Granulomatous Research Articles

Leçons sur les réactions aux produits de comblement à visée esthétique

Any product injected to fill wrinkles can behave like a foreign body and cause unsightly granulomatous reactions. The subject is constantly evolving, subject to the vagaries of the market. Hyaluronic acid is the most injected product because it is resorbable and probably the least "toxic". In the event of sarcoidosis or an immune disorder, and in the event of vaccination against Covid, granulomas can develop even after very old injections.

Differential Diagnosis of Tuberculosis and Sarcoidosis by Immunological Features Using Machine Learning.

Despite the achievements of modern medicine, tuberculosis remains one of the leading causes of mortality globally. The difficulties in differential diagnosis have particular relevance in the case of suspicion of tuberculosis with other granulomatous diseases. The most similar clinical and radiologic changes are sarcoidosis. The aim of this study is to apply mathematical modeling to determine diagnostically significant immunological parameters and an algorithm for the differential diagnosis of tuberculosis and sarcoidosis. Materials and methods: The serum samples of patients with sarcoidosis (SD) (n = 29), patients with pulmonary tuberculosis (TB) (n = 32) and the control group (n = 31) (healthy subjects) collected from 2017 to 2022 (the average age 43.4 ± 5.3 years) were examined. Circulating 'polarized' T-helper cell subsets were analyzed by multicolor flow cytometry. A symbolic regression method was used to find general mathematical relations between cell concentrations and diagnosis. The parameters of the selected model were finally fitted through multi-objective optimization applied to two conflicting indices: sensitivity to sarcoidosis and sensitivity to tuberculosis. Results: The difference in Bm2 and CD5-CD27- concentrations was found to be more significant for the differential diagnosis of sarcoidosis and tuberculosis than any individual concentrations: the combined feature Bm2 - [CD5-CD27-] differentiates sarcoidosis and tuberculosis with p < 0.00001 and AUC = 0.823. An algorithm for differential diagnosis was developed. It is based on the linear model with two variables: the first variable is the difference Bm2 - [CD5-CD27-] mentioned above, and the second is the naïve-Tregs concentration. The algorithm uses the model twice and returns "dubious" in 26.7% of cases for patients with sarcoidosis and in 16.1% of cases for patients with tuberculosis. For the remaining patients with one of these two diagnoses, its sensitivity to sarcoidosis is 90.5%, and its sensitivity to tuberculosis is 88.5%. Conclusions: A simple algorithm was developed that can distinguish, by certain immunological features, the cases in which sarcoidosis is likely to be present instead of tuberculosis. Such cases may be further investigated to rule out tuberculosis conclusively. The mathematical model underlying the algorithm is based on the analysis of "naive" T-regulatory cells and "naive" B-cells. This may be a promising approach for differential diagnosis between pulmonary sarcoidosis and pulmonary tuberculosis. The findings may be useful in the absence of clear differential diagnostic criteria between pulmonary tuberculosis and sarcoidosis.

Efficacy of combined doxycycline and intense pulsed light therapy for the management of intractable recurrent chalazion.

Management of chalazion, characterized by noninfectious chronic granulomatous inflammation of the meibomian glands (MGs), remains challenging in ophthalmic practice, particularly because of its propensity for recurrence even after surgical intervention. This study aimed to evaluate the combined efficacy of doxycycline and intense pulsed light (IPL) therapy for treating intractable recurrent chalazion, focusing on reducing recurrence rates and improving MG status. This retrospective study included patients with intractable recurrent chalazion refractory to conventional treatments including surgical intervention and antibiotics. All patients were treated with a combination of doxycycline and IPL therapy. Clinical assessments included best-corrected visual activity, intraocular pressure, and MG evaluations using slit-lamp biomicroscopy and Keratograph 5 M topography. The study included 12 patients (5 male and 7 female) with an average age of 36.3 years. Treatment outcomes were categorized as 'success' (83.3%), 'stationary' (8.3%), and 'failure' (8.3%). Significant improvements were noted in the MG expression scores (p = 0.038), MG quality scores (p = 0.045), and lid margin telangiectasia scores (p = 0.002). In addition, significant improvement in meiboscores was observed (p = 0.002). The combination of doxycycline and IPL therapy demonstrated promising efficacy in treating intractable recurrent chalazion, with significant improvements in MG function and reduced recurrence rates. This treatment approach offers a viable alternative for patients with recurrent chalazions, particularly for those who are unresponsive to conventional treatments.

