DOCSLIB.ORG

Diagnostic Approach to Lymph Node Enlargement MARIA LAURA GHIRARDELLI, VASSILI JEMOS,* PAOLO G

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Diagnostic Approach to Lymph Node Enlargement MARIA LAURA GHIRARDELLI, VASSILI JEMOS,* PAOLO G Haematologica 1999; 84:242-247 decision making and problem solving Diagnostic approach to lymph node enlargement MARIA LAURA GHIRARDELLI, VASSILI JEMOS,* PAOLO G. GOBBI Divisione di Medicina Interna e Oncologia Medica, Dipartimento di Medicina Interna; *Patologia Chirurgica I, Dipartimento di Chirurgia Generale, Università di Pavia, IRCCS Policlinico S. Matteo, Pavia, Italy ABSTRACT Background and Objective. How to reach the correct ther investigation; second, deciding whether it would diagnosis of a lymph node enlargement is still a prob- be advisable to perform a nodal biopsy when tests lem which strongly challenges the knowledge and and other clinical findings have not provided suffi- experience of the clinician. Organized and specifi- cient diagnostic elements to categorize the LAM with cally oriented literature on the right sequential steps certainty. and the logical criteria that should guide this diag- It should, however, be noted that all the findings, nostic approach is still lacking. observations and testing that make up the rational Methods. The authors have tried to exploit available approach to LAM offer no predetermined relation- knowledge and their personal experience by corre- ships, but only merely probable ones, and that lating a large body of information regarding size, together they constitute a set of norms in which dif- physical characteristics, anatomical location of ferent factors play significant roles: e.g. the variabil- enlarged lymph nodes, and the possible epidemio- logical, environmental, occupational and clinical cat- ity of expression of the different possible disorders, egorization of this condition. individual patient variability, and a hard-to-quanti- fy amount of clinical experience and specific obser- Results and Conclusions. It was intended that such vational expertise on the part of the physicians work- material would have constituted the basis of a hypo- thetic decision-making tree, but this was impossible ing on the case. The entire subject matter of this because of the lack of epidemiological investigation study could be used to outline a decision-making and registry data. Nevertheless, we present this tree that would be extremely complex and quite dif- preparatory work here in order to stimulate the inter- ficult to construct. est of concerned readers and because of its possible The definition of what constitutes a normal lymph direct usefulness in hematologic practice. node may in itself frequently be difficult. It is well ©1999, Ferrata Storti Foundation known that the lymph nodes, together with the spleen, are the peripheral organs of the immune sys- Key words: diagnosis, lymph node enlargement, tem within which the anatomical and functional lymphadenopathy, lymphadenomegaly interconnections fundamental to immunity occur between the lymphatic and hematic circulations. There are approximately 600 lymph nodes, strategi- n general the question of what to do when a cally distributed throughout the human body, each patient presents with lymphadenomegaly (LAM) of which consists of a cellular component composed Ihas no immediate solution. Most of the time the of fibroblasts (whose function is mainly structural), family doctor only participates in the early stages of macrophages, dendritic and Langerhans’ cells the diagnostic process, then a specialist is called in (whose function is to recognize and present an anti- – usually a hematologist – whose goal is not only to gen and to activate lymphocytes), T and B lympho- do his best to reach a diagnosis but to do so in the cytes (which are the effector cells of cellular and shortest, most reasonable, least expensive and, humoral immunity, respectively). All these elements above all, least uncomfortable way for the patient. are contained within connective stroma and encased The clinical approach to LAM follows two main 1 in a capsular shell. logical steps: first, making a diagnostic distinction During an immune response the flow of blood and between a true lymphadenopathy, with a patholog- lymph through a lymph node can increase by as ical significance that deserves more detailed diag- much as twenty-five times with a resulting accumu- nostic attention, and a state of exaggerated palpa- lation of activated proliferating cells, and the entire bility of normal lymph nodes, due to causes such as lymph node may swell up to fifteen times its normal a very thin patient or flaccid connective tissue, or a volume. When this occurs it is capsular edema and simple LAM – mainly stromal – that is the result of a the tension this causes, along with the consequent previous adenopathy and does not require any fur- process of perilymphadenitis, that is responsibile for the characteristic pain of inflammatory adenopathy. Correspondence: Paolo G. Gobbi, M.D., Medicina Interna e Oncologia Medica, Università di Pavia, IRCCS Policlinico S. Matteo, p.le Golgi, Moreover, if the etiologic agent is bacterial and 27100 Pavia, Italy. reaches the lymph node in large numbers, this can Diagnosis