Granulomatous Research Articles

Absorbable Haemostatic Artefacts as a Diagnostic Challenge in Postoperative Follow-Up After Oncological Resection in Head and Neck Tumours: Systematic Review of Current Literature and Two Case Reports

Objectives: This article aims to define the clinical, radiological, and pathological characteristics of non-resorbed oxidised cellulose-induced pseudotumours to raise awareness among surgeons and radiologists, to prevent misdiagnosis, and avoid unnecessary invasive procedures and delays in adjuvant oncological treatments. Methods: A systematic review of oxidised resorbable cellulose (ORC)-induced pseudotumours of the head and neck was conducted following PRISMA 2020 guidelines. Articles were retrieved from PubMed, Scopus, Cochrane, and Web of Science. Two ORC-induced pseudotumour cases from the Maxillofacial Surgery Department of Verona are also presented. Results: In most cases, pseudotumours were monitored using ultrasound. Further investigations included CT, MRI, PET-CT, and scintigraphy. Ultrasound images showed stable, elongated, and non-homogeneous masses. In CT scans, pseudotumours showed a liquefied core, and none or only peripheral enhancement. In MRI, pseudotumours presented none or only peripheral enhancement, and a heterogeneous pattern in T2-weighted images. 18-FDG PET scans demonstrated an FDG-avid mass (SUV 7.5). Scintigraphy was inconclusive. Cytology indicated a granulomatous reaction without neoplastic cells. Where surgical excision was performed, a granulomatous reaction with the presence of oxidised cellulose fibres was confirmed. Conclusions: Surgeons should consider artifacts from retained oxidised absorbable haemostatic material when suspecting tumour recurrence or metastasis on postoperative imaging, especially if certain features are present. Fine-needle aspiration cytology (FNAC) is a useful diagnostic tool, but surgical excision may be needed if FNAC is inconclusive or impractical. Collaboration between surgeons and radiologists is essential to avoid misdiagnosis and delays in treatment. Documenting the use and location of haemostatic material in operative reports would aid future understanding of these phenomena.

Repurposing Historic Drugs for Neutrophil-Mediated Inflammation in Skin Disorders

Neutrophil-mediated inflammation is a key feature of immune-mediated chronic skin disorders, but the mechanistic understanding of neutrophil involvement in these conditions remains incomplete. Dapsone, colchicine, and tetracyclines are established drugs within the dermatologist’s therapeutic armamentarium that are credited with potent anti-neutrophilic effects. Anti-neutrophilic drugs have established themselves as versatile agents in the treatment of a wide range of dermatological conditions. Some of these agents are approved for the management of specific dermatologic conditions, but most of their current uses are off-label and only supported by isolated reports or case series. Their anti-inflammatory and immunomodulatory properties make them particularly valuable in managing auto-immune bullous diseases, neutrophilic dermatoses, eosinophilic dermatoses, interface dermatitis, and granulomatous diseases that are the focus of this review. By inhibiting inflammatory pathways, reducing cytokine production, and modulating immune responses, they contribute significantly to the treatment and management of these complex skin conditions. Their use continues to evolve as our understanding of these diseases deepens, and they remain a cornerstone of dermatological therapy.

Case report: Cerebral syphilitic gumma: a case retrospective report of eight cases

BackgroundCerebral syphilitic gumma (CSG), a rare manifestation of neurosyphilis, presents characteristics akin to intracranial tumors, often leading to clinical misdiagnosis.ObjectiveThis study aimed to summarize the clinical experience in diagnosing and treating CSG.Materials and methodsThe present study conducted a retrospective analysis of clinical data, encompassing the baseline characteristics, clinical presentation, diagnosis, treatment, and prognosis of eight patients with CSG who were treated and diagnosed by our institution.ResultsThe median age at the initial diagnosis was 57.5 years, comprising six males and two females. The predominant clinical manifestations included headaches in eight cases, motor and sensory disorders in four cases, epileptic seizures in one case, and dysarthria in one patient. The serum Treponema pallidum haemagglutination assay (TPHA) and toluidine red unheated serum test (TRUST) yielded positive in all eight patients. The contrast-enhanced magnetic resonance imaging (MRI) revealed irregular ring-shaped enhancement of lesions in three patients, while nodular enhancement of lesions was observed in five patients. In terms of treatment, seven patients underwent surgery. The postoperative pathological tissue showed granulomatous inflammation. Six patients exhibited an elevated protein concentration in their cerebrospinal fluid (CSF), while two patients demonstrated a reduced CSF glucose level. Additionally, positive results were obtained for both CSF TPHA and TRUST in all eight patients. The clinical diagnosis of CSG was confirmed in eight patients who exhibited notable clinical improvement following penicillin treatment. Subsequent reevaluation of the imaging findings demonstrated complete resolution of the enhanced lesions.ConclusionIn clinical practice, CSG should be considered for patients with intracranial lesions and positive serum syphilis antibodies. Timely and accurate diagnosis enables patients with CSG to achieve a more favorable prognosis through active anti-syphilis treatment.

