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Wintler T, Zherebtsov M, Carmack S, Muntean R, Hill SJ. Acute PR3-ANCA vasculitis in an asymptomatic COVID-19 teenager. J Pediatr Surg Case Rep 2021; 75:102103. [PMID: 34729348 PMCID: PMC8554009 DOI: 10.1016/j.epsc.2021.102103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 12/24/2022] Open
Abstract
We present the case of an acute onset ANCA positive vasculitis in an asymptomatic COVID-19 infected teenager, resulting in significant colonic damage. The patient was initially diagnosed with Henoch-Schönlein purpura and presented with worsening symptoms with significant necrosis of her perineum and rectum requiring surgical debridement and diverting colostomy. As a part of her work-up, she tested positive for COVID-19 total IgG/IgM antibodies and ANCA antibodies. This case complements previously reported cases of COVID-19 induced autoimmune disease in children but is novel in describing extensive intestinal disease as a result of an autoimmune vasculitis in a child.
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Key Words
- ANA, anti-nuclear antibody
- ANCA
- ANCA, antineutrophil cytoplasmic antibody
- CMV, Cytomegalovirus
- COVID-19
- COVID-19, coronavirus disease 2019
- EBV, Epstein-Barr virus
- HSP, Henoch Schönlein Purpura
- Henoch Schonlein purpura
- IgG, immunoglobulin G
- MIS-C, multisystem inflammatory syndrome in children
- NSAIDs, Non-steroidal anti-inflammatory drugs
- Vasculitis
- anti-MPO, myeloperoxidase antibody
- anti-PR3, proteinase 3 antibody
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Affiliation(s)
- Taylor Wintler
- Washington State University, Elson S. Floyd College of Medicine, Spokane, WA, USA
| | - Monica Zherebtsov
- Pediatric Gastroenterology Providence Digestive Health Institute, Spokane, WA, USA
| | | | - Rebecca Muntean
- Providence Rheumatology Providence Health and Services, Spokane, WA, USA
| | - Sarah J Hill
- Providence Sacred Heart Medical Center Pediatric Surgery, Spokane, WA, USA
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Clark LA, Ghazi A, Gaffney K, Soto R, Agarwal A, Carmack S, Boland CR. Diagnosis of Malignant Potential in Mucinous Peritoneal Neoplasms by Characterization of Mucin Carbohydrate Structure. Cell Mol Gastroenterol Hepatol 2018; 6:108-109.e2. [PMID: 29928675 PMCID: PMC6007818 DOI: 10.1016/j.jcmgh.2018.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- L. August Clark
- Division of Gastroenterology, Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health Care, Dallas, Texas
| | - Alexia Ghazi
- Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health Care, Dallas, Texas
| | - Kristin Gaffney
- Division of Gastroenterology, Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health Care, Dallas, Texas
| | - Rodrigo Soto
- Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health Care, Dallas, Texas
| | - Atin Agarwal
- Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health Care, Dallas, Texas
| | - Susanne Carmack
- Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health Care, Dallas, Texas
| | - C. Richard Boland
- Division of Gastroenterology, Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health Care, Dallas, Texas,Charles Sammons Cancer Center and Baylor Research Institute, Baylor University Medical Center, Baylor Scott & White Health Care, Dallas, Texas,Current address: University of California San Diego, San Diego, California,Corresponding author: C. Richard Boland, MD, University of California San Diego, Medicine, GI Division, Gilman Drive, San Diego, California 92093.
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Richardson B, Preskitt J, Lichliter W, Peschka S, Carmack S, de Prisco G, Fleshman J. The effect of multidisciplinary teams for rectal cancer on delivery of care and patient outcome: has the use of multidisciplinary teams for rectal cancer affected the utilization of available resources, proportion of patients meeting the standard of care, and does this translate into changes in patient outcome? Am J Surg 2015; 211:46-52. [PMID: 26601650 DOI: 10.1016/j.amjsurg.2015.08.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/27/2015] [Accepted: 08/02/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND We hypothesized that mandatory multidisciplinary team (MDT) participation improves process evaluation, outcomes, and technical aspects of surgery for rectal cancer in a stable practice of colorectal surgery. METHODS A retrospective review of MDT data was conducted of all patients with colorectal cancer since 2010. Demographic, clinical stage, process evaluation, quality of surgery, and outcome data were collected. Total mesorectal excision and MDT required participation started 2013. RESULTS One hundred thirty patients were included in this study: 47 patients in 2014; 41 patients in 2013; and 42 patients pre-MDT. Improvements were seen in 12 of the 14 preoperative process variables, 6 significantly. Improvement in the completeness of total mesorectal excision (0% to 76%) was significant. Local recurrence occurred in 10% of the pre-MDT group, and follow-up is ongoing in the MDT groups. CONCLUSIONS MDT participation improves care of patients with rectal cancer. Preoperative clinical staging, multimodality treatment, pathologic staging, and technical aspects of surgery have improved.
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Affiliation(s)
- Bradford Richardson
- Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA
| | - John Preskitt
- Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA
| | - Warren Lichliter
- Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA
| | - Stephanie Peschka
- Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA
| | - Susanne Carmack
- Department of Pathology, Baylor University Medical Center, Dallas, TX, USA
| | - Gregory de Prisco
- Department of Radiology, Baylor University Medical Center, Dallas, TX, USA
| | - James Fleshman
- Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA.
