Gastric autoimmunity in children and adolescents with type 1 diabetes: a prospective study

BACKGROUND/AIMS

Type 1 diabetes (T1DM) is associated with gastric autoimmunity, which is characterized by the presence of parietal cell antibodies (APCA). We investigated gastric autoimmunity prevalence in T1DM children, its manifestations, determinants and association with thyroid gland (anti-Tg, anti-TPO) and pancreatic β-cell autoimmunity (anti-GAD) at baseline and 4 years later.

METHODS

The initial cohort (D1) included 97 children with T1DM. At follow-up after 4 years (D2), 84.5% of participants were evaluated. We assessed APCA, anti-Tg, anti-TPO, and anti-GAD presence, as well as symptoms of gastritis. APCA-positive patients were evaluated with gastrin, B₁₂, ferritin levels and were submitted to gastroscopy.

RESULTS

Thyroid antibody positivity was increased among the APCA-positive patients. Four years later, among initially APCA-positive patients, 2/6 became APCA negative, while 4/6 developed high titers of APCA. On gastroscopy, 2 patients had chronic hypertrophic gastritis and one Helicobacter pylori gastritis.

CONCLUSIONS

Gastric autoimmunity was associated with thyroid autoimmunity and anti-GAD persistence. After 4 years, the majority of APCA-positive patients developed high titers of APCA and mild symptoms of gastritis. Thus, patients with T1DM, and in particular those with thyroid and/or pancreatic autoimmunity, should have periodic autoantibody screening for the early diagnosis and follow-up of gastric autoimmunity.

Atopic patients with genital warts have a more protracted clinical course and a greater probability of recurrences

The factors predicting an unfavourable response of genital warts to treatment have not been determined. The disease characteristics were recorded for 390 patients with genital warts and treated by cryotherapy. The time to achieve clearance was recorded. A personal and family history of asthma, hay fever or eczema, as well as a personal history of common warts and number of recurrences was obtained by telephone four to five years after the clinical visits. In multiple regression analysis, the number of lesions (P < 0.001), extent of the disease (P = 0.003) and personal history of atopy (P = 0.001) were found to influence the time until response to treatment. Similar results were obtained for family history of atopy. The number of sexual partners (P = 0.007), extent of the disease (P = 0.009) and personal history of atopy (P < 0.001) were the main factors influencing the probability of recurrence in multiple logistic regression. The results for family history of atopy were again similar. The study concludes that atopy is a major factor influencing the time frame of the therapeutic response and the probability of recurrence in patients with genital warts.

Kaposi's sarcoma after repeated surgical procedures in an immunocompetent patient: the lymphatic hypothesis

A 63-year-old Swiss patient developed acquired nodules on his right palm after 3 localized surgeries, called 'needle fasciotomy', for Dupuytren's disease. Kaposi's sarcoma (KS) was diagnosed in a biopsy of a nodule. A positive immunolabeling and serology for human herpesvirus 8 has been found, but human immunodeficiency virus and hepatitis C identification remained negative. The nodules were limited to the surgically traumatized area. This first report of a nonimmunocompromised patient developing a KS after repeated surgeries in a unique peculiar localized area with a dense lymphatic network sustains the hypothesis that tissue alterations involving the lymphatic system could play a central role in the occurrence of KS.

Coeliac disease and alopecia areata in childhood

Coeliac disease is a genetic, immunologically mediated small bowel enteropathy that causes malabsorption. The immune inflammatory response to gluten frequently causes damage to many other tissues of the body. We report the association of coeliac disease and alopecia areata in two children, a 13-year-old girl and a 29-month-old girl. Both of our patients had immunoglobulin A (IgA) class endomysial antibodies, IgA and immunoglobulin G (IgG) antigliadin antibodies and subtotal villous atrophy on jejunal biopsy. Administration of a gluten-free diet to our patients resulted in complete hair growth and improved the gastrointestinal symptoms.

Clinical features, complications and treatment outcome of childhood brucellosis in central Greece

OBJECTIVES

To examine the epidemiology, clinical and hematological characteristics, complications and treatment outcome of childhood brucellosis in central Greece.

METHODS

Retrospective record review of all patients 0-14 years of age with brucellosis admitted during a 16-year period between 1984 and 1999.

RESULTS

A total of 39 cases (23 males, median age 132 months) were recorded in which the diagnosis was confirmed by a positive culture (n=30) or detection of IgM antibodies with ELISA (n=9). About 38% of these patients came from families of farmers or shepherds who owned a few domestic animals or small herds of goats or sheep and another 43% had consumed dairy products bought from shepherds. In 41% of the cases another family member developed symptomatic infection. Most of the patients presented with fever (61%) and musculoskeletal symptoms (69%). Splenomegaly was recorded in 38% and hepatomegaly in 28% of the cases. Anemia (39%) and monocytosis (31%) were the most common hematological manifestations, followed by lymphopenia (18%). Unusual complications were detected in two patients who developed thrombocytopenic purpura and acute facial nerve palsy, respectively, but recovered without long-term sequelae. None of the 22 patients who received a combination of two or three antibiotics for > or =6 weeks and had adequate follow-up had a relapse.

CONCLUSION

Childhood brucellosis remains an important public health problem in central Greece. It usually occurs in families that raise small ruminants and the development of symptomatic infection in more than one family member is common. It may cause serious complications in children and treatment with at least two antibiotics for not less than six weeks appears to be effective.

Polychondritis associated with Schönlein-Henoch purpura: report of a case

A case of polychondritis in a psoriatic boy is reported, involving purpura, arthritis which included the costochondral joints, and swelling of his scrotum, eyelids and pinnae. Many of his clinical manifestations showed an overlapping presentation with Schönlein-Henoch purpura (SHP).