Poncet rheumatism secondary to ceco-appendicular tuberculosis in systemic lupus erythematosus

Background. Poncet’s rheumatism (RP) is an aseptic reactive arthritis secondary to active tuberculosis. Systemic lupus erythematosus (SLE) and tuberculosis are intricately related with an increase in the risk of tuberculosis in SLE. We present an original case of Poncet’s disease secondary to appendicular tuberculosis in patient with lupus disease. Case report. A 36-year-old female was followed in internal medicine for systemic lupus. In September 2023, she suffered from digestive complaints and polyarthritis. Infectious investigation and microbiologic study of joint fluid was negative. She had tenderness on pressure on the right iliac fossa. The computed tomography (CT) found an appendicular mucocele. She underwent laparotomy with right colectomy. Macroscopic aspect revealed tumorous lesion suggestive for malignancy. Histological study concluded to granulomatous inflammation with epithelioid and gigantocellular granulomas with anhist necrosis. Ceco-appendicular tuberculosis was retained. The patient received the anti-tuberculosis therapy with good progress. Conclusions. Early recognition of atypical location of tuberculosis leads to initiate appropriate treatment especially in immune compromise statue patient.

Neurosarcoidosis presenting as transient ischemic attacks: A Case Report

Sarcoidosis is a multi-organ granulomatous disease of unknown etiology characterized by the presence of non-caseating granulomas. It has the potential to affect multiple organs including the nervous system. Neurosarcoidosis is present in around 5% of sarcoidosis patients. The clinical manifestations of neurosarcoidosis are heterogeneous, as granulomas can affect the brain, spinal cord and peripheral nervous system, separately or in different combinations. We report a case of neurosarcoidosis with pulmonary involvement in a young female patient presented with multiple episodes of transient ischemic attacks (TIAs). She was treated with boluses of cyclophosphamide followed by azathioprine which led to marked clinical and radiological improvement.

Multibacillary Leprosy: Presentation of a Clinical Case

Leprosy is an infectious-contagious, chronic granulomatous disease, with a long incubation period (2-21 years), caused by the Mycobacterium leprae complex. It has tropism for skin, mucous membranes of the upper respiratory tract, and peripheral nerves.We present a clinical case of a 24-year-old patient, phototype VI, from the municipality of Huambo, Benfica neighborhood, with a history evolving for about 18 months, without actually making any consultation and with several empirical treatments.

Elevated serum angiotensin converting enzyme correlates with specific HLA-DRB1 alleles and extrapulmonary manifestations in sarcoidosis

BackgroundGenetics influence the clinical picture in sarcoidosis, a granulomatous heterogeneous disease often accompanied by elevated serum angiotensin converting enzyme (s-ACE). We aimed to investigate if certain HLA-DRB1 alleles correlate with the levels of s-ACE, known as a marker of the granuloma burden. MethodsMedical journals of patients with sarcoidosis from a Swedish clinical registry were retrospectively examined to extract the highest recorded s-ACE value and analysed in relation to patient characteristics including phenotype [Löfgren syndrome (LS)/ non-LS], chest X-ray staging according to Scadding, treatment with immunosuppressants, presence of extrapulmonary manifestations (EPM), HLA-DRB1 alleles and prognosis (resolving vs. non-resolving disease within 2 years). Data were analysed with Fisher's exact test and Bonferroni correction was applied for HLA analyses. ResultsOf 1204 patients included, 40% had s-ACE levels above reference value. In comparison with patients with normal s-ACE, those with elevated levels were more often classified into non-LS (78% vs 59%, p < 0.001), and Scadding stage II (50% vs 38%, p < 0.001) but less often Scadding stage I (33% vs 46%, p < 0.001) and had more often EPM (45% vs 23%, p < 0.001). The patients with HLA-DRB1×04 had more often elevated s-ACE (p < 0.01) while those with HLA-DRB1×03 commonly had normal levels (p < 0.001). ConclusionsIn this retrospective study, HLA alleles associated with s-ACE levels in sarcoidosis patients, which in turn correlated with occurrence of EPM. These findings shed some new light on possible mechanisms behind differences in s-ACE levels.

Temporal artery biopsy in giant cell arteritis: clinical perspectives and histological patterns.

