Suppurative Lymphadenitis Research Articles

Evaluation of the clinical characteristics, laboratory parameters, and antibiotic treatment in patients diagnosed with tularemia

IntroductionThis retrospective, cross-sectional, multi-center study aimed to evaluate the impact of laboratory results and treatments on the treatment response in patients diagnosed with tularemia. MethodsThe study included 190 adult patients diagnosed with tularemia between November 2023 and June 2024. Results67.9 % were female, mean age was 45.8 ± 14.9 years. The most frequently detected symptoms were sore throat (74.2 %), fatigue (71.6 %), and neck swelling (56.3 %). The most common form of tularemia was oropharyngeal (82.6 %) and glandular (14.2 %). The most used monotherapy was ciprofloxacin (80.5 %, n = 136), and combination therapy was streptomycin-ciprofloxacin (81.0 %, n = 17). Treatment failure was observed in 29 patients (15.2 %). No difference was found between patients who responded and didn't respond to treatment regarding laboratory parameters. Lymph node drainage or excision was performed in 47 patients (23 %). Suppurative lymphadenitis, abscess, necrosis, and conglomerate lymphadenopathy were more common in the lymph node drainage group. Reactive lymph nodes were more common in the group without lymph node drainage. There was no difference between the two groups regarding laboratory parameters of patients with and without lymph node drainage. The duration of antibiotic treatment was longer in patients who underwent lymph node drainage than in those who didn't. ConclusionRadiological evaluation of lymph nodes upon hospital admission, in addition to antibiotic therapy during treatment, may help predict which patients are more likely to require surgical drainage. Laboratory parameters may not provide significant benefits in predicting the need for lymph node drainage and long-term treatment did not affect the treatment response.

Increase of pyogenic bacterial infections after relaxation of social distancing measures linked to COVID-19 pandemic.

After the relaxation of COVID-19 mitigation measures, we observed a dramatic increase in pyogenic infections. Based on this observation, we retrospectively analysed all cases of invasive bacterial infections of brain, lung and complicated ear-nose-throat (ENT) infections, in the period from 1 August to 31 March from the years 2018-2019 to 2022-2023. The study was conducted in two Paediatric Emergency Departments, at IRCCS 'Burlo Garofolo' of Trieste and at Treviso Hospital. Electronic medical records were searched for all cases with a definitive diagnosis at discharge of mastoiditis, suppurative cervical lymphadenitis, retropharyngeal, parapharyngeal and peritonsillar abscess (ENT group), bacterial brain abscesses, epidural empyema, subdural empyema (central nervous system group), thoracic empyema and necrotising pneumonia (lung group). In 2022-2023, we observed an increase in infections compared to the previous years. Total number of cases were 22, 29, 8, 27 and 63 in 2018-2019, 2019-2020, 2020-2021, 2021-2022 and 2022-2023, respectively. The greater increase occurred in thoracic empyema, with a peak incidence of +120% in 2022-2023 in respect of 2021-2022. We reported an important increase in paediatric bacterial complicated infections in two North East Italian regions, possibly correlated with the relaxation of COVID-19 social distancing measures.

Using T2-weighted magnetic resonance imaging-derived radiomics to classify cervical lymphadenopathy in children

