scholarly journals Blastomycosis Presenting as Multiple Splenic Abscesses: Case Report and Review of the Literature

2010 ◽  
Vol 21 (1) ◽  
pp. 53-56 ◽  
Author(s):  
Sami Al-Nassar ◽  
Tracy MacNair ◽  
Jeremy Lipschitz ◽  
Howard Greenberg ◽  
Elly Trepman ◽  
...  
Keyword(s):  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Silver Stain ◽  
Rare Presentation ◽  
Computed Tomographic ◽  
Northwestern Ontario ◽  
Abdominal Symptoms ◽  
History Of ◽  
Oral Itraconazole ◽  
Methenamine Silver Stain

A 31-year-old Canadian Aboriginal man from northwestern Ontario presented with left upper quadrant pain and a tender left upper quadrant mass. Evaluation with a computed tomography scan showed multiple lesions within the spleen, a collection between the splenic tip and splenic flexure of the colon, and several small adrenal lesions. Computed tomographic-guided needle biopsy showed necrotizing granulomatous inflammation and multinucleated giant cells. Gomori’s methenamine silver stain showed broad-based budding yeast consistent withBlastomyces dermatitidis. Abdominal symptoms resolved after two months of oral itraconazole. Multiple splenic abscesses are a rare presentation of blastomycosis and should be considered in the differential diagnosis of left upper quadrant abdominal pain in a patient with a history of travel or residence in a region endemic forB dermatitidis.

scholarly journals Pneumocystis jirovecii Pneumonia in a HIV-Infected Patient with a CD4 Count Greater Than 400 Cells/μL and Atovaquone Prophylaxis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Abigayle Sullivan ◽  
Theresa Lanham ◽  
Ronald Krol ◽  
Shilla Zachariah
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Lung Biopsy ◽  
Cd4 Count ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Silver Stain ◽  
Highly Active ◽  
History Of ◽  
Methenamine Silver ◽  
Methenamine Silver Stain

We describe a rare case of Pneumocystis jirovecii pneumonia (PCP) in a heterosexual man with a pertinent medical history of well-controlled human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART) and PCP prophylaxis with atovaquone. The patient presented with recurrent shortness of breath, worsening malaise, and fever, following treatment for hypersensitivity pneumonitis one month prior, including a twenty-four-day course of 40 milligrams daily glucocorticoid with taper. However, transbronchial biopsies, lavage, and cytology from prior admission were inconclusive. The patient refused video-assisted thoracic surgery (VATS) at that time. Upon readmission, bronchoscopy with right VATS and lung biopsy were performed. Grocott’s methenamine silver stain of right lung biopsy was positive for Pneumocystis jirovecii. This case is a rare example of PCP in a patient with a normal CD4 count (>487 cells/μL) and a low viral load (<20 copies/mL) despite PCP prophylactic antibiotics in the setting of recent iatrogenic immunosuppression.

scholarly journals A Role for CD154, the CD40 Ligand, in Granulomatous Inflammation

2017 ◽  
Vol 2017 ◽  
pp. 1-14 ◽  
Author(s):  
Julien Villeneuve ◽  
Alexis Desmoulière ◽  
Antoine Dewitte ◽  
Nelly Bordeau ◽  
Pierre Costet ◽  
...  
Keyword(s):  
Carbon Tetrachloride ◽  
Granulomatous Inflammation ◽  
Cd40 Ligand ◽  
Giant Cells ◽  
Absorbable Suture ◽  
Epithelioid Cells ◽  
History Of ◽  
Toxic Liver Injury ◽  
Deficient Mice

Granulomatous inflammation is a distinctive form of chronic inflammation in which predominant cells include macrophages, epithelioid cells, and multinucleated giant cells. Mechanisms regulating granulomatous inflammation remain ill-understood. CD154, the ligand of CD40, is a key mediator of inflammation. CD154 confers a proinflammatory phenotype to macrophages and controls several macrophagic functions. Here, we studied the contribution of CD154 in a mouse model of toxic liver injury with carbon tetrachloride and a model of absorbable suture graft. In both models, granulomas are triggered in response to endogenous persistent liver calcified necrotic lesions or by grafted sutures. CD154-deficient mice showed delayed clearance of carbon tetrachloride-induced liver calcified necrotic lesions and impaired progression of suture-induced granuloma. In vitro, CD154 stimulated phagocytosis of opsonized erythrocytes by macrophages, suggesting a potential mechanism for the altered granulomatous inflammation in CD154KO mice. These results suggest that CD154 may contribute to the natural history of granulomatous inflammation.