of lymph node enlargement 243 cause follicular necrosis with suppuration, trans- ous enlargements and current adenomegalies with forming the lymph node into a soft, more or less taut, clinical significance, the different physical character- floating mass that is extremely painful and extremely istics of the lymph node, as determined by physical sensitive to the slightest touch. While in time, after examination, are also fundamental to making such a every episode of functional hyperplasia, the cellular distinction. There are four main types of physical component returns to its original normal propor- characteristics: 1) enlarged nodes that are the result tions, the same is not always true for the stroma. It of a previous inflammatory process are firm, elastic, is difficult for stromal hyperplasia to return to its orig- very mobile, hard to hold in one place and absolute- inal dimensions, especially if there has been conspic- ly painless and insensitive to handling; 2) in acute uous necrosis or suppuration, and this creates an infections lymph nodes are often tender, softly elas- anatomical basis for greater palpability of the node tic and sometimes asymmetrically enlarged if they are even under conditions of functional rest. The more isolated; other times, however, they are confluent, times these functional stimuli are repeated, the more painful and sensitive to touch, and covered by flushed pronounced this condition becomes. skin. If the infection is localized, a painful red streak A lymph node may be enlarged a) in an immune (lymphangitis) may connect the site of the infection response to infective agents (bacterial, viral); b) as a to the involved lymph node; 3) the lymph nodes of result of inflammatory cells in infections involving the lymphomas are firmer, rigidly elastic with superficial lymph node (lymphadenitis); c) by the infiltration of and deep mobility that is less than normal but not neoplastic cells carried to the node by lymphatic or completely absent. Often these lymph nodes aggre- blood circulation (metastasis); d) due to localized gate to form small packets without modifying their neoplastic proliferation of lymphocytes or macro- integument; they are only slightly or not at all painful, phages (lymphomas), and e) as a result of an infiltra- only slightly or not at all sensitive to handling (ten- tion of macrophages filled with metabolite deposits derness and sensitivity to touch are possible in sites (lipid storage diseases).2 that are readily exposed to repeated infections, such Evaluation of lymphadenomegaly as the tonsils and inguinal lymph nodes); 4) metasta- tic lymph nodes from solid tumors are typically hard, It is known that most of the information necessary at times with an irregular surface, not mobile, espe- for formulating a diagnosis of LAM comes from the cially at the deeper levels, painless and insensitive to patient’s medical history and a physical examination. touch; in extreme cases the overlying skin can take In fact, in most cases these two tools are able to pro- on a bluish-red hue and may become very thin, to vide the following data:1 the point of ulcerating. a. the size of the lymph node in relation to the patien- These four types of physical examination findings t's age; permit a distinction, albeit not perfect, of the gener- b. the characteristics of the lymph node obtained ic etiologic categories to which LAM can be attrib- from physical examination (observation, palpa- uted. While rare, it has happened occasionally that tion); lymph nodes showing inflammatory characteristics c. its anatomical location; have been biopsied years after their appearance and d. the epidemiological and clinical categorization found to be lymphomatous. Others, although they that is possible in this patient. are extremely painful and sensitive to touch, prove From the point of view of just the size of the node, to be neoplastic, and still others that are hard and there is agreement that up to 2 cm in diameter they fixed in older patients are found to be granuloma- can be normally palpable – i.e. without carrying def- tous and partially calcified. This must be kept in mind inite pathologic significance – only in young children, when interpreting the relationships which will be pre- who readily respond to any number of antigenic stim- sented below. uli with lymphoid hyperplasia, and in adults at The site itself of a LAM is often crucial. Localized LAM inguinal sites, as evidence of previous infections, even first requires a scrupulous clinical examination of all subclinical ones, of limbs, perineum and genitals. It the zones that are anatomically afferent to the enlarged is believed that except for infancy, and in the inguinal lymph nodes, although it cannot be ruled out that they area at any age, the presence of one or more lymph might be the first signs of a precocious clinical man- nodes larger than 1 cm in diameter calls for further ifestation in the course of a progressive systemic investigation if a definite cause cannot be identified. process. This is especially true if the physical charac- LAM arising in subjects under 30 years of age have an teristics of these lymph nodes are of the lymphomatous infectious or inflammatory origin in 80% of the cas- or metastatic type.