BackgroundCervical lymphadenopathy is common in children and has diverse causes varying from benign to malignant, their similar manifestations making differential diagnosis difficult.ObjectiveThis study aimed to investigate whether radiomic models using conventional magnetic resonance imaging (MRI) could classify pediatric cervical lymphadenopathy.MethodsA total of 419 cervical lymph nodes from 146 patients, and encompassing four common etiologies (Kikuchi disease, reactive hyperplasia, suppurative lymphadenitis and malignancy), were randomly divided into training and testing sets in a ratio of 7:3. For each lymph node, 1,218 features were extracted from T2-weighted images. Then, the least absolute shrinkage and selection operator (LASSO) models were used to select the most relevant ones. Two models were built using a support vector machine classifier, one was to classify benign and malignant lymph nodes and the other further distinguished four different diseases. The performance was assessed by receiver operating characteristic curves and decision curve analysis.ResultsBy LASSO, 20 features were selected to construct a model to distinguish benign and malignant lymph nodes, which achieved an area under the curve (AUC) of 0.89 and 0.80 in the training and testing sets, respectively. Sixteen features were selected to construct a model to distinguish four different cervical lymphadenopathies. For each etiology, Kikuchi disease, reactive hyperplasia, suppurative lymphadenitis, and malignancy, an AUC of 0.97, 0.91, 0.88, and 0.87 was achieved in the training set, and an AUC of 0.96, 0.80, 0.82, and 0.82 was achieved in the testing set, respectively.ConclusionMRI-derived radiomic analysis provides a promising non-invasive approach for distinguishing causes of cervical lymphadenopathy in children.Graphical

T cell histiocyte rich large B cell lymphoma presenting as suppurative lymphadenitis causing a diagnostic pitfall

T cell histiocytes rich large cell lymphoma (THRLBCL) is rare variant of DLBCL and characterised by predominantly reactive cell and a few atypical B cells. It has an aggressive clinical course and can metastasise to different organ. Due to presence of reactive T cells and histiocytes, it can be misdiagnosed as reactive lymphadenitis. Ancillary technique like immunohistochemistry can help in diagnosing this entity. We describe a case of T cell histiocyte rich large B cell lymphoma presenting as suppurative lymphadenitis which is a rare presentation.

Severe BCG immune reconstitution inflammatory syndrome lymphadenitis successfully managed with pre-antiretroviral counseling and a non-surgical approach: a case report

BackgroundBacillus Calmette-Guérin (BCG) reactions are the most common cause of immune reconstitution inflammatory syndrome (IRIS) in HIV-positive infants who initiate antiretroviral therapy (ART). There is limited evidence regarding the incidence of BCG-IRIS; however, reports from outpatient cohorts have estimated that 6–9% of infants who initiated ART developed some form of BCG-IRIS within the first 6 months. Various treatment approaches for infants with BCG-IRIS have been reported, but there is currently no widely accepted standard-of-care.Case PresentationA 5-month-old male HIV-exposed infant BCG vaccinated at birth was admitted for refractory oral candidiasis, moderate anemia, and moderate acute malnutrition. He had a HIV DNA-PCR collected at one month of age, but the family never received the results. He was diagnosed with HIV during hospitalization with a point-of-care nucleic acid test and had severe immune suppression with a CD4 of 955 cells/µL (15%) with clinical stage III disease. During pre-ART counseling, the mother was educated on the signs and symptoms of BCG-IRIS and the importance of seeking follow-up care and remaining adherent to ART if symptoms arose. Three weeks after ART initiation, he was readmitted with intermittent subjective fevers, right axillary lymphadenopathy, and an ulcerated papule over the right deltoid region. He was subsequently discharged home with a diagnosis of local BCG-IRIS lymphadenitis. At six weeks post-ART initiation, he returned with suppurative lymphadenitis of the right axillary region that had completely eviscerated through the skin without signs of disseminated BCG disease. He was then started on an outpatient regimen of topical isoniazid, silver nitrate, and oral prednisolone. Throughout this time, the mother maintained good ART adherence despite this complication. After 2.5 months of ART and one month of specific treatment for the lymphadenitis, he had marked mass reduction, improved adenopathy, increased CD4 count, correction of anemia, and resolution of his acute malnutrition. He completely recovered and was symptom free two months after initial treatment without surgical intervention.ConclusionsThis case details the successful management of severe suppurative BCG-IRIS with a non-surgical approach and underlines the importance of pre-ART counseling on BCG-IRIS for caregivers, particularly for infants who initiate ART with advanced HIV.

