Background-Pyoderma gangrenosum-like ulcers and cellulitis of the lower extremities associated with recurrent fevers in patients with X-linked (Bruton) agammaglobulinemia have been reported to be caused by Helicobacter bilis (formerly classified as Flexispira rappini and then Helicobacter strain flexispira taxon 8). Consistent themes in these reports are the difficulty in recovering this organism in blood and wound cultures and in maintaining isolates in vitro. We confirmed the presence of this organism in a patient's culture by using a novel application of gene amplification polymerase chain reaction and electrospray ionization time-of-flight mass spectrometry.Observation-An adolescent boy with X-linked agammaglobulinemia presented with indurated plaques and a chronic leg ulcer whose origin was strongly suspected to be an H bilis organism. Histologic analysis demonstrated positive Warthin-Starry staining of curvilinear rods, which grew in culture but failed to grow when sub-cultured. They could not be identified by conventional techniques. A combination of gene amplification by polymerase chain reaction and electrospray ionization time-of-flight mass spectrometry confirmed the identity of this organism.Conclusions-This novel technology was useful in the identification of a difficult-to-grow Helicobacter organism, the cause of pyoderma gangrenosum-like leg ulcers in patients with Xlinked agammaglobulinemia. Correct identification of this organism as the cause of pyoderma gangrenosum-like ulcers in patients with X-linked agammaglobulinemia is of great importance for the early initiation of appropriate and curative antibiotic therapy.

Gingival overgrowth is a well recognized, unwanted side-effect associated with three major drugs/drug groups – phenytoin, cyclosporine and the calcium channel blockers. Cyclosporine is a potent immunosuppressive compound that has been used increasingly in conjunction with kidney, heart and other transplants. Calcium channel blockers are widely used in medical practice for the management of cardiovascular disorders. Due to their wide range of use, gingival overgrowth is now a recognized side-effect associated with them. Here we discuss a case report dealing with severe gingival overgrowth induced by cyclosporine and amlodipine. A 36-year-old man who underwent renal transplant came with a chief complaint of generalized gingival swelling. He had very severe gingival overgrowth in both arches and required thorough scaling and oral hygiene instructions, followed by supportive periodontal therapy for 4 months, after which radical gingivectomy using electrocautery and CO2 laser was performed. The post operative results were excellent and there was no recurrence at 1 year follow-up.

Objectives: Gingival enlargement as an adverse effects of drugs has been found to be long associated with the use of anticonvulsants; phenytoin, anti-hypertensives; calcium channel blockers and immunosuppressants; cyclosporine. Nifedepine was found to cause gingival overgrowth with an incidence ranging from 15-85%. However, Amlodepine a relatively newer agent of the same group which is being routinely and vastly prescribed either alone or as part of combination therapy to middle to older aged adults has also been found to exhibit this adverse effect with very few cases reported till date. The effect of the dose of amlodepine on the severity of gingival enlargement needs to be assessed. Study design: A clinical presentation of a series of five cases in the age range of 45-65 yrs with gingival over-growth as a side effect of therapy with amlodepine is presented with prescription of variable doses of 2.5 mg, 5 mg and 10 mg per day. A brief review on the pathogenesis of this condition, commonly associated etiological mechanisms and sequence of periodontal therapy rendered have also been included. Conclusion: Irrespective of the dose of amlodepine administered, gingival enlargement continues to be a predominant side effect in all of the five cases presented. The accentuated gingival contours accumulate plaque leading further to the destruction of the underlying periodontium. Dental professionals need to identify and then guide the patient to seek necessary medical intervention.

BACKGROUND AND OBJECTIVES: To analyze the panorama optical coherence tomography angiography (P-OCTA) characteristics of serpiginous-like choroiditis (SLC) and to correlate these findings with indocyanine green angiography (ICGA). PATIENTS AND METHODS: Prospective, observational study of 32 eyes of 24 patients. Twenty-seven eyes of 16 patients who met inclusion criteria were included in the final study. Multimodal imaging was performed using P-OCTA, OCT, fundus autofluorescence, fluorescein angiography, and ICGA. Morphologic features at the site of lesions were analyzed using P-OCTA and correlated with ICGA. RESULTS: P-OCTA in active phase revealed areas of large flow void, which correlated with hypofluorescent areas on ICGA. Healing phase revealed appearance of vascular network due unmasking of choriocapillaris that corresponded to reduced hypofluorescence on ICGA. CONCLUSION: P-OCTA as a noninvasive tool provides widefield and high-resolution images that can be used as an complementary tool to ICGA for diagnosis of SLC cases. [ Ophthalmic Surg Lasers Imaging Retina. 2018;49:859–869.]

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