Nonspecific Infiltration Research Articles

Immunological upgrading with combined immunotherapy and chemotherapy in a lepromatous leprosy patient: a case report

Immunotherapy with Mycobacterium w was given, in addition to standard multidrug therapy (MDT) to a lepromatous leprosy (LL) patient with a bacteriological index (BI) of 6. After 15 months of treatment this patient attained bacteriological negativity and clinical inactivity. Histopathologically the patient upgraded to borderline-tuberculoid at 12 months, and at 15 months showed features of nonspecific infiltration in the dermis. The rapid immunological upgrading seen in the patient is highlighted in this paper.

Wegener Granulomatosis Presenting on CT with Atypical Bronchovasocentric Distribution

AbstractWe report a patient with Wegener granulomatosis who presented with nonspecific pulmonary infiltrates on routine chest radiographs, but who showed a “bronchovasocentric” distribution on CT.

Amiodarone pulmonary toxicity: CT findings in symptomatic patients.

The computed tomographic (CT) chest scans of 11 patients who developed respiratory or constitutional symptoms while receiving amiodarone therapy were reviewed. CT findings indicative of significant amiodarone exposure included (a) high-attenuation parenchymal-pleural lesions in eight of the 11 patients (73%), and (b) increased liver and/or spleen attenuation in 10 of the 11 patients (91%). Nonspecific pulmonary infiltrates were identified in nine of the 11 patients (82%). Four patients had interstitial infiltrates, four had mixed alveolar and interstitial disease, and one had a conglomerate mass. CT findings of high-attenuation parenchymal-pleural abnormalities are thought to be related to the iodinated chemistry of the drug and its prolonged half-life within the lung. These unique properties of the drug and the use of CT to discriminate attenuation levels provide a means of identifying patients with significant pulmonary accumulation of amiodarone.

Erythroderma with Generalized Lymphadenopathy Induced by Phenytoin

A 40-year-old man developed a generalized erythematous rash, fever, and systemic lymphadenopathy after treatment for two months with anticonvulsants including phenytoin. Laboratory examinations revealed increased white blood cell counts with eosinophilia, abnormal liver function, and increased gammaglobulin levels. A lymphocyte stimulation test showed a significant stimulation index for phenytoin. Skin biopsy findings were nonspecific cellular infiltrates in the upper dermis whereas in lymph nodes the normal architecture was replaced by massive cellular infiltrates consisting largely of lymphocytes, immunoblasts, and eosinophils suggesting a pattern of phenytoin lymphadenopathy. No malignant changes were noted. Phenytoin was discontinued and after a two-month treatment with oral corticosteroids, all manifestations had nearly subsided. However, the patient should be carefully followed up since phenytoin occasionally induces lymphoproliferative states including malignant lymphoma even after cessation of the medication.

Computertomographie und Kernspintomographie des Unterschenkels bei chronischer Veneninsuffizienz

Sixty-two lower limbs in 29 women and six men with chronic venous insufficiency (CVI) of grade II and III were examined by CT and eight of these additionally with MRI. The changes were compared with the findings in 21 patients of similar age, but without venous abnormalities. The most important findings were subcutaneous fibrosis with or without calcification, nonspecific infiltration of the extrafascial spaces and degeneration of the Achilles' tendon. The simultaneous occurrence of these changes can be regarded as typical of advanced CVI. CT was somewhat superior to MRI; its use can be justified as part of posttherapeutic follow-up and for special problems.

Pancreatic secretory trypsin inhibitor as a marker for early detection of rejection in canine pancreas allotransplantation.