Load more

Recommended publications
  • Primary Cutaneous Nocardiosis: a Case Study and Review
    Study Primary cutaneous nocardiosis: A case study and review Arun C. Inamadar, Aparna Palit Department of Dermatology, Venereology & Leprosy, BLDEA’s SBMP Medical College, Hospital & Research Centre, Bijapur, India. Address for correspondence: Dr. Arun C. Inamadar, Professor & Head, Department of Dermatology, Venereology & Leprosy, BLDEA’s SBMP Medical College, Hospital & Research Centre, Bijapur - 586103, India. E-mail: [email protected]. ABSTRACT Background: Primary cutaneous nocardiosis is an uncommon entity. It usually occurs among immunocompetent but occupationally predisposed individuals. Aim: To study clinical profile of patients with primary cutaneous nocardiosis in a tertiary care hospital and to review the literature. Methods: The records of 10 cases of primary cutaneous nocardiosis were analyzed for clinical pattern, site of involvement with cultural study and response to treatment. Results: All the patients were agricultural workers (nine male) except one housewife. The commonest clinical type was mycetoma. Unusual sites like the scalp and back were involved in two cases. Culture was positive in six cases with N. brasiliensis being commonest organism. N. nova which was previously unreported cause of lymphocutaneous nocardiosis, was noted in one patient, who had associated HIV infection. All the patients responded to cotrimaxazole. Conclusion: Mycetoma is the commonest form of primary cutaneous nocardiosis and responds well to cotrimoxazole. KEY WORDS: Primary cutaneous nocardiosis, Mycetoma, Lymphocutaneous nocardiosis INTRODUCTION infection is prevalent. Many of the large series on nocardial infections mention the incidence of Cutaneous nocardiosis presents either as a part of cutaneous nocardiosis without specifying whether the disseminated infection or as a primary infection infection is primary or secondary. Indian reports of resulting from inoculation.
    [Show full text]
  • Granulomatous Diseases: Disease: Tuberculosis Leprosy Buruli Ulcer
    Granulomatous diseases: Disease: Tuberculosis Leprosy Buruli ulcer MOTT diseases Actinomycosis Nocardiosis Etiology Mycobacterium M. leprae M. ulcerans M. kansasii Actinomyces israelii Nocardia asteroides tuberculosis M. scrofulaceum M. africanum M. avium- M. bovis intracellulare M. marinum Reservoir Humans (M. tuberculosis, HUMANS only Environment Environment HUMANS only Environment M. africanum*) (uncertain) Animals (M. bovis) Infects animals Transmission Air-borne route Air-borne route Uncertain: Air-borne NONE Air-borne route to humans Food-borne route Direct contact traumatic Traumatic inoculation endogenous infection Traumatic (M. bovis) inoculation, Habitat: oral cavity, inoculation insect bite? intestines, female genital tract Clinical Tuberculosis (TB): Leprosy=Hansen’s Disseminating Lung disease Abscesses in the skin Broncho-pulmonary picture pulmonary and/or disease skin ulcers Cervical lymphadenitis adjacent to mucosal surfaces (lung abscesses) extra-pulmonary Tuberculoid leprosy Disseminated (cervicofacial actinomycosis), Cutaneous infections (disseminated: kidneys, Lepromatous leprosy infection in the lungs (pulmonary) or such as: mycetoma, bones, spleen, meninges) Skin infections in the abdominal cavity lymphocutaneous (peritonitis, abscesses in infections, ulcerative appendix and ileocecal lesions, abscesses, regions) cellulitis; Dissemination: brain abscesses Distribution All over the world India, Brazil, Tropical disease All over the world All humans Tropical disease * Africa Indonesia, Africa (e.g. Africa, Asia, (e.g.
