Absence Of Cutaneous Lesions Research Articles

DisseminatedMycobacterium avium–intracellulareInfection in a Persian Cat

This report describes a disseminated infection with mycobacteria of the avium/intracellulare complex in a Persian cat in the absence of cutaneous lesions. Postmortem examination revealed severe granulomatous inflammation with numerous intrahistiocytic acid-fast bacilli in multiple organs. A gastrointestinal port of entry seems likely, as the ileocaecal lymph node was most severely affected.

Molecular Approaches To Detecting Herpes Simplex Virus and Enteroviruses in the Central Nervous System

The initial presentation of symptoms and clinical manifestations of viral central nervous system (CNS) infectious diseases often makes a specific diagnosis difficult and uncertain. For example, the clinical features of CNS disease due to nonpolio enteroviruses (EV) can overlap those caused by herpes simplex virus (HSV), which sometimes occur in young infants and adults in the absence of cutaneous lesions (4, 12, 39). The etiological agent and type of infection can determine potential prognoses as well as optimal treatment modality for the patient. Enterovirus infections often do not require antiviral intervention, but at least two new antivirals are undergoing trials, the more prominent of which is pleconaril (16, 22). Also, if a mean time of 24 h to diagnosis was assumed, 1.2 to 2.8 days of hospitalization per patient could be saved over current averages (1, 13, 18, 26). Mortality from HSV, however, before the use of acyclovir was 60 to 70% and has been reported to drop to 19 to 38% with therapy (27, 38). Early diagnosis and treatment of viral CNS infections, therefore, will decrease morbidity and mortality rates.

Clinical aspects and management of AIDS-related Kaposi's sarcoma

AIDS-related Kaposi's sarcoma (KS) is a tumour of vascular endothelium, which is seen predominately in men who have sex with men. The majority of affected individuals have advanced immunosuppression at the time of the initial KS diagnosis. The disease may present with cutaneous lesions, or with involvement of visceral organs, of which the gastrointestinal tract is most common. KS may also present with lymphoadenopathy or with isolated lymphoedema, even in the absence of cutaneous lesions. Affected individuals are uniformly co-infected with HIV and with Human Herpesvirus type 8 (HHV8). HHV8 is present within KS tissues, and is aetiological in the pathogenesis of disease, along with aberrant cytokine expression, production of multiple angiogenic peptides, and immune dysregulation. While not presently curable, multiple treatment options exist and must be evaluated in terms of the specific needs of the individual patient. Various local therapies are aimed at eradicating small lesions, while acknowledging that the KS in general, or its likelihood of recurring will be unaffected. Systemic chemotherapy is used to treat extensive visceral involvement. Knowledge of the pathogenesis of disease has led to the development of novel treatment strategies, aimed at HHV8 as the target of therapy, or at the inflammatory cytokine or angiogenic milieu necessary for KS growth. Use of highly active anti-retroviral therapy, aimed at controlling the underlying HIV infection, has been associated with a dramatic decrease in the incidence of KS, and may also be useful in the treatment of existing KS disease.

Parálisis motora segmentaria por virus varicela­zoster. Estudio clínico y pronóstico funcional

Segmental motor paralysis of the limbs (SMP) complicates 2-3% of the cases of cutaneous herpes zoster. Viral invasion and inflammation of the motor neurons of the anterior horn cells by the varicella-zoster virus (VVZ) causes clinical weakness at the same time and site as the cutaneous eruption. To analyze the clinical findings, complementary investigations and functional prognosis of patients with SMP at brachial plexus and lumbosacral levels. We made a retrospective study of 10 patients with SMP admitted to the Hospital Universitario Gregorio Maranon de Madrid during 1989-1999, aged between 38 and 84 years (6 women, 4 men). Neurological examination was done, including muscle balance, complementary studies including microbiology (serum and CSF serology, viral PCR-ADN), neurophysiology using MNR of the spine and plexuses and functional prognosis on the NDS, NSS and RANKIN scales. There is a close relationship between dermatome and myotome involvement (90%). The brachial and lumbosacral plexuses were equally affected (50%). Plasma and CSF VVZ serology was positive in 50% of the cases, permitting diagnosis of a patient with no cutaneous lesions (zoster sine herpete). Denervation of the myotomes involved and the paraspinal muscles was shown on neurophysiological studies. In most cases there was functional improvement, with complete functional recovery in 80% of the cases after 12 months. VVZ should be considered amongst the aetiologies of SMP, even in the absence of cutaneous lesions (zoster sine herpete). The SMP coincides in time and place with the dermatome lesions. In most patients there is complete functional recovery within 12 months.

