Granulomatous Lymphadenitis
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Isolated Cervical Lymph Node Sarcoidosis Presenting in an Asymptomatic Neck Mass: a Case Report
http://dx.doi.org/10.4046/trd.2013.75.3.116 CASE REPORT ISSN: 1738-3536(Print)/2005-6184(Online) • Tuberc Respir Dis 2013;75:116-119 Isolated Cervical Lymph Node Sarcoidosis Presenting in an Asymptomatic Neck Mass: A Case Report Yong Shik Kwon, M.D.1, Hye In Jung, M.D.1, Hyun Jung Kim, M.D.1, Jin Wook Lee, M.D.1, Won-Il Choi, M.D., Ph.D.1, Jin Young Kim, M.D.2, Byung Hak Rho, M.D., Ph.D.2, Hye Won Lee, M.D.3 and Kun Young Kwon, M.D., Ph.D.3 Departments of 1Internal Medicine, 2Radiology, and 3Pathology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea Sarcoidosis, a systemic granulomatous disease of unknown etiology. The presentation of sarcoidal granuloma in neck nodes without typical manifestations of systemic sarcoidosis is difficult to diagnose. We describe the case of a 37-year-old woman with an increasing mass on the right side of neck. The excisional biopsy from the neck mass showed noncaseating epithelioid cell granuloma of the lymph nodes. No evidence of mycobacterial or fungal infection was noted. Thoracic evaluations did not show enlargement of mediastinal lymph nodes or parenchymal abnormalities. Immunohistochemistry showed abundant expression of tumor necrosis factor-α in the granuloma. However, transforming growth factor-β was not expressed, although interleukin-1β was focally expressed. These immunohistochemical findings supported characterization of the granuloma and the diagnosis of sarcoidosis. Sarcoidosis can present with cervical lymph node enlargement without mediastinal or lung abnormality. Immunohistochemistry may support the diagnosis of sarcoidosis and characterization of granuloma. -
A Misunderstood Teenager with Paediatric Inflammatory Multisystem Syndrome – Temporarily Associated with SARS-Cov-2 Admitted Under Adult Medicine
LESSONS OF THE MONTH Clinical Medicine 2021 Vol 21, No 1: e96–9 Lessons of the month: A misunderstood teenager with paediatric inflammatory multisystem syndrome – temporarily associated with SARS-CoV-2 admitted under adult medicine Authors: Sachin T PatelA and Harry WrightB The emergence of SARS-CoV-2 has proven to be a challenge low total protein (52 g/L), albumin (28 g/L), globulin (23 g/L) and to healthcare bodies globally. The virus has been associated alkaline phosphatase (49 U/L). A surgical review was sought, and with a spectrum of clinical features, from anosmia to they recommended radiological imaging. Contrast computed gastrointestinal upset to multiorgan dysfunction in the tomography (CT) of the chest, abdomen and pelvis showed most severe cases. Given the range of features observed, it is multiple enlarged mesenteric nodes, especially in the RIF, possibly ABSTRACT important to be aware that infectious diseases can present in keeping with mesenteric adenitis (Fig 1). The visualised appendix atypically. Furthermore, in many hospitals, including our own, was unremarkable and both lung fields were clear. All other teenagers aged 16 to 18 years old are admitted under the abdominal and pelvic viscera were unremarkable. care of adult medical services. Clinicians should be aware of As appendicitis was ruled out by the surgical team, he was patients presenting with the novel condition of paediatric started on intravenous (IV) aciclovir 600 mg, 3 times a day, and IV inflammatory multisystem disorder – temporarily associated ceftriaxone 2 g, 12 hourly, to cover for meningitis. He also received with SARS-CoV-2 (PIMS-TS). -
Follicular Lymphoma
Follicular Lymphoma What is follicular lymphoma? Let us explain it to you. www.anticancerfund.org www.esmo.org ESMO/ACF Patient Guide Series based on the ESMO Clinical Practice Guidelines FOLLICULAR LYMPHOMA: A GUIDE FOR PATIENTS PATIENT INFORMATION BASED ON ESMO CLINICAL PRACTICE GUIDELINES This guide for patients has been prepared by the Anticancer Fund as a service to patients, to help patients and their relatives better understand the nature of follicular lymphoma and appreciate the best treatment choices available according to the subtype of follicular lymphoma. We recommend that patients ask their doctors about what tests or types of treatments are needed for their type and stage