scholarly journals Unusual presentation and successful treatment of necrobiosis lipoidica in a 15-year-old girl

2019 ◽  
Vol 3 (3) ◽  
pp. 219-222
Author(s):  
Allison L Limmer ◽  
Levi C Holland ◽  
Annabelle L Garcia
Keyword(s):  
Glucose Intolerance ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Diabetic Patients ◽  
Thyroid Disorder ◽  
Necrobiosis Lipoidica ◽  
Clinical Context ◽  
Cutaneous Sarcoidosis ◽  
Topical Tacrolimus ◽  
The Right

Necrobiosis lipoidica (NL) is a rare, granulomatous skin disease with a predilection for diabetic patients. NL can present both histopathologically and clinically in a similar fashion to other granulomatous dermatoses such as granuloma annulare, necrobiotic xanthogranuloma, and cutaneous sarcoidosis. When NL is suspected in patients without glucose intolerance, affirmative diagnosis can be difficult, and other comorbidities may be probed, as NL has been associated with conditions such as hypertension, dyslipidemia, and thyroid disorders. Familial disease has also been reported.In the following case report, we discuss a 15-year-old girl who presented with a new, single, pink atrophic plaque of the right pretibial region. Biopsy showed palisaded granulomatous inflammation within the dermis, absent dermal mucin, and rare multinucleated giant cells. This histopathologic description combined with the clinical context led to the diagnosis of necrobiosis lipoidica. The patient developed another similar lesion on the left anterior shin over the next 1.5 years which was also approached as necrobiosis lipoidica. The lesions were treated with intralesional triamcinolone acetonide and topical tacrolimus. Both lesions are now resolved with only mild atrophy of the affected areas. To date, the patient’s labs have shown no evidence of glucose intolerance, hyperlipidemia, or thyroid disorder.

scholarly journals Rhinofacial Conidiobolomycosis in a 16-Year-Old Girl

2016 ◽  
Vol 31 (2) ◽  
pp. 36-40
Author(s):  
Xirxiz Vin C. Parilla ◽  
Joseph E. Cachuela
Keyword(s):  
Fungal Infection ◽  
Eosinophilic Granuloma ◽  
Granulomatous Inflammation ◽  
Staining Technique ◽  
Giant Cells ◽  
The Philippines ◽  
Body Type ◽  
Lower Lip ◽  
Facial Swelling ◽  
The Right

Objectives : To present the case of a 16-year old girl with progressive facial disfigurement spanning 11 months due to Conidiobolomycosis. Methods:             Design:           Case Report             Setting:           Tertiary Government Hospital             Patient:           One Results: A 16-year-old girl presented with a severe facial deformity of 11 months duration. The lesion started as a swelling in the right nasal vestibule, which later involved the entire nose, forehead, cheeks, upper and lower lip. A series of tissue biopsies revealed varied results -- chronic inflammation, chronic granulomatous inflammation with foreign body type giant cells, and eosinophilic granuloma—resulting in delayed provision of appropriate treatment. On the fourth biopsy using Grocott methenamine silver staining technique, septate fungal hyphae were identified. With a diagnosis of rhinofacial conidiobolomycosis, she was started on Itraconazole 100mg three times daily for eight months. Her facial swelling subsided gradually during the course of treatment and no systemic drug-related complications were observed. Conclusion: Rhinofacial conidiobolomycosis is a rare chronic localized fungal infection that usually affects midline facial structures in immunocompetent hosts. Early detection and diagnosis, and appropriate medication can give rapid resolution. To the best of our knowledge, this may be the first documented case of rhinofacial conidiobolomycosis in the Philippines.   Keywords: Conidiobolomycosis; Conidiobolus; fungal infection; Itraconazole, Therapeutic use

scholarly journals Classical Pathology of Sympathetic Ophthalmia Presented in a Unique Case

2014 ◽  
Vol 8 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Shida Chen ◽  
Mary E Aronow ◽  
Charles Wang ◽  
Defen Shen ◽  
Chi-Chao Chan
Keyword(s):  
Fungal Infection ◽  
Vision Loss ◽  
Corneal Transplantation ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Sympathetic Ophthalmia ◽  
Posterior Chamber ◽  
Surgical Specimen ◽  
Oral Corticosteroids ◽  
The Right

