Node Enlargement Research Articles

The chest CT signs for pulmonary veno-occlusive disease correlate with pulmonary haemodynamics in systemic sclerosis.

Pulmonary arterial hypertension associated with systemic sclerosis (PAH-SSc) sometimes accompanies pulmonary veno-occlusive disease (PVOD). We aimed to reveal the relation between clinical signs of PVOD and severing of pulmonary vasculopathy in SSc. This study comprised 52 consecutive SSc patients who had pulmonary haemodynamic abnormalities (mPAP > 20 mmHg, PVR > 2 W.U. or PAWP > 15 mmHg). The chest CT scan was evaluated in all patients. Patients were divided into two groups, the 0-1 group and the 2-3 group, according to the number of chest CT signs for PVOD, including 1) mediastinal lymph node enlargement, 2) thickened interlobular septal wall, and 3) ground glass opacity. Pulmonary haemodynamics, echocardiography and MRI-based cardiac function, pulmonary function, and serum biomarkers were compared between the two groups. Mediastinal lymph node enlargement, thickened interlobular septal wall, and ground glass opacity were observed in 11 (21%), 32 (62%), and 11 (21%) patients, respectively. The 2-3 group (n = 15) had higher mPAP (p= 0.02) while lower DLco/VA (p= 0.02) compared with the 0-1 group (n = 37). Other parameters, including PAWP, cardiac output, left ventricular ejection fraction, left atrial diameter, forced vital capacity, brain natriuretic peptide, and Krebs von den Lunge-6 were not different between the two groups. The CT signs for PVOD had positive correlation with mPAP but negative correlation with DLco in SSc patients, indicating that PAH-SSc may reflect a spectrum of pulmonary vascular disease that ranges from the pulmonary artery to the vein.

Elderly-onset pulmonary sarcoidosis: A radiological approach to diagnosis.

The aim was to compare the radiological and clinical characteristics of sarcoidosis between elderly and non-elderly patients. This retrospective observational study was carried out in patients with sarcoidosis. Elderly-onset sarcoidosis was defined as sarcoidosis diagnosed in patients ≥65 years-old. Patients were stratified by age (≥65 years versus <65 years) and radiological and clinical data were compared between age groups. Of the 163 patients, 38 (23.3%) were in the elderly group and 125 (76.7%) were in the non-elderly group. Elderly patients more frequently demonstrated arthralgia (50% vs. 12.8%, p<0.001), coronary artery disease (15.8% vs. 2.4%, p=0.005), congestive heart failure (13.2% vs. 0.8%, p=0.003), pneumonia (7.9% vs. 0.8%, p=0.04), and pleural fluid (18.4% vs. 0.0%, p<0.001). Clinical remission was significantly more likely in younger patients than in the elderly (76.8% vs. 55.3%, p=0.01). The clinical course to chronic-progressive disease was similar in both groups (p=0.635). Radiologically, lymph nodes measuring 10-25 mm in the short axis (89.5% vs. 72.6%, p=0.032), usual interstitial pneumonia pattern (10.5% vs. 0.8%, p=0.011), and main pulmonary artery diameter above 30 mm (34.2% vs. 16.0%, p=0.014) were significantly more frequent in the elderly group. Elderly patients tended to demonstrate Scadding stage I and II sarcoidosis (39.5% and 31.6%). Presentation of elderly-onset sarcoidosis appears to differ from young-onset sarcoidosis. Radiologically, lymph node enlargement and the pattern of fibrosis may be distinctive.

Differentiation of pulmonary solid nodules attached to the pleura detected by thin-section CT