Kaposi Sarcoma in a Renal Transplant Patient

The radiographic abnormalities of primary Kaposi's sarcoma of the lung in a patient with a renal transplant are reported. The findings are similar to other malignancies and infections that are well recognized in the renal transplant population. In the appropriate clinical setting, the radiologist should consider the diagnosis of Kaposi's sarcoma even in the absence of cutaneous lesions as reducing immunosuppression can be curative therapy.

DEEP JUVENILE XANTHOGRANULOMA: An Unusual Presentation

Juvenile xanthogranuloma (JXG) is a disorder of histiocytes usually associated with cutaneous lesions. It may present a diagnostic dilemma in the absence of cutaneous lesions and when deeply located. Differentiation of JXG from other childhood histiocytosis syndromes, especially Langerhans' cell histiocytosis (LCH), is important. We describe an unusual case of deep JXG in a 21-month-old girl with multiple omental and peritoneal nodules presenting with ascites. Although a diagnosis of LCH was suspected clinically, the absence of Birbeck granules and S-100 protein and T6 antigen negativity, together with CD68 and factor XIIIa positivity, led us to a diagnosis of JXG. Physicians should be aware of the widening spectrum of manifestations of juvenile xanthogranuloma.

Deep Juvenile Xanthogranuloma: An Unusual Presentation

Juvenile xanthogranuloma (JXG) is a disorder of histiocytes usually associated with cutaneous lesions. It may present a diagnostic dilemma in the absence of cutaneous lesions and when deeply located. Differentiation of JXG from other childhood histiocytosis syndromes, especially Langerhans' cell histiocytosis (LCH), is important. We describe an unusual case of deep JXG in a 27-month-old girl with multiple omental and peritoneal nodules presenting with ascites. Although a diagnosis of LCH was suspected clinically, the absence of Birbeck granules and S-100 protein and T6 antigen negativity, together with CD68 and factor XIIIa positivity, led us to a diagnosis of JXG. Physicians should be aware of the widening spectrum of manifestations of juvenile xanthogranuloma.

Intra-oral keratoacanthoma: an eruptive variant and review of the literature

Intra-oral keratoacanthoma, occurring in the absence of cutaneous lesions, is a rare lesion which may resemble a well-differentiated squamous cell carcinoma both clinically and histologically. A case is reported of two simultaneously occurring keratoacanthomas, of the eruptive variant, on the hard palate of a 25-year-old woman. A review of the English literature, which has identified ten documented cases to date, is presented.