Caseous Lymphangitis in a Goat Farm

Caseous lymphadenitis (CL) is a sporadic bacterial disease of chronic suppurative lymphadenitis in goats. The prevalence of CL is considered high in many countries, but detailed research on prevalence rates, farm practices, and abattoir findings is limited in India. This paper reports the presence of this disease on an endemic form in a goat farm. A two-year-old mixed breed doe was presented with the history of swelling in mandibular region and inappetence for the past one week. Greenish pus was aspirated from it and Giemsa stain confirms the presence of coccobacillus bacteria. Culture and isolation identified it as Corynebacterium pseudotuberculosis on 10% sheep blood agar. The abscess drained off, flushed with 5 % iodine solution and treated with injection lincomycin @ 10 mg/kg until recovery. The same history was repeated by the owner after a month and visit to the farm exposed three more animals were also affected. All of them confirmed CL based on bacterial culture and isolation. Based on this it was confirmed that the disease was endemic in that farm. Rearing goats as semi-intensive flocks, sharing of grazing fields together with other animals, commingling of animals after grazing particularly in the night time, rupture of abscess in the shelter itself, improper knowledge about disease and poor husbandry practices favours the endemicity of this disease in goats. This paper reports the endemicity of the caseous lymphadentitis in a goat flock.

An assessment of radiology resident competency in identifying suppurative retropharyngeal lymphadenitis: an examination using the WIDI SIM platform.

Suppurative retropharyngeal lymphadenitis is a retropharyngeal space infection almost exclusively seen in the young (4-8years old) pediatric population. It can be misdiagnosed as a retropharyngeal abscess, leading to unnecessary invasive treatment procedures. This retrospective study aims to assess radiology residents' ability to independently identify CT imaging findings and make a definitive diagnosis of suppurative retropharyngeal lymphadenitis in a simulated call environment. The Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM) is a computer-aided emergency imaging simulation proven to be a reliable method for assessing resident preparedness for independent radiology call. The simulation included 65 cases across various imaging modalities of varying complexity, including normal studies, with one case specifically targeting suppurative retropharyngeal adenitis identification. Residents' free text responses were manually scored by faculty members using a standardized grading rubric, with errors subsequently classified by type. A total of 543 radiology residents were tested in three separate years on the imaging findings of suppurative retropharyngeal lymphadenitis using the Wisdom in Diagnostic Imaging simulation web-based testing platform. Suppurative retropharyngeal lymphadenitis was consistently underdiagnosed by radiology residents being tested for call readiness irrespective of the numbers of years in training. On average, only 3.5% of radiology residents were able to correctly identify suppurative retropharyngeal lymphadenitis on a contrast-enhanced computed tomography (CT). Our findings underscore a potential gap in radiology residency training related to the accurate identification of suppurative retropharyngeal lymphadenitis, highlighting the potential need for enhanced educational efforts in this area.

Risk Factors for Invasive Interventions in Hospitalized Children With Suppurative Cervical Lymphadenitis.

Suppurative cervical lymphadenitis sometimes resolves with oral antibiotic treatment; however, many children are hospitalized for intravenous treatment due to lack of improvement. When there is no substantial improvement, the possibility of a liquefaction process is considered, and as a result, source control such as needle aspiration or open surgical drainage is recommended. We examined, among pediatric patients hospitalized with suppurative cervical lymphadenitis, clinical and laboratory predictors for invasive intervention that may lead to early imaging and intervention, hasten recovery, and shorten length of hospitalization. We compared laboratory and clinical characteristics of pediatric patients hospitalized with suppurative cervical lymphadenitis during 2010-2017, according to 3 treatments: needle aspiration (N = 54), open surgical drainage (N = 37), and conservative adequate antibiotic treatment only (N = 292). Physical indicators such as local erythema and fluctuation were found as predictors for invasive interventions in hospitalized pediatric patients diagnosed with suppurative cervical lymphadenitis. No significant associations were found between invasive interventions and laboratory parameters assessed in this study. Children who underwent interventions displayed a prolonged average length of hospitalization and received extended antibiotic treatment prior to hospital admission. In hospitalized pediatric patients diagnosed with suppurative cervical lymphadenitis, physical examination findings are the main predictive factors for invasive interventions. Consequently, when such straightforward clinical findings are observed in the context of insufficient improvement during antibiotic treatment, they should prompt consideration of invasive intervention.

