Suppurative Lymphadenitis Research Articles

Chronic granulomatous disease with markedly elevated IgE levels mimicking hyperimmunoglobulin E syndrome

Patients with hyperimmunoglobulin E syndrome (HIES) and chronic granulomatous disease (CGD) have prominently increased immunoglobulin (Ig) E levels. We present a 9-year-old boy with medical history revealing recurrent pneumonia, suppurative lymphadenitis, diarrhea, and otitis. The patient was hospitalized with severe pneumonia. The examination showed tachypnea, crackles at the right and left base of the lung, freckles on his face, red-hair, gingivitis, a high arched palate, and retained primary dentition. Serum IgE level was markedly increased. Nevertheless, patient did not have STAT3 or DOCK8 mutation, characteristic of HIES. Neutrophil function test with dihydrorhodamine (DHR) showed X linked-CGD pattern and molecular analysis of DNAshowed a splice site mutation (c.338-1G > A) in CYBB gene. Herein, we present a case of CGD with selective IgA deficiency. Laboratory findings and elevated IgE mimic the features seen in HIES. Thus, CGD must be considered as a differential diagnosis in patients with elevated Ig E.

Recurrent Burkholderia gladioli Suppurative Lymphadenitis associated with Neutralizing Anti-IL-12p70 Autoantibodies

IntroductionBurkholderia gladioli is a rare human pathogen, and pul-monary infections occur almost exclusively in cystic fibro-sis, chronic granulomatous disease and lung transplant pa-tients [1–3]. A single case of disseminated disease wasdescribed in a woman with anti-interferon gamma (IFNγ)autoantibodies [4]. Other opportunistic infections are com-mon with defects in the IFNγ/Interleukin-12 (IL-12) path-way [5]. While high-titer neutralizing anti-IL-12 autoanti-bodies can occur with thymoma, their association with in-fections has not been clearly established [6–8]. We report acase of severe B. gladioli infection associated with autoan-tibodies to IL-12p70 in a Southeast Asian woman withrecurring B. gladioli suppurative lymphadenitis.Case ReportA 45-year-old Cambodian woman presented with 2 monthsof progressive left-sided cervical lymphadenitis and tonsil-litis. Approximately 2 years earlier she had similar findingson the right side of her neck when excisional lymph nodebiopsy revealed B. gladioli. She received 3 weeks of oralantibiotics followed by 6 weeks of meropenem for pre-sumed melioidosis. Although she reported continued painand restricted neck motion, her acute infection appeared tohave resolved.As an adolescent in Cambodia, she had worked in ricepaddies before immigrating to the United States over30 years earlier. She had not been in Cambodia since thattime. She had intractable bloody diarrhea during her preg-nancy 13 years prior with large rectal granulomata.Postpartum, she developed perirectal and pelvic abscesseswith fistulae which required multiple surgeries and6monthsof oral antibiotics before resolution. The etiologic agent wasnever identified. Her daughter is healthy without recurrentinfections.She was a thin, chronically-ill appearing woman withbilateral tender, fluctuant cervical and submandibularlymphadenopathy and tonsillar swelling. Notable labs in-cluded a normocytic anemia, leukocytosis without elevatedband forms, and negative HIV serologies. There was noevidence of a monoclonal gammopathy on serum proteinelectrophoresis with immunofixation. Her cervical lymphnodes were massively enlarged and suppurative upon exci-sion, and histopathology revealed granulocytes and histio-cytes with intracellular gram-negative bacilli (Fig. 1) anddid not suggest any lymphoproliferative disease. B. gladioliwas isolated from all excised tissues and confirmed bycomparative 16S ribosomal RNA analysis by the Centersfor Disease Control and Prevention (CDC). Complement,superoxide production, immunoglobulin levels, and T cellquantitation were normal. An intradermal tuberculin test was

Investigation of Chlamydia trachomatis with Cell Culture, DFA and PCR Methods in the Genital Swab Samples of Symptomatic Patients

Chlamydia trachomatis infection is considered the most prevalent bacterial sexually transmitted disease worldwide. C.trachomatis causes eye infections such as trachoma and newborn inclusion conjunctivitis, newborn pneumonia, genitourinary system infections and suppurative inguinal lymