Finding Of Granulomas Research Articles

Thoracale adenopathieën en neutropenie: een onverwachte diagnose

Thoracic lymphadenopathies and neutropenia: an unexpected diagnosis A 68-year-old patient, known with rheumatoid arthritis (RA) and treated with TNF-alpha antagonists, presents with a persistent cough with coloured sputum. Further examination reveals neutropenia and thoracic adenopathies. Histopathologic examination shows non-necrotizing granulomas in the thoracic lymph nodes and bone marrow. After infectious and malignant evaluation, the diagnoses of sarcoidosis and sarcoidosis-like granulomatosis by TNF-alpha antagonists are made. The clinic, imaging, laboratory findings and histopathology do not allow the doctors to distinguish between the 2 diagnoses. Several arguments point in the direction of sarcoidosis-like granulomatosis due to TNF-alpha antagonists. First, there is a temporal relationship between the initiation of the antagonists and the finding of granulomas. Additionally, the association of RA and sarcoidosis is extremely rare. Sarcoidosis-like granulomatosis due to TNF-alpha antagonists may be considered as a form of drug-induced sarcoidosis.

Sarcoid Granulomas and Systemic Sarcoidosis Triggered by Cosmetic Tattoos.

Cosmetic tattooing of eyebrow and lips has become very popular and is expected to be paralleled by more frequent complications. We present 4 cases of granulomas in cosmetic tattoos complicated by regional or systemic manifestations of sarcoidosis including affection of the lungs in 2 cases, the activity triggered by the tattoo. Three cases of traditional decorative tattoos on extremities serve as reference. It is noteworthy that cosmetic tattoos despite small size and thereby low relative dose of pigment injected in the skin can trigger fully developed systemic sarcoidosis. It is hypothesized that iron oxide pigments popular in cosmetic tattoo inks of red or brown color may be prone to elicit sarcoid reactions and thus carry a special risk of granuloma. In decorative tattoos, carbon black is the commonest trigger. It is emphasized that the finding of granulomas in tattoos shall be followed by search of other manifestations of sarcoidosis through patient history and diagnostic examinations to exclude pulmonary, ocular, and other organ manifestations. Patients with granulomas in tattoos shall be informed that active sarcoidosis, if not already present, can become manifest later with a latency of months or years and often with abrupt debut when the triggering tattoo may be overlooked by the doctor who is unfamiliar with this less common type of sarcoidosis.

10 YEAR REVIEW OF CHRONIC GRANULOMATOUS INflAMMATORY REACTIONS FOUND IN THE ORAL CAVITY: 2007-2016

10 YEAR REVIEW OF CHRONIC GRANULOMATOUS INflAMMATORY REACTIONS FOUND IN THE ORAL CAVITY: 2007-2016

Tubercular mastitis - a great masquerader

Tubercular mastitis is a rare clinical entity as mammary gland tissue, like spleen and skeletal muscle, offers resistance to the survival and multiplication of the tubercle bacillus. Tuberculosis of the breast can mimic carcinoma, whereas in young patients it can be mistaken for a pyogenic breast abscess, thus labeled a "great masquerader" in recognition of its multifaceted presentation. Breast tuberculosis commonly affects women in the reproductive age group, between 21 and 30 years, and is rare in prepubescent females and elderly women. Fine needle aspiration cytology is very useful and it is a promising technique in expert hands. In tuberculosis-endemic countries, the finding of granuloma on fine needle aspiration cytology warrants empirical treatment for tuberculosis even in the absence of positive acid-fast bacilli and without culture results. We hereby report a case of tubercular mastitis in a post-menopausal seronegative female diagnosed on fine needle aspiration cytology with a positive acid-fast bacilli and a review of the recent literature.

Intravesical bacille Calmette–Guérin-induced multiorgan failure after treatment for transitional cell carcinoma

Intravesical bacille Calmette-Guérin (BCG) has been safely used to treat stage Ta and T1 bladder carcinoma since 1976. This report presents the case of a 56-year-old man who presented with multiorgan failure after bacille Calmette-Guérin (BCG) treatment for stage T1 transitional cell carcinoma of the bladder. On admission the patient was jaundiced, had inflammatory infiltrates on chest radiography and required dialysis for renal failure. He had a persisting fever of unknown origin and elevated cholestatic liver function tests, which prompted a liver biopsy.This demonstrated hypersensitivity hepatic granuloma but no organism was identified. He responded well to steroid and antimycobacterial treatment. A small percentage of BCG-treated patients suffer hypersensitivity side-effects (pneumonitis, hepatitis or interstitial nephritis). This complication most commonly follows a traumatic installation. Mycobacteriumbovis is rarely cultured or identified using polymerase chain reaction techniques, and the diagnosis is based on histological findings of granuloma.