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Abstract
Total mesorectal excision (TME) is the current optimal surgical treatment for patients with rectal carcinoma. A complete TME is related to lower local recurrence rates and increased patient survival. Many confounding factors in the patient's anatomy and prior therapy can make it difficult to obtain a perfect plane, and thus a complete TME. The resection specimen can be thoroughly evaluated, grossly and microscopically, to identify substandard surgical outcomes and increased risk of local recurrence. Complete and accurate data reporting is critical for patient care and helps surgeons improve their technique.
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Affiliation(s)
- Molly Campa-Thompson
- Department of Pathology, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Robert Weir
- Department of Pathology, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Natalie Calcetera
- Department of Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Philip Quirke
- Department of Pathology and Tumor Biology, Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Susanne Carmack
- Department of Pathology, Baylor University Medical Center at Dallas, Dallas, Texas
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Shtutman M, Maliyekkel A, Levina E, Ohouo P, Shao Y, Carmack S. High-throughput function-based gene identification using enzymatically generated short hairpin RNA library and massive parallel sequencing. N Biotechnol 2010. [DOI: 10.1016/j.nbt.2010.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Carmack S, Taddei T, Robert ME, Mistry P, Jain D. Increased T-cell sinusoidal lymphocytosis in liver biopsies in patients with chronic hepatitis C and mixed cryoglobulinemia. Am J Gastroenterol 2008; 103:705-11. [PMID: 17970837 DOI: 10.1111/j.1572-0241.2007.01603.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Mixed cryoglobulinemia (MC) has a strong association with hepatitis C virus (HCV) infection and is associated with a higher degree of fibrosis and poor response to therapy. Currently, there are no known histological findings on liver biopsy that correlate with the presence of MC in HCV-infected patients, although we have occasionally noted prominent sinusoidal lymphocytosis in MC patients. The goal of this study is to determine whether sinusoidal lymphocytosis is a histological marker of MC in liver biopsies from patients with chronic hepatitis C. The liver clinic database at our institution was searched for chronic hepatitis C patients with MC who underwent liver biopsy during 1999-2005. Ten such cases were identified and were included in the study. Ten chronic hepatitis C MC-negative cases were matched for age and stage of fibrosis to serve as controls. Histological features (sinusoidal lymphocytes, inflammatory activity, acidophil bodies, and fibrosis stage) were evaluated in each biopsy. Clinical and laboratory data (serum protein electrophoresis, liver enzymes, hepatitis C viral load, treatment status, comorbidities, etc.) were also recorded. Formalin-fixed, paraffin-embedded sections were submitted for immunohistochemical analysis using antibodies against CD3, CD20, CD4, CD8, and CD68. Sinusoidal lymphocytes were counted in 5 hpf (40x) on hematoxylin and eosin (H&E) stain, and on CD3 and CD20 immunostains. The number of CD68+ Kupffer cells was also counted in a similar fashion. In the MC-positive versus MC-negative cases, mean fibrosis stage (2.4 vs. 2.4), inflammatory grade (1.7 vs. 2.1), lymphocyte count (359 vs. 128/5 hpf), and Kupffer cell count (239 vs. 220/5 HPF) were assessed. There was a significant increase in sinusoidal T-cell lymphocytes (P < 0.05) in MC-positive cases as compared to MC-negative cases. Nearly all sinusoidal lymphocytes were CD8-positive cells in both groups. Other histological parameters did not differ in the two groups. MC-positive cases tended to have a lower viral load as compared to controls (P= 0.059). The role of sinusoidal T cells in the pathogenesis of MC is currently unknown. It is unclear if the presence of these cells implies ongoing antigenic stimulation that may lead to increased risk of lymphoma. This feature may be an important clue to predict the presence of MC, an HCV-associated phenomenon that has important implications for response to treatment and disease progression.
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Affiliation(s)
- Susanne Carmack
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut 06520-8023, USA
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Frattini JC, Sosa JA, Carmack S, Robert ME. Sclerosing epithelioid fibrosarcoma of the cecum: a radiation-associated tumor in a previously unreported site. Arch Pathol Lab Med 2008; 131:1825-8. [PMID: 18081443 DOI: 10.5858/2007-131-1825-sefotc] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2007] [Indexed: 11/06/2022]
Abstract
Data from the nuclear reactor explosion in Chernobyl and the atomic bomb detonations in Hiroshima and Nagasaki demonstrated an association between ionizing radiation and tumoriogenesis. There is a significant association between external beam radiation and radiation-induced sarcoma. Sclerosing epithelioid fibrosarcoma is a rare form of malignant fibrosarcoma that is low grade and indolent with distinct immunohistopathologic characteristics that usually occurs in the soft tissues of the extremities. A 62-year-old man from Kiev who aided in the cleanup at Chernobyl presented with crampy abdominal pain, nausea, and vomiting. His workup revealed a cecal mass, and the final pathology from his laparotomy confirmed sclerosing epithelioid fibrosarcoma with metastasis to the liver. In addition to a review of the literature, we report the first case of sclerosing epithelioid fibrosarcoma arising from the large bowel. Exposure to ionizing radiation from Chernobyl could have played a role in the development of his tumor.
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Affiliation(s)
- Jared C Frattini
- Department of Surgery, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06520, USA
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