Woodland Hills Medical Center

Extraintestinal manifestations of Crohn's disease are rare but should be considered in patients with newly discovered lesions in organs not typically affected by inflammatory bowel disease (IBD). Here, we describe a case of a patient who presented with abdominal pain due to splenic lesions, with incidental discovery of pulmonary nodules. The patient was also found to have methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia on presentation, raising initial concern for septic emboli to the lungs and spleen. However, the patient's abdominal pain did not improve, and the splenic lesions and pulmonary nodules increased in size despite appropriate antibiotic therapy, prompting evaluation for an alternative diagnosis. After further workup and multidisciplinary discussion, the patient was started on corticosteroids for suspected extraintestinal Crohn's disease, with rapid clinical improvement. This case highlights the importance of reconsidering the differential diagnosis when a presumed etiology and its treatment do not explain the clinical course, and it reviews the literature on pulmonary nodules and splenic lesions as rare extraintestinal manifestations of Crohn's disease.

Background and Clinical Significance: Optic neuritis, an inflammatory demyelinating condition affecting the optic nerve, can present as an isolated phenomenon or as a harbinger of an underlying systemic disorder. While often associated with multiple sclerosis (MS), optic neuritis has been reported in the context of various infectious and inflammatory conditions, including human immunodeficiency virus (HIV) infection. Case Presentation: We describe a case of bilateral optic neuritis that led to the diagnosis of acute HIV infection in a young man actively engaged in bodybuilding, anabolic steroid use, and high-risk sexual behavior. The patient initially presented with an acute onset of vision loss, headache, and photophobia. Magnetic resonance imaging (MRI) findings confirmed demyelination of the optic nerves, and laboratory workup revealed acute HIV-1 infection. The patient improved following high-dose corticosteroids and initiation of antiretroviral therapy. Conclusions: This case highlights the need to consider systemic infections such as HIV in atypical presentations of optic neuritis.

Mesenchymal neoplasms composed of vascular, smooth muscle, and adipocytic components are uncommon in the nasal cavity. While angioleiomyoma (AL) is a smooth muscle tumor in the Head & Neck WHO classification, it is considered of pericytic origin in the Skin as well as Soft Tissue and Bone classifications. For nasal AL with an adipocytic component, the terms AL with adipocytic differentiation and angiomyolipoma (AML) have been applied, among others. AML is a type of perivascular epithelioid cell tumor (PEComa), most often arising in the kidney, sometimes associated with the tuberous sclerosis complex (TSC). It is uncertain whether nasal cavity AML and AL are best considered hamartomas or neoplasms, as their genetics are largely unexplored. We performed a multi-institutional retrospective study of nasal cavity mesenchymal lesions. Patient demographics, clinical histories, and histologic and immunohistochemical findings were collected. DNA and RNA were extracted from formalin-fixed, paraffin-embedded tissue and analyzed by SNP-based chromosomal microarray, targeted RNA fusion sequencing, and whole-exome sequencing. Fifteen lesions (3-42mm) were identified, predominantly in male (87%) patients with a median age of 60. Patients typically presented with obstructive symptoms, and none had a history of TSC. One AL was a recurrence from six years prior; 11 cases showed no recurrence (median 4.7 years, range: 0.88-12.4). Morphologically, 11 AML contained 30-80% smooth muscle, 10-25% vasculature, and 2-60% adipose tissue, while four AL contained 70-80% smooth muscle and 20-30% vasculature. Other histologic observations included ulceration, thrombosis, inflammation, myxoid change, senescent nuclei, and extramedullary hematopoiesis; no well-developed epithelioid cell morphology was identified. Immunohistochemically, all cases were positive for smooth muscle markers (actin, desmin, and/or caldesmon) and negative for melanocytic markers. Molecular analysis revealed loss of 3p and 11q in a single AML. No other known pathogenic copy number or molecular alterations were seen, including in TSC1/2, TFE3, or NOTCH2. Nasal cavity AML lacks morphologic, immunophenotypic, and genetic features of PEComa family AML. The significant histologic overlap between nasal AML and AL without distinguishing molecular features in either entity suggests "sinonasal angioleiomyoma with adipocytic differentiation" may be the most appropriate terminology for hybrid vascular and smooth muscle lesions containing adipocytic components.

Quantum sensors represent a new generation of sensors with improved precision, accuracy, stability, and robustness to environmental effects compared to their classical predecessors. After decades of laboratory development, several types of quantum sensors are now commercially available or are part-way through the commercialization process. This paper provides a brief description of the operation of a selection of quantum sensors that employ the principles of atom–light interactions and discusses progress toward packaging those sensors into products. This paper covers quantum inertial and gravitational sensors, including gyroscopes, accelerometers, gravimeters, and gravity gradiometers that employ atom interferometry, nuclear magnetic resonance gyroscopes, atomic and spin-defect magnetometers, and Rydberg electric field sensors.