The ocular pathology of sympathetic ophthalmia is demonstrated in a 10 year-old boy who sustained a penetrating left globe injury and subsequently developed sympathetic ophthalmia in the right eye two months later. Two and a half weeks following extensive surgical repair of the left ruptured globe, he developed endophthalmitis and was treated with oral and topical fortified antibiotics. One month after the initial injury, a progressive corneal ulcer of the left eye led to perforation and the need for emergent corneal transplantation. The surgical specimen revealed fungus, Scedosporium dehoogii. The boy received systemic and topical anti-fungal therapy. Two months following the penetrating globe injury of the left eye, a granulomatous uveitis developed in the right eye. Sympathetic ophthalmia was suspected and the patient began treatment with topical and oral corticosteroids. Given the concern of vision loss secondary to sympathetic ophthalmia in the right eye, as well as poor vision and hypotony in the injured eye, the left eye was enucleated. Microscopically, granulomatous inflammation with giant cells was noted within a cyclitic membrane which filled the anterior and posterior chamber of the left globe. Other classic features including Dalen-Fuchs nodules were identified. Small, choroidal, ill-defined granulomas and relative sparing of the choriocapillaris were present. Molecular analysis did not identify evidence of remaining fungal infection. The pathology findings were consistent with previously described features of sympathetic ophthalmia. The present case is unique in that co-existing fungal infection may have potentiated the risk for developing sympathetic ophthalmia in the fellow eye.

DIAGNOSIS TIROID

2016 ◽  
Vol 21 (3) ◽  
pp. 304
Author(s):  
Liong Boy Kurniawan ◽  
Mansyur Arif
Keyword(s):  
Thyroid Hormone ◽  
Laboratory Tests ◽  
Thyroid Disorder ◽  
Functional Tests ◽  
Hormone Binding ◽  
Functional Diagnosis ◽  
Underlying Condition ◽  
Unusual Combination ◽  
The Right ◽  
Underlying Diseases

Thyroid disease often causes unspecific or mild symptoms, so laboratory tests are needed to confirm the functional diagnosis of the thyroid disorder. The laboratory tests which are important to establish the diagnosis of thyroid disorder include: total and free thyroidhormones, its related (thyroid) hormone binding proteins and auto antibodies. The thyroid hormone tests are mostly measured with competitive or sandwich immunoassays and each method can be interfered by several factors. Some drugs may increase or decrease thethyroid functional tests and several factors such as: underlying diseases, age, pregnancy, occurrence of heterophil antibody and auto antibodies may also interfere the thyroid tests results. The interpretation of an unusual combination from thyroid stimulating hormonesuch as free thyroxin and tri-iodothyronine results needs confirmation of underlying condition for establishing the right diagnosis. This review is aimed to evaluate several factors which may influence the thyroid tests and interpretation.

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.

Giant Cell Granuloma of the Temporal Bone: A Case Report With Immunohistochemical, Enzyme Histochemical, and In Vitro Studies

2003 ◽  
Vol 127 (9) ◽  
pp. 1217-1220 ◽  
Author(s):  
Xue-Fei Tian ◽  
Tie-Jun Li ◽  
Shi-Feng Yu
Keyword(s):  
Giant Cell ◽  
Temporal Bone ◽  
Mononuclear Cells ◽  
Giant Cells ◽  
Tartrate Resistant Acid Phosphatase ◽  
Giant Cell Granuloma ◽  
Ki 67 ◽  
The Right ◽  
Histochemical Reactivity

Abstract A case of giant cell granuloma (GCG) that occurred in the right temporal bone is reported. The lesion showed histologic features identical to GCG. The multinuclear giant cells (MGCs) in the lesion showed strong reactivity with CD68, but patchy staining for myeloid/histiocyte antigen, α-1-antitrypsin, α-1-antichymotrypsine, and lysozyme. Activity of tartrate-resistant acid phosphatase was also consistently detected in the MGCs. Some of the mononuclear cells of the lesion exhibited similar immunocytochemical and histochemical reactivity as the MGCs. Ki-67 staining, however, was only detected in the mononuclear cells. The MGCs isolated from the lesion presented characteristic morphology of osteoclasts and possessed the ability to excavate bone in vitro. Thus, the MGCs in GCG appeared to express both macrophage- and osteoclast-associated phenotypes. The mononuclear cells were the major proliferative elements in the lesion and a subpopulation of these cells may represent precursors of the MGCs.

