scholarly journals Necrotizing Encephalitis Caused by Disseminated Aspergillus Infection after Orthotopic Liver Transplantation

2015 ◽  
Vol 9 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Luis E. Barrera-Herrera ◽  
Alonso Vera ◽  
Johanna Álvarez ◽  
Rocio Lopez
Keyword(s):  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Fungal Infections ◽  
Periodic Acid ◽  
Surgical Techniques ◽  
Mortality Rates ◽  
Variceal Hemorrhage ◽  
Early Recovery ◽  
Periodic Acid Schiff ◽  
Aspergillus Infection

Liver transplantation is the only available treatment for some patients with end-stage liver disease. Despite reduction in mortality rates due to advances related to surgical techniques, intensive medical management and immunosuppressive therapy, invasive fungal infections remain a serious complication in orthotopic liver transplantation. We report the case of an 18-year-old male diagnosed with autoimmune cirrhosis in 2009 who was assessed and listed for liver transplantation for massive variceal hemorrhage. One year after listing a successful orthotopic liver transplantation was performed. Uneventful early recovery was achieved; however, he developed pulmonary and neurological Aspergillus infection 23 and 40 days after surgery, respectively. Antibiotic therapy with voriconazole and amphotericin was started early, with no major response. Neuroimaging revealed multiple right frontal and right parietal lesions with perilesional edema; surgical management of the brain abscesses was performed. A biopsy with periodic acid-Schiff and Gomori stains revealed areas with mycotic microorganisms morphologically consistent with Aspergillus, later confirmed by culture. The patient developed necrotizing encephalitis secondary to aspergillosis and died. Necrotizing encephalitis as a clinical presentation of Aspergillus infection in an orthotopic liver transplant is not common, and even with adequate management, early diagnosis and prompt antifungal treatment, mortality rates remain high.

scholarly journals Heterozygous M3Mmalton α1-Antitrypsin Deficiency Associated with End-Stage Liver Disease: Case Report and Review

2001 ◽  
Vol 47 (8) ◽  
pp. 1490-1496 ◽  
Author(s):  
Valérie Canva ◽  
Sandrine Piotte ◽  
Jean-Pierre Aubert ◽  
Nicole Porchet ◽  
Martine Lecomte-Houcke ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Liver Biopsy ◽  
Orthotopic Liver Transplantation ◽  
Periodic Acid ◽  
Autosomal Recessive Disorder ◽  
Periodic Acid Schiff ◽  
Exon 2 ◽  
Disease Case ◽  
Abused Drugs

Abstract α1-Antitrypsin (α1AT) deficiency is an autosomal recessive disorder that can cause pulmonary emphysema and liver disease. We report here the case of a 59-year-old woman who was admitted to hospital for evaluation of jaundice. She had no history of hepatitis or childhood liver disease. She had never received a blood transfusion, nor had she abused drugs or alcohol. Transjugular liver biopsy was then performed and revealed a micronodular cirrhosis. Ten months later, because of persistent liver cell failure and ascites, she underwent an orthotopic liver transplantation. Investigation of α1AT system in the proband revealed a substantial decrease in serum α1AT associated with a low elastase inhibitory capacity. The Pi phenotype revealed a PiM-like profile. Sequencing of exons 1–5 demonstrated the presence of the M3 allele. Moreover, a triple nucleotide deletion was detected in exon 2 of one allele. This caused an “in-phase” frameshift, coding for a protein deficient in a single Phe residue, which corresponded to the Mmalton variant. After liver biopsy, periodic acid-Schiff-positive acidophilic bodies resistant to diastase digestion were observed in the cytoplasm of hepatocytes. These results demonstrated that our patient had a heterozygous M3Mmalton α1AT genotype related to a deficiency phenotype. This observation is the first of a patient with heterozygous Mmalton genotype associated with an α1AT deficiency that induced severe liver disease requiring orthotopic liver transplantation.

scholarly journals Histologic Aspect of the Curved Vomerine Mucosa in Cleft Lip and Palate

2021 ◽  
pp. 105566562110314
Author(s):  
Benito K. Benitez ◽  
Andrzej Brudnicki ◽  
Prasad Nalabothu ◽  
Jeannette A. von Jackowski ◽  
Elisabeth Bruder ◽  
...  
Keyword(s):  
Nasal Mucosa ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Squamous Metaplasia ◽  
Periodic Acid ◽  
Surgical Techniques ◽  
Basal Cells ◽  
Periodic Acid Schiff ◽  
Tissue Samples ◽  
Nasal Floor