Demographic, clinical and laboratory characteristics of extrapulmonary tuberculosis: Eight-year results of a multicenter retrospective study in Turkey.

Extrapulmonary tuberculosis (EPTB) is an important public health problem due to its diverse clinical presentations, diagnostic complexities, and significant impact on patient outcomes and public health. Our study aimed to understand the sociodemographic, clinical, and laboratory characteristics as well as diagnostic and treatment modalities of adult patients with EPTB. This is a multicentric retrospective study that covers patients with EPTB cases followed up from January 2015 to December 2022 among tuberculosis (TB) dispensaries and Infectious Diseases and Clinical Microbiology clinics of 15 hospitals located in various regions of Turkey. The study included 64.6% women with a mean age of 44 years and a mortality rate of 3.5% within 1 year of diagnosis. Initial constitutional symptoms were predominantly fatigue (57%) and anorexia (53.7%). The most commonly affected sites were the lymph nodes (49.1%) and pleura (9.7%). The lumbar region was particularly involved in cases with spinal TB. Diagnostic findings included acid-fast bacilli positivity in 27.5% of cases, tuberculosis polymerase chain reaction positivity in 41%, elevated adenosine deaminase levels in 91.2% (especially in pleural and peritoneal fluids), and mycobacterial culture positivity in 40.9%. Pathology slides showed granulomatous inflammation in 97.7%. Increased C-reactive protein (CRP) levels correlated with the number of organs affected. Anti-TB treatment-related hepatotoxicity was detected in 8.9% of patients. In this study, it is important to note that the lumbar region is predominantly affected with involvement in spinal region. CRP level was consistent with the number of organ involvements and was one of the most critical results of this study.

Susceptibility of Tambaqui (Colossoma macropomum) to Nile Tilapia-Derived Streptococcus agalactiae and Francisella orientalis

Nile tilapia (Oreochromis niloticus) and tambaqui (Colossoma macropomum) are the two most produced freshwater fishes in Brazil. This study investigated the potential pathogenicity of Streptococcus agalactiae and Francisella orientalis, previously isolated from diseased Nile tilapia, to tambaqui. Experimental infection trials were conducted in juvenile tambaqui at a dose of approximately 107 CFU fish−1, assessing clinical signs, mortality, bacterial recovery, and histopathological changes. Results demonstrated that S. agalactiae exhibited high pathogenicity to tambaqui, causing rapid disease progression, high mortality (83.33%) within 48 h post-infection, and severe lesions in multiple organs, under the experimental conditions. In contrast, F. orientalis infection did not result in mortality or clinical signs, despite bacterial recovery and granulomatous inflammation observed in the tissues. This study highlights the need to consider the potential impact of these pathogens in tambaqui farming.

The Spectrum of Cutaneous Granulomatous Inflammation and Detection of Rubella Virus in Skin Biopsies of Patients With Common Variable Immune Deficiency.