Although its role has been debated, temporal artery biopsy (TAB) remains the gold standard for the diagnosis of cranial giant cell arteritis (GCA). The specificity of TAB is excellent and the sensitivity, albeit lower, is comparable with other diagnostic modalities used for the diagnosis of GCA. This outpatient procedure has a low rate of complications and is well integrated in the majority of healthcare systems. The length of the specimen, the number of the examined sections and the prolonged use of glucocorticoids before the biopsy may affect the outcome of the TAB as diagnostic tool. The typical histological findings in GCA are often characterized by granulomatous inflammation with infiltration of mononuclear cells with or without the presence of giant cell, varying degrees of external and internal elastic lamina damage and intimal thickening. Overlooking signs of inflammation in the adventitia and in connective tissue surrounding the temporal artery may lead to false negative results. The distinction between healed arteritis and age-related atherosclerosis may be challenging.

WASOG 2023 conference highlights.

The World Association of Sarcoidosis and Other Granulomatous Diseases (WASOG) 2023 conference held in Stockholm, Sweden, focused on disseminating the science and updating the interstitial lung diseases (ILDs) community with the latest science and concepts in precision medicine. This article summarizes the first four sessions of the conference that focused on disease and phenotype characterization, genetics in population cohorts, uses of biobanks and big data, epidemiology in diverse racial and ethnic groups, and data-driven applications that can be applicable to move the ILD field toward precision medicine.

Chronic granulomatous intestinal disease: case report

Chronic intestinal granulomatous disease is a disorder that directly compromises the entire immune system. The estimated incidence is one in a million inhabitants. Among the associated risk factors, the presence of chronic and recurrent infections stands out. In the present case, it is a 39-year-old female patient with a history of intestinal obstruction and endometriosis, who presents abdominal pain in the left abdomen and recurrent abdominal pain without an identifiable cause. Laboratory tests revealed leukocytosis and mild neutrophilia. The tomography showed intestinal dilation at the jejunoileal level without transition zones, and the serological tests were negative. Exploratory laparoscopy was performed and the presence of tumor implants was found in the omentum, extending to the abdominal, uterine, intestinal, and peritoneal regions, as well as sallow fluid at the abdominal level. Tumor markers are normal. Histopathology details fungal colonization with eosinophilic necrosis and presence of granulomas, negative immunohistochemistry for Aspergillus and negative Lowestein-jensen culture. Antifungal and antituberculous treatment was started, with a decrease in symptoms and improvement in the clinical picture.

Erythematous plaques and cervical lymphadenopathy

We present the case of an 89-year-old patient who presented to the skin cancer screening clinic with a 2-year history of two tender erythematous lesions on the left side of the neck with underlying palpable lymphadenopathy. An incisional biopsy showed multifocal granulomatous inflammation, and an interferon-γ release assay was positive.

Takayasu Arteritis Presented with Unilateral Vision Loss : A Case Report

Background: Takayasu Arteritis (TA) is a rare chronic granulomatous inflammation of the aorta or its branches and is prevalent all around the world. It causes stenosis of large arteries and ischaemic damage to target organs. There is usually a delay in recognising TA because of the rarity and unfamiliarity with the disease, unspecific early symptoms and lack of diagnostic equipment for early diagnosis. The purpose of the study to reminding readers of this issue and emphasize the necessity for further research on how to deal with in the best way. Case Report: We report a case of 30 years old male presented on 22nd August 2023 at Institute of Applied Health Sciences (IAHS) Chattogram with gradual loss of vision of left eye over a month accompanied by headache and later on diagnosed as a case of Takayasu’s Arteritis. Conclusion: Visual loss is the most common ocular symptom in Takayasu arteritis. Since a variety of causes may result in reduced vision in Takayasu arteritis. A careful history is very important to ascertain the cause of visual loss in Takayasu arteritis patients to reduce unnessary investigations and referrals. IAHS Medical Journal Volume 6(2) December 2023; 90-92

An Unusual Case of Blastomycosis Presenting as "Punched Out" Ulcerations

Background: Cutaneous blastomycosis commonly presents as verrucous, hyperkeratotic nodules or plaques. Less commonly, it presents as ulcerations with accompanying scale crusting or verrucous features. Case Report: A healthy 34-year-old incarcerated male with a history of drug abuse presented with several, well-defined (punched out), deep ulcerating cutaneous lesions with undermined borders. There was no crusting, or verrucous features. The clinical differential diagnoses included pyoderma, vasculitic ulcers, and pyoderma gangrenosum. The histopathology from a gluteal ulceration demonstrated pseudoepitheliomatous hyperplasia with acute, chronic, and granulomatous inflammation. PAS stain of the specimen exhibited thick-walled yeast demonstrating broad-based budding typical of blastomycosis and tissue cultures grew Blastomyces dermatitidis after one month. Conclusion: Ulceration without verrucous features can portend cutaneous blastomycosis. Diagnosis using fungal culture of the wound or tissue takes weeks to result. A prompt biopsy and histopathologic examination or broad-range PCR testing of a wound swab, tissue or urine specimen can lead to a prompt diagnosis.