    [Show full text]
  • 17110-Disseminated-Nocardiosis-A-Case-Report.Pdf
    Open Access Case Report DOI: 10.7759/cureus.5294 Disseminated Nocardiosis: A Case Report Ines M. Leite 1 , Frederico Trigueiros 1 , André M. Martins 1 , Marina Fonseca 1 , Tiago Marques 2 1. Serviço De Medicina 2, Hospital De Santa Maria, Lisboa, PRT 2. Serviço De Doenças Infecciosas, Hospital De Santa Maria, Lisboa, PRT Corresponding author: Ines M. Leite, [email protected] Abstract Disseminated nocardiosis is a rare infection associated with underlying immunosuppression, and patients usually have some identifiable risk factor affecting cellular immunity. Due to advances in taxonomy and microbiology identification methods, infections by Nocardia species are more frequent, making the discussion of its approach and choice of antibiotherapy increasingly relevant. A 77-year-old man presented to the emergency department with marked pain on the right lower limb, weakness, and upper leg edema. He had been diagnosed with organized cryptogenic pneumonia one year before and was chronically immunosuppressed with methylprednisolone 32 mg/day. Blood cultures isolated Nocardia cyriacigeorgica. Computed tomography revealed a gas collection in the region of the right iliacus muscle with involvement of the gluteal and obturator muscles upwardly and on the supragenicular plane inferiorly. Triple therapy with imipenem, amikacin, and cotrimoxazole was started, and the patient was submitted for emergent surgical decompression, fasciotomy, and drainage due to acute compartment syndrome. The patient had a good outcome and was discharged from the hospital after 30 days of intravenous therapy. This case illustrates the severity of Nocardia infection and highlights the need for a meticulous approach in the diagnosis and treatment of these patients. Categories: Internal Medicine, Infectious Disease Keywords: nocardia, nocardia infection, immunosuppression Introduction In the suborder of Corynebacterineae, three genera have strains that may be pathological to humans, with some characteristics similar to Fungi: Mycobacterium, Corynebacterium, and Nocardia.
    [Show full text]
  • Kikuchi Disease with Generalized Lymph Node, Spleen And
    Case Report Mol Imaging Radionucl Ther 2016;25:102-106 DOI:10.4274/mirt.25338 Kikuchi Disease with Generalized Lymph Node, Spleen and Subcutaneous Involvement Detected by Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Flor-18-Florodeoksiglukoz Pozitron Emisyon Tomografisi/Bilgisayarlı Tomografi ile Saptanan Yaygın Lenf Nodu, Dalak ve Deri Altı Tutulumu Olan Kikuchi Hastalığı Alshaima Alshammari1, Evangelia Skoura2, Nafisa Kazem1, Rasha Ashkanani1 1Mubarak Al Kabeer Hospital, Clinic of Nuclear Medicine, Jabriya, Kuwait 2University College London Hospital, Clinic of Nuclear Medicine, London, United Kingdom Abstract Kikuchi-Fujimoto disease, known as Kikuchi disease, is a rare benign and self-limiting disorder that typically affects the regional cervical lymph nodes. Generalized lymphadenopathy and extranodal involvement are rare. We report a rare case of a 19-year- old female with a history of persistent fever, nausea, and debilitating malaise. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) revealed multiple hypermetabolic generalized lymph nodes in the cervical, mediastinum, axillary, abdomen and pelvic regions with diffuse spleen, diffuse thyroid gland, and focal parotid involvement, bilaterally. In addition, subcutaneous lesions were noted in the left upper paraspinal and occipital regions. An excisional lymph node biopsy guided by 18F-FDG PET/CT revealed the patient’s diagnosis as Kikuchi syndrome. Keywords: Kikuchi-Fujimoto disease, histiocytic necrotizing lymphadenitis, fluorine-18-fluorodeoxyglucose Öz Kikuchi hastalığı olarak bilinen Kikuchi-Fujimoto hastalığı, genellikle bölgesel servikal lenf düğümlerini etkileyen, nadir görülen benign ve kendini sınırlayıcı bir hastalıktır. Yaygın lenfadenopati ve ekstranodal tutulum nadirdir. Bu yazıda sürekli ateş, bulantı ve halsizlik şikayetleri olan 19 yaşında bir kadın hasta sunulmaktadır.