Utility of Conventional ZN Staining and Modified Bleach Techniques in Detection of Acid Fast Bacilli from Aspirates of Suspected Cases of Tuberculous Lymphadenitis

Introduction: Tuberculosis (TB) is a significant public health problem in many developing countries, including India. Diagnosing tuberculous lymphadenitis, in particular, poses challenges as it requires the demonstration of Acid-Fast Bacilli (AFB) using the conventional Ziehl-Neelsen (ZN) technique. The Modified Bleach Technique, which involves liquefying the aspirated specimen with sodium hypochlorite followed by centrifugation, has been described to enhance the yield of AFB, improving sensitivity and diagnostic accuracy. Aim: To highlight the role of the bleach concentration method compared to conventional ZN staining in detecting AFB in Fine-Needle Aspiration (FNA) material from clinically suspected cases of tuberculous lymphadenitis. Materials and Methods: A prospective cross-sectional study was conducted at the Department of Pathology, MVJ Medical College and Research Hospital, Bengaluru, Karnataka, India from November 2020 to December 2022. Fine needle aspiration material from 100 cases of clinically suspected tuberculous lymphadenitis was included. In each case, part of the aspirate was processed for ZN staining, while the remaining material was used for modified bleach staining and Cartridge Based Nucleic Acid Amplification Test (CBNAAT). Patient data, including age, sex, duration and site of swelling, nature of aspirate, and cytomorphological diagnosis, were documented. The data was entered into a Microsoft excel spreadsheet and analysed using the Chi-square test, with a p-value<0.05 considered statistically significant. Results: The age range of the study participants was 1-80 years. Out of 100 cases, 13 were excluded due to inadequate material. The most common lymph node site was cervical 69 (79.3%), followed by axillary 8 (9.1%) and supraclavicular 6 (6.89%). Among the 87 cases, reactive lymphadenitis was diagnosed in 36 (41.3%), suppurative lymphadenitis in 12 (13.8%), necrotising granulomatous lymphadenitis in 12 (13.8%), granulomatous lymphadenitis in 15 (17.3%), and necrotising lymphadenitis in 12 (13.8%). Out of the 100 cases included in the study, 32 cases were confirmed as tubercular lymphadenitis by CBNAAT. Among these 32 cases, conventional ZN stain was positive for AFB in only 3 cases (9%), whereas the Modified bleach stain was positive in 16 cases (50%). The results were compared with CBNAAT findings, and the modified bleach technique showed sensitivity (59.4%), specificity (100%), Positive Predictive Value (PPV) (100%), Negative Predictive Value (NPV) (80%), and Accuracy (85%). Conclusion: The Modified bleach method of ZN staining is a simple, safe, inexpensive, and easy-to-perform technique. With the bleach method, AFB was easily visible and detectable in the majority of AFB-positive cases. Additionally, the bleach method preserved the morphology of AFB better. It improves the microscopic detection of AFB, leading to a definitive diagnosis of TB on cytology.

Evaluating Panchvalkala Ointment’s Healing Properties in Suppurated Cervical Lymphadenitis: A Case Report

An inflammatory or non-inflammatory enlargement of the lymph nodes is known as lymphadenopathy. The prevalence of lymphadenopathy illnesses increases with age. In Ayurveda, lymphadenopathy is generally described as five diseases, namely Arbuda (Tumor), Granthi (Cyst), Apachi (Cervical lymphadenitis), Gandamala (scrofula), and Pashangardabh (Temporomandibular inflammation). The case described here is Apachi. Acharyas focused on the disease's site of occurrence while characterizing Apachi. The book described the following locations as the site of occurrence: Hanuasthi (mandible bone), Kaksha (axillary), Akshak (clavicle), Manya (neck), and Vangshan (medial aspect of thigh). These were the lymph nodes mostly superficial lymphatic outflow regions. The method followed here was pre-operative medications followed by surgical management, i.e., Bhedana (Incision) leading to immediate drainage of tubercular cervical abscesses along with post-operative management and successive dressing of the wound until complete healing of the cavity through Ayurvedic Panchavalkal ointment. The problem was completely cured as a result of the prescribed Wound care ointment treatment followed by Incision and Drainage. This case study described how to successfully combine surgical and Ayurvedic treatment to treat Manyagata Apachi, or tubercular cervical lymphadenitis, which developed into an abscess. Suppurative cervical lymphadenitis is a frequently encountered condition with various aetiologies. Early recognition, Accurate diagnosis, and appropriate management are essential to prevent complication and promote optimal patients’ outcomes.

The spectrum of cytological findings in patients with BCG lymphadenitis: A series of 13 cases

ContextBacillus Calmette–Guérin (BCG) vaccine has been used to prevent tuberculosis and/or its severe complications for long. BCG lymphadenitis is a common complication of the vaccine, which is sometimes subjected to cytological examination.The aim of the study is to describe the cytological findings of BCG lymphadenitis. SettingsThe study was conducted in a tertiary care hospital in the western part of India from January 2021 to December 2022. DesignThe study was performed on archived material of all patients who were referred to the fine needle aspiration clinic for cytology examination. Clinical and pathological data of cases were retrieved, and cases of BCG lymphadenitis were selected in the study based on these data. Slides of cases were retrieved, and cytological findings were studied. Materials and methodsPapanicolaou, Giemsa, and Hematoxylin & eosin-stained smears, as well as Ziehl-Neelson stain (Z.N. stain) smears of all BCG lymphadenitis cases, were retrieved. Cases were reviewed for individual cytological features and overall cytological diagnostic categories. Z.N. stain smears were evaluated for acid-fast bacilli. Results and conclusionsDiagnostic categories observed in BCG lymphadenitis include suppurative lymphadenitis/abscess (15 %), necrotizing lymphadenitis (23 %), necrotizing granulomatous lymphadenitis (46 %), suppurative granulomatous lymphadenitis (8 %), non-necrotizing granulomatous lymphadenitis (8 %). Acid-fast bacilli were detected by Z.N. stain in 8 cases (62 %).The cytological findings of BCG lymphadenitis closely overlap with those of tuberculous lymphadenitis. So, clinical context is very important while reporting isolated axillary lymphadenopathy, specifically in recently vaccinated infants, to avoid misdiagnosis as tuberculous lymphadenitis.

A comparison of ultrasound-guided aspiration with open surgical drainage in the management of pediatric acute suppurative cervical lymphadenitis

ObjectivesImage-guided aspiration has been proposed as an alternative to the traditional open drainage in acute suppurative cervical lymphadenitis, although little evidence comparing these approaches exists. The aim of this study was to compare ultrasound-guided aspiration and open surgical drainage in the management of pediatric acute suppurative cervical lymphadenitis. MethodsPatients treated for acute suppurative cervical lymphadenitis at a tertiary referral pediatric hospital over a three-year period were retrospectively analyzed. ResultsOf eighteen patients included, 9 (50 %) underwent aspiration and 9 (50 %) underwent open surgical drainage. None required repeat intervention or readmission over a median follow up of 10.5 weeks. Those undergoing aspiration had a shorter post-operative length of stay (1.67 vs 4.33 days, p = 0.001) compared with open surgical drainage. ConclusionUltrasound-guided aspiration of pediatric acute suppurative cervical lymphadenitis is a safe and effective alternative to open drainage.

