Background: Although histologic chorioamnionitis (HCA) is known to be associated with poor outcomes in preterm infants, its clinical significance among term infants is not clearly known.Objectives: To investigate the utility of HCA in determining early onset clinical sepsis (EOCS) among term newborns.Methods: The incidence of HCA and EOCS in term infants born during 2008–2009 was evaluated in a single center retrospective study (n = 3417). The predictive value of HCA for determining EOCS in term infants admitted to the neonatal intensive care unit (NICU) for suspected sepsis (n = 388) was quantified. Outcome of otherwise healthy term infants in the nursery with HCA was also investigated.Results: Overall, 11% of term infants with HCA also had EOCS. HCA was associated with increased risk for EOCS (OR 2.6, 95% confidence interval 1.6–4.2, P < 0.001) among term infants admitted to the NICU for suspected sepsis. No cases of EOCS were found among otherwise well-appearing infants in the nursery with HCA. Multiple logistic regression analysis indicated that addition of HCA does not increase the power of a model combining C-reactive protein (CRP) and immature to total neutrophil ratio in determining EOCS.Conclusion: Although HCA in term infants is associated with EOCS, it did not improve the ability of CRP and immature to total neutrophil ratio to predict EOCS. Routine placental examination may not contribute to the diagnosis of EOCS in term infants.

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Nodular hyperplasia (NH) of the Bartholin gland is an exceedingly rare benign solid lesion of the female genital tract that can mimic the Bartholin gland cyst clinically. The histologic criteria for NH were established in 1998 by Koenig and Tavassoli. In this case series, we describe 4 cases of NH from Women and Infants Hospital in Rhode Island. All cases have microscopic features of lobular proliferation of acini and inspissated mucin. One case especially has extensive mucin extravasation mimicking an aggressive angiomyxoma. In this case series, we call attention to NH as another entity to consider in the differential diagnosis of an enlarged Bartholin gland. We also discuss ways to distinguish it from other benign and malignant solid lesions of the vulvar vestibule.

A previously healthy 58-year-old woman presented with tender, pink papules and plaques over the palms (a) and soles, episcleritis, ankle edema, and bloody stools. She was afebrile, with a normal abdominal exam, and lab tests showed an elevated leukocyte count (13,300/µl), erythrocyte sedimentation rate (56 mm/h), and C-reactive protein (29.3 mg/L). Colonoscopy identified ulcerations in the rectosigmoid and sigmoid colon (b), and the biopsy revealed active colitis and crypt distortion (c; hematoxylin and eosin (H&E) ×10), consistent with ulcerative colitis. Palmar punch biopsy demonstrated nodular and diffuse neutrophilic infiltrate in the mid-to upper dermis (d; H&E ×10), consistent with neutrophilic dermatosis. Among the many extraintestinal manifestations of inflammatory bowel disease, palmoplantar neutrophilic dermatosis is a rare cutaneous complication.An 18-year-old man presented with intermittent colicky abdominal pain associated with vomiting and absolute constipation lasting for 2-3 days. He had experienced this two or three times in the previous year. He denied any weight loss, fever, taking of drugs, history of abdominal surgery, or peritoneal dialysis. Examination revealed only mild tenderness in the abdomen. Computed tomography showed a cluster of small bowel loops in the center of the abdomen within a thick membranous sac. These features probably represent a cocoon formation in the small bowel. Primary sclerosing encapsulating peritonitis is a rare benign condition.