BackgroundPulmonary solid pleura-attached nodules (SPANs) are not very commonly detected and thus not well studied and understood. This study aimed to identify the clinical and CT characteristics for differentiating benign and malignant SPANs.ResultsFrom January 2017 to March 2023, a total of 295 patients with 300 SPANs (128 benign and 172 malignant) were retrospectively enrolled. Between benign and malignant SPANs, there were significant differences in patients’ age, smoking history, clinical symptoms, CT features, nodule-pleura interface, adjacent pleural change, peripheral concomitant lesions, and lymph node enlargement. Multivariate analysis revealed that smoking history (odds ratio [OR], 2.016; 95% confidence interval [CI], 1.037–3.919; p = 0.039), abutting the mediastinal pleura (OR, 3.325; 95% CI, 1.235–8.949; p = 0.017), nodule diameter (> 15.6 mm) (OR, 2.266; 95% CI, 1.161–4.423; p = 0.016), lobulation (OR, 8.922; 95% CI, 4.567–17.431; p < 0.001), narrow basement to pleura (OR, 6.035; 95% CI, 2.847–12.795; p < 0.001), and simultaneous hilar and mediastinal lymph nodule enlargement (OR, 4.971; 95% CI, 1.526–16.198; p = 0.008) were independent predictors of malignant SPANs, and the area under the curve (AUC) of this model was 0.890 (sensitivity, 82.0%, specificity, 77.3%) (p < 0.001).ConclusionIn patients with a smoking history, SPANs abutting the mediastinal pleura, having larger size (> 15.6 mm in diameter), lobulation, narrow basement, or simultaneous hilar and mediastinal lymph nodule enlargement are more likely to be malignant.Critical relevance statementThe benign and malignant SPANs have significant differences in clinical and CT features. Understanding the differences between benign and malignant SPANs is helpful for selecting the high-risk ones and avoiding unnecessary surgical resection.Key points• The solid pleura-attached nodules (SPANs) are closely related to the pleura.• Relationship between nodule and pleura and pleural changes are important for differentiating SPANs.• Benign SPANs frequently have broad pleural thickening or embed in thickened pleura.• Smoking history and lesions abutting the mediastinal pleura are indicators of malignant SPANs.• Malignant SPANs usually have larger diameters, lobulation signs, narrow basements, and lymphadenopathy.Graphical

Ultrasound features of an unusual intramural gastric haemorrhage secondary to rodenticide intoxication in a dog

AbstractA 3‐year‐old, neutered, female, mix‐breed dog was presented with a history of acute haemorrhagic vomiting, diarrhoea, anorexia and lethargy. The patient had a hyperkinetic pulse, pale mucous membranes, bilateral hyphema and the capillary refill time was increased. Coagulation testing showed increased values. Abdominal ultrasound revealed diffuse thickening of the submucosal layer with hyperechoic peritoneum and enlargement of the gastric lymph node. The presumptive diagnosis was gastric wall haemorrhage secondary to rodenticide intoxication. The dog responded to treatment and was discharged after 48 hours. Fifteen days later, the thickness and layering of the stomach wall was normal. Gastric wall haemorrhage is a rare condition in dogs with rodenticide intoxication, which requires a biopsy for confirmation. However, the risk of haemorrhage does not make this feasible. In this case, the authors suspect that submucosal gastric thickening was secondary to anticoagulant rodenticide intoxication based on history, clinical examination, haematological analysis and coagulation testing.

Computed Tomography Imaging of COVID-19 Vaccination–related Axillary Lymphadenopathy: Updated Review of Literature

As of September 2022, approximately 606 million cases of COVID-19 have been reported and 6.5 million deaths have occurred worldwide [1]. COVID-19 vaccination programs are in progress around the world to control the pandemic [2]. Till September 2022 approximately 12.6 billion doses of the vaccine have been globally administered [3]. It has been found that reactive hyperplasia of the ipsilateral axillary nodes and sometimes contralateral node is a side effect of vaccination [4]. The frequency of imaging-detected lymphadenopathy ranged between 14.5 to 53% [5]. Cancer patients undergoing active treatment or follow-up surveillance undergo frequent cross-sectional imaging which incidentally detects vaccine-related lymphadenopathy. A Chest CT scan is the most used imaging modality for lung cancer monitoring and lung screening for metastasis of other malignancies. Thus, incidentally detected COVID-19-associated axillary lymph node enlargement is seen in these patients who undergo frequent chest CT scans including the axilla. It is difficult to differentiate lymph node enlargement due to Covid vaccination from lymph node metastasis on imaging. This can lead to unnecessary fine needle aspiration cytology or biopsy thus increasing the patient’s cost and public health burden [6][7][8]. This systematic review aims to evaluate the published literature evidence of axillary lymphadenopathy after COVID-19 vaccination and its imaging features on Chest CT.

