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Pop C.S.,Carol Davila University of Medicine and Pharmacy | Becheanu G.,Victor Babes National Institute for Research | Calagiu D.,Carol Davila University of Medicine and Pharmacy | Jantea P.-V.,Carol Davila University of Medicine and Pharmacy | And 6 more authors.
Romanian Journal of Morphology and Embryology | Year: 2015

We report a case of CMV (cytomegalovirus) infection in a Crohn’s disease patient, resulting in severe hemophagocytic syndrome and death. A 63-year-old man with a 10-year history of ileal and colonic Crohn’s disease presented with general malaise, loss of appetite and weight loss over the last month. He was in clinical remission for two years, with maintenance therapy 5-Aminosalicylic acid (5-ASA)-derived Mesalamine. The patient had no prior immunomodulators or suppressive treatment. A colonoscopy was performed and we found appearance suggestive of active Crohn’s disease, confirmed by histopathological examination. A diagnosis of an exacerbation of Crohn’s disease was established. Although the specific treatment was initiated, patient’s general condition degraded progressively and diarrheal stools appeared, followed by an episode of massive gastrointestinal bleeding – hematochezia. We performed a new colonoscopy and the pathological examination revealed Crohn’s ileocolitis with superimposed CMV infection. Despite the initiation of Ganciclovir alongside with other intensive care measures, he increasingly deteriorated and chest X-ray confirmed multilobar pneumonia. The occurrence of rapidly progressing pancytopenia and evidence for disseminated intravascular coagulopathy as well as hyperferritinemia, raised the suspicion of hemophagocytic syndrome confirmed by bone marrow aspiration. Hence, CMV-associated hemophagocytic syndrome in the context of recent corticotherapy for Crohn’s disease was established. There is enough evidence that supports the gravity of the CMV infection in the case of inflammatory bowel disease (IBD) patients, especially the ones on immunomodulator treatment. The hemophagocytic syndrome reactively occurs in patients with infections in cases of immunodeficiency, displaying a hematological aspect of multiple organ dysfunction syndrome. © 2015 ROMANIAN ACADEMY PUBLISHING HOUSE. All rights reserved. Source

Cambrea S.C.,Clinical Hospital of Infectious Diseases | Cambrea S.C.,Ovidius University | Resul G.,Clinical Hospital of Infectious Diseases | Bulbuc I.,Ovidius University | And 2 more authors.
Romanian Journal of Morphology and Embryology | Year: 2014

Background: Pulmonary inflammatory myofibroblastic tumor (PIMT) is a rare disease that occurs more frequently in younger patients. Its etiopathogeny remains debated whether this is an inflammatory lesion characterized by uncontrolled cell growth or a true neoplasm. Aim: To present a case of PIMT in a young men, HIV-positive since childhood. Patient, Methods and Results: We report the case of an HIVpositive patient, aged 21 years, with collapsed immunity (CD4=23 cells/mm3), which in the second half of 2009 was clinically and radiologically diagnosed with recurrent right pneumonia. Serological tests were negative for Mycoplasma, Epstein-Barr and HHV-8 and positive for cytomegalovirus (CMV). Further monitoring of this episode raises imaging suspicion of the tumor in right upper pulmonary lobe. A lung wedge biopsy by thoracotomy was performed. The result of histopathological examination was suggestive for Kaposi sarcoma but required an immunohistochemical examination (vimentin, smooth muscle actin, CD34, anaplastic lymphoma kinase, CK7, L26/CD20, CD38, CD68), which established diagnosis of PIMT. In our case, we noticed a favorable evolution under antiretroviral treatment (by increasing CD4 count - immunity slowly improved), broad-spectrum antibiotics, and steroidal anti-inflammatory treatment, with regression of PIMT over eight months. Conclusions: Although inflammatory myofibroblastic tumor (IMT) is rare, it should be considered in the differential diagnosis of pulmonary tumoral lesions in young adults. This is the first PIMT case in an HIV-positive patient described in Romania. Even good response in such cases was noticed after surgical treatment, in our case we achieved complete remission of the disease with anti-inflammatory steroidal therapy and combined antiretroviral therapy (cART). As other infectious etiologies, CMV also could represent a trigger for developing a pulmonary inflammatory myofibroblastic tumor. Source