Perineal Crohn's Disease

There is a subset of patients with perianal Crohn's disease whose course is unusually severe. The hypotheses of this study are that these patients often have direct perineal involvement with Crohn's disease and that this involvement can be recognized clinically. A prospective database with data from 1989 to 2005 was examined for patients with perianal Crohn's disease. Patients were divided into those with and those without perineal involvement, defined by the presence of at least one of the following findings: spontaneous perineal ulceration; nonhealing, painless fissures; or waxy perineal edema. Presentation, treatment, and outcome of the two groups were compared. Seventy-two patients were identified, 19 with perineal involvement and 63 without. Perineal Crohn's disease was more often seen in women, presented at a younger age, and was associated with less small bowel and more colonic Crohn's. The chances of healing in patients with perineal Crohn's disease were lower (32 vs. 66 percent) and proctectomy was more likely (26 vs. 3.7 percent) than when the perineum was normal. Perineal involvement with Crohn's disease can be diagnosed on physical examination and confirmed by the finding of granulomas. When perineal involvement is suspected, surgery should be avoided and consideration given to medical therapy.

Is there a role for microorganisms in the pathogenesis of sarcoidosis?

Sarcoidosis is a granulomatous disease that has the immunopathological features of being antigen-driven. It is a complex disease that appears to arise from the interaction of one or more triggers with an immunologically predisposed host. Previous reports of familial clustering and varying prevalence of sarcoidosis in different populations could reflect differences in ethnic predisposition or differences in local environmental exposures. This review focuses specifically on these areas that have been the subjects of intensive investigation recently. Specific focus is provided on the issue of an infective trigger and highlights popular candidates. It is concluded that microbes are a likely trigger (but not as an infection) in a genetically predisposed individual and that this initial event culminates in the sarcoidosis granulomatous response.

An African male with cough, haemoptysis, weight loss and hypercalcaemia: TB or not TB?

A 60-yr-old Sudanese male was referred to the University Hospital, Riyadh, Saudi Arabia, with the chief complaints of chronic cough productive of scanty sputum and occasional haemoptysis, anorexia and weight loss for 9 months. The patient was extensively investigated in other hospitals and was treated as a pulmonary tuberculosis (TB) patient on the basis of lymphocytic pleural fluid cytology and the finding of granuloma on pleural biopsy. He continued to get worse, despite receiving four anti-TB drugs for the previous 4 months. The patient's course was complicated by hypercalcaemia, which failed to respond to steroids and saline diuresis and required calcitonin. He also developed right-sided pneumothorax, which required prolonged thoracostomy drainage. He was a nonsmoker and worked as a painter. On physical examination, the patient was cachectic, depressed and had finger clubbing. Furthermore, he had findings consistent with right pleural effusion. A summary of investigations is shown in table 1⇓. An initial chest radiograph is shown in figure 1⇓. Selected images of computed chest tomography (CT) are shown in figure 2⇓. In addition, the patient underwent a CT-guided lung biopsy, which is shown in figure 3⇓. Fig. 1.— Chest radiograph. Fig. 2.— Selected cuts of computed tomographic images of the chest. Fig. 3.— Lung biopsy (haematoxylin and eosin stained; internal scale bar=250 µm). View this table: Table 1— Relevant investigations BEFORE TURNING THE PAGE, INTERPRET THE RADIOGRAPHS AND HISTOLOGICAL …

Intérêt de la biopsie hépatique en médecine interne. À propos d'une série de 300 ponctions-biopsies

Intérêt de la biopsie hépatique en médecine interne. À propos d'une série de 300 ponctions-biopsies

Liver disease in brucellosis. A clinical and pathological study of 40 cases.

Summary Among 82 patients with brucellosis, physical and/or biochemical abnormalities suggesting liver disease were found in 40 cases. A soft and tender liver enlargement was present in 65% of them, and the spleen was palpable in 52%. The most frequent biochemical abnormalities were a slight increase of serum transaminases and alkaline phosphatase. Liver biopsy showed a non-specific reactive hepatitis in 90% of patients, and minimal changes in the remaining 10%. Non-caseating granulomas were present in 28 patients, always associated with reactive hepatitis. No differences were found when comparing clinical and biochemical features in patients with and without granulomas. However, statistically significant differences were obtained when the duration of the process was related to the type of alteration found in the liver biopsy; the finding of granulomas was practically constant when the duration of the disease before liver biopsy was under 100 days, but was infrequent after this time.