of disease. The medical information described in this document is based on the clinical practice guidelines of the European Society for Medical Oncology (ESMO) for the management of newly diagnosed and relapsed follicular lymphoma. This guide for patients has been produced in collaboration with ESMO and is disseminated with the permission of ESMO. It has been written by a medical doctor and reviewed by two oncologists from ESMO including the lead author of the clinical practice guidelines for professionals, as well as two oncology nurses from the European Oncology Nursing Society (EONS). It has also been reviewed by patient representatives from ESMO’s Cancer Patient Working Group. More information about the Anticancer Fund: www.anticancerfund.org More information about the European Society for Medical Oncology: www.esmo.org For words marked with an asterisk, a definition is provided at the end of the document. Follicular Lymphoma: a guide for patients - Information based on ESMO Clinical Practice Guidelines – v.2014.1 Page 1 This document is provided by the Anticancer Fund with the permission of ESMO. -
Pigmentation Associated Histopathological Variations in Sympathetic Ophthalmia
Br J Ophthalmol: first published as 10.1136/bjo.64.3.220 on 1 March 1980. Downloaded from British Jolarnal of Ophthalmology, 1980, 64, 220-222 Pigmentation associated histopathological variations in sympathetic ophthalmia GEORGE E. MARAK, JR., AND HIROSHI IKUI From the Department of Ophthalmology, Georgetown University, Washington, DC, USA, and the Department of Ophthalmology, Kyishia University, Fukiioka, Japani SUMMARY The severity of inflammation in sympathetic ophthalmia is related to the degree of pigmentation, and the granulomatous response seems to be related to pigmentation. Eosinophilia is also associated with pigmentation, but this association appears to be fortuitous and is a result of the association of eosinophilia with severity of the inflammation. Elsching presented his most confusing pearl to the reasonably be considered intermediate in pigmen- ophthalmological community when he proposed tation between North American black and white that sympathetic ophthalmia represented an autoim- populations. mune response to uveal pigment.12 Recent obser- The magnitude of choroidal thickening by the vations have raised considerable doubts about the inflammatory infiltrate, the intensity of tissue role of uveal pigment as the offending antigenin eosinophilia, and the proportion of the epithelioid sympathetic ophthalmia.34 The function of the uveal cell response in the choroid compared to the melanocytes in sympathetic ophthalmia is not well lymphocytic infiltration were rated by a single understood, but pigmentary disturbances occur -
A Fatal Case of Necrotising Fasciitis of the Eyelid
Br J Ophthalmol: first published as 10.1136/bjo.72.6.428 on 1 June 1988. Downloaded from British Journal of Ophthalmology, 1988, 72, 428-431 A fatal case of necrotising fasciitis of the eyelid R WALTERS From Southampton Eye Hospital, Wilton A venue, Southampton S09 4XW SUMMARY A fatal case of necrotising fasciitis in a 35-year-old man is described and the differential diagnosis and management discussed. Necrotising fasciitis is a potentially fatal skin were taken. The Gram stain revealed Gram-positive infection which is being increasingly recognised as an cocci. He was then treated with intravenous underdiagnosed condition. It requires prompt diag- cefotaxime and gentamicin and topical chlor- nosis, investigation, and treatment. Early surgical amphenicol and gentamicin drops. Because of the debridement is, in combination with suitable intra- poor visual acuity of the right eye it was thought that venous antibiotics, the mainstay of treatment. an orbital cellulitis could not be excluded despite the normal eye movements and absence of proptosis. He Case report was therefore transferred to the General Hospital under the care of an ear, nose, and throat consultant In December 1985 a previously fit 35-year-old factory in order to exclude underlying sinus disease and an manager was referred by his general practitioner to associated abscess. the Casualty Department of the Southampton Eye Skull x-rays (including sinus views) revealed no Hospital with a 12-hour history of increasing redness abnormality and he was therefore continued on his and swelling of his right upper lid. He said that two medical treatment (with the addition of intravenous http://bjo.bmj.com/ days previously he had been poked in the same eye by metronidazole), the presumed diagnosis being his daughter (who had been playing with her guinea- preseptal cellulitis. -