There is a known association between common variable immunodeficiency (CVID) and granulomas in multiple organ systems, including the skin, lung, liver, and spleen. Rubella virus has also been detected within cutaneous granulomas in both immunocompetent and immunocompromised hosts. We present a retrospective case series of patients with CVID and granulomatous skin disease and describe the spectrum of clinical and histopathologic features, including the status of rubella virus in the cutaneous granulomas. We retrospectively reviewed the clinical and histopathological characteristics of patients diagnosed with CVID at our institution, with cutaneous findings and skin biopsies available for review between 1990 and 2023, demonstrating granulomatous inflammation. Eight patients met the inclusion criteria. The most common histopathologic pattern was palisaded granulomatous inflammation, seen in five of eight cases. Three cases showed strictly sarcoidal granulomas. Background inflammation was peri-granulomatous (8/8) and the predominant background inflammatory cell type was lymphocytic (6/8). Rubella virus testing was performed for seven of eight cases and found to be positive in one case. Cutaneous granulomatous disease in CVID can present with a spectrum of clinical morphologies, granulomatous patterns, and variable rubella virus persistence. Dermatopathologists should be aware of the spectrum of findings when considering cutaneous CVID-related granulomatous disease in the differential diagnosis.

Granulomatous Reactions From Microneedling: A Systematic Review of the Literature.

Microneedling is a common minimally invasive procedure for skin rejuvenation. Granulomatous reactions after microneedling have been rarely reported. To systematically review the literature for granulomatous reactions from microneedling. A systematic review of the Medline, Scopus, Google Scholar, and Cochrane databases was performed for articles describing granulomatous reactions to microneedling. Thirteen studies were selected for inclusion after full-text review, which described 15 patients (26-74 years old) with non-necrotizing granulomatous inflammation postmicroneedling. Motorized microneedling pen use and topical Vitamin C application were implicated in a majority of cases. Although delayed-type hypersensitivity was commonly proposed as the underlying etiology, patch testing or further workup was rarely performed. Improvement or clearance occurred inconsistently with myriad treatment options, including topical steroids, oral antibiotics, and systemic anti-inflammatory medications. Granulomatous reactions to microneedling and microneedling-mediated transepidermal drug delivery can rarely occur and may be treatment-resistant.

Alveolar Echinococcosis - Diagnostic challenges of a parasitic disease on the rise in Europe - a case report.

A 45-year-old male presented with jaundice, abdominal discomfort, and weight loss. Abdominal ultrasound revealed intrahepatic cholestasis and cholelithiasis indicative of Caroli-syndrome. Subsequent magnetic resonance imaging demonstrated a corresponding 5 × 4 cm polycyclic, calcified mass and a distant 12 mm subhilar stenosis of the common bile duct resembling cholangiocarcinoma. Calcifications seemed unusual and brought up differential diagnosis of echinococcosis. Serology revealed an echinococcus antibody-titer of 33 U (cut-off > 11.5 U). However, the clinical presentation with jaundice, weight loss, and a distant subhilar stenosis of the common bile duct without association to the intrahepatic process led to underestimation of the positive antibody-titer. Thus, the patient underwent right hemihepatectomy for potential cholangiocarcinoma. Dense infiltrative small cysts interspersed the resected right lobe of the liver. Histopathology revealed a granulomatous inflammation surrounding typical cuticulas, confirming hepatobiliary alveolar echinococcosis. Alveolar echinococcosis is considered as one of the neglected diseases by the World Health Organization, although incidence is rising worldwide and specifically in Germany. Our case illustrates hurdles in diagnosing alveolar echinococcosis and underlines the importance to be aware of classical and rare clinical manifestations.

Prevalence and Incidence of Uveitis in Korean Patients with Sarcoidosis: A Population-Based Study

ABSTRACT Purpose Sarcoidosis is a systemic granulomatous inflammatory disease with varying clinical presentations, including sarcoid uveitis, which is the most prevalent ocular manifestation of sarcoidosis and differs by region and ethnicity. This study aims to determine the incidence and prevalence of sarcoidosis-related uveitis in South Korea, providing essential epidemiological data. Methods This nationwide, population-based retrospective study used the Korean Health Insurance Review and Assessment database from 2010 to 2019. It included all individuals diagnosed with sarcoidosis (ICD-10 code D86) and focused on those with newly developed uveitis. We assessed annual incidence, prevalence, gender-specific trends, age at diagnosis, treatment patterns, and recurrence. Cases were categorized as single episode or recurrent/chronic based on treatment duration and interval before recurrence. Results Among 9,485 patients with sarcoidosis, 2,730 (28.8%) had sarcoidosis-related uveitis, with 2,413 (88.4%) being recurrent/chronic. Anterior uveitis was the most common presentation (78.0%), with posterior segment involvement in 22.0% of cases. The peak age of onset was 50–59 years for both genders. The incidence rate was 0.33 and 0.64 per 100,000 for men and women, respectively. The prevalence was 0.18 and 0.35 per 100,000 for men and women, respectively. Among sarcoidosis patients, 32.9% with uveitis used three or more combinations of systemic steroids and immunosuppressants, compared to 11.1% without uveitis. Conclusion The high prevalence of sarcoid uveitis in sarcoidosis patients necessitates regular ophthalmic examinations. Our findings highlight the need for comprehensive eye care in managing sarcoidosis and suggest that uveitis may increase disease severity, warranting tailored treatment and enhanced monitoring protocols in Korea.