Equine Granulomatous Enteritis

1974 ◽  
Vol 11 (6) ◽  
pp. 535-547 ◽  
Author(s):  
R. E. Cimprich
Keyword(s):  
Weight Loss ◽  
Mycobacterium Tuberculosis ◽  
Plasma Cells ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Gut Content ◽  
Epithelioid Cells ◽  
History Of ◽  
Microscopic Change ◽  
Granulomatous Enteritis

The gross abnormalities in the intestines of 10 horses with a history of chronic weight loss varied greatly. The principal microscopic change was granulomatous inflammation characterized by lymphocytes, plasma cells, macrophages, epithelioid cells and giant cells. Mycobacterium tuberculosis, avian type, was isolated from the gut content of one horse, but no cause was found in the others. Horses previously reported to have tuberculosis had lesions similar to those described here. These lesions are also similar to those in Crohn's disease of man.

scholarly journals Necrotising granulomatous mass of the foreskin with inguinal lymphadenopathy: a rare presentation of syphilis

2021 ◽  
Vol 14 (3) ◽  
pp. e238539
Author(s):  
Cecile Pham ◽  
Luke Wang ◽  
Vivienne Lea ◽  
Prem Rathore
Keyword(s):  
Unusual Case ◽  
Inguinal Lymph Node ◽  
Treponema Pallidum ◽  
Granulomatous Inflammation ◽  
Developed Countries ◽  
Benzathine Penicillin ◽  
Rare Presentation ◽  
Causative Microorganism ◽  
History Of ◽  
Inguinal Lymphadenopathy

We report the case of a 24-year-old man who presented with a 5-week history of painful right inguinal lymphadenopathy, weight loss and non-ulcerative foreskin mass. The patient’s symptoms progressed despite initial antibiotic therapy. The foreskin mass was clinically suspicious for squamous cell carcinoma; however, histopathology of both the foreskin mass and inguinal lymph node showed necrotising granulomatous inflammation. Extensive immunohistochemistry testing was inconclusive and could not identify a causative microorganism. Ultimately, serology was positive for Treponema pallidum and he was treated with intramuscular benzathine penicillin. This is an unusual case, which highlights the importance of extensive investigation for differential diagnoses of penile mass and exemplifies the resurgence of syphilis in developed countries.

scholarly journals Report of the First Human Case of Lobomycosis in the United States

2000 ◽  
Vol 38 (3) ◽  
pp. 1283-1285 ◽  
Author(s):  
Robert A. Burns ◽  
J. Stephen Roy ◽  
Cavan Woods ◽  
Arvind A. Padhye ◽  
David W. Warnock
Keyword(s):  
Periodic Acid ◽  
White Male ◽  
High Water ◽  
Giant Cells ◽  
The United States ◽  
Human Case ◽  
Silver Stain ◽  
Periodic Acid Schiff ◽  
Male Resident ◽  
Methenamine Silver Stain

We describe the first human case of lobomycosis caused byLacazia loboi in a 42-year-old white male resident of Georgia. The patient had traveled to Venezuela 7 years earlier, where he had planned to rappel down Angel Falls in Canaima. Although he never actually rappelled the falls, he did walk under the falls at least three times, exposing himself to the high water pressures of the falls. He noticed a small pustule with surrounding erythema developing on the skin of his right chest wall. The lesion gradually increased in size and had an appearance of a keloid. For cosmetic reasons, the patient sought medical treatment to remove the lesion. After an uncomplicated excision of the lesion, the patient recovered completely. The excised tissue was fixed in formalin for pathologic examination. Tissue sections stained by hematoxylin and eosin, periodic acid-Schiff stain, and Gomori methenamine silver stain procedures showed numerous histiocytes, multinucleated giant cells, and numerous globose or subglobose, lemon-shaped cells producing multiple blastoconidia connected by narrow tube-like connectors and catenate chains of various lengths characteristic of L. loboi.