Using T2-Weighted MR Imaging-Derived Radiomics to Classify Cervical Lymphadenopathy in Children

Background: Cervical lymphadenopathy is common in children with diverse causes varying from benign to malignant, their similar manifestations make differential diagnosis difficult. This study intended to investigate whether radiomic models using conventional magnetic resonance imaging (MRI) could classify pediatric cervical lymphadenopathy. Methods: A total of 419 cervical lymph nodes (LNs) from 146 patients, belonging to four common causes (kikuchi disease, reactive hyperplasia, suppurative lymphadenitis and malignancy), were randomly divided into training and testing sets at a ratio of 7:3. For each LN, 1218 features were extracted from T2-weighted images. Then the least absolute shrinkage and selection operator (LASSO) model were used to select the most relevant ones. Two models were built using support vector machine classifier, one was to classify benign and malignant LNs and the other further distinguished four different diseases. The performance was assessed by receiver operating characteristic curves and decision curve analysis. Results: By LASSO, 20 features were selected to construct a model to distinguish benign and malignant LNs, which achieved an area under the curve (AUC) of 0.89 and 0.80 in the training and testing set respectively. Sixteen features were selected to construct a model to distinguish four different cervical lymphadenopathies. For each etiology (kikuchi disease, reactive hyperplasia, suppurative lymphadenitis and malignancy respectively), an AUC of 0.97, 0.91, 0.88 and 0.87 was achieved in the training set, and an AUC of 0.96, 0.80, 0.82 and 0.82 was achieved in the testing set. Conclusion: MRI-derived radiomic analysis provides a promising noninvasive approach for distinguishing cervical lymphadenopathy in children.

Observer- and radiomics model-based computed tomography classification of suppurative versus tuberculous lymphadenitis complicated with nodal necrosis of the neck in children.

Computed tomography (CT) can be used for the early detection of lymphadenitis. Radiomics is able to identify a large amount of hidden information from images. However, few CT-based radiomics studies on cervical lymphadenitis in children have been published. This study aimed to investigate the role of visual CT analysis and CT radiomics in differentiating cervical suppurative node necrosis from tuberculous node necrosis in pediatric patients. A total of 101 patients with cervical suppurative lymphadenitis (n=52) or cervical tuberculous lymphadenitis (n=49) were included. Clinical data and CT images were retrieved for analysis. For visual observation, 11 major CT features were identified for univariate and multivariate analyses. For radiomics analysis, image segmentation, feature value extraction, and dimension reduction, feature selection and the construction of radiomics-based models were performed through the RadCloud platform. For the visual observation, significant differences were found between the two groups, including the short diameter of the largest necrotic lymph node (P=0.03), sharp border of the node (P=0.02), fusion of nodes (P=0.02), regular silhouette of the necrotic area (P=0.001), multilocular necrotic area (P=0.02), node calcification (P=0.004), and enhancement degree of the nodal nonnecrotic area (P=0.01). No feature was found to be an independent predictor for suppurative or tuberculous lymphadenitis (P>0.05 for all features). Concerning the radiomics analysis, after feature value extraction and dimension reduction, nine related features were selected. The support vector machine classifier achieved high diagnostic performance in distinguishing suppurative from tuberculous lymphadenitis. The area under the curve, accuracy, sensitivity, and specificity of the support vector machine model test set were 0.89 (95% confidence interval: 0.72-1.00), 0.88, 0.78, and 0.90, respectively. Compared to observer-based CT image analyses, radiomics model-based CT image analyses exhibit better performance in the differential diagnosis of cervical suppurative and tuberculous lymphadenitis complicated with nodal necrosis in children.

Disseminated tuberculosis complicating Bacillus Calmette-Guérin (BCG) vaccine as only presentation of severe combined immunodeficiency (SCID): A report of 3 cases.

