Objective: The purpose of our study was to evaluate the alterations of bone metabolism and the prevalence of vertebral fractures in the population with HIV and hepatitis B and C seropositivity in treatment with antiretroviral drugs (HAART). Methods: We selected 83 patients with diagnosis of HIV, HBV, HCV infection. In all these patients biochemical examinations of phospho-calcium metabolism and a densitometry of lumbar spine were performed. We also evaluated lateral spine X-rays in order to analyze the presence of vertebral deformities and to define their severity. As a control group we analyzed the prevalence of vertebral fractures in a group of 40 non-infectious patients. Results: We selected 82 seropositive patients, 46 males and 37 females, with a median age of 55 ± 10 years. Out of these patients, 55 were infected by HIV, 12 were infected by HBV, 11 presented HIV and HCV co-infection and 4 were HCV+. The prevalence of hypovitaminosis D in the studied population was 53%, while the prevalence of osteoporosis and osteopenia was 14 and 48%, respectively. The average T-score in the fractured population was −1.9 SD. The viral load and the CD4+ cell count were respectively, directly, and inversely correlated with the number and severity of vertebral fractures. Antiretroviral therapy regimen containing TDF and PI was a significant determinant of the presence of vertebral deformities. The use of these drugs was also associated with lower levels of vitamin D and higher bone turnover levels compared to other antiretroviral drugs. Conclusions: HIV patients suffer from bone fragility, particularly at spine, independently by the level of bone mineral density. In this population, the T-score threshold for the risk of fracture is higher than that usually used in general population. For this reason, it would be indicated to perform an X-ray of the spine in order to detect vertebral deformities even in patients with a normal or slighlty reduced bone mineral density.

A woman in her 60s with a history of atrial fibrillation, hypertension and dyslipidaemia was admitted to the Intensive Care Unit with hypotension, dehydration and acute kidney injury after 20 days of watery diarrhoea. Although initial investigations did not detect an evident infectious aetiology, a diagnosis of infectious colitis was hypothesised. After supportive care and quick recovery, she was discharged and instructed to resume her prior medications, including olmesartan (used for 1 year) for hypertension. Diarrhoea and renal failure recurred promptly, leading to readmission. Gastroscopy revealed severe villous atrophy and inflammation of the duodenum. However, serological tests for coeliac disease were negative. Olmesartan-related sprue-like enteropathy was diagnosed after discontinuing olmesartan, leading to clinical improvement without a gluten-free diet. This case emphasised the importance of considering iatrogenic causes in severe enteropathy differential diagnosis, particularly olmesartan-related complications in patients presenting with sprue-like symptoms, watery diarrhoea and acute renal failure.

Background and Clinical Significance: Disorders caused by platelet-activating antibodies targeting platelet factor 4 (PF4) are recognized as the cause of severe thrombotic events and are not restricted to heparin-induced thrombocytopenia (HIT). Case Presentation: We report a 67-year-old man with thrombocytopenia and extensive portal-splenic-mesenteric vein thrombosis complicated by intestinal ischemia. Despite intravenous unfractionated heparin (UFH), his condition worsened toward pulmonary embolism, septic shock, and multi-organ failure. Thrombolysis with alteplase was also ineffective. Both thrombophilia testing and autoimmune panels were negative, including those for antiphospholipid syndrome. An anti-PF4 immune thrombotic disorder was hypothesized. Therefore, argatroban was initiated instead of UFH therapy and intravenous immune globulin (IVIG) was administered. The platelet count increased and the patient’s clinical condition progressively improved. An anti-PF4/heparin assay on a blood sample collected before IVIG was highly positive. Platelet activation assays did not demonstrate an increased activation after the addition of heparin (the Heparin-Induced Platelet Activation [HIPA] assay was negative) though increased activation was observed with the addition of PF4 (the PF4-Induced Platelet Activation [PIPA] assay was positive), thus defining a VITT-like syndrome. Conclusions: This case report highlights the crucial function of having adequate laboratory facilities available to disentangle different anti-PF4 disorders for an accurate definition of a specific diagnosis, such as VITT-like syndrome, thereby allowing for the most appropriate therapeutic management of these complex pathological conditions. The clinical suspicion of an anti-PF4 immune disorder should be considered in cases of severe, otherwise unexplained, thrombotic events associated with thrombocytopenia. Specific tests like HIPA and PIPA are essential for definitive diagnosis.

Background. Acquired hemophilia A (AHA) is a rare autoimmune disorder, characterized by the development of autoantibodies directed against coagulation factor VIII (FVIII), thereby leading to a severe bleeding diathesis. Clinical suspicion and understanding of AHA's features are essential for its effective diagnosis and management.Aims. To describe the clinical characteristics of AHA patients in a monocentric cohort.Methods. We conducted a retrospective observational study on a cohort of 39 patients with diagnosis of AHA between 2008 and 2025 at the Hospital of Verona, Italy.Results. This study included 39 patients (males n=19/49%). The age at diagnosis ranged from 41 to 96 years with a mean age of 77 years. Fifteen subjects (38%) were classified as idiopathic AHA. Malignancy was the most frequent underlying condition in 14 subjects (36%), with 6 cases of cancer of the genitourinary tract, 4 cases of cancer of the gastrointestinal tract, 3 cases of breast cancer, and 1 case of brain tumor. Seven subjects (18%) had concomitant autoimmune disorders. Only one case of postpartum AHA was identified, along with single cases linked to with dermatological disease (bullous pemphigoid) or recent drug administration (clopidogrel). The great majority of patients (n=36/92%) had bleeding at diagnosis. The most frequent hemorrhages involved the mucocutaneous district (n=31/79.4%) and the genitourinary tract (n=4/10%). Only 3 patients (8%) had no significant bleeding and were diagnosed based on the laboratory coagulation tests. The mean hemoglobin level was 8.9±3.8 g/dL and the mean platelet count was 235.000±109.000/mcL. The mean aPTT ratio was 2.64±0.92. The mean FVIII activity level was 5.1±7.7%, with 12 subjects (31%) with FVIII activity 5 BU).Conclusions. The data from our cohort align with the existing medical literature. AHA should be suspected especially in the elderly population, either males or females, when there are novel and severe bleeding associated with anotherwise unexplained prolonged aPTT. The development of large registries for AHA could allow for better understanding of this rare and sometimes underdiagnosed disease.

Antiphospholipid syndrome (APS) is an acquired thrombophilic disorder related to the presence of antiphospholipid antibodies (LAC, anticardiolipin, anti Beta2-glycoprotein) known to cause venous and arterial thrombosis and recurrent pregnancy loss. Skin disorder is a frequent finding usually due to vascular thrombosis involving the dermal layer and can be either localized or widespread causing necrosis and ulceration of the skin, without histological evidence of vasculitis. We present a case of a woman with APS with both arterial and venous thrombotic involvement associated with an atypical dermatological manifestation histologically consistent with a pauci-inflammatory intermediate-deep dermal arteriolar platelet–mediated thrombosis that appeared despite anticoagulation with warfarin and responding to the addition of antiplatelet therapy.