A 61-year-old woman presented with longstanding cough and progressive dyspnoea. She underwent an extensive evaluation and was diagnosed with common variable immunodeficiency (CVID) with granulomatous lymphocytic interstitial lung disease (GLILD). She was initially treated with subcutaneous immunoglobulin therapy, having declined intravenous immunoglobulin (IVIG) therapy. She also declined treatment with oral glucocorticoids. Over several months, she became increasingly symptomatic and developed increased pulmonary infiltrates, pleural effusions, mediastinal adenopathy, splenomegaly, pancytopenia and ascites. An interdisciplinary team composed of an immunologist, pulmonologist and haematologist deliberated over a therapeutic management approach. The patient received a recently reported immunotherapy regimen with azathioprine and rituximab. The therapy led to rapid improvement of her constitutional and respiratory symptoms, with clinical and radiographic improvement in her interstitial lung disease, lymphadenopathy, pleural effusions and ascites. This case report reviews the literature surrounding the diagnosis and management of GLILD.

Although 5 biologic therapies have Food and Drug Administration (FDA)-approved indications for difficult-to-control asthma, the clinical trials that proved the efficacy and safety of these biologics were similar in their inclusion criteria, study protocols, and measured outcomes. Initial trial results are now being reanalyzed and reinterpreted in subsets of patients with asthma that demonstrate enhanced responses. As a result, keeping up with the growing body of literature surrounding asthma biologic therapy has become increasingly difficult. This review summarizes and compares trial designs, patient cohorts, and study results of the major trials involving these therapies. Because of variations in inclusion criteria and natural variations in enrolled cohorts, the baseline clinical traits and severity of study populations in asthma biologic trials have differed significantly. For example, baseline annualized exacerbation rates in the year before enrollment and blood eosinophilia, which are both strong predictors of a biologic's success, differed strongly among populations. Early omalizumab efficacy trials did not stratify subjects by blood eosinophils or include patients taking long-acting beta agonists or oral steroids but showed relative reductions in exacerbation rates comparable to those of the newer asthma biologics among less severe cohorts. If a care provider's aim is to reduce clinically significant exacerbations in a patient with peripheral blood eosinophilia, it is our opinion that dupilumab, mepolizumab, and reslizumab have the strongest supporting data. Mepolizumab has also demonstrated an ability to reduce emergency department visits and hospitalizations. If the goal is to improve lung function, dupilumab therapy has demonstrated the largest numeric improvements in prebronchodilator forced expiratory volume in 1 second (FEV 1) % predicted compared with placebo, with consistent results across all phase II and phase III trials, including its steroid-sparing trial (QUEST LIBERTY VENTURE). Benralizumab also demonstrated improvements in lung function in 2 phase III trials (SIROCCO, CALIMA) and its long-term safety trial (BORA). If the objective is to reduce daily oral steroids, benralizumab and dupilumab have the strongest supporting data, with roughly 50% of subjects in both trials demonstrating an ability to stop steroids altogether. Of note, a strong difference was seen across studies in the ability to reduce steroids among the placebo groups, which makes comparisons between these 3 steroid-sparing trials challenging.

IMPORTANCE These data may be useful for developing guidelines for clinicians and the general population related to the reversal of photoaging effects on the aging face damaged by solar radiation.OBJECTIVE To investigate antiaging effects of 4 commercially available topical agents on the dorsal skin in photoaged hairless mice.DESIGN AND SETTING Animal study at an academic medical center. Animals comprised 56 female Skh-1 hairless mice (6-8 weeks old). Skin samples were collected from nonirradiated intact mice (control), mice irradiated with UV-B for 8 weeks, mice irradiated with UV-B and then exposed to a topical cosmeceutical applied for 5 weeks, and UV-B-irradiated mice not exposed to cosmeceuticals and retained for 5 weeks until the end of the experiment.INTERVENTION The mice were exposed to UV-B light 3 times a week for 2 months, followed by topical application of a peptide, antioxidant, estrogen, and retinoic acid agent for 5 weeks. MAIN OUTCOMES AND MEASURESSurface features such as wrinkling were analyzed from replicas along with histomorphometric determination of epidermal thickness, sebocyte counts, and immunohistochemical study of proliferating cell nuclear antigen (PCNA).RESULTS Exposure to UV-B induced significant wrinkle formation after 13 weeks, which was attenuated with treatments with a peptide cream, antioxidant mixture, and estrogen cream

Hereditary angioedema (HAE) is a genetic condition that is characterized by frequent episodes of localized angioedema. It is a rare disorder that a primary care provider, otolaryngologist, dermatologist, or rheumatologist may encounter only occasionally. This disease is being reviewed because of the significant advances in further understanding the genetics, biology, and therapeutic management surrounding the condition. Histamine-mediated angioedema responds to steroids, antihistamines, and epinephrine, whereas bradykinin-mediated angioedema is resistant to those interventions and requires specialized therapy. Previously used medications have significant adverse effects. Approved medications for HAE have been effective in decreasing morbidity and mortality in patients with this condition. We review the presentation, diagnosis, and available pharmaceutical options for HAE and explore the limitations of implementing recommended therapy.

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.