Severe combined immunodeficiency disease (SCID) is a rare primary immunodeficiency disease, usually manifest in the first six months of life with failure to thrive, oral thrush, recurrent respiratory infection, and chronic diarrhea. In three male patients, we describe an unusual presentation of SCID. They are an outcome of consanguineous marriage; all received the BCG vaccine at birth. All three cases presented with regional lymphadenopathy at three months, progressing to generalized lymphadenopathy treated with anti-tuberculous. The first and second cases were twins. The first had an uneventful history until 33 months when he developed multiple Suppurative Tuberculous lymphadenitis confirmed by biopsy. The second and the third cases were diagnosed with Disseminated Tuberculosis at 24 months as they developed fever, anemia, weight loss, tuberculous peritonitis, and lymphadenopathy confirmed by biopsy. After investigations, the first case was diagnosed as CD4, CD16 lymphopenic SCID, the second one as CD4, CD8, CD19, CD16 lymphopenic SCID with hypogammaglobulinemia and the third case as CD3, CD4, CD8 lymphopenic SCID with hypogammaglobulinemia. They received anti-Tuberculous medications, prophylactic Trimethoprim/Sulfamethoxazole, and Immunoglobulin infusion. When writing this abstract, the patients were alive and had no other bacterial, viral, or fungal infections. The twins are three years old, and the third case is 30 months old. SCID may not exhibit the classical manifestation of recurrent infections. It may present only as a complication of the BCG vaccine, alarming to maintain high susceptibility in such patients, especially in a developing country, specifically in Sudan, where the BCG vaccine is usually given at birth.

AN UNUSUAL MANIFESTATION OF METASTATIC CROHN’S DISEASE: A CASE REPORT

Crohn’s Disease (CD) is a chronic granulomatous inflammatory disease involving any section of the gastrointestinal (GI) tract. Metastatic Crohn’s Disease (MCD) is a rare extraintestinal manifestation of CD defined as cutaneous granulomatous lesions non-adjacent to the GI tract. We present a case of suppurative lymphadenitis as a presentation of MCD. This has not yet been reported in the literature.

Spectrum of cytomorphology in palpable head and neck lesions in a zonal care centre & its diagnostic utility

A prospective observational study was conducted in a zonal care hospital probing the role of FNAC in palpable head and neck lesions & its diagnostic utility which can differentiate the various neoplastic and non neoplastic lesions of head and neck very cost effectively. To study diagnostic utility of fine needle aspiration cytology(FNAC) in head and neck lesions. A one year prospective observational study carried out at a zonal care hospital, which included a total of 120 patients reported with head and neck masses in the Otorinolaryngology OPD. Out of 120 FNACs, 38 (31.66%) cases were of thyroid origin, 35 (29.16%) cases included cervical lymph nodes, 34 cases (28.33%) arised from soft tissue and 04 (3.33%) from salivary glands. Thyroid lesion involvement (31.66%) was more common than any other lesion, out of which 84.21% were colloid goitre, 7.89% were Hashimoto’s thyroditis, 5.26% follicular neoplasm and 2.56% papillary carcinoma of thyroid. Amongst the lymph node swellings, 13 cases (36.11%) were reactive/ nonspecific lesion, 12 cases (33.33%) were tuberculous granulomatous lymphadenitis, 16.66% were cases of suppurative lymphadenitis. In malignant lesions of lymph nodes, metastatic deposit of carcinoma and poorly differentiated carcinoma were the predominant pathology and lymphoma case was nil. FNAC of head and neck swelling is a worldwide accepted diagnostic modality. It is simple, inexpensive and rapid method for the diagnosis of head and neck lesion and avoids unnecessary surgery in the form of excision biopsy for diagnosis.

PROFILE OF “CLINICO PATHOLOGICAL SIGNIFICANT CERVICAL LYMPHADENOPATHY IN CHILDREN”

Introduction: Lymph node enlargement is normal age related physiological change, may also herald chronic infections and serious conditions like autoimmune disorders. Aims: To study the clinicopathological profile of significant Cervical lymphadenopathy in paediatric age group (1 month -12 years) and to arrive at an etiological diagnosis. Materials and Methods: Prospective study in our Chalmeda Anand Rao Institute Of Medical Sciences. Seventy consecutive children reporting to the Department of Paediatrics from 1 December 2020 to 30 June 2022 were studied. FNAC, Mantoux test and hematological parameters were performed in all the cases. Additional investigations like culture pus, serological test and x-ray were done wherever required. Among 70 cases the common age group was 4year to 8 years in Results: 41.4% children .The etiology was confirmed in 84.3% cases and could not be ascertained in 15.7% cases even after relevant investigations. Cytological examination revealed reactive lymphadenitis in 74.3% cases, tubercular lymphadenitis in 14.3% cases and Suppurative lymphadenitis in 7.1% cases. Also 4.3% cases yielded inadequate aspirate. Commonest etiology diagnosed after detailed investigation was due to infections in areas of drainage like tonsils, ear and scalp, oral cavity in 48.6% cases followed by tuberculosis in 25.3% cases Reactive lymphadenitis due to underly Conclusion: ing infection causedbystreptococcal and staphylococcal infections were the commonest treatableentityofsignificant paediatric cervical lymphadenopathy

AN UNUSUAL MANIFESTATION OF METASTATIC CROHN’S DISEASE: A CASE REPORT

Abstract INTRODUCTION Crohn’s Disease (CD) is a chronic granulomatous inflammatory disease involving any section of the gastrointestinal (GI) tract. Metastatic Crohn’s Disease (MCD) is a rare extraintestinal manifestation of CD defined as cutaneous granulomatous lesions non-adjacent to the GI tract. We present a case of suppurative lymphadenitis as a presentation of MCD. This has not yet been reported in the literature. CASE REPORT A 22-year-old female with a history of iron deficiency anemia and left calf abscess, secondary to Methicillin-Resistant Staphylococcus Aureus (MRSA) infection, was diagnosed with ileocolonic CD at 18. Her CD was complicated by strictures and abdominal and left tubo-ovarian abscesses with a fistula to the sigmoid. She underwent Ileocolonic resection, sigmoid colectomy and left salpingo-oophorectomy. Histology of the ovarian abscesses unveiled granulation tissue with pseudocysts. Azathioprine and Infliximab were started. At 20, the patient reported acute onset of swelling and pain on the left side of her neck. She denied any constitutional symptoms, sick person or animal contacts, travel, use of recreational drugs and sexual activities. Physical exam was remarkable for a tender, rubbery, 2-centimetre left cervical lymph node. The neck Ultrasound showed cervical lymphadenitis. Antibiotic was started and later extended to target resistant infections. Despite this, she reported worsening symptoms. Computed Tomography of the neck noted a collection suggestive of suppurative lymphadenitis. Incision and Drainage (I & D) of the abscess was done; MRSA was detected. Histology exposed necrotizing granulomata encircled by palisading histocytes and giant cells. There was no evidence of dysplasia, fungal, acid-fast bacilli or spirochetes. Further, Human Immunodeficiency Virus serology, Interferon-Gamma Release Assay and chest radiograph were unremarkable. Later, she underwent surgical excision revealing a fistula to the lower mandible. A drain was placed and then removed upon recovery. Meantime, her CD stayed stable; Infliximab was held till the completion of antibiotics. A year later, she reported a tender, swollen lump on the left side of her groin with an ultrasound confirming inguinal suppurative lymphadenitis. Antibiotics were started, and I &D was done for lasting symptoms. The culture and histology were similar to the previous. Considering the history of CD and histology findings, MCD was concluded as the etiology of this patient’s recurrent MRSA abscesses. CONCLUSION Patients on biologic therapy are immunocompromised and presumed high risk for super-infections. In a setting of a persistent infection, despite antibiotics, the possibility of MCD as the cause of lymphadenitis should be raised to cue the clinician to alter therapy and address the MCD within a multidisciplinary setting.

Statement of Retraction: Cu(II)-based coordination polymers: protective effect on suppurative lymphadenitis by regulating miR-155 and miR-34a expression in the lymph node cells

Statement of Retraction: Cu(II)-based coordination polymers: protective effect on suppurative lymphadenitis by regulating miR-155 and miR-34a expression in the lymph node cells