A Long-Term and Sustainable Response to Orapali in a BRCA2 Mutant Advanced Pancreatic Cancer: A Case Report

Pancreatic cancer is a highly malignant cancer characterized by high mutation rates of oncogenes and tumor suppressor genes and genomic instability. It has a poor prognosis owing to early metastasis and rapid growth. Therefore, new drugs or treatments are urgent to be required. Poly ADP-Ribose polymerase (PARP) inhibitors have shown therapeutic efficacy in pancreatic cancer driven by defects in homologous recombinant (HRD). Here we report a case of advanced pancreatic cancer with BRCA2 mutation. The patient came to our hospital due to abnormal enlargement of the left supraclavicular lymph node. Further examination revealed pancreatic cancer with multiple retroperitoneal lymph nodes metastases and lung metastases. Pathological and immunohistochemical results of supraclavicular lymph node confirmed it was pancreatic cancer metastasis. Next generation sequencing (NGS) demonstrated that BRCA2 germline mutation. Subsequently, gemcitabine combined with cisplatin as first line therapy was commenced for the patient. The tumors were significant reduced after 6 cycles of treatment. Then, the patient was given orapali (PARP inhibitors) to maintain treatment. Surprisingly, the efficacy has lasted for about 20 months (from Dec 2021 to Aug 2023) and no signs of disease progression have been found. Our case shows that orapali provides a more efficient and low-toxic treatment for patient with BRCA2 mutation advanced pancreatic cancer, which is expected to change the treatment pattern of advanced pancreatic cancer.

Tuberculosis in Superficial Lymphadenopathy Based on Fine Needle Aspiration Cytology: A Cross Sectional Study

Objective: To investigate the prevalence of tuberculosis among individuals presenting with superficial lymphadenopathy using Fine Needle Aspiration Cytology (FNAC) as a diagnostic method. Methodology: This cross-sectional research spanned three years, conducted at HBS General Hospital in Islamabad from July 2016 to June 2019. The study enrolled individuals meeting specified inclusion and exclusion criteria, presenting with superficial lymph node enlargement. All participants provided written consent before undergoing fine needle aspiration cytology (FNAC), and the diagnosis of tuberculosis relied on histopathological findings. Results: Among 632 patients aged 15 to 60 years who underwent FNAC following clinical examination and relevant lab investigations, 85.4% (n=540) exhibited cervical lymphadenopathy. Among these, 57.7% (n=312) were diagnosed with tuberculous lymphadenitis, comprising 58.3% females (n=182) and 41.6% males (n=130). Axillary lymphadenopathy was observed in 5.53% (n=35) of patients, among whom 3.64% females (n=23) and 2.1% males (n=13) were diagnosed with tuberculous lymphadenopathy. Generalized lymphadenopathy was seen in 5.1% (n=32) of cases, with 0.94% males (n=6) and 0.79% (n=5) demonstrating histological evidence of TB on FNAC. Inguinal lymphadenopathy was observed in 3.95% (n=25) of patients, including 0.94% males (n=5) and 0.47% females (n=3). Conclusion: Lymphadenopathy, a prevalent clinical condition, encompasses various underlying causes, ranging from manageable tuberculosis to malignant conditions. FNAC serves as a safe and rapid diagnostic technique, reducing the need for excisional biopsies. In this study, cervical lymph nodes were most frequently affected by tuberculous lymphadenopathy, particularly among females.

Evaluation of CT features for differentiating consolidation pattern of pulmonary MALT lymphoma from pneumonic-type lung adenocarcinoma.