Serum pancreatic secretory trypsin inhibitor (PSTI)* was measured in the course of canine segmental pancreas allotransplantation without immunosuppression. Serum PSTI concentrations showed two distinct elevations: the first elevation was on the first day and the onset of the second elevation was the sixth day after operation. The first postoperative elevation of the serum PSTI level is thought to be related to the operative procedures, because the first elevation was observed after both autotransplantation and allotransplantation, and biopsies of the autograft and allograft at the first day after the operations showed nonspecific neutrophilic infiltration and no perivascular lymphoid infiltrates. The second postoperative elevation of the serum PSTI level is thought to reflect a rejection process because this elevation was not seen after autotransplantation, and biopsies of allografts at the sixth day after the operation showed typical perivascular lymphoid infiltrates and cellular rejection of the exocrine tissue. In addition, the onset of the second elevation of serum PSTI level preceded by about three days the onset of the elevation of blood sugar at the ninth day after the operation. The results suggest that serum PSTI can be used as a marker for diagnosis of early pancreatic allograft rejection.

Cutaneous Microthrombi

Hypereosinophilic syndrome is a rare systemic disease that frequently has cutaneous lesions. Past reviews of the histopathology of the skin lesions have revealed a nonspecific dermal infiltrate with occasional eosinophils as a constant finding. A case of hypereosinophilic syndrome with cutaneous manifestations, in which the skin biopsy demonstrated multiple cutaneous microthrombi, is reported. The diagnostic and prognostic significance of this finding is discussed.

Pathologic features of gastrointestinal tract lesions in childhood-onset systemic lupus erythematosus: study of 26 patients, with review of the literature.

A review of the gastrointestinal tracts of 26 autopsied cases of childhood-onset systemic lupus erythematosis (SLE) showed the single most common pathologic finding to be chronic nonspecific mucosal infiltration (96%). The most frequent general category was ischemic bowel lesions, attributable to vascular lesions of SLE (60%) or to nonocclusive causes of circulatory insufficiency such as congestive heart failure, uremia, or shock (40%). Complications of ischemic bowel lesions included secondary invasion by opportunistic organisms such as Candida (9 patients), pneumatosis intestinalis (1), and perforation of a gastroesophageal ulcer (1). Colonic ulcers, clearly ischemic in etiology, were noted in 6 patients, none of whom had other bowel lesions resembling those of Crohn's disease or ulcerative colitis. Other relevant findings included ascites (88%), peritoneal inflammation or fibrosis (42%), upper esophageal skeletal muscle fiber atrophy (8%), heterotopic calcification of gastric mucosa (12%), and severe intestinal mucus inspissation (4%). Correlations between the various lesions and clinical manifestations, and possible etiologic and pathogenetic mechanisms of these lesions, are discussed.

Elevated levels of a glycoprotein antigen (P-80) in gray and white matter of brain from victims of multiple sclerosis.

The levels of a glycoprotein reactive with monoclonal antibody (MAb) 44D10 in white and gray matter from brains of victims of several neurological diseases, including Multiple Sclerosis, Alzheimer's, Parkinson's and Huntington's diseases, were compared to that of normal individuals. The concentration of antigen reactive with MAb 44D10 was elevated in both gray and white matter of all MS brains examined, but not in brains with other neurological diseases. The increase in the concentration of antigen varied amongst the MS brains, such that the levels of antigen were only slightly increased in 2 of the 6 MS brains whereas 2 to 4 fold higher levels were found in the other 4 brains. Increased levels of antigen were detected in gray matter of MS brains, whereas this antigen was either not detected or present in very low levels in gray matter homogenates prepared from age-matched normal brains. MAb Leu 1, which reacts with T lymphocytes, was not absorbed by normal and MS brain tissue suggesting the increase in antigen reactive with MAb 44D10 in MS brain homogenates was not associated with non-specific infiltration by T lymphocytes. Comparison of the purified antigen from MS gray matter and normal white matter by gel electrophoresis demonstrated that MAb 44D10 was reacting with a similar protein in both tissues with an apparent molecular weight of 80K. We have named this molecule P-80 glycoprotein.

Evaluation of patients with the acquired immunodeficiency syndrome (AIDS) by fiberoptic bronchoscopy.

Hospital records were reviewed on 78 consecutive patients (33 homosexuals, 37 Haitians and 8 IV drug abusers) who had AIDS and who underwent fiberoptic bronchoscopy over a two year period. Pneumocystis carinii pneumonia (PCP) was the most common bronchoscopic finding (53.8% of patients) followed by tuberculosis (14.1%), cytomegalovirus infection (12.8%) and atypical mycobacteriosis (3.8%). In 15.4% of patients multiple organisms were found. Twenty-seven percent of patients had non-diagnostic bronchoscopies. In 8 patients with non-diagnostic bronchoscopies, open-lung biopsy or autopsy revealed PCP (2 patients), Kaposi's sarcoma (3 patients) and non-specific lymphocytic-plasmacytic infiltrates (3 patients). Histologic studies of transbronchial biopsy specimens were more sensitive for the diagnosis of PCP than touch imprints. PCP was diagnosed in 15 patients who had received trimethoprim-sulfamethoxazole for up to 4 days. Mean duration of respiratory symptoms prior to bronchoscopy was 4.2 weeks in patients with PCP and was not significantly different in patients with other bronchoscopic diagnoses. Historical, laboratory and chest radiographic parameters were not helpful in establishing a diagnosis or assessing prognosis in these AIDS patients with pulmonary infiltrates. Fiberoptic bronchoscopy with transbronchial biopsy is safe (only one of the patients had a self limited hemorrhagic episode) and sensitive for the diagnosis of pulmonary infiltrates in patients with AIDS.

Eosinophilic Cellulitis (Wells' Syndrome)

To the Editor.— In 1971 Wells described an unusual cutaneous eruption resembling acute cellulitis. Grossly it appears as single or multiple erythematous, edematous plaques and histologically demonstrates an intense eosinophilic infiltrate with an edematous dermis, which later is infiltrated by histiocytes. Many patients demonstrate a peripheral blood eosinophilia, and several authors have reported more striking hematologic alterations. Report of a Case.— A 36-year-old woman was seen in February 1981 for a cutaneous eruption that had been present since late 1980. The eruption was characterized by arcuate, raised, erythematous lesions on both wrists and thighs. Prior to admission, the patient had received erythromycin and prednisone. Cutaneous biopsy at that time revealed a nonspecific perivascular infiltrate composed of an admixture of lymphocytes with a substantial, but smaller, number of eosinophils. Scattered, small eosinophilic granules were present in an edematous dermis, with focal fragmentation of the collagen fibers. Laboratory studies indicated a hemoglobin

Defective elicitation of delayed-type hypersensitivity in W/Wv and SI/SId mast cell-deficient mice.

Previous studies have indicated that cutaneous mast cells are involved in the elicitation of delayed-type hypersensitivity (DTH) in mice. Mast cells are thought to be required in DTH to release serotonin to open gaps between endothelial cells, allowing entrance of effector cells into the tissue. Two different strains of mice with independent genetic defects that lead to a substantial mast cell deficiency (W/Wv and SI/SId), and their normal littermate +/+ controls, were studied for their ability to express DTH. Both strains were shown to be deficient in serotonin-containing mast cells at skin sites of preferential elicitation of DTH in normal mice, such as the ear or footpad. Defective DTH was found in both mast cell-deficient strains by using two different systems: 1) sheep erythrocyte-induced footpad DTH, and 2) picryl chloride-induced contact sensitivity ear swelling responses. Adoptive transfer experiments demonstrated that abnormal DTH in mast cell-deficient mice was due to a defect in the elicitation of DTH, rather than a defect in the induction of effector T cells. In these experiments, the ability to elicit DTH could be transferred to normal +/+ mice with sensitized cells from mast cell-deficient mice, but sensitized cells from +/+ mice could not transfer DTH responsiveness to mast cell-deficient mice. In addition, no defects in numbers of epidermal Langerhans cells or in antigen-presenting cell function were found in W/Wv or SI/SId mice. We therefore concluded that abnormal elicitation of DTH in W/Wv and SI/SId mice was probably due to their mast cell deficiency. The inability of mast cell-deficient mice to express DTH was overcome when sensitized T cells and specific antigen were placed in the extravascular tissues by local passive transfer. These results suggest that mast cell release of vasoactive mediators, such as serotonin, is required in DTH to allow effector T cells to leave the intravascular space, enter the tissues, and become activated by antigen to release chemoattractant lymphokines that recruit a nonspecific infiltrate of inflammatory cells.