Disseminated Mycobacterium Avium Serotype 1 Infection in a Seven-Month-Old Cat

A 7-month-old, neutered, male, domestic shorthair cat was presented for examination to a practicing veterinarian after 2 weeks of anorexia and unspecified treatment for “chronic respiratory disease.” Physical and hematologic examinations revealed generalized lymphadenopathy, fever (39.7 C), and a corrected total blood leukocyte count of 17,329/μ1 with 27 nucleated red blood cells/100 leukocytes. Blood packed cell volume was 17%, and plasma contained 6.5 g/d1 total protein. After the animal had shown nonspecific signs for an additional week, smears made from aspirated bone marrow and a popliteal lymph node collected by biopsy and fixed in formalin were referred to the College of Veterinary Medicine at Iowa State University (ISU) for microscopic evaluation, and the cat was returned to its owner. Following a histologic diagnosis of disseminated mycobacterial disease, the cat was rehospitalized at the referring clinic for further observation and treatment. No cutaneous lesions were found. After consultation with the owner, the cat was euthanatized, necropsy was performed by the referring veterinarian, and tissue specimens were collected and submitted to ISU for further laboratory examination. Samples of lungs, liver, spleen, intestine, and tracheobronchial and mesenteric lymph nodes were received both frozen and in formalin. The remaining popliteal lymph node was received frozen, and bone marrow from a femur was received fixed in formalin. Blood had been collected in serum and anticoagulant (ethylenediaminetetraacetic acid) tubes prior to euthanasia. This report describes disseminated Mycobacterium avium serotype 1 infection of a young cat in the absence of cutaneous lesions or evidence of antecedent immunosuppressive disease or treatment. At necropsy, mandibular, ileocecal, and tracheobronchial lymph nodes were reportedly “very enlarged,” and the lungs contained nodular densities throughout. The fixed ileocecal and tracheobronchial lymph nodes and lung nodules measured 1.0, 1.5, and 0.5 cm in diameter, respectively. Bone marrow smears revealed adequate megakaryocytes, myeloid hyperplasia, and erythroid hypoplasia. No atypical cells were noted, but fine, elongate, refractile forms, unstained by Wright’s stain and frequently aggregated in clusters, were seen in the cytoplasm of mononuclear cells and large multinucleate cells (Fig. 1). Acid-fast staining by the Ziehl-Neelsen method (ZN) showed abundant, 4-6 μm, slender, acidfast (beaded) organisms in the same cells. Peripheral blood smears and whole blood revealed anemia (hemoglobin 5.6 g/dl packed cell volume 18%, red blood cell count 2,850,000/ μl), leukopenia (total corrected leukocyte count 4,700/μ1), and lymphopenia (1,175/μ1). Serum contained 6.6 g/d1 of total

Definition of high‐proficiency serological markers for diagnosis of Varicella‐zoster virus infections by enzyme immunoassay

The levels of Varicella-zoster virus (VZV)-specific IgG, IgM, and IgA antibodies produced in 22 cases of varicella, 22 cases of cutaneous zoster, and 12 cases of acute aseptic meningitis due to VZV in the absence of cutaneous lesions, were measured by indirect enzyme immunoassay (EIA) and compared with those observed in a group of 34 age-matched controls. The definition of cutoff titres for each serological marker and combinations of them allowed early diagnosis of infection in 82% of varicella patients and 91% of patients with acute aseptic meningitis lacking cutaneous lesions on a single serum sample, the specificity being over 90%. The system was as sensitive as the demonstration of intrathecally produced IgG antibodies for the early diagnosis of the infection in 22 cases of neurological disease due to VZV. A working protocol for the serological diagnosis of VZV infections, using currently available EIA reagents, is described.

Aseptic meningitis due to varicella-zoster virus: serum antibody levels and local synthesis of specific IgG, IgM, and IgA.

We used an indirect enzyme immunoassay to describe the evolution of serum levels and the intrathecal production of IgG, IgA, and IgM antibodies to varicella-zoster virus (VZV) in eight patients with a syndrome of acute aseptic meningitis (AAM) and evidence of intrathecal production of VZV-specific IgG antibodies. Four of the eight patients showed no cutaneous zoster while hospitalized. Our results suggested an etiologic relation between VZV and AAM in all cases. Furthermore, we observed some differences in the pattern of evolution of antibodies in serum and cerebrospinal fluid in relation to the presence or absence of cutaneous lesions in our patients. These differences could reflect different pathogenic mechanisms in the spread of VZV to the central nervous system and in the production of the AAM syndrome.