Ehrlichiosis and Anaplasmosis Are Tick-Borne Diseases Caused by Obligate Anaplasmosis: Intracellular Bacteria in the Genera Ehrlichia and Anaplasma
Ehrlichiosis and Importance Ehrlichiosis and anaplasmosis are tick-borne diseases caused by obligate Anaplasmosis: intracellular bacteria in the genera Ehrlichia and Anaplasma. These organisms are widespread in nature; the reservoir hosts include numerous wild animals, as well as Zoonotic Species some domesticated species. For many years, Ehrlichia and Anaplasma species have been known to cause illness in pets and livestock. The consequences of exposure vary Canine Monocytic Ehrlichiosis, from asymptomatic infections to severe, potentially fatal illness. Some organisms Canine Hemorrhagic Fever, have also been recognized as human pathogens since the 1980s and 1990s. Tropical Canine Pancytopenia, Etiology Tracker Dog Disease, Ehrlichiosis and anaplasmosis are caused by members of the genera Ehrlichia Canine Tick Typhus, and Anaplasma, respectively. Both genera contain small, pleomorphic, Gram negative, Nairobi Bleeding Disorder, obligate intracellular organisms, and belong to the family Anaplasmataceae, order Canine Granulocytic Ehrlichiosis, Rickettsiales. They are classified as α-proteobacteria. A number of Ehrlichia and Canine Granulocytic Anaplasmosis, Anaplasma species affect animals. A limited number of these organisms have also Equine Granulocytic Ehrlichiosis, been identified in people. Equine Granulocytic Anaplasmosis, Recent changes in taxonomy can make the nomenclature of the Anaplasmataceae Tick-borne Fever, and their diseases somewhat confusing. At one time, ehrlichiosis was a group of Pasture Fever, diseases caused by organisms that mostly replicated in membrane-bound cytoplasmic Human Monocytic Ehrlichiosis, vacuoles of leukocytes, and belonged to the genus Ehrlichia, tribe Ehrlichieae and Human Granulocytic Anaplasmosis, family Rickettsiaceae. The names of the diseases were often based on the host Human Granulocytic Ehrlichiosis, species, together with type of leukocyte most often infected. -
Familial Mediterranean Fever and Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis (PFAPA) Syndrome: Shared Features and Main Differences
Rheumatology International (2019) 39:29–36 Rheumatology https://doi.org/10.1007/s00296-018-4105-2 INTERNATIONAL REVIEW Familial Mediterranean fever and periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome: shared features and main differences Amra Adrovic1 · Sezgin Sahin1 · Kenan Barut1 · Ozgur Kasapcopur1 Received: 10 June 2018 / Accepted: 13 July 2018 / Published online: 17 July 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Autoinflammatory diseases are characterized by fever attacks of varying durations, associated with variety of symptoms including abdominal pain, lymphadenopathy, polyserositis, arthritis, etc. Despite the diversity of the clinical presentation, there are some common features that make the differential diagnosis of the autoinflammatory diseases challenging. Familial Mediterranean fever (FMF) is the most commonly seen autoinflammatory conditions, followed by syndrome associated with periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA). In this review, we aim to evaluate disease charac- teristics that make a diagnosis of FMF and PFAPA challenging, especially in a regions endemic for FMF. The ethnicity of patient, the regularity of the disease attacks, and the involvement of the upper respiratory systems and symphonies could be helpful in differential diagnosis. Current data from the literature suggest the use of biological agents as an alternative for patients with FMF and PFAPA who are non-responder classic treatment options. More controlled studies -
Mycobacterium Tuberculosis Scott M