Comparison of Polymerase Chain Reaction With Histopathologic Features for Diagnosis of Tuberculosis in Formalin-Fixed, Paraffin-Embedded Histologic Specimens

2003 ◽  
Vol 127 (3) ◽  
pp. 326-330 ◽  
Author(s):  
Do Youn Park ◽  
Jee Yeon Kim ◽  
Kyung Un Choi ◽  
Jin Sook Lee ◽  
Chang Hun Lee ◽  
...  
Keyword(s):  
Chronic Inflammation ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Caseous Necrosis ◽  
Formalin Fixed Paraffin ◽  
Formalin Fixed Paraffin Embedded ◽  
Type Giant ◽  
Tb Pcr ◽  
Formalin Fixed ◽  
Histopathologic Features

Abstract Objective.—To investigate the relationship between various histopathologic features and the results of the tuberculosis (TB)–polymerase chain reaction (PCR) method in routinely submitted histologic specimens for the histopathologic diagnosis of TB. Design.—We used 95 formalin-fixed, paraffin-embedded tissue blocks from 81 patients who were clinically suspected of having TB. We assessed the presence of histopathologic features including well-formed granuloma, poorly formed granuloma, caseous necrosis, and Langhans-type giant cells. We performed nested PCR for IS6110 and Ziehl-Neelsen staining for acid-fast bacilli (AFB). Results.—Of the 81 patients studied, 53 patients had chronic granulomatous inflammation, whereas 28 patients had only chronic inflammation without definite granulomatous inflammation. Of the 53 cases with chronic granulomatous inflammation, 17 (32%) were AFB positive and 36 (68%) were TB-PCR positive. Among cases with chronic granulomatous inflammation, the percentage that were positive and negative by TB-PCR differed significantly with the presence of various histopathologic features. All of the 13 cases with well-formed granuloma, caseous necrosis, and Langhans-type giant cells were TB-PCR positive; however, 10 (36%) of the 28 cases with chronic inflammation without granulomatous lesions were also TB-PCR positive. Conclusions.—TB-PCR is a rapid, sensitive method for the diagnosis of TB in routinely processed formalin-fixed, paraffin-embedded histologic specimens and is readily available in histopathology laboratories. We recommend use of TB-PCR when TB is suspected clinically, especially in cases of chronic inflammation without definite evidence of granulomatous inflammation.

scholarly journals Giant criptogenic pyogenic gas containing left liver abscess

2008 ◽  
Vol 136 (5-6) ◽  
pp. 292-294
Author(s):  
Radoje Colovic ◽  
Nikica Grubor ◽  
Vladimir Radak
Keyword(s):  
Escherichia Coli ◽  
Liver Abscess ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Diabetic Patients ◽  
Surgical Drainage ◽  
X Ray ◽  
Left Liver ◽  
Liver Abscesses ◽  
The Right

INTRODUCTION Pyogenic gas containing liver abscesses are rare. Less than 50 cases seem to have been described so far. Most of them were localised within the right liver. The majority of those abscesses appear in diabetic patients. CASE OUTLINE The authors present a 64-year old diabetic male patient in whom the investigation (US, CT, plain X-ray) performed for fever of unknown origin confirmed a giant liver gas containing abscess that destroyed almost the entire left liver. Escherichia coli sensitive to several antibiotics was isolated from the abscess. The patient was cured by surgical drainage, limited debridement, lavage, drainage and antibiotics. CONCLUSION Pyogenic gas containing liver abscesses are easy to diagnose nowadays. The type of surgical drainage has to be adapted to a particular patient.