Background: Common surgical techniques aim to turn the entire vomerine mucosa with vomer flaps either to the oral side or to the nasal side. The latter approach is widely performed due to the similarity in color to the nasal mucosa. However, we lack a histologic description of the curved vomerine mucosa in cleft lip and palate malformations. Methods: We histologically examined an excess of curved vomerine mucosa in 8 patients using hematoxylin–eosin, periodic acid–Schiff, Elastin van Gieson, and Alcian blue stains. Tissue samples were obtained during surgery at 8 months of age. Results: Our histological analysis of the mucoperiosteum overlying the curved vomer revealed characteristics consistent with those of an oral mucosa or a squamous metaplasia of the nasal mucosa, as exhibited by a stratified squamous epithelium containing numerous seromucous glands. Some areas showed a palisaded arrangement of the basal cells compatible with metaplasia of respiratory epithelium, but no goblet cells or respiratory cilia were identified. Abundant fibrosis and rich vascularity were present. Conclusion: The vomer mucosa showed no specific signs of nasal mucosa. These findings should be considered in presurgical cleft orthopedics and palatal surgery for further refinement. Shifting the vomer mucosa according to a fixed physiologic belief should not overrule other important aspects of cleft repair such as primary healing and establishing optimal form and function of palatal roof and nasal floor.

scholarly journals Surgical techniques of arterialized orthotopic liver transplantation in rats

2007 ◽  
Vol 120 (21) ◽  
pp. 1914-1917 ◽  
Author(s):  
Yi MA ◽  
Guo-dong WANG ◽  
Zhi-yong GUO ◽  
Zhi-gang GUO ◽  
Xiao-shun HE ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Surgical Techniques

scholarly journals Immunomycology: rapid and specific immunocytochemical identification of fungi in formalin-fixed, paraffin-embedded material.

1993 ◽  
Vol 41 (8) ◽  
pp. 1217-1221 ◽  
Author(s):  
J A Reed ◽  
B A Hemann ◽  
J L Alexander ◽  
D J Brigati
Keyword(s):  
Complement Fixation ◽  
Fungal Infections ◽  
Periodic Acid ◽  
Cross Reactivity ◽  
Periodic Acid Schiff ◽  
Formalin Fixed Paraffin ◽  
Identification Of Fungi ◽  
Formalin Fixed Paraffin Embedded ◽  
Methenamine Silver ◽  
Formalin Fixed

We report the rapid (less than 1 hr), immunocytochemical identification of various fungi in formalin-fixed, paraffin-embedded tissues using antisera originally developed for use in immunodiffusion assays. Primary antisera directed towards fungal genera including Aspergillus, Blastomyces, Candida, Coccidioides, Cryptococcus, Histoplasma, and Sporothrix were examined. The specificity of each antiserum was evaluated by the presence or absence of crossreactivity with other morphologically similar fungi in both paraffin-embedded pure fungal cultures and tissues with culture-confirmed fungal infections. Each antiserum reacted strongly with the fungus to which it had been raised, whether examined in pure culture or infected tissues. The antisera raised against Candida, Cryptococcus, and Sporothrix did not exhibit cross-reactivity with any other fungus tested. However, the antisera raised to Aspergillus, Blastomyces, Coccidioides, and Histoplasma demonstrated significant crossreactivity with other genera of fungi, thus precluding their routine use in diagnostic immunocytochemistry. The results indicate that immunocytochemistry may provide an important adjunct to other methods, such as immunodiffusion or complement fixation assays and histochemical stains such as the Grocott methenamine silver or periodic acid-Schiff, when attempts are made to specifically identify certain fungi in formalin-fixed, paraffin-embedded tissues before mycology culture results are available.

Role of FNA and Special Stains in Rapid Cytopathological Diagnosis of Pulmonary Nocardiosis

2018 ◽  
Vol 62 (3) ◽  
pp. 178-182 ◽  
Author(s):  
Ridhi Sood ◽  
Ruchita Tyagi ◽  
Pavneet Kaur Selhi ◽  
Gursheen Kaur ◽  
Harpreet Kaur ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Periodic Acid ◽  
Tertiary Care ◽  
Opportunistic Pathogen ◽  
Clinical Findings ◽  
Accurate Diagnosis ◽  
Care Hospital ◽  
Periodic Acid Schiff ◽  
Pulmonary Nocardiosis ◽  
Inflammatory Infiltrates

Background: Nocardia, a gram-positive aerobic bacillus of the Actinomycetales family, is a significant opportunistic pathogen in immunocompromised individuals. Clinical and radiological features of pulmonary nocardiosis are nonspecific and can be misdiagnosed as tuberculosis, pneumocystis, staphylococcal or fungal infections, or as malignancy. Aspiration cytology with special stains is a quick and effective approach for accurate diagnosis. Materials and Methods: We present 7 cases of pulmonary nocardiosis, admitted to the pathology department in a tertiary-care hospital in Punjab. Clinical findings, immune status, laboratory tests, chest radiographs, and computed tomography scans were reviewed. Cytologically, special stains like 1% Ziehl-Neelsen (ZN), 20% ZN, periodic acid-Schiff (PAS), Grocott methenamine silver (GMS), and reticulin stains were studied along with May-Grünwald Giemsa, Papanicolaou, and hematoxylin and eosin. Results: All the patients were immunocompromised. The radiological changes were nonspecific. Cytomorphology showed acute and chronic inflammatory infiltrates with necrosis. None of the cases showed well-defined granulomas. GMS, modified 1% ZN and, Gordon and Sweet reticulin stains highlighted the delicate filamentous bacteria in all cases. PAS and 20% ZN stain for tuberculous bacilli were uniformly negative. Conclusion: FNAC can provide a quick and accurate diagnosis of nocardiosis and thereby facilitate timely medical management.

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