Hypercalcemia due to Elevated 1,25 dihydroxyvitamin D in Tophaceous Gout - Case Report and Literature Review

Granulomatous diseases can cause hypercalcemia due to elevated 1,25-dihydroxyvitamin D through the production of 1-α hydroxylase by macrophages in the granulomas. Tophaceous gout is not considered to cause this picture. However, there are a few case reports of this occurrence in tophaceous gout, as well as the description of intense 1-α hydroxylase activity in granulomas of tophi in gout patients. We review this literature, and we report a well-documented case of hypercalcemia with elevated serum 1,25 dihydroxyvitamin D in a patient with extensive tophaceous gout and tophi loaded with granulomas. An extensive work-up ruled out other causes of hypercalcemia and granulomatous diseases. Prednisone corrected the chemical abnormalities. Diffuse tophaceous gout should be considered a rare cause of hypercalcemia due to excessive 1,25 dihydroxy vitamin D.

Investigating the Role of C-Reactive Protein/Albumin Ratio in the Preliminary Diagnosis of Patients With Unexplained Neck Lymphadenopathy.

Purpose: Lymphadenopathies in the neck are associated with several etiological factors, such as inflammation, infection, and tumors. We diagnose some of these lymphadenopathies using serologic tests, while others are diagnosed using biopsies. The C-reactive protein/albumin ratio (CAR) has recently emerged as a crucial inflammatory marker in cardiovascular diseases and various types of cancer. Our aim in this study was to investigate the role of the CAR in the preliminary diagnosis of patients with unexplained neck lymphadenopathy. Methods: Between 2013 and 2020, 223 patients presented to our clinic with neck lymphadenopathy. Among these patients, whose cause of lymphadenopathy was not identified, 74 patients (8 children, 66 adults) who underwent neck lymphadenopathy excision were included in the study. Patients were divided into 4 groups according to pathology results: (1) patients with reactive lymphoid hyperplasia; (2) patients with granulomatous disease; (3) patients with lymphoma; and (4) patients with metastatic disease. C-reactive protein (CRP), albumin, and CAR values were compared. Results: When the CAR of the patients were compared, a significant difference was found between reactive lymphoid hyperplasia and lymphomas (P = .006). CRP values were significantly higher in lymphomas than in lymphoid hyperplasia (P = .007). When the albumin values of the patients were compared, it was found that the albumin value was significantly lower in patients with metastatic disease than in those with reactive lymphoid hyperplasia (P = .032). Patients with carcinoma metastases were more common in male patients than in other groups. Conclusion: The CAR is a parameter that can be used in the preliminary diagnosis of unexplained neck lymphadenopathy. The elevation should be evaluated in favor of malignancy. It can be used as an auxiliary parameter, particularly in the diagnosis between the preliminary diagnosis of reactive lymphoid hyperplasia and lymphoma.

Diagnostic Efficacy of Combined CT Guided Fine Needle Aspiration and Core Needle Biopsy Versus Either Technique Alone in Peripheral Lung Lesions