In clinical practice, the consolidation pattern of pulmonary mucosa-associated lymphoid tissue (C-MALT) was often misdiagnosed as pneumonic-type lung adenocarcinoma (P-LADC). However, the mainstay of treatment and prognosis of these two diseases are different. The purpose of this study was to distinguish C-MALT from P-LADC by pre-treatment chest computed tomography (CT) features. A total of 31 patients with C-MALT (15 men and 16 women; mean age, 61.1 ± 11.2 years) and 58 patients with P-LADC (34 men and 24 women; mean age, 68.6 ± 7.4 years) confirmed by pathology who underwent contrast-enhanced chest CT were retrospectively enrolled from September 2014 to February 2023. Detailed clinical and CT characteristics of the two groups were evaluated. Logistic regression analysis was used to assess the effectiveness of statistically significant variables in distinguishing C-MALT from P-LADC. The average age of C-MALT was younger than P-LADC patients (p<0.001). With regard to CT features, bronchiectasis within the consolidation was more common in the C-MALT group than the P-LADC group [83.87% (26 of 31) vs 20.69% (12 of 58), p<0.001]; whereas lymph nodes enlargement [75.86% (44 of 58) vs 9.68% (3 of 31), p<0.001] and pleural effusion [43.10% (25of 58) vs 19.35% (6 of 31), p=0.025] were more frequently observed in the P-LADC group than C-MALT group. The predictors with p<0.05 (age, bronchiectasis, lymph node enlargement, and pleural effusion) were used to construct a logistic regression model in discriminating C-MALT from P-LADC, the area under curve (AUC), positive predictive value (PPV), negative predictive value (NPV), specificity, sensitivity, and accuracy were 0.9555, 86.67%, 91.53%, 83.87%, 93.10%, and 89.89%, respectively. C-MALT and P-LADC have differential clinical and CT features. An adequate understanding of these different characteristics can contribute to the early accurate diagnosis of C-MALT and provide an appropriate therapeutic strategy.

Canine Leishmania spp. infection in two distinct foci of visceral and cutaneous leishmaniasis in Tunisia.

Visceral leishmaniasis (VL) and zoonotic cutaneous leishmaniasis (ZCL) caused by Leishmania (L.) infantum and L. major, respectively, are endemic in Tunisia. The aim of the study was to assess canine Leishmania spp. infection prevalence as well as to identify the Leishmania species involved in two well-documented and geographically distinct VL and ZCL foci. One hundred seventy-six dogs were randomly recruited in the VL focus of Sbikha-Zaghouan (n = 100) and the ZCL focus of Echrarda-Nasrallah (n = 76). Physical examination and blood collection were systemically performed. Needle aspiration was done in case of lymph node (LN) enlargement. All sera were tested by ELISA. kDNA RT-PCR was performed on DNA extracts from (i) buffy coats of seropositive dogs and (ii) LN aspirates. Leishmania species identification was done by ITS1 PCR-sequencing. Thirty-three dogs (18.8%) were infected by Leishmania; 30 having anti-Leishmania antibodies and 3 were seronegative dogs with Leishmania DNA in LN aspirates. Prevalence of infection was significantly higher in VL foci than in ZCL foci (27% versus 7.9%, p = 0.002). Leishmania species was identified in 11 dogs and corresponded to L. infantum. Combination of serology and qPCR on LN aspirates seems to be the best option for canine leishmaniasis diagnosis. Infection is more frequent in VL foci and L. infantum is the only identified species.

Evaluation of hypermetabolic mediastinal-hilar lymph nodes determined by PET/CT with EBUS-TBNA and calculation of SUVmax cutoff values in differentiation of malignancy.

Computed tomography (CT) and positron emission tomography (PET) are the most commonly used methods for diagnosis and staging in both malignant and benign diseases of the lung parenchyma and mediastinum. Endobronchial ultrasonography (EBUS) guided transbronchial needle aspiration biopsy (TBNA) has become widespread in recent years because it allows minimally invasive tissue sampling. PET-CT has high sensitivity in the diagnosis of malignancy but has low specificity. The false positive rate is high with the SUVmax 2.5 cutoff value, which is widely used in studies about malignancy. In our study, we evaluated lymph nodes with high F18-fluorodeoxyglucose (FDG) uptake on PET/CT and sampled by EBUS-TBNA. We aimed to calculate the new SUVmax cutoff values in the differentiation of malignancy. Our study included 103 patients who were examined for any reason and who underwent biopsy with EBUS-TBNA due to mediastinal or hilar lymph node enlargement on PET-CT. The relationship between PET-CT findings and EBUS findings, EBUS-TBNA results was evaluated. Biopsies were taken from 140 lymph nodes in 103 patients included in our study, and 39 (27.8%) were diagnosed as malignant. In our study, when the SUVmax cutoff value in PET-CT is taken as 2.54, the sensitivity is 98%, but the specificity remains at the level of 12%. When the SUVmax cutoff value in PET-CT was taken as 4.58, the sensitivity was 92% and the specificity was 49%. When this value was accepted as 5.25, and 6.09 the sensitivity was respectively 90% and 85%, the specificity was respectively 52% and 60%. In evaluations, we conducted in order to determine different SUVmax cutoff values that can be used for higher sensitivity and specificity in malignancy studies, the cutoff values were 4.58, 5.25, and 6.09. It is thought that these cutoff values will be useful both for diagnosing malignancy and for distinguishing benign pathologies.

