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BackgroundInflammatory bowel disease (IBD) and its immunosuppressive therapy alter the body's immune response, predisposing patients to higher infection risk preventable with vaccination. The CDC recommends every adult receive the annual influenza vaccine and patients with certain comorbidities receive the pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23). However, vaccination rates among IBD patients remain unacceptably low. The aim of our study is to present influenza and pneumococcal vaccinations rates of IBD patients at our center. MethodsWe hypothesized that vaccination rates will be suboptimal at our outpatient center and that patients are not being vaccinated based on comorbid conditions in accordance with guidelines. We retrieved electronic medical records from the gastroenterology clinic between December 2018 and December 2019. Data regarding influenza and pneumococcal vaccines, immunosuppressive drugs, and comorbidities were obtained. Microsoft Excel and SPSS Statistics (IBM Corp., Armonk, NY) were used for data analyses. A pvalue < 0.05 was considered statistically significant. ResultsIn total, 109 IBD patients were identified, 46.8% female and 53.2% male. The majority were African American (77.06%). The mean age was 45 years. Around 26.61% of the patients were on immunosuppressive therapy. Around 28.7% received the annual influenza vaccine, 42.2% PPSV23 alone, 19.27% PCV13 alone, and 16.5% received both. Patients >50 years were more likely to receive the influenza vaccine (P = 0.0122). Patients on immunosuppressive therapy were not more likely to be vaccinated with both PCV13 and PPSV23 (P = 0.1848, P = 0.7382). Active smokers were not more likely to be vaccinated with PPSV23 (P = 0.695). Patients with human immunodeficiency virus (HIV), chronic kidney disease (CKD), and sickle-cell disease were more likely to be vaccinated with both PCV13 and PPSV23 (P = 0.02, P = 0.02). Patients with other chronic medical conditions were more likely to be vaccinated with PPSV23 (P = 0.0201). ConclusionOur study revealed suboptimal influenza and pneumococcal vaccination rates among IBD patients at our facility. We also found that patients were not consistently vaccinated based on qualifying co-morbid conditions. Age plays a role in whether patients received the influenza vaccine contrary to guidelines. We urge clinicians to examine IBD patient vaccination rates at their facilities.

Cryptococcoid Sweet syndrome is a rare histologic variant of the neutrophilic dermatosis presenting clinically with skin lesions typical of classical Sweet syndrome but with yeast-like structures suggestive of Cryptococcus on histopathology. Histochemical stains for fungus and cultures are negative while staining for myeloperoxidase is positive. We present two cases of cryptococcoid Sweet syndrome with atypical skin manifestations, including hemorrhagic bullae and plaques, and provide a brief review of the literature. Clinicians should be aware that this variant of Sweet syndrome can present with uncommon clinical findings and has histopathology findings suggestive of Cryptococcus species.

INTRODUCTION Inflammatory bowel disease (IBD) affects patients across diverse ethnic, minority, cultural, and socioeconomic backgrounds; however, the relationship between these social determinants of health (SDOH) and IBD outcomes is not well-studied. SDOH have a known impact on disparities in vaccination, but these effects may be more salient in the IBD population where patients are at greater risk for vaccine-preventable illness from immunosuppressive therapies. The social vulnerability index (SVI) is a tool provided by Centers for Disease Control that can identify individuals at risk for health care disparities by estimating neighborhood-level social need on a 0-1 scale (higher scores indicating greater social vulnerability). Utilizing census tract-level SVI data, we aimed to identify the relationship between the SDOH and vaccination rates in patients with IBD. METHODS We used a retrospective cohort design of patients seen at a single IBD center between 01/01/2015 and 08/31/2022. Using the current address listed in the electronic medical record, we geocoded patients to individual census tracts and linked them to corresponding SVI and subscales (Figure 1). Controlling a priori for age, gender, race, ethnicity, marital status, English proficiency, electoral district, and religious affiliation, we used multivariable linear regression to examine the relationship between SVI and vaccination against influenza, Covid-19, pneumococcal pneumonia (conjugate and polysaccharide), and Zoster. RESULTS 15,245 patients with IBD were included and the percent of unvaccinated individuals was high across all vaccine types: flu (42.8%), Covid-19 (50.9%), pneumonia (62.4%), and Zoster (89.6%). High total levels of social vulnerability were associated with lower vaccination rates across all vaccine groups: flu (B -1.3, 95% CI -1.5, -1.2, p&lt;0.001), Covid-19 (B -0.99, 95% CI -1.1, -0.88), p&lt;0.001), pneumonia (B -0.21, 95% CI -0.27, -0.14, p&lt;0.001), Zoster (B -0.23, 95% CI -0.27, -0.19, p&lt;0.001). On SVI sub-scales, high scores in Socioeconomic Status, Household Composition, and Housing/Transportation were important predictors of vaccine uptake while Minority Status/Language was non-significant (Table 1). CONCLUSION Living in a socially vulnerable community is associated with lower vaccination rates across all vaccine types. Higher scores on neighborhood level Socioeconomic Status, Household Composition, and Housing/Transportation were also associated with lower vaccine uptake. Many factors may affect why socially vulnerable patients are under-vaccinated, including a lack of patient and provider knowledge of routine vaccines, lack of access to care, and poor trust in vaccines and healthcare system. Further research is needed improve IBD health maintenance in gastroenterology clinics and ensure equitable distribution of vaccines to socially vulnerable patients.

The JAK signaling pathway plays a major role in the immunopathology of autoimmune diseases, including inflammatory bowel disease. JAK enzymes provide novel targets for rapidly effective inflammatory bowel disease therapy, particularly in ulcerative colitis. Upadacitinib is a targeted JAK1 inhibitor. In multiple phase III clinical trials, upadacitinib has demonstrated significant improvement in clinical and endoscopic outcomes and quality of life for patients with moderate-to-severe ulcerative colitis. In this drug evaluation we describe the role of the JAK signaling pathway in ulcerative colitis, the mechanism of action of upadacitinib and the current clinical evidence for its use in ulcerative colitis; we also review its safety and tolerability, including for special populations.