hg sec (p = 0.02); mean maximum upstroke, 61.4 +/- 10.4 mm Hg sec vs. 47.0 +/- 12.4mm Hg sec (p = 0.04); and relaxing duration, 5.36 +/- 2.0 sec vs. 8.76 +/- 1.6 sec (p = 0.01).

CONCLUSIONS

1. No differences in the manometric characteristics of the esophagus were found between individuals with and without reflux. 2. The wave amplitude and the upstroke were significantly higher in the proximal esophagus of patients with less severe complaints. 3. The mean and maximum upstroke of the esophageal wave were lower in individuals with severe reflux. 4. The relaxation duration was higher in patients with severe complaints.

High levels of leptin modulate esophageal motor characteristics in type 2 diabetic patients

Leptin regulates gastric and intestinal motility, but its effect on oesophageal motility is unknown. We analyzed oesophageal manometric characteristics in diabetics with elevated leptin.

METHODS

Fasting blood leptin levels were measured in 32 type 2 individuals aged from 39-81 years. An oesophageal stationary manometry was then performed. Each manometric door (P) registered one third of the oesophageal activity. Results are presented as mean +/- SD.

RESULTS

Twenty-one subjects had elevated leptin (HLL) while 11 displayed normal levels (NLL). Peristaltic wave distributions (%) in NLL vs. HLL were 79.4 +/- 26.3 vs. 88.6 +/- 8.3 (p = 0.2). Simultaneous and retrograde waves showed similar trends. Non-transmitted waves were 16.1 +/- 26.5 vs. 4.6 +/- 4.5% (p < 0.05). Amplitudes in NLL vs. HLL (in mm Hg) were P1: 30.2 +/- 10.8 vs. 33.2 +/- 11.7 (p = 0.4), P2: 38.4 +/- 14.4 vs. 58.0 +/- 21.2 (p = 0.01), P3: 42.4 +/- 14.4 vs. 64.7 +/-2 8.3 (p < 0.006), and average amplitudes: 37.1 +/- 12.1 vs. 52.1 +/- 17.6 (p = 0.01). Wave average upstroke (in mm Hgs) was P1: 25.6 +/- 19.1 vs. 23.3 +/- 10.1 (p = 0.6), P2: 26.8 +/- 10.7 vs. 36.2 +/- 11.6 (p < 0.03), and P3: 25.5 +/- 9.1 vs. 34.1 +/- 16.3, (p < 0.06). Wave maximum upstroke was P1: 39.0 +/- 18.6 vs. 40.5 +/- 13.8, (p = 0.8), P2: 45.5 +/- 15.5 vs. 63.8 +/- 19.2 (p = 0.01), P3: 46.6 +/- 17.8 vs. 65.0 +/- 29.1 (p <0.03). Wave duration in distal oesophagus was 4.5 +/- 0.7 vs. 5.5 +/- 1.1 s (p = 0.01), and velocity 3.3 +/- 3.3 vs. 2.96 +/- 3.7 cm/s (p = 0.6).

CONCLUSION

1--Non-transmitted waves were slightly higher in NLL. 2--In medium and distal oesophagus, the wave amplitude, medium and maximum upstroke, and duration in distal oesophagus were increased in HLL.