Basal Subnuclear Vacuolization, Armanni-Ebstein Lesions, Wischnewsky Lesions, and Elevated Vitreous Glucose and β-Hydroxybuyrate

Abstract

Hypothermia and diabetic ketoacidosis are both potentially fatal conditions, which have historically been considered to have associated pathognomonic pathologies. Hypothermia and diabetic ketoacidosis share similar pathological mechanisms, which result in metabolic derangement, with increased post mortem vitreous glucose and β-hydroxybuyrate, and are able to exacerbate and precipitate one another. Although Wischnewsky lesions are associated with hypothermia, and Armanni-Ebstein lesions and basal subnuclear vacuolization are associated with diabetic ketoacidosis, recent studies have demonstrated that there is a significant overlap between the pathological findings of these 2 conditions. We report a case of a 50-year-old woman with type 1 diabetes who was found deceased in the middle of winter. Autopsy showed Wischnewsky lesions, Armanni-Ebstein lesions, and basal subnuclear vacuolization, together with elevated vitreous glucose and β-hydroxybuyrate. The cause of death was the combined effects of hypothermia and diabetic ketoacidosis. This case highlights the overlapping clinical presentation, pathophysiology, and pathology of these 2 conditions.

Detection and Classification of Novel Renal Histologic Phenotypes Using Deep Neural Networks

“…17,18 In the KO animals, the DNN has highlighted the presence of tubular simplification, as shown by a lack of SGLT2 staining (Figure 8), which has been shown to occur in diabetic ketoacidosis. 19 In our study, the KO mice lack fatty acyl-CoA reductase 2, a reductase enzyme involved in the conversion of fatty acids to fatty alcohols. 20 Albumin reabsorption has been shown to occur in the tubules, 21 albumin is a normal carrier for free fatty acids, and fatty acid couptake in the tubules has already been proposed as a disease mechanism.…”

Biological Mechanisms behind Wischnewsky Spots Finding on Gastric Mucosa: Autopsy Cases and Literature Review

“…The literature review led to the selection of 23 papers, published over the period 2001–2021 [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. The review included 12 case reports, 4 retrospective analyses, 3 experimental models, 2 immunohistochemical analyses, 1 review, 1 commentary.…”

Clinicopathologic Appearance of Advanced Ketoacidosis With Basal Vacuolation in Renal Tubules

“…22 Furthermore, in DM patients, Armanni-Ebstein lesions, which may be confused with BV, can also be observed. [23][24][25] Thus, confirmation of BHB concentration is essential to distinguish ketoacidosis from these conditions.…”