scholarly journals A rare association of tonsillar tuberculosis and lichen scrofulosorum

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Anshika Harit ◽  
Anjan Kumar Sahoo ◽  
Ishwar Singh
Keyword(s):  
Sore Throat ◽  
Extrapulmonary Tuberculosis ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Skin Lesions ◽  
Epithelioid Cell ◽  
Body Sensation ◽  
Biopsy Report ◽  
History Of ◽  
Systemic Examination

Abstract Background Both tonsillar tuberculosis and lichen scrofulosorum are sporadic presentations of extrapulmonary tuberculosis. Lichen scrofulosorum commonly presents in children and young adults as lichenoid eruptions over the skin. Granulomatous inflammation of the tonsils, however, presents as non-specific sore throat and foreign body sensation in the throat. The concomitant presentation of the abovementioned tubercular manifestations has not been reported in the literature. Case presentation Herein, we report a case of an 11-year-old male patient who presented with a history of recurrent sore throat and ulcerative lesion over the tonsil. Systemic examination revealed multiple perifollicular eruptions over the trunk and back. The diagnosis was confirmed on histopathological findings of epithelioid cell granulomas with Langerhans giant cells following biopsy from the tonsil and skin lesions. Antitubercular therapy was initiated soon after. The patient responded to treatment as early as 6 weeks and was completely asymptomatic at 1 year of follow-up. Conclusion A diagnosis of granulomatous tonsillitis should alert the physician to the possibility of underlying systemic tuberculosis. In our case, coexistence of lichen scrofulosorum helped us to substantiate the diagnosis based on the biopsy report. Response to antitubercular agents is excellent and should be started at the earliest.

scholarly journals An Uncommon Cause of a Small-Bowel Obstruction

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Ali Zakaria ◽  
Bayan Al Share ◽  
Issam Turk ◽  
Samira Ahsan ◽  
Waseem Farra
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Previous History ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Unknown Etiology ◽  
Granulomatous Disease ◽  
History Of ◽  
Noncaseating Granulomas

Sarcoidosis is a systemic granulomatous disease of unknown etiology, characterized by the formation of noncaseating granulomas. Gastrointestinal (GI) system involvement that is clinically recognizable occurs in less than 0.9% of patients with sarcoidosis, with data revealing small intestine involvement in 0.03% of the cases. A high index of suspension is required in patients presenting with small-bowel obstruction and previous history of sarcoidosis. Establishing a definitive diagnosis of GI sarcoidosis depends on biopsy evidence of noncaseating granulomas, exclusion of other causes of granulomatous disease, and evidence of sarcoidosis in at least one other organ system. Treatment of GI sarcoidosis depends on symptomatology and disease activity. Herein, we are presenting a case of 67-year-old female patient who had acute small-bowel obstruction at the level of jejunum with postoperative histopathologic evidence of noncaseating granulomatous inflammation with multinucleated giant cells, consistent with sarcoidosis.

Pneumomediastinum: A Rare Presentation of Inflicted Injuries in Infants

2020 ◽  
Author(s):  
Adam Lee ◽  
Adam Bajinting ◽  
Abby Lunneen ◽  
Colleen M. Fitzpatrick ◽  
Gustavo A. Villalona
Keyword(s):  
Literature Review ◽  
Retrospective Review ◽  
Review Of The Literature ◽  
Rare Presentation ◽  
Spontaneous Pneumomediastinum ◽  
Nonaccidental Trauma ◽  
Comprehensive Literature Review ◽  
Healthy Infants ◽  
History Of

AbstractReports of incidental pneumomediastinum in infants secondary to inflicted trauma are limited. A retrospective review of infants with pneumomediastinum and history of inflicted trauma was performed. A comprehensive literature review was performed. Three infants presented with pneumomediastinum associated with inflicted trauma. Mean age was 4.6 weeks. All patients underwent diagnostic studies, as well as a standardized evaluation for nonaccidental trauma. All patients with pneumomediastinum were resolved at follow-up. Review of the literature identified other cases with similar presentations with related oropharyngeal injuries. Spontaneous pneumomediastinum in previously healthy infants may be associated with inflicted injuries. Clinicians should be aware of the possibility of an oropharyngeal perforation related to this presentation.