scholarly journals Herpes Zoster pada Anak – Laporan Kasus

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Thigita A. Pandaleke ◽  
Herry E. J. Pandaleke ◽  
Ratna I. Susanti ◽  
Julieta D. P. Dotulong
Keyword(s):  
Herpes Zoster ◽  
Physical Examination ◽  
Primary Infection ◽  
Giant Cells ◽  
Lumbar Region ◽  
Sensory Ganglia ◽  
Laboratory Findings ◽  
Varicella Zoster ◽  
History Of ◽  
The Right

Abstract: Herpes zoster (HZ) is an acute vesicular eruption caused by latent varicella zoster virus (VVZ) reactivation in sensory ganglia after primary infection. Its incidence increases with age and it is rarely found in children. We reported a case of 10-year-old male with blisters on the right side of his stomach and back 3 days ago. The patient was suffered from fever, common cold, and cough a week before, and had a history of varicella at 5 years old. Dermatologic status showed multiple vesicles on erythematous base at the anterior dan posterior sides of his right lumbar region. The Tzank test showed multinucletaed giant cells. Acyclovir resulted in significant improvement after 7- day therapy. Conclusion: Diagnosis of herpes zoster was based on anamnesis, physical examination, and laboratory findings. Antiviral drugs was aimed to reduce complications and viral shedding.Keywords: Herpes zoster, childAbstrak: Herpes zoster (HZ) merupakan erupsi vesikuler akut yang disebabkan oleh reaktivasi dari virus varisela zoster (VVZ) laten pada ganglia sensoris yang sebelumnya terpajan dengan infeksi primer varisela. Insiden HZ meningkat seiring pertambahan usia dan jarang ditemukan pada anak-anak. Kami melaporkan kasus seorang anak laki-laki, 10 tahun, dengan bintil-bintil berair di perut dan punggung sebelah kanan sejak 3 hari lalu. Riwayat demam, batuk dan pilek 1 minggu sebelum timbul lesi. Riwayat varisela pada usia 5 tahun. Status dermatologis ditemukan vesikel multipel berisi cairan jernih yang tersusun bergerombol di atas kulit yang eritema di regio lumbar dekstra anterior dan posterior. Tes Tzank memperlihatkan sel raksasa berinti banyak. Pasien diterapi dengan asiklovir oral selama 7 hari dan menunjukkan perbaikan yang bermakna. Simpulan: Anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang kasus ini khas untuk herpes zoster. Pemberian obat antiviral bertujuan untuk mengurangi komplikasi dan menurunkan viral shedding.Kata kunci: herpes zoster, anak

Smartphone Application for Diabetes in Indonesia: A Narrative Review

2021 ◽  
pp. 3955-3960
Author(s):  
Perdani Adnin Maiisyah ◽  
Zullies Ikawati ◽  
Zainol Akbar Zainal
Keyword(s):  
Clinical Studies ◽  
Diabetes Management ◽  
Smartphone Application ◽  
Alternative Methods ◽  
Diabetic Patients ◽  
Smartphone Applications ◽  
Information Utility ◽  
Diet Compliance ◽  
The Right ◽  
Diabetic Care

In 2017, Indonesia was ranked sixth in the top ten countries with the highest diabetes cases. The prevalence is expected to continue increasing. The use of Smartphone applications is one of the alternative methods in promoting better disease management and preventing diabetes. The purpose of this review is to identify existing studies regarding Smartphone applications for diabetes in Indonesia and to highlight the important findings. There are only a few original clinical studies about Smartphone applications for diabetes in Indonesia. A total of 5 studies were reviewed here. There are the Nutri Diabetic Care, the Teman DM, the DM Calendar App, the E-diary DM, and the Salam Sehat. The study was conducted on several respondents with the use of short-term applications and using the variable method. Nevertheless, the studies found that Smartphone applications for diabetes can be beneficial for improving self-care, self-efficacy, increased knowledge, and medication and diet compliance among diabetic patients in Indonesia. The information and utility criteria for diabetes application which should be relevant to clinical guidelines are not discussed. The implementation of Smartphone applications for diabetes is suitable for Indonesian condition. The best application with the right information, utility, and supported by clinical studies is suggested as a complement to the diabetes management by a health professional.

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