    [Show full text]
  • Focus: Blood Cancer
    JAN-MAR 17 www.singhealth.com.sg A SingHealth Newsletter for Medical Practitioners MCI (P) 027/11/2016 FOCUS: BLOOD CANCER Haematologic Emergencies An Overview of in the General Practice Myeloproliferative Neoplasms When to Suspect Approach to an Adult with Myeloma in Primary Care Lymphadenopathy in Primary Care SingHealth Duke-NUS Academic Medical Centre • Singapore General Hospital • KK Women’s and Children’s Hospital • Sengkang Health • National Cancer Centre Singapore • National Dental Centre of Singapore • National Heart Centre Singapore • National Neuroscience Institute • Singapore National Eye Centre • SingHealth Polyclinics • Bright Vision Hospital Medical Appointments: 6321 4402 (SGH) Focus: Update Blood Cancer 6436 8288 (NCCS) Haematologic Emergencies in the General Practice Adj Assoc Prof Wong Gee Chuan, Senior Consultant, Department of Haematology, Singapore General Hospital; SingHealth Duke-NUS Blood Cancer Centre Patients with malignant haematological diseases may present with dramatic and life-threaten- ing complications. General physicians must be able to recognise these conditions as prompt treatment can be life-saving. Hyperleukocytosis and leukostasis and febrile neutropaenia in patients with haematologic malignancies are two such conditions highlighted in this article. mental state and unsteadiness in gait. patient presents with a high white cell HYPERLEUKOCYTOSIS AND There is also increased risk of intracra- count and symptoms suggestive of tis- LEUKOSTASIS IN HAEMATOLOGIC nial haemorrhage. sue hypoxia. MALIGNANCIES Besides affecting the central nervous Hyperleukocytosis has been variably system, eyes and lungs, other manifes- Leukostasis constitutes a medi- defined as a total white cell count tations include myocardial ischaemia, cal emergency. Prompt treatment (WBC) of 50 x 109/L or 100 x 109/L. Leu- limb ischaemia or bowel infarction.
    [Show full text]
  • Pediatric Nocardial Brain Abscesses in Acquired Immunodeficiency Syndrome
    C S & lini ID ca A l f R o e l Chotey et al., J AIDS Clin Res 2016, 7:11 s a e Journal of n a r r c DOI: 10.4172/2155-6113.1000628 u h o J ISSN: 2155-6113 AIDS & Clinical Research Case Report Open Access Pediatric Nocardial Brain Abscesses in Acquired Immunodeficiency Syndrome Chotey NA1, Ramdial PK1*, Miles E1, Nargan K2 and Mubaiwa L3 1Department of Anatomical Pathology, National Health Laboratory Service & University of KwaZulu-Natal, Durban, South Africa 2KwaZulu-Natal Research Institute for Tuberculosis and HIV, Durban, KwaZulu-Natal, South Africa 3Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa Abstract Nocardiosis is relatively uncommon in children and adults with acquired immunodeficiency syndrome (AIDS), despite the profound associated cellular immunodeficiency. Acquired most often by inhalation and less commonly by percutaneous inoculation, subsequent hematogenous dissemination may lead to infection of almost any organ, with a particular predilection for the central nervous system. Nocardial brain abscesses are rare. To the best of our knowledge, pediatric Nocardial brain abscesses have not been documented in Human Immunodeficiency Virus (HIV)-infected children in the English-language literature, to date. In reporting two Nocardial brain abscesses in a 9 year old AIDS patient with intermittent seizures, we highlight the difficulty associated with the ante-mortem diagnosis of Nocardial brain abscesses, and the need for cognizance of rare entities occurring in HIV-infected children. Furthermore, we emphasize the pivotal role of the autopsy in finalizing the nature of the cerebral pathology, the cause of the seizures albeit post-mortem, a cause of death and in providing a platform for continued learning in the AIDS era.
