Diagnosis of eosinophilic gastroenteritis is easily missed

AIM To analyze the clinical characteristics of eosinophilic gastroenteritis(EGE)and to investigate the situations of missed diagnosis of EGE.METHODS First,the clinical characteristics of 20 EGE patients who were treated at our hospital were retrospectively summarized.Second,159 patients who underwent gastroscopy and 211 patients who underwent colonoscopy were enrolled.The pathological diagnosis showed only chronic inflammation in their medical records.The biopsy slides of these patients were reevaluated to determine the number of infiltrating eosinophils in order to assess the probability of a missed diagnosis of EGE.Finally,122 patients who experienced refractory upper gastrointestinal symptoms for at least one month were recruited.At least 6biopsy specimens were obtained by gastroscopy,and the number of eosinophils that had infiltrated was evaluated.Those who met the pathological diagnostic criteria of EGE underwent further examination to confirm the diagnosis of EGE.The probability of a missed diagnosis of EGE was prospectively investigated.RESULTS Among the 20 patients with EGE,mucosal EGE was found in 15 patients,muscular EGE was found in 3patients and serosal EGE was found in 2 patients.Abdominal pain was the most common symptom.The number of peripheral blood eosinophils was elevated in all 20 patients,all of whom were sensitive to corticosteroids.Second,among the 159 patients who underwent gastroscopy,7(4.40%)patients met the criteria for pathological EGE(eosinophil count≥25/HPF).Among the 211 patients who underwent colonoscopy,9(4.27%)patients met the criteria for pathological EGE(eosinophil count≥30/HPF).No patients with eosinophil infiltration were diagnosed with EGE in clinical practice before or after endoscopy.Although these patients did not undergo further examination to exclude other diseases that can also lead to gastrointestinal eosinophil infiltration,these might be the cases where the diagnosis of EGE was missed.Finally,among the 122 patients with refractory upper gastrointestinal symptoms,eosinophil infiltration was seen in 7 patients(5.74%).The diagnosis of EGE was confirmed in all 7 patients after the exclusion of other diseases that can also lead to gastrointestinal eosinophil infiltration.A positive correlation was observed between the duration of the symptoms and the risk of EGE(r=0.18,P<0.01).The patients whose symptoms persisted longer than 6 mo more readily developed EGE.None of the patients were considered to have EGE by their physicians before endoscopy.CONCLUSION Although EGE is a rare inflammatory disorder,it is easily misdiagnosed.When a long history of abdominal symptoms fails to improve after conventional therapy,EGE should be considered.

A new luciferase immunoprecipitation system assay provided serological evidence for missed diagnosis of severe fever with thrombocytopenia syndrome

Severe fever with thrombocytopenia syndrome(SFTS),caused by SFTS virus(SFTSV)infection,was first reported in 2010 in China with an initial fatality of up to 30%.The laboratory confirmation of SFTSV infection in terms of detection of viral RNA or antibody levels is critical for SFTS diagnosis and therapy.In this study,a new luciferase immunoprecipitation system(LIPS)assay based on p REN2 plasmid expressing SFTSV NP gene and tagged with Renilla luciferase(Rluc),was established and used to investigate the levels of antibody responses to SFTSV.Totally 464 serum samples from febrile patients were collected in the hospital of Shaoxing City in Zhejiang Province in 2019.The results showed that 82 of the 464 patients(17.7%)had antibody response to SFTSV,which were further supported by immunofluorescence assays(IFAs).Further,q RT-PCR and microneutralization tests showed that among the 82 positive cases,15 patients had viremia,10 patients had neutralizing antibody,and one had both(totally 26 patient).However,none of these patients were diagnosed as SFTS in the hospital probably because of their mild symptoms or subclinical manifestations.All the results indicated that at least the 26 patients having viremia or neutralizing antibody were the missed diagnosis of SFTS cases.The findings suggested the occurrence of SFTS and the SFTS incidence were higher than the reported level in Shaoxing in 2019,and that LIPS may provide an alternative strategy to confirm SFTSV infection in the laboratory.

Hoffa's fracture in a five-year-old child diagnosed and treated with the assistance of arthroscopy:A case report

BACKGROUND Hoffa’s fracture is a coronal-oriented fracture of the femoral condyle.It is rarely observed in pediatric patients that isolated coronal fracture of the medial femoral condyle accompanies an intact lateral femoral condyle.Only a few cases involving Hoffa’s fracture of the medial femoral condyle have been reported in patients with undeveloped skeletons.Such a fracture cannot be observed by routine imaging examinations,thus resulting in possible misdiagnosis and further treatment challenges.CASE SUMMARY A 5-year-old boy with Hoffa’s fracture of the medial femoral condyle suffered from right knee pain and severe swelling after being hit by a heavy object.The patient was misdiagnosed and initially treated in a local primary healthcare center.No improvement in his right knee’s extension was observed following conservative treatment for 2 wk.The patient was transferred to our hospital,rediagnosed using arthroscopy,and underwent open reduction and internal fixation.The therapeutic outcome was satisfactory with the screws removed 7 mo after fixation.At the final follow-up of 40 mo,the range of motion in the knee had recovered.There was no varus-valgus instability.CONCLUSION Hoffa’s fracture is rarely seen in children aged 5 years,let alone in the medial condyle,and can easily be misdiagnosed due to limited physical and imaging examinations.Suspected Hoffa’s fracture in preschool children should be confirmed based on arthroscopic findings.Open reduction and internal fixation should be performed to protect the articular surface and prevent long-term complications.

Median arcuate ligamentum syndrome:Four case reports

BACKGROUND Median arcuate ligamentum syndrome(MALS)is a disease entity with unclear pathogenesis.If it is not considered in advance,the clinical diagnosis of the disease is very difficult because patients complain of digestive discomfort including pain.However,this characteristic is not specific to MALS.There have been no studies to assist in making a quick diagnosis.The aim of this case series was to recognize that MALS must be considered as a differential factor in the cause of abdominal pain.CASE SUMMARY We described cases in which four patients complained of abdominal pain over a long period but in whom a diagnosis of MALS could not be made.If the gastroenterologist does not take into account abdominal pain in advance,the patient is considered an asymptomatic gallstone patient and has their gallbladder removed despite imaging evaluation.The patient may also be considered a psychiatric patient and may be administered psychiatric drugs over a long period.In all four cases in this report,the patients experienced abdominal pain.In three cases,the diagnosis was possible by the clinician’s judgment considering both clinical symptoms and imaging techniques shortly after the onset of symptoms.However,in one case that lasted over 20 years,a clear diagnosis was not possible.Even after complaining of colicky pain and performing a cholecystectomy,the diagnosis was made only after the symptoms persisted.In all four cases,the symptoms were relieved by neuromodulators.CONCLUSION MALS is a rare disease and it is easy to miss because it is not malignant,but patients can suffer from pain over a long period.For the accurate diagnosis of a patient complaining of abdominal pain,the diagnosis must be differentiated.In addition,as there are asymptomatic patients,patients who need treatment should be carefully selected,and improvement with medical treatment can be expected.Large-scale studies are also needed.