Kaposi's sarcoma, chronic ulcerative herpes simplex, and acquired immunodeficiency

Recently, increasing numbers of young homosexual men with a fulminant form of Kaposi's sarcoma have been described.^1,2We report herein a case of a young homosexual man with Kaposi's sarcoma, chronic perianal and nasolabial ulcerating herpes simplex infection, oral candidiasis, and immunodeficiency, presumably acquired. <h3>Report of a Case</h3> In December 1980, a 22-year-old Hispanic homosexual man residing in New York City was hospitalized for a six-month history of weight loss and fever. Physical examination disclosed a man with cachexia, oral mucosal white pseudomembranous plaques, generalized adenopathy, and splenomegaly. Physical examination findings were otherwise normal. Laboratory studies disclosed the following values: WBCs, 3,200/cu mm; hemoglobin, 10g/dL; ESR, 109 mm/hr; hepatitis B antigen test, negative; and hepatitis B antibody test, positive. Pharyngeal culture for yeasts showed the presence of<i>Candida albicans</i>. Chest x-ray films showed a nonspecific infiltrate in the right upper lobe. However,<i>Pneumocystis carinii</i>was not detected in the

Chronic lip fissures: Prevalence, pathology and treatment

In a prevalence study of oral mucosal lesions carried out 1973–1974, 20,333 individuals, aged 15 years or above were examined. Chronic lip fissures were found in 110 people, corresponding to a prevalence rate of 0.57%. The fissures were more prevalent among males (0.92%) than females (0.20%) and more prevalent in the age groups below 45 years than in those above. In 1976 – 1978, 7 patients with annoying, chronic lip fissures were treated by excision. The mean observation time was 26 months (range 17–33 months). No recurrences of the fissures were observed. Histologic examination revealed a chronic inflammatory non-specific infiltrate and no dysplasia or cellular atypia was seen.

Specific and nonspecific infiltration of sponge matrix allografts by specifically sensitized cytotoxic lymphocytes

Urethane sponges coated with allogeneic or syngeneic cells were implanted subcutaneously into mice and the cytotoxicity of infiltrating host cells was assessed in vitro. First-set allogeneic sponges attracted a population of lymphocytes enriched in cytotoxic T cells directed against the alloantigens in the sponge. If two sponges bearing cells of different H-2 specificity were grafted simultaneously to a single recipient, specifically sensitized cytotoxic cells (SSCL) were found in both sponges directed against both sets of alloantigens, although specific infiltration predominated. If a syngeneic and allogeneic sponge were transplanted, SSCL were found in both the syngeneic sponge and allogeneic sponge. These data are interpreted to suggest that chemotactic substances are elaborated at graft sites which can attract circulating SSCL into sites of inflammation and that those released at the specific site are more attractive for SSCL than are those elaborated at sites of nonspecific rejection or healing. In recipients who had previously been sensitized to alloantigens, second-set grafts were rapidly infiltrated by SSCL directed against the sensitizing antigen. First-set indifferent allografts in sensitized recipients were infiltrated by SSCL directed against the previous alloantigens as well as SSCL directed against its own alloantigens. Syngeneic grafts were not infiltrated by SSCL in presensitized recipients. These data suggest that any alloantigenic stimulus can induce the mobilization from lymphoid depots of preformed SSCL directed against another set of antigens; syngeneic grafts cannot. Once mobilized, however, circulating SSCL can respond to specific and nonspecific chemotactic factors elaborated by either healing or rejecting grafts.