Foreign body pulmonary vessel embolism and granulomatosis in intravenous drug abuse: An autopsy study.

The abuse of illicit drugs causes a myriad of systemic complications. Intravenous (IV) injection of such drugs poses various additional threats, primarily due to the use of excipient materials in them. Pulmonary artery embolism with foreign material and granulomatosis may be encountered in the lungs on histopathological examination in such cases. In this study, we aimed to analyze the histopathological findings in lungs in postmortem specimens with suspected IV drug abuse. This was a retrospective study of 5 years in which 15 cases of known or suspected history of drug abuse were assessed. The clinical details were compiled, and the hematoxylin and eosin (H and E)-stained microscopic slides were retrieved from the archives for reviewing the histopathological features in lungs submitted for postmortem analysis. All the cases were male, aged 21 to 36 years (median: 27 years). Gross examination revealed edematous lungs in four cases (26.6%). On microscopic examination of the lungs, all the cases (100%) showed the presence of basophilic irregular structures to rod-like pale crystalline refractile material, which was accompanied by a granulomatous reaction in the lumen of the pulmonary arteries. Four of these cases (26.6%) showed birefringence on polarizing microscopy. The use of illicit drugs is becoming widespread, especially among young individuals. IV drug abuse increases the rate of morbidity and mortality by affecting primarily the pulmonary vasculature, particularly pulmonary arteries. An acquaintance with the various patterns of pulmonary involvement in IV drug abuse is essential to arrive at an accurate pathological diagnosis and provide a possible cause of death in such cases.

Psychodermatological disorders as an interdisciplinary problem: diagnostic features based on the example of our own clinical observations

At the present stage, there is an increase in the prevalence of psychodermatological disorders, while this pathology has a pronounced negative impact on the quality of life of patients. The observed bidirectional relationship between psychological well-being and skin health is being actively studied. Skin lesions can be caused by primary psychiatric diseases or provoke their appearance. The clinical symptoms of autodestructive dermatoses can imitate parasitic infections and pyoderma, skin tuberculosis, granulomatous and allergic diseases, vasculitis, and lymphomas. In this regard, patients initially seek medical help from doctors of various profiles, which, in the absence of proper awareness of specialists, often lengthens the diagnostic search, leads to progression of the disease and a deterioration in the quality of life of patients. Increasing awareness of psychodermatological comorbidity among primary care physicians is important to reduce the time required to make a correct diagnosis and timely referral of patients to a psychiatrist. The article provides an analysis of our own clinical observations of patients with psychodermatological pathology, for whom more than a year passed from the initial visit to the doctor to verification of the diagnosis. Late diagnosis was accompanied by an increase in symptoms with the formation of pronounced destructive skin lesions. The diagnostic search was also hampered by the significant similarity of the clinical picture with other diseases that have skin symptoms. When analyzing the presented clinical cases, attention is focused on the need for a thorough differential diagnostic search, an analysis of the characteristics of the anamnesis and characteristic symptoms of the skin process in psychodermatological pathology is provided. The importance of an integrated approach to patient management with the participation of specialists from both psychiatric and dermatological profiles was noted.

Natural Bacterial Co-Infection in Farmed European Sea Bass Intended for Experimental Research in Sicily, Southern Italy: Pathological Findings