Background: Precise cytological and histological diagnosis is crucial in the era of targeted therapy for lung lesions. Both Fine Needle Aspiration Cytology (FNAC) and Core Needle Biopsy (CNB) are established diagnostic techniques, yet their individual and combined efficacy remains debated. Objective: To evaluate the diagnostic yield of combined CT-guided FNAC and CNB versus either technique alone in peripheral lung lesions. Methods: This prospective study enrolled 110 patients with undiagnosed peripheral lung lesions at the National Institute of Diseases of Chest and Hospital (NIDCH) during 2023. CT-guided FNAC was performed using a 22-gauge spinal needle, followed by CNB using an 18-gauge Trucut needle in the same setting. Six FNAC smears were prepared and stained with hematoxylin and eosin, while CNB specimens were processed as paraffin-embedded blocks. Results were classified into four categories: inadequate, negative, suspicious, and positive for malignancy. Results: The diagnostic yield of the combined approach was 99.1%, compared to 89.1% for FNAC alone and 98.2% for CNB alone. FNAC showed 85.1% sensitivity while CNB demonstrated 97.7% sensitivity. Both methods achieved 100% specificity and positive predictive value. The negative predictive value was 77.3% for FNAC versus 95.7% for CNB. Among malignant lesions (n=87), CNB provided definitive diagnosis in cases where FNAC showed suspicious findings (10 cases). For benign lesions (n=22), CNB showed superior diagnostic capability, particularly in granulomatous inflammation and chronic pneumonitis. Procedure-related complications were minimal (3.6%) with no major adverse events. Conclusion: Combined FNAC and CNB approach provides superior diagnostic yield compared to either technique alone. While CNB demonstrated higher individual diagnostic accuracy, the combined approach offered maximum diagnostic precision without significantly increasing complications. This strategy is particularly valuable for cases ...

Characterization and Comparative Genomic Analysis of vB_BceM_CEP1: A Novel Temperate Bacteriophage Infecting Burkholderia cepacia Complex.

The increasing prevalence of multidrug-resistant bacteria imminently threatens public health and jeopardizes nearly all aspects of modern medicine. The Burkholderia cepacia complex (Bcc) comprises Burkholderia cepacia and the related species of Gram-negative bacteria. Members of the Bcc group are opportunistic pathogens responsible for various chronic illnesses, including cystic fibrosis and chronic granulomatous disease. Phage therapy is emerging as a potential solution to combat the antimicrobial resistance crisis. In this study, a temperate phage vB_BceM_CEP1 was isolated from sewage and fully characterized. Transmission electron microscopy indicated that vB_BceM_CEP1 belongs to the family Peduoviridae. The isolated phage demonstrated enhanced environmental stability and antibiofilm potential. One-step growth analysis revealed a latent period of 30min and an average burst size of 139 plaque-forming units per cell. The genome of vB_BceM_CEP1 consists of 32,486bp with a GC content of 62.05%. A total of 40 open reading frames were annotated in the phage genome, and none of the predicted genes was annotated as tRNA. Notably, genes associated with antibiotic resistance, host virulence factors, and toxins were absent from the vB_BceM_CEP1 genome. Based on its unique phenotype and phylogeny, the isolated phage vB_BceM_CEP1 is classified as a new temperate phage with lytic activity. The findings of this study enhance our understanding of the diversity of Bcc phages.

ACE and chitotriosidase as possible predictive biomarkers for activity of sarcoidosis in correlation with PET/CT findings

Sarcoidosis is a granulomatous disease which can afflict virtually any tissue in human body, most commonly the mediastinal lymph nodes and lungs. Pathohistological confirmation is the gold standard in establishing a diagnosis; however, determining the activity of the disease requires multiple clinical, radiographic and laboratory procedures. PET/CT scan is considered the gold standard for determining the presence of active granuloma, but has several significant limitations (radioactive material, cost, overall access to device). ACE and chitotriosidase are biomarkers used for diagnosis of sarcoidosis, and could have a place in determining the activity of the disease, when compared with the results of PET/CT scan. We have compared the levels of ACE and chitotriosidase with the levels of SUVmax values in patients with sarcoidosis. SUVmax and chitotriosidase level were significantly correlated both at the baseline and after the follow-up period, regardless of gender, age, duration of disease and radiography stage, while SUVmax and ACE level were not. Chitotriosidase had also shown a significant predictive ability of the decrease of the activity of sarcoidosis represented as the decrease of SUVmax as the effect of therapy in comparison with ACE. In the absence of ideal biomarker for sarcoidosis (high sensitivity, specificity and stability), chitotriosidase can be used in determining the activity of disease, as it had shown a significant correlation to the gold standard- PET/CT scan.