© 2015. Published by The Company of Biologists Ltd | Disease Models & Mechanisms (2015) 8, 591-602 doi:10.1242/dmm.019570 RESEARCH ARTICLE Presence of multiple lesion types with vastly different microenvironments in C3HeB/FeJ mice following aerosol infection with Mycobacterium tuberculosis Scott M. Irwin1, Emily Driver1, Edward Lyon1, Christopher Schrupp1, Gavin Ryan1, Mercedes Gonzalez-Juarrero1, Randall J. Basaraba1, Eric L. Nuermberger2 and Anne J. Lenaerts1,* ABSTRACT reservoir (Lin and Flynn, 2010). Since 2008, the incidence of Cost-effective animal models that accurately reflect the pathological multiple-drug-resistant (MDR) tuberculosis (TB) in Africa has progression of pulmonary tuberculosis are needed to screen and almost doubled, while in southeast Asia the incidence has increased evaluate novel tuberculosis drugs and drug regimens. Pulmonary more than 11 times (World Health Organization, 2013). Globally, disease in humans is characterized by a number of heterogeneous the incidence of MDR TB increased 42% from 2011 to 2012, with lesion types that reflect differences in cellular composition and almost 10% of those cases being extensively drug-resistant (XDR) organization, extent of encapsulation, and degree of caseous TB. With the rise in MDR and XDR TB, new drugs and especially necrosis. C3HeB/FeJ mice have been increasingly used to model drugs with a novel mechanism of action or drugs that can shorten the tuberculosis infection because they produce hypoxic, well-defined duration of treatment are desperately needed. granulomas -
Spider Bite Inducing Superficial Lymphangitis: a Case Report
ISSN: 2574-1241 Volume 5- Issue 4: 2018 DOI: 10.26717/BJSTR.2018.12.002232 El Anzi Ouiam. Biomed J Sci & Tech Res Case Report Open Access Spider Bite Inducing Superficial Lymphangitis: A Case Report El Anzi Ouiam*, Meziane Mariam and Hassam Badredine Department of Dermatology-Venereology, Morocco Received: Published: *Corresponding: December author: 04, 2018; : December 17, 2018 El Anzi Ouiam, Department of Dermatology-Venereology, Morocco Abstract Superficial lymphangitis after insect bite is the result of an allergic reaction to the insect antigen. We present the case of a 22-year-old patient with no notable medical history, presented with a pruritic rash on the chest, two days after an insect bite. Unlike bacterial lymphangitis, the site of insectKeywords: bite is not painful but pruritic. Spider Bite; Lymphangitis; Allergic Reaction Introduction lymphadenopathy. Different authors assume that superficial Superficial lymphangitis after insect bite is the result of an lymphangitis after spider sting is the consequence of an allergic allergic reaction to the insect antigen, which is injected into the skin immune reaction due to insect toxins [3]. Unlike bacterial andClinical drained Case by lymphatic vessels [1]. lymphangitis, the site of insect bite is not painful but pruritic. It’s also characterised by the absence of fever and lymph node A 22-year-old female with no notable medical history, presented enlargement and a rapid spontaneous regression [1-3] (Figure 1). with a pruritic rash on the chest. She mentioned intense pruritus and low pain. Two days before she had been bitten on the shoulder by a spider. Physical examination showed a red linear lesion starting from erythematous macule of the shoulder and extending toward the anterior wall of the chest. -
Fine Structure and Histochemistry of Epithelioid Cells in Sarcoidosis
Thorax: first published as 10.1136/thx.29.1.115 on 1 January 1974. Downloaded from Thorax (1974), 29, 115. Fine structure and histochemistry of epithelioid cells in sarcoidosis E. M. VALERIE JAMES and W. JONES WILLIAMS Pathology Department, Welsh National School of Medicine, The Heath, Cardiff James, E. M. Valerie and Jones Williams, W. (1974). Thorax, 29, 115-120. Fine structure and histochemistry of epithelioid cells in sarcoidosis. In this fine structure study of epithelioid cells in the granulomata of sarcoidosis we confirm our previous findings that they appear to be synthesizing rather than phagocytosing cells. The numerous characteristic intracyto- plasmic vesicles, 0 5 ,u in size, are shown to contain mucoglycoprotein and only rarely acid phosphatase activity. Epithelioid cells show varying quantities of extravesicular acid phos- phatase activity which is sometimes on the outer surface of the protein-containing vesicles. The possible role of secretory products of epithelioid cells in the formation and persistence