Serum procalcitonin levels remain below the threshold of 0.5 ng/ml in all patients with uncomplicated cirrhosis, irrespective of the cause of the disease, while they are significantly elevated when bacterial infection complicates the course of the disease. A significant proportion of patients with acute alcoholic hepatitis on a cirrhotic background as well as of patients with acute on chronic viral hepatitis, without bacterial infection, exhibit serum procalcitonin levels above 0.5 ng/ml, suggesting that this cut-off value is probably not enough to discriminate between patients with or without bacterial infection within these subgroups of patients with liver disease.

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We report the case of a 43-year-old woman who presented with lower abdominal pain, maculopapular rash, arthritis of the left knee and left ankle joints, with a history of thalassemia and heavy iron overload. She was also on haemodialysis therapy three times a week for end stage renal therapy. Yersinia enterocolitica and Yersinia pseudotuberculosis cause yersiniosis, a diarrhoeal illness. Members of the genus Yersinia are gram-negative coccobacilli; they are facultative anaerobes in the family Enterobacteriaceae. Serological examinations revealed positive IgA and IgG antibodies against Yersinia enterocolitica outer membrane proteins (Yops) for YopD(4a) and Yop M(2a) and IgG for LorV (V antigen). Enteritis an reactive arthritis presented as the primary manifestation of Y. enterocolitica infection. Important risk factors include iron overload, cirrhosis, and immune suppression. The patient was successfully treated with oral ciprofloxacin.

Introduction There is increasing evidence that metabolic disease burden in lymphoma influence patients' outcome.However, the impact of disease severity on cardiovascular system remains unknown. Purpose To assess whether lymphoma is associated with arterial inflammation by examining the relationship between disease metabolic burden and arterial fluorodeoxyglucose (FDG) uptake. Methods Sixty-two patients (43 male, mean age 58±18 years) with Hodgkin (n=29) or non-Hodgkin lymphoma (n=33) before chemotherapy and two separate control groups of 14 and 16 healthy individuals for Hodgkin and non-Hodgkin population respectively, with similar age, sex and cardiovascular risk factors,underwent FDG position emission tomography (FDG-PET/CT) imaging.Disease severity was quantified by metabolic tumor volume (MTV) and total lesion glycolysis (TLG) corresponding to standard uptake values (SUV) ≥41% or ≥2.5 of maximum SUV within lymphoma regions, and aortic FDG uptake by target-to-background ratio (TBR). Serum high sensitivity-C-reactive protein (hs-CRP), white blood count (WBC), ratio of neutrophils to lymphocytes (N/L), albumin and lactic acid dehydrogenase (LDH) values were measured for patient group. Results MTV and TLG measurements correlated significantly with hs-CRP, WBC,N/L ratio,albumin and LDH table 1.Patients with non-Hodgkin or Hodgkin lymphoma had increased aortic TBR compared to controls (p=0.001 and p=0.023, respectively).Aortic TBR was higher in patients with stage III-IV disease compared to those with stage I-I (p=0.046).There were significant associations between aortic FDG uptake and MTV values, which remained significant after adjustment for confounders (β=0.353, p=0.001, adjusted R2=0.318 for MTV41%, β=0.442, p=0.001, adjusted R2=0.269 for MTV2.5), Figure 1. Conclusions Aortic wall FDG uptake is related with disease severity indicating a vascular effect of lymphoma, as well as a new potential role of molecular imaging in cardio-oncology for evaluating disease severity and its consequences to vascular beds with a single examination. Figure 1 Funding Acknowledgement Type of funding source: None