Clinico-histopathological characteristics and management outcome of rare chronic infective granulomatous diseases: A case series study

Granulomatous skin diseases are common cutaneous dermatoses commonly encountered by practicing dermatologist. Granulomatous skin lesions are distinctive pattern of chronic inflammatory response of skin due to reaction against various organic and inorganic antigens. Granulomas are characterized by focal collection of epithelioid cells or histiocytes, admixed with variable number of leucocytes (especially mononuclear cells) and multinucleated giant cells. Granulomatous reaction is a type IV hypersensitivity reaction evoked by poorly soluble reactive substances. Incidence and prevalence of different types of granulomatous dermatitis depend on geographic location. Granulomatous skin lesions are common in the eastern parts of India. Many granulomatous skin lesions have identical histomorphology and conversely a single pathology can produce varied histological features. Some rare suppurative chronic granulomatous skin diseases include Botryomycosis, Actinomycosis, Rhinosporoidosis, Nocardiosis, and Cutaneous Tuberculosis. To describe clinical, histopathological features and treatment outcome of rare chronic infective granulomatous diseases. In this observational case series study, we retrospectively analysed six biopsy proven cases of rare chronic infective granulomatous diseases presented to our department (OPD) of Dermatology, Venereology and Leprosy (DVL) over a period of six months between June 2023 to November 2023 at Great Eastern Medical School and Hospital (GEMS), Srikakulam, Andhra Pradesh, India. The patient’s full clinical history, morphology of lesions, histopathological findings and treatment outcome were analysed. Along with histopathology, other necessary laboratory investigations were performed if required. A total of six patients were involved in the study, of whom four were males and two were females. The male to female ratio was 2:1, with a slight male majority. The most common age group was 31-40 years for both males and females. Painful raised lesion for long duration was the predominant complaint among those patients. Out of these six rare chronic granulomatous diseases, bacterial infections were common than fungal infection. All the cases showed clinical improvement after one month of starting treatment.: Most of the patients had a chronic history with improper treatment. So, it is imperative that the clinical diagnosis has to be confirmed with histopathology for the definitive diagnosis and appropriate treatment of these rare chronic infective granulomatous diseases. All these rare cases showed excellent progress after starting the right treatment.

Cases of Mycobacteriosis with Intrathoracic Lymph Node Involvement in Infants

The article describes two clinical cases of mycobacteriosis with intrathoracic lymph node involvement in infants. In both cases, the disease occurred in infancy and tuberculosis was initially diagnosed. The protracted disease required surgical treatment. The histological signs were consistent with granulomatous inflammation with caseous necrosis. The diagnosis was established by the detection of M. avium DNA in the surgical specimens. No underlying diseases accompanied by immunosuppression were found in the infants. Only anti-tuberculosis drugs were used for treatment. The disease was successfully cured; during follow-up examinations (one year after the treatment completion), there was no evidence of the disease relapse.

Abstract 4112639: A Rare Case of Atypical Sarcoidosis Presenting as an Intra-Atrial Septal Mass

Introduction: Sarcoidosis is a granulomatous disease that can affect multiple organ systems, including the heart. Cardiac Sarcoidosis (CS) is one of the most severe manifestations. It is characterized by a dysregulated T-cell driven immune response which generates non-necrotic inflammatory granulomas with myocardial infiltration. CS has a range of clinical syndromes: impaired conduction, arrhythmias, heart failure, and sudden cardiac death. We discuss a rare presentation of CS as an intra-atrial septal mass. Case Description: A 27-year-old Caucasian female with history of depression on citalopram presented with a one-month history of palpitations, fatigue, and dyspnea with exertion. An EKG demonstrated sinus rhythm with first-degree AV block. A cardiac monitor revealed intermittent 2-1 AV block and high degree AV block occurring mostly during sleep. An echocardiogram revealed normal biventricular function and morphology. Due to the concern for infiltrative cardiomyopathy, she underwent a cMRI which revealed a focal mass centered along the intra-atrial septum extending from the fossa ovalis to the septal AV junction, measuring 4.5 cm in size. She underwent pacemaker implantation with mild improvement of symptoms. PET scan demonstrated hypermetabolic activity of the intra-atrial region. She underwent surgical resection of the cardiac mass. Pathology was significant for fibrotic tissue with non-caseating granuloma and multinucleated giant cells consistent with an extremely rare presentation of CS. She was started on immunosuppressive medications. Subsequent cMRI and PET demonstrated resolution of the mass and hypermetabolic activity. Discussion: CS is a severe condition that most commonly presents with symptoms of heart failure, conduction abnormalities, and cardiac morphological changes of hypertrophy or thinning. However, it is often missed as a diagnosis, even in patients with extracardiac sarcoidosis. It is rare for CS to present as an isolated cardiac mass, especially in a younger patient as in this case. Advances in imaging techniques such as echocardiography, MRI, and PET have improved the ability to diagnosis CS and provide timely specialized treatment. This case highlights the need to include CS as an important diagnosis on the differential for a patient presenting with conduction abnormalities, heart block, and dyspnea. It also accentuates the critical role of multimodality imaging in working up this disease.