What do the clinical features of positive nontuberculous mycobacteria isolates from patients with HIV/AIDS in China reveal? A systematic review and meta-analysis.

China has a high burden of nontuberculous mycobacterial (NTM) infections. Immunocompromised populations, such as those with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), are at a higher risk of being infected with NTM than immunocompetent individuals. Yet, there is a paucity of information on the clinical features of positive NTM isolates from patients with HIV/AIDS in China. To address this gap, we conducted a systematic review and meta-analysis of existing studies, comparing them against current expert consensus to provide guidance for clinical practice. Two researchers independently searched eight databases (SinoMed, China National Knowledge Infrastructure, Wanfang, VIP, Cochrane Library, PubMed, Embase, and Web of Science) from inception to 26 December 2022 to retrieve published Chinese- and English-language studies reporting clinical features of NTM-positive isolates among patients with HIV/AIDS in China. We included 28 studies with 1861 patients. The rate of positive NTM isolates detected from men among all patients was 87.3%. NTM species distribution was mainly Mycobacterium avium complex (64.3%), which was predominant in different regions. The five most common clinical symptoms were fever (68.5%), cough or expectoration (67.0%), appetite loss (49.4%), weight loss (45.5%), and superficial lymphadenectasis (41.1%). The prevalence of laboratory tests were as follows: albumin <35 g/L (55.6%), erythrocyte sedimentation rate >20 mm/h (91.4%), anaemia (59.0%), predominantly mild, CD4+ T cell count ≤50 pieces/μL (70.3%), and CD4+ T cell count 51-200 pieces/μL (22.1%). Lesion manifestations in thoracic imaging mainly included bilateral lung involvement (83.8%), showed stripe shadows (60.3%), patchy shadows (42.9%), nodules (40.6%), and bronchiectasis (38.6%). Accompanied signs included thoracic lymph node enlargement (49.5%). Seventy per cent of symptoms improved after treatment. Focusing on clinical symptoms, laboratory tests, and thoracic imaging helps with initial screening for NTM infections. Physicians should raise awareness of the diagnosis and treatment of Mycobacterium avium complex, providing guidance for experimental treatment, screening of priority populations for NTM infections, and prophylactic treatment of NTM disease. PROSPERO CRD42023388185.

Diagnostic role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in abdominal lymphadenopathy of unknown etiology.

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an established method for the evaluation of abdominal organ lesions. However, there are few studies on EUS-FNA for abdominal lymph node (LN) lesions. The purpose of this study was to evaluate the diagnostic role of EUS-FNA in isolated abdominal lymphadenopathy (LAP). A retrospective analysis was performed on patients with isolated abdominal LAP who underwent a EUS-FNA examination. The diagnosis was made based on cytology, histology, and immunohistochemical (IHC) studies. The area under curve (AUC) value, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. A total of 99 patients were included in this study. The final diagnoses were metastatic tumor (n = 32), lymphoma (n = 32), tuberculosis (n = 17), sarcoidosis (n = 5), castleman's disease (n = 1), and reactive LAP (n = 12). The AUC value, sensitivity, specificity, PPV, NPV, and accuracy of EUS-FNA in the diagnosis of malignant LAP were 0.9531, 90.6, 100, 100, 85.4, and 93.9%, respectively. For the diagnosis of lymphoma, the accuracy of EUS-FNA combined with IHC staining was 94.9%. Retroperitoneal LN enlargement is more commonly associated with lymphoma, while hepatic hilar LN enlargement predominantly suggests benign conditions or metastatic tumors. Malignant lymph nodes are more likely to be regular border, circular/quasi-circular, and fusion. Lymphomas are more likely to present with fusion and heterogeneous echogenicity than metastatic tumors. EUS-FNA is a safe and effective method to diagnose isolated abdominal LAP.

A Rare Case of Pseudo-Malignant Paranasal Extranodal Rosai-Dorfman Disease.

Rosai-Dorfman disease is a very rare disease characterized by histiocytic accumulation in the head and neck region and lymph node enlargement. We report a rare pseudo-malignant paranasal extranodal Rosai-Dorfman disease. A 69-year-old-man presented nasal bleeding and nasal obstruction. Paranasal mass was detected in the left nasal cavity and computed tomography (CT) findings are the sphenoid sinus, maxillary sinus, and ethmoid sinus were involved with inconstant bone thickening, however, no bone destruction was detected. Magnetic resonance imaging scans show iso-intensity signal in T1-weighed image and T2-weighed image. Positron emission tomography/CT fluorodeoxyglucose (FDG) uptake in posterior ethmoid sinus and sphenoid sinus, bilateral cervical lymph node, clavicle, and sternum. Based on the above results, we considered malignant lymphoma and performed a biopsy. After pathological examination, a diagnosis of Rosai-Dorfman disease was established.

Factors associated with in-hospital recurrence of intestinal intussusception in children.

A minority of children experience in-hospital recurrence of intestinal intussusception after treatment. This study investigated the factors associated with in-hospital recurrence of intussusception in pediatric patients in China. This retrospective study included patients aged 0-18 years-old with intestinal intussusception treated at Hainan Women and Children's Medical Center between January 2019 and December 2019. Demographic and clinical characteristics were extracted from the medical records. Factors associated with in-hospital recurrence of intussusception were identified by logistic regression analysis. The analysis included 624 children (400 boys) with a median age of 1.8 years (range, 2 months and 6 days to 9 years). Seventy-three children (11.7%) had in-hospital recurrence of intussusception after successful reduction with air enema. Multivariate logistic regression analysis identified age > 1 year-old (odds ratio [OR]: 7.65; 95% confidence interval [95%CI]: 2.70-21.71; P < 0.001), secondary intestinal intussusception (OR: 14.40; 95%CI: 4.31-48.14; P < 0.001) and mesenteric lymph node enlargement (OR: 1.90; 95%CI: 1.13-3.18; P = 0.015) as factors independently associated with in-hospital recurrence of intussusception. Age > 1 year-old, secondary intussusception and mesenteric lymph node enlargement were independently associated with increased odds of in-hospital recurrence of intussusception after successful reduction with air enema.

Axillary lymph nodes enlargement after Sars-CoV-2 vaccine in patients undergoing breast examination: a single-centre experience in 285 women.

To assess the incidence of axillary lymphadenopathy over established time ranges after COVID-19 vaccination and lymph node pathologic features (i.e. size increase and qualitative characteristics) in subjects undergoing axillary evaluation during a breast imaging examination. The institutional review board approved this prospective study. women undergoing mammography and breast ultrasound between July and October 2021; information about the COVID-19 vaccine and infection, if any. known metastatic lymphadenopathy. Participants were divided into 5 subgroups according to time between vaccine and imaging: < 6weeks; 7-8weeks; 9-10weeks; 11-12weeks; > 12weeks. Evaluation of axillary lymph nodes was performed with ultrasound. Descriptive statistical analysis was performed. p < 0.05 was considered significant. A total of 285 women were included. Most of the patients underwent Moderna vaccine (n = 175, 61.4%). 63/285 patients had a previous history of breast cancer (22.1%). 13/17 (76.5%) patients with previous COVID-19 infection had no previous history of cancer, whereas 4/17 had a previous history of cancer (p < .001). 41/285 (14.4%) women showed lymphadenopathy, and they were significantly younger (46.9 ± 11.6years) than women with borderline (54.0 ± 11.9years) or no lymphadenopathy (57.3 ± 11.9years) (p < .001). Lymphadenopathy and borderline lymphadenopathy were more frequently observed in the Moderna-vaccinated women and in the subgroup of patients evaluated < 6weeks after vaccination (p < 0.001). The most common pathologic feature was cortical thickening, followed by complete or partial effacement of fatty hilum. A lymphadenopathy within 12weeks after vaccination is a common finding particularly in younger women and after Moderna vaccine and no further assessment should be required.