    [Show full text]
  • Kikuchi–Fujimoto Disease: Lymphadenopathy in Siblings
    Practice CMAJ Cases Kikuchi–Fujimoto disease: lymphadenopathy in siblings Allison Stasiuk BSc Pharm, Susan Teschke MD, Gaynor J. Williams MD MPhil, Matthew D. Seftel MD MPH Patient 1 Key points • Kikuchi–Fujimoto disease is an uncommon and sometimes A 19-year-old Aboriginal woman presented with a three-week familial disorder that should be considered in the history of swollen neck glands, nausea, vomiting, chills and differential diagnosis of cervical lymphadenopathy. weight loss. On examination, she had bilateral, nontender, dif- • Typical presentation includes fever, leukopenia and fuse cervical lymphadenopathy. Oral examination revealed cervical lymphadenopathy. extensive dental caries and periodontal disease. The results of • Although Kikuchi–Fujimoto disease is self-limiting and no her laboratory workup are shown in Table 1. Both a lymph definitive treatment exists, lymph node biopsy is required node aspiration and a bone marrow biopsy were nondiagnostic. to rule out malignancy. The patient was scheduled for a surgical lymph node biopsy, • Patients should be followed closely because of increased but when she was seen one month later, the lymphadenopathy risk for recurrence and for systemic lupus erythematosus. had resolved spontaneously. Based on these findings, she was diagnosed with Kikuchi–Fujimoto disease. At follow-up a year and a half later, she had no evidence of recurrence. of a cervical lymph node in the first sister was nondiagnostic. In the second sister, an excisional biopsy showed geographic areas Patient 2 of necrosis containing apoptotic bodies and a striking degree of karyorrhexis with nuclear debris (Figure 1). Cells within the Two years after the initial presentation of the first patient, her 19- areas of necrosis were highly proliferative; more than 60% of year-old younger sister was assessed for a three-week history of the cells tested positive for the Ki-67 proliferation marker.
    [Show full text]
  • Kikuchi's Disease with Multisystemic Involvement and Adverse Reaction to Drugs Maria L
    Kikuchi’s Disease With Multisystemic Involvement and Adverse Reaction to Drugs Maria L. Murga Sierra, MD*; Eva Vegas, MD*; Javier E. Blanco-Gonza´lez, MD*; Almudena Gonza´lez, MD‡; Pilar Martı´nez, MD‡; and Maria A. Calero, MD§ ABSTRACT. Kikuchi’s disease (KD), or histiocytic ne- 163 mg/dL. Biochemical analysis, coagulation, hepatic and renal crotizing lymphadenitis, was initially described in Japan functions, immunoglobulins, and complement count were normal in 1972. In the following years, several series of cases (Tables 1, 2). Rheumatoid factor, antinuclear antibodies, direct involving patients of different ages, races, and geo- Coombs test, and two Mantoux test results proved to be negative. graphic origins were reported, but pediatric reports have Multiple blood, urine, feces, sputum, and tissue culture results been rare. also were negative. Antibody titers against Epstein–Barr, cyto- megalovirus, hepatitis, HIV, and Parvovirus B19, and serum poly- The etiology of KD is unknown, although a viral or merase chain reaction for herpesvirus type 6 were negative as autoimmune hypothesis has been suggested. The most well, as were results of serologic tests for syphilis, Brucella, toxo- frequent clinical manifestation consists of local or gen- plasmosis, Leishmania, Rickettsia, Borrelia, and Bartonella henselae eralized adenopathy, although in some cases, it is asso- and quintana. ciated with more general symptoms, multiorganic in- Results of chest roentgenography, echocardiography, and bone volvement, and diverse analytic changes (leukopenia, scan were normal; an abdominal ultrasound examination detected elevated erythrocyte sedimentation rate, and C-reactive hepatosplenomegaly with uniform density and nephromegaly protein, as well as an increase of transaminases and se- with increased cortical echogenicity.