Cutaneous Adverse Effects From Diabetes Devices in Pediatric Patients With Type 1 Diabetes Mellitus: Systematic Review

Abstract Background Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusions (CSIIs) are the current standard treatment devices for type 1 diabetes (T1D) management. With a high prevalence of T1D beginning in pediatrics and carrying into adulthood, insufficient glycemic control leads to poor patient outcomes. Dermatologic complications such as contact dermatitis, lipodystrophies, and inflammatory lesions are among those associated with CGM and CSII, which reduce glycemic control and patient compliance. Objective This systematic review aims to explore the current literature surrounding dermatologic complications of CGM and CSII as well as the impact on patient outcomes. Methods A systematic review of the literature was carried out using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines using 5 online databases. Included articles were those containing primary data relevant to human participants and adverse reactions to CGM and CSII devices in pediatric populations, of which greater than 50% of the sample size were aged 0‐21 years. Qualitative analysis was chosen due to the heterogeneity of outcomes. Results Following the application of exclusion criteria, 25 studies were analyzed and discussed. An additional 5 studies were identified after the initial search and inclusion. The most common complication covered is contact dermatitis, with 13 identified studies. Further, 7 studies concerned lipodystrophies, 5 covered nonspecific cutaneous changes, 3 covered unique cutaneous findings such as granulomatous reactions and panniculitis, and 2 discussed user acceptability. Conclusions The dermatologic complications of CGM and CSII pose a potential risk to long-term glycemic control in T1D, especially in young patients where skin lesions can lead to discontinuation. Increased manufacturer transparency is critical and further studies are needed to expand upon the current preventative measures such as device site rotation and steroid creams, which lack consistent effectiveness.

Two distinct clinical progressions of P67phox-deficient CGD, both commencing with cervical lymphadenitis.

We present two rare cases of p67phox-deficient chronic granulomatous disease (CGD) caused by compound heterozygous mutations in the NCF2 gene. They developed cervical lymphadenitis as the initial manifestation of CGD but had distinct clinical progressions. Patient 1 presented with aspergillous meningitis, an extremely rare manifestation of neurological involvement in CGD, which has not been reported before. Patient 2 presented with non-infectious inflammatory lymphadenitis is also very rare and has not been reported previously. These cases emphasize the importance of considering p67phox-deficient CGD in children with late-onset invasive fungal infections and non-infectious inflammatory lesions. Additionally, we also reviewed previous reports of Chinese patients with P67phox-Deficient CGD. Our objective is to raise awareness about the clinical, diagnostic, and genetic characteristics of P67phox-deficient CGD in China, to reduce misdiagnosis and improve the management and prognosis of the disease.

Revision of Hip Luxation in a Canine Total Hip Replacement Caused by a Greater Trochanteric Fracture Secondary to an Inflammatory Granuloma.

A hip luxation 3 years following a cementless total hip replacement was diagnosed in a 4.7-year-old neutered male Lagotto Romagnolo that presented with a non-weight-bearing left pelvic limb lameness. Orthogonal radiographs revealed a left hip luxation and an osteolytic fracture of the greater trochanter. A mass consistent with an inflammatory granuloma was identified on preoperative computed tomography scan. Surgical revision consisted of granuloma excision, replacement of the loose acetabular cup, and repair of the femoral fracture with a locking plate. Fracture biology was augmented with the use of recombinant human bone morphogenetic protein 2 (rhBMP2) impregnated collagen sponge applied around the acetabulum and femoral fracture site. Osteointegration of the prosthetics and fracture healing were documented within 3 months of revision. Long-term follow-up at 3 years postrevision showed normal limb usage and no further evidence of total hip replacement complication.