Macrophage activation syndrome in systemic lupus erythematosus - a case report

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition that results from the immune system hyperactivation. The primary form of HLH appears mainly in children and is caused by a genetically determined failure of NK and T cells. Secondary (acquired) HLH usually occurs due to insufficiency of these cells caused by other disease entities or drugs. Potential factors that may be responsible for the appearance of this rare condition include: malignancies (especially lymphomas), infections (EBV, CMV, HIV), autoimmune diseases (SLE, Still’s disease). The clinical appearance of hemophagocytic lymphohistiocytosis is dominated by persistent fever, hepatomegaly, splenomegaly, pallor of the skin, signs of hemorrhagic diathesis, lymph node enlargement. Characteristic abnormalities in laboratory tests include: hypertriglyceridemia, cytopenia, hyperferritinemia, hyperfibrinogenemia and hypertransaminasemia. One subtype of the secondary form of hemophagocytic lymphohistiocytosis, which is associated with rheumatic diseases, is called the macrophage activation syndrome (MAS). The following describes a case of a 26-year-old woman with exacerbated systemic lupus erythematosus, who was admitted to a Rheumatology Unit in severe general condition. Clinical presentation of the patient included primarily: long-lasting fever, hepatomegaly and splenomegaly. Various test were performed during her hospitalization, including laboratory test and a bone marrow biopsy. Finally, the woman was diagnosed with the macrophage activation syndrome. She was successfully treated with ciclosporin and methylprednisolone.

Case Reports: Clinical features and postmorteum findings of sheep-associated malignant catarrhal fever in a 2-years old bull

Malignant Catarrhal Fever (MCF) is a fatal lymphoproliferative disease of cattle and other ungulates caused by alcelaphine herpesvirus 1 (AlHV-1) and ovine herpesvirus 2 (OvHV-2), the main causative agents of wildebeest-associated MCF (WA-MCF) and sheep-associated MCF (SA-MCF), respectively. The virus is mainly spread by aerosols from pregnant or newborn sheep, goats, and wildebeest to susceptible animals. This case report presents the clinical features and post-mortem findings of an unusual case of malignant catarrhal fever (MCF) in a two-year-old bull brought to the Professor Feseha Gebreab Memorial Veterinary Teaching Hospital in Bishoftu, Ethiopia. The bull was semi-intensively managed, co-housed, and fed with sheep and other domestic animals. The animal was shivering upon arrival, with naso-ocular discharge and clouding of the eyes. The bull was febrile, with a rectal body temperature of 41.4 oC and a respiratory and heart rate of 40 and 48 beats per minute, respectively. On physical examination, the bull was emaciated, with bilateral yellowish mucopurulent naso-ocular discharge, frequent blinking, bilateral corneal opacity, salivation, a foamy mouth, head pressing, and enlargement of superficial lymph nodes. Malignant catarrhal fever was suspected based on the history and clinical signs, and empiric therapy with 10% oxytetracycline, diclofenac, and IV fluid was initiated. The bull died after receiving the third day of treatment. At necropsy, hemorrhages were found in the esophagus, trachea, and small and large intestines. In the kidney, white foci, enlargement, and fatty degeneration were observed. An ulcerated lesion was seen on the abomasum. In the gall bladder, enlargement and vascularization were also noted. The current case report confirms the rare case of clinical SA-MCF based on the history, exhibited clinical pictures, post-mortem findings, and PCR results. Separation of cattle and sheep is strongly advised to prevent SA-MCF, as no vaccine has yet been developed.