Prolapsed Nasal Polyp Causing Acute Airway Obstruction: An Exceptional Presentation

ORL ◽  
2021 ◽  
pp. 1-3
Author(s):  
Krupa R. Patel ◽  
Ashton E. Lehmann ◽  
Aria Jafari ◽  
Daniel L. Faden
Keyword(s):  
Airway Obstruction ◽  
Nasal Polyp ◽  
Nasal Polyposis ◽  
Upper Airway ◽  
Rare Presentation ◽  
First Case ◽  
Acute Airway Obstruction ◽  
History Of ◽  
Sinonasal Symptoms ◽  
Or History

Although nasal polyposis is a common clinical entity, there is limited literature describing the rare presentation of sudden prolapse of a massive nasal polyp resulting in an airway emergency in an adult. We present the first case report to our knowledge of a patient without any preceding sinonasal symptoms or history of anticoagulation who experienced acute upper airway obstruction due to sudden hemorrhage and prolapse of a large nasal polyp. Based on our experience treating this patient, we discuss special considerations in all phases of care to ensure safe and effective management of such an exceptional clinical scenario.

scholarly journals Hepatocellular carcinoma with regional lymphadenopathy caused by sarcoid-like reaction: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Tomoko Mizota ◽  
Masato Suzuoki ◽  
Saya Kaku ◽  
Kenichi Mizunuma ◽  
Kazuto Ohtaka ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Epithelioid Cell ◽  
Imaging Modalities ◽  
Hepatoduodenal Ligament ◽  
Regional Lymph Nodes ◽  
Multiple Imaging

Abstract Background Sarcoid-like reaction (SLR) is a histological pattern of granulomatous inflammation that is clinically differentiated from sarcoidosis. Since SLR is known to occur in several neoplasias and occasionally causes lymphadenopathy and mimics metastatic malignancy, it needs to be considered whether lymphadenopathy is due to metastasis or SLR for the choice of cancer treatment. Few cases of hepatocellular carcinoma (HCC) with SLR have been reported. Here, a case of HCC with lymphadenopathy diagnosed as SLR without metastasis is presented. Case presentation A 69-year-old woman was admitted to our hospital because of upper abdominal pain. She tested positive for hepatitis C virus ribonucleic acid. Imaging modalities showed an 81 × 65-mm-sized tumor with multiple nodules in segment 3 and a 17 × 12-mm-sized tumor in segment 5 with a common HCC enhancement pattern. In addition, a lymph node in the hepatoduodenal ligament was enlarged at 13 mm in size, suggesting the metastasis of HCC. Hepatectomy of the lateral segment and segment 5 and lymph node dissection in the hepatoduodenal ligament were performed. Both tumors in segments 3 and 5 were pathologically diagnosed as HCC without vessel invasion. The tumors contained necrotic cells and epithelioid cell granulomas with multinucleated giant cells, which is typically observed in sarcoidosis. The dissected lymph nodes also contained epithelioid cell granulomas, as well as giant cells with asteroid bodies. There was no malignancy in the lymph nodes. The pathological findings suggested the coexistence of malignancy and sarcoidosis. However, since the patient did not show any typical findings of pulmonary or cardiac sarcoidosis, the case was diagnosed as HCC with SLR in the primary lesion and regional lymph nodes. Conclusions SLR needs to be considered in the differential diagnosis when a cancer patient develops lymphadenopathy. However, lymphadenopathy due to SLR is indistinguishable from that due to metastasis even when using multiple imaging modalities. Pathological examinations may be helpful for the diagnosis.

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