ofgranulomata is discussed. It is suggested that epithelioid cells may be forming lymphokines. We have previously demonstrated that the fine that of Ericsson and Trump (1965) using the lead structure of granulomata in sarcoidosis and tuber- nitrate Gomori technique. Substrate-free and sodium culosis (Jones Williams, Erasmus, James, and fluoride control blocks were also prepared. After being Davies, 1970), in the Kveim test lesion (Jones washed in acetate buffer solutions the tissues were post-fixed in Millonig's osmium tetroxide, dehydrated, Williams, 1972), and in chronic beryllium disease and embedded in Araldite. Sections were cut on an (Jones Williams, Fry, and James, 1972a) are LKB ultramicrotome and 0.5 ,u sections were stained http://thorax.bmj.com/ similar. -
A Case of Lupus Vulgaris Carmen D
Symmetrically Distributed Orange Eruption on the Ears: A Case of Lupus Vulgaris Carmen D. Campanelli, BS, Wilmington, Delaware Anthony F. Santoro, MD, Philadelphia, Pennsylvania Cynthia G. Webster, MD, Hockessin, Delaware Jason B. Lee, MD, New York, New York Although the incidence and morbidity of tuberculo- sis (TB) have declined in the latter half of the last decade in the United States, the number of cases of TB (especially cutaneous TB) among those born outside of the United States has increased. This discrepancy can be explained, in part, by the fact that cutaneous TB can have a long latency period in those individuals with a high degree of immunity against the organism. In this report, we describe an individual from a region where there is a rela- tively high prevalence of tuberculosis who devel- oped lupus vulgaris of the ears many years after arrival to the United States. utaneous tuberculosis (TB) is a rare manifes- tation of Mycobacterium tuberculosis infection. C Scrofuloderma, TB verrucosa cutis, and lupus vulgaris (LV) comprise most of the cases of cutaneous TB. All 3 are rarely encountered in the United States. During the last several years, the incidence of TB has declined in the United States, but the incidence of these 3 types of cutaneous TB has increased in foreign-born individuals. This discrepancy can be ex- plained, in part, by the fact that TB can have a long latency period, especially in those individuals with a Figure 1. Orange plaques and nodules on the right ear. high degree of immunity against the organism. Indi- viduals from regions where there is a high prevalence Case Report of TB may develop cutaneous TB many years after ar- A 71-year-old man from the Philippines presented rival to the United States, despite screening protocol with an eruption on both ears that had existed for when they enter the United States. -
Periodic Fever with Aphtous Pharyngitis Adenitis (PFAPA) What
Pædiatric Rheumatology InterNational Trials Organisation Periodic fever with Aphtous Pharyngitis Adenitis (PFAPA) What is it? The patient suffers from recurrent attacks of fever and affects children in early childhood, two to four years). This disease has a chronic course, but is a benign disease with a tendency toward improvement over time. This disease was recognised for the first time in 1987 and called Marschalls’ syndrome at that time. How common is it? The frequency of PFAPA is not known, but the disease appears to be more common than generally appreciated. What are the causes of the disease? The exact cause of the disease is currently unknown. During periods of fever, the immune system is activated. This activation leads to an inflammatory response with fever and inflammation of the mouth, or throat. This inflammation is self-limited as there are no signs of inflammation to be found between two episodes. There is no infectious agent present during attacks. Is it inherited? Familial cases have been described, but no genetic cause has been found so far. Is it contagious? Infectious agents may play a role in the PFAPA syndrome, but it is not an infectious disease and is not contagious. What are the main symptoms? The main symptom is a recurrent fever, accompanied by a sore throat, mouth ulcers, or enlarged cervical lymph nodes (an important part of the immune system). The episodes of fever start abruptly and last for three to six days. During episodes, the child looks very ill and complains about at least one of the three above-mentioned symptoms.