In mariculture facilities, bacterial infections pose significant production challenges, with potentially catastrophic impacts on fish species. Bacterial co-infections are a widespread phenomenon in the natural marine environment, although their impact on aquatic organisms remains poorly investigated. This study aimed to detail the pathological findings associated with a natural bacterial co-infection caused by three different pathogens, namely Photobacterium damselae subsp. piscicida, Tenacibaculum maritimum and Vibrio sp., as the cause of mass mortality in European sea bass. The fish had been reared in open-net cages in Sicily and later transferred for experimental research purposes to a user establishment after immunization with an inactivated vaccine. Macroscopic, cytological and histopathological examinations were performed on 109 animals, and bacterial species were identified by the 16S rRNA gene. Overall, ulcerative skin lesions, necrotizing myositis and tail rot with occasional tail loss were associated with tenacibaculosis and vibriosis, while P. damselae subsp. piscicida mainly caused granulomatous inflammation in the spleen and head kidney. Finally, an injection site reaction due to the oil-adjuvanted vaccine administered intraperitoneally was observed in the abdominal fat. Understanding the impact of bacterial pathogens is essential to manage the health and welfare of farmed fish, and the importance of a good health monitoring program cannot be overstated to avoid outbreaks and the possible emergence of new pathogens due to the intensification of the production systems, antibiotic resistance and climate changes. The study would also highlight the importance of the quarantine period when animals supplied for research come from aquaculture farms and how the main goal in the near future should be to better define the procedures to provide completely pathogen-free animals.

Mycobacterium paratuberculosis: A HERV Turn-On for Autoimmunity, Neurodegeneration, and Cancer?

Human endogenous retroviruses (HERVs) are remnants of ancient retroviral infections that, over millions of years, became integrated into the human genome. While normally inactive, environmental stimuli such as infections have contributed to the transcriptional reactivation of HERV-promoting pathological conditions, including the development of autoimmunity, neurodegenerative disease and cancer. What infections trigger HERV activation? Mycobacterium avium subspecies paratuberculosis (MAP) is a pluripotent driver of human disease. Aside from granulomatous diseases, Crohn's disease, sarcoidosis and Blau syndrome, MAP is associated with autoimmune disease: type one diabetes (T1D), multiple sclerosis (MS), rheumatoid arthritis (RA) and autoimmune thyroiditis. MAP is also associated with Alzheimer's disease (AD) and Parkinson's disease (PD). Autoimmune diabetes, MS and RA are the diseases with the strongest MAP/HERV association. There are several other diseases associated with HERV activation, including diseases whose epidemiology and/or pathology would prompt speculation for a causal role of MAP. These include non-solar uveal melanoma, colon cancer, glioblastoma and amyotrophic lateral sclerosis (ALS). This article further points to MAP infection as a contributor to autoimmunity, neurodegenerative disease and cancer via the un-silencing of HERV. We examine the link between the ever-increasing number of MAP-associated diseases and the MAP/HERV intersection with these diverse medical conditions, and propose treatment opportunities based upon this association.

A rare case of non-specific chronic supraglottic laryngitis in a young female: a comprehensive case report

Chronic non-specific supraglottic laryngitis is a rare clinical condition characterized by chronic inflammation of the supraglottic structures without any evidence of infection, granulomatous disease, autoimmunity or malignancy. This is a case report of a young female presenting with a long-standing history of voice change and dysphagia. Laryngoscopy revealed diffuse inflammation of the supraglottis. Thorough workup, including radiological investigations, blood tests, bronchoscopy and biopsy, ruled out any known etiology. She was thus diagnosed with non-specific chronic supraglottic laryngitis. The patient responded well to the long-term use of oral corticosteroids and immunosuppressant drugs. This study summarizes the clinical presentation, comprehensive investigations and management of chronic, non-specific supraglottic laryngitis.

High symptom burden in female X-linked chronic granulomatous disease carriers

High symptom burden in female X-linked chronic granulomatous disease carriers

A serum B-lymphocyte activation signature is a key distinguishing feature of the immune response in sarcoidosis compared to tuberculosis

Sarcoidosis and tuberculosis (TB) are two granulomatous diseases that often share overlapping clinical features, including uveitis. We measured 368 inflammation-related proteins in serum in both diseases, with and without uveitis from two distinct geographically separated cohorts: sarcoidosis from the Netherlands and TB from Indonesia. A total of 192 and 102 differentially expressed proteins were found in sarcoidosis and active pulmonary TB compared to their geographical healthy controls, respectively. While substantial overlap exists in the immune-related pathways involved in both diseases, activation of B cell activating factor (BAFF) signaling and proliferation-inducing ligand (APRIL) mediated signaling pathways was specifically associated with sarcoidosis. We identified a B-lymphocyte activation signature consisting of BAFF, TNFRSF13B/TACI, TRAF2, IKBKG, MAPK9, NFATC1, and DAPP1 that was associated with sarcoidosis, regardless of the presence of uveitis. In summary, a difference in B-lymphocyte activation is a key discriminative immunological feature between sarcoidosis/ocular sarcoidosis (OS) and TB/ocular TB (OTB).