Caseous lymphadenitis: A case of sheep and its management in Ethiopia

Caseous lymphadenitis (CLA) is a contagious and chronic bacterial disease of animals that affects the lymphatic system with the formation of abscesses. This case report documents a sheep diagnosed with CLA that was brought to the Veterinary Teaching Hospital of Addis Ababa University College of Veterinary Medicine and Agriculture (AAU-CVMA), Bishoftu on March 06/2022. The primary complaint was weakness, anorexia, and a slight, fluctuating, sickleshaped, enlarged swelling in the neck region between the ear and jaws, which developed due to a laceration by a wire on the fence. Physical and clinical examination revealed increased body temperature (40.7oC) and respiratory rate (44 breaths/min) and mildly fluctuating swelling on lymph nodes. Anorexia, coughing, general ill thrift, exercise intolerance, and enlargement of subcutaneous tissues and lymph nodes around the neck region were observed. Aspiration of the swelling revealed thick, pale greenish-cheesy pus. Using the Ethiopian Differential Diagnosis and Information Environment App-based diagnosis and bacterial culture of the pus revealed the case as CLA. It was managed by surgical removal of the pus, topical wound spray, and systemic administration of fortified procaine penicillin for five days intramuscular and once topically on the site, respectively. The sheep recovered after a month. In conclusion, CLA is a challenging suppurative disease of sheep and goats that can be successfully treated by topical wound management and systemic penicillin therapy.

Common and Uncommon CT Findings in CVID-Related GL-ILD: Correlations with Clinical Parameters, Therapeutic Decisions and Potential Implications in the Differential Diagnosis

PurposeTo investigate computed tomography (CT) findings of Granulomatous Lymphocytic Interstitial Lung Disease (GL-ILD) in Common Variable Immunodeficiency (CVID), also in comparison with non-GL-ILD abnormalities, correlating GL-ILD features with functional/immunological parameters and looking for GL-ILD therapy predictive elements.MethodsCT features of 38 GL-ILD and 38 matched non-GL-ILD subjects were retrospectively described. Correlations of GL-ILD features with functional/immunological features were assessed. A logistic regression was performed to find a predictive model of GL-ILD therapeutic decisions.ResultsMost common GL-ILD CT findings were bronchiectasis, non-perilymphatic nodules, consolidations, Ground Glass Opacities (GGO), bands and enlarged lymphnodes. GL-ILD was usually predominant in lower fields. Multiple small nodules (≤10 mm), consolidations, reticulations and fibrotic ILD are more indicative of GL-ILD. Bronchiectasis, GGO, Reticulations and fibrotic ILD correlated with decreased lung performance. Bronchiectasis, GGO and fibrotic ILD were associated with low IgA levels, whereas high CD4+ T cells percentage was related to GGO. Twenty out of 38 patients underwent GL-ILD therapy. A model combining Marginal Zone (MZ) B cells percentage, IgA levels, lower field consolidations and lymphnodes enlargement showed a good discriminatory capacity with regards to GL-ILD treatment.ConclusionsGL-ILD is a lower field predominant disease, commonly characterized by bronchiectasis, non-perilymphatic small nodules, consolidations, GGO and bands. Multiple small nodules, consolidations, reticulations and fibrotic ILD may suggest the presence of GL-ILD in CVID. MZ B cells percentage, IgA levels at diagnosis, lower field consolidations and mediastinal lymphnodes enlargement may predict the need of a specific GL-ILD therapy.

Significance and prognostication of mediastinal lymph node enlargement on chest computed tomography among adult Indigenous Australians.

There is a lack of data on chest computed tomography (CT) findings on mediastinal lymph node enlargement (MLE), including normal size threshold of less than 10 or 15 mm for MLE among Indigenous Australians. In this study, we assessed the significance and the applicability of the current guidelines for the threshold for abnormal MLE among adult Indigenous Australians. Patients who underwent chest CT between 2012 and 2020 among those referred to undergo lung function test (spirometry) were assessed for the presence of MLE which were classified as Group A (no measurable nodes), Group B (<10 mm), Group C (≥10 to 14.99 mm) and Group D (≥15 mm). Of the total 67 patients identified to have MLE, 49 patients had at least two CT scans available for assessment over a median follow-up period of 101.3 weeks (IQR: 62.4, 235.6) and were included in the analysis. Evidence of chronic lung disease was common, with a significant proportion demonstrating either COPD or bronchiectasis and a high proportion with smoking history (93%). During the first CT scan, 34/49 (69%) had >10 mm nodes, of which 12/34 (35%) reduced in size, 22/34 (65%) remained stable, and 3/34 (9%) had malignancy on follow-up. Despite most patients demonstrating the presence of significant MLE with varying size and in most >10 mm, the majority remain stable or benign in nature and only a minor proportion showed evidence of lung malignancy. Further prospective studies are needed in the characterisation of MLE among Indigenous patients.