The multicellular tumor spheroid model: I. Characterization of the allograft response in sensitized mice

Intraperitoneal implants of multicellular spheroids of EMT6 mammary sarcoma cells into specifically sensitized allogeneic mice have been used as a model to study in situ immunity to solid tumor allografts. Morphological examination of the spheroids recovered from sensitized mice revealed massive infiltration by host cells. There was an early but apparently nonspecific infiltration by large numbers of polymorphonuclear leukocytes followed by the infiltration of large numbers of macrophages and smaller numbers of lymphocytes. The later infiltration correlated with tumor cell killing as determined by a cloning assay for surviving EMT6 cells, and with the presence of cells with cytotoxic activity in in vitro assays. The kinetics of tumor cell killing indicated that tumor cell survival decreased within a few hours of spheroid implantation and less than 1% of the tumor cells survived after 48 h. Purification of the infiltrating cells by nylon wool fractionation and by treatment with anti-T-cell serum and complement indicated that the primary cytotoxic cell is a T lymphocyte.

Primary hepatic actinomycosis

Fever of 10 mo duration in a man of 35 yr was discovered at the time of a second laparatomy to be caused by actinomycotic infection of the liver. Actinomycosis of the liver usually presents as large single or as multiple abscesses. In this patient only nonspecific cellular infiltrates of the liver were found in liver biopsies performed after 4 mo of fever. Not until 10 mo had elapsed were miniscule liver abscesses detected. It took an average of 8 mo to make a diagnosis in our patient and in 6 others like him reported since 1928. Exploratory surgery was required for diagnosis in all of them.

Remittent painful ophthalmoplegia: the Tolosa-Hunt syndrome? A report of seven cases and review of the literature.

Seven patients with remittent painful ophthalmoplegia for which no specific local cause was found were seen during a period of five years. One had coincidental rheumatoid arthritis, and another had actinomycosis of the ipsilateral middle ear and contralateral parotid gland. The other five had no evidence of generalised autoimmune disease nor any other systemic disorder, two having separate episodes affecting each side. A history of relapsing and remitting painful ophthalmoplegia is suggestive of the Tolosa-Hunt syndrome, but it is rarely possible to confirm that the lesion in the cavernous sinus is the result of non-specific granulomatous infiltration so that the diagnosis remains one of exclusion. Carotid arteriography may show narrowing of the intracavernous part of the internal carotid artery. Orbital venography may also be helpful, particularly when the carotid arteriogram is normal. We believe that the Tolosa-Hunt syndrome is more common in England than is generally realised, but that its clinical features do not necessarily indicate a single pathological entity. Its recognition is important since the response to steroids, although not specific, is rapid in most patients, and the prognosis for complete recovery is relatively good.

Subcutaneous Mycosis Fungoides

In five cases of mycosis fungoides, previously treated with electron-beam therapy, subcutaneous nodules developed. Clinically, these lesions were thought to be epidermoid cysts or lipomas, but on biopsy were discovered to be subcutaneous infiltrates, three of which were diagnosed as mycosis fungoides. The other two specimens showed only a nonspecific subcutaneous infiltrate. There is no ready explanation for the appearance of these lesions, but it is speculated that they may be the result of inadequate penetration of the electron beam to the depth at which some atypical cells may originally have been located. Patients with mycosis fungoides who develop unusual subcutaneous nodules should be fully investigated so that appropriate and adequate therapy may be initiated.

Morphological patterns of the liver in South American blastomycosis.

Histological features were semi-quantitatively analysed in 60 livers, obtained by necropsy, from patients who died of South American blastomycosis. These findings were classified and correlated with duration of the disease and treatment. Bile-duct lesions were prominent and a particular pattern was found in which segments of bile ducts were "disrupted" and replaced by inflammatory reaction. A classification of the lesions is proposed: Class o--near normal livers; Class I--predominance of necrosis and suppuration; Class II--predominance of tuberculoid granulomas; Class III--portal fibrosis and non-specific infiltrate. There has been no evidence that treatment could induce bile-duct proliferation, fatty change of liver cells, or cholestasis. On the other hand, less fibrosis was found in treated patients. Pathogenesis of the bile-duct lesions is discussed.