Harza M.,Carol Davila University of Medicine and Pharmacy | Ismail G.,Carol Davila University of Medicine and Pharmacy | Mitroi G.,University of Medicine and Pharmacy of Craiova | Gherghiceanu M.,Victor Babes National Institute for Research | And 2 more authors.
Romanian Journal of Morphology and Embryology | Year: 2014

The paper presents the case of a female patient who was admitted to our department because of prolonged febrile syndrome, altered general status and renal tumoral masses revealed by thoracic and abdominal CT. After thorough histological examination, including immunohistochemistry and in situ hybridization studies, we reached the diagnosis of renal pseudotumoral masses due to IgG4-related tubulointerstitial nephritis. The kidney is a distinct target organ affected by IgG4-related sclerosing disease, and the most frequent manifestation is tubulointerstitial nephritis. We described the clinical, imagistic and histopathological features of kidney and urological involvement in IgG4-related sclerosing disease, especially focusing on IgG4-related tubulointerstitial nephritis. This is a rare case of IgG4-related sclerosing disease without extrarenal features, excepting lumboaortic lymphadenopathy. Source

Arsene D.,Victor Babes National Institute for Research | Ardeleanu C.,Victor Babes National Institute for Research | Ardeleanu C.,Carol Davila University of Medicine and Pharmacy
Romanian Journal of Morphology and Embryology | Year: 2010

Neurodegenerative pathological changes are known as occurring in human brain, in some way paralleling aging. We characterized prospectively the occurrence of cortical senile plaques and neurofibrillary tangles in 55 adult human subjects, by post-mortem examination. We tried to determine if aging is associated with greater senile plaque and neurofibrillary tangles burden and what is the cortical distribution of lesions, regardless the mental status of the patient. The series comprised a large spectrum of ages, from 30 to 97-year-old. Immunohistochemistry for amyloid-beta (Abeta) and tau protein was the technique we used. ApoE genotyping was performed in 33 cases by polymerase chain reaction. In our series brain Abeta deposition as senile plaques occurred only after 65-year-old. These accumulations were strongly associated with the occurrence of neurofibrillary tangles. However, several very old patients were lacking both beta-amyloid and tau-positive lesions. As a result, even though Abeta and tau protein show a certain predilection for brain deposition in elder people, their relationship with aging still needs further investigation, mostly in human subjects. Source

Dobre M.,Victor Babes National Institute for Research | Comanescu M.,Victor Babes National Institute for Research | Arsene D.,Victor Babes National Institute for Research | Iosif C.,Victor Babes National Institute for Research | Bussolati G.,Victor Babes National Institute for Research
Romanian Journal of Morphology and Embryology | Year: 2013

Background: In patients with high-stage colorectal carcinomas (CRC), anti-EGFR therapy is known to be effective only in cases with a wild-type K-ras gene status. Different procedures have been proposed for such evaluation. Materials and Methods: The mutation status of K-ras gene, codons 12, 13 and 61 was determined in 250 CRC cases using the pyrosequencing assay. In addition, we compared the performance of the pyrosequencing procedure with that of PCR-RFLP in a subset (n=100) of the CRC samples the latter only in codons 12 and 13. Results: Using pyrosequencing, 46.4% of the 250 CRC cases were found mutated. Most mutations were located in codon 12 (36.4% from all cases) and several were located in codon 61 (3.2%). All mutation identified by PCR-RFLP were confirmed by pyrosequencing and, in addition, one more mutated sample was identified in the subset of 100 samples. Conclusions: Both methods are highly specific and can profitably be used in the molecular diagnosis of colorectal cancer in order to establish the adequate therapy. Source

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