    [Show full text]
  • (12) Patent Application Publication (10) Pub. No.: US 2010/0210567 A1 Bevec (43) Pub
    US 2010O2.10567A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2010/0210567 A1 Bevec (43) Pub. Date: Aug. 19, 2010 (54) USE OF ATUFTSINASATHERAPEUTIC Publication Classification AGENT (51) Int. Cl. A638/07 (2006.01) (76) Inventor: Dorian Bevec, Germering (DE) C07K 5/103 (2006.01) A6IP35/00 (2006.01) Correspondence Address: A6IPL/I6 (2006.01) WINSTEAD PC A6IP3L/20 (2006.01) i. 2O1 US (52) U.S. Cl. ........................................... 514/18: 530/330 9 (US) (57) ABSTRACT (21) Appl. No.: 12/677,311 The present invention is directed to the use of the peptide compound Thr-Lys-Pro-Arg-OH as a therapeutic agent for (22) PCT Filed: Sep. 9, 2008 the prophylaxis and/or treatment of cancer, autoimmune dis eases, fibrotic diseases, inflammatory diseases, neurodegen (86). PCT No.: PCT/EP2008/007470 erative diseases, infectious diseases, lung diseases, heart and vascular diseases and metabolic diseases. Moreover the S371 (c)(1), present invention relates to pharmaceutical compositions (2), (4) Date: Mar. 10, 2010 preferably inform of a lyophilisate or liquid buffersolution or artificial mother milk formulation or mother milk substitute (30) Foreign Application Priority Data containing the peptide Thr-Lys-Pro-Arg-OH optionally together with at least one pharmaceutically acceptable car Sep. 11, 2007 (EP) .................................. O7017754.8 rier, cryoprotectant, lyoprotectant, excipient and/or diluent. US 2010/0210567 A1 Aug. 19, 2010 USE OF ATUFTSNASATHERAPEUTIC ment of Hepatitis BVirus infection, diseases caused by Hepa AGENT titis B Virus infection, acute hepatitis, chronic hepatitis, full minant liver failure, liver cirrhosis, cancer associated with Hepatitis B Virus infection. 0001. The present invention is directed to the use of the Cancer, Tumors, Proliferative Diseases, Malignancies and peptide compound Thr-Lys-Pro-Arg-OH (Tuftsin) as a thera their Metastases peutic agent for the prophylaxis and/or treatment of cancer, 0008.
    [Show full text]
  • Case Report Widespread Nocardiosis in a Patient with Refractory ANCA-Associated Vasculitides: Relapse Or Mimics? a Case Report and Literature Review
    Int J Clin Exp Med 2019;12(6):7878-7886 www.ijcem.com /ISSN:1940-5901/IJCEM0089770 Case Report Widespread nocardiosis in a patient with refractory ANCA-associated vasculitides: relapse or mimics? A case report and literature review Wo Yao1, Jing Xue2 Departments of 1Allergy, 2Rheumatology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China Received December 13, 2018; Accepted April 9, 2019; Epub June 15, 2019; Published June 30, 2019 Abstract: Immunocompromised patients are at high risk of Nocardia, however infection in these patients can also mimic relapsed or refractory autoimmune disease and that make diagnosis difficult. Herein is described a 60-year- old male diagnosed with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) who presented with fever, short of breath, cough, headache, and a subcutaneous mass in his right forearm after 3 months therapy with full-dose oral corticosteroid and intravenous cyclophosphamide. Given that the currently available laboratory tests and associated imaging features are nonspecific, it was quite difficult to differentiate between a recurrence of the patient’s AVV and infection as a complication. The patient was finally diagnosed with systemic nocardiosis base on a subcutaneous abscess puncture fluid culture after 3 weeks of hospitalization. Trimethoprim-sulfamethoxazole (TMP-SMX) was administered while the steroid was tapered, after which the patient’s systemic manifestations grad- ually resolved. A literature review identified 24 cases of nocardiosis as a complication of systemic vasculitis was performed. Male patients with systemic vasculitis (especially AAV or Behcet’s disease) aged ≥ 60 years who were treated with corticosteroid in conjunction with or without immunosuppressant therapy were at high risk of Nocardia infection.
    [Show full text]
  • Mycobacterium Marinum Infection: a Case Report and Review of the Literature
    CONTINUING MEDICAL EDUCATION Mycobacterium marinum Infection: A Case Report and Review of the Literature CPT Ryan P. Johnson, MC, USA; CPT Yang Xia, MC, USA; CPT Sunghun Cho, MC, USA; MAJ Richard F. Burroughs, MC, USA; COL Stephen J. Krivda, MC, USA GOAL To understand Mycobacterium marinum infection to better manage patients with the condition OBJECTIVES Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Identify causes of M marinum infection. 2. Describe methods for diagnosing M marinum infection. 3. Discuss treatment options for M marinum infection. CME Test on page 50. This article has been peer reviewed and approved Einstein College of Medicine is accredited by by Michael Fisher, MD, Professor of Medicine, the ACCME to provide continuing medical edu- Albert Einstein College of Medicine. Review date: cation for physicians. December 2006. Albert Einstein College of Medicine designates This activity has been planned and imple- this educational activity for a maximum of 1 AMA mented in accordance with the Essential Areas PRA Category 1 CreditTM. Physicians should only and Policies of the Accreditation Council for claim credit commensurate with the extent of their Continuing Medical Education through the participation in the activity. joint sponsorship of Albert Einstein College of This activity has been planned and produced in Medicine and Quadrant HealthCom, Inc. Albert accordance with ACCME Essentials. Drs. Johnson, Xia, Cho, Burroughs, and Krivda report no conflict of interest. The authors report no discussion of off-label use. Dr. Fisher reports no conflict of interest. Mycobacterium marinum is a nontuberculous findings, the differential diagnosis, the diagnostic mycobacteria that is often acquired via contact methods, and the various treatment options.
    [Show full text]
  • Evaluation of Pathologic Lesions in Superficial Lymph Node Biopsies
    Sangeeta Gupta et al / International Journal of Biomedical Research 2016; 7(5): 289-294. 289 International Journal of Biomedical Research ISSN: 0976-9633 (Online); 2455-0566 (Print) Journal DOI: 10.7439/ijbr CODEN: IJBRFA Original Research Article Evaluation of pathologic lesions in superficial lymph node biopsies Vidyadhara Rani P*1, Naveen Kumar S.1 and Ravinder T2 Department of Pathology, Department of Radiology, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana *Correspondence Info: Dr. Vidyadhara Rani P, Department of Pathology, Department of Radiology, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana, India E-mail: [email protected] Abstract Introduction: Lymphadenopathy can be due to any disease process involving lymph nodes. Enlargement of lymph node is a very common clinical symptom seen in outpatient department of any hospital. Lymphadenopathy can occur at any age group and at any site of the body. Detail clinical history for signs and symptoms, size of lymph nodes, presence of generalized lymphadenopathy, and hepatosplenomegaly help to arrive at provisional diagnosis. Histopathological examination of the lymph node biopsies is a gold standard test in the distinction between reactive and malignant lymphoid proliferations as well as for detailed subtyping of lymphomas. Aim: The aim of present study is to analyze pathological spectrum of various neoplastic and non-neoplastic lesions affecting superficial lymph nodes in the neck, axilla, inguinal region and correlation with clinical findings. Materials and Methods: The present study was a retrospective study conducted in the department of Pathology, at Chalmeda Anand Rao Institute of Medical Sciences, Bommakal Karimnagar,during the period from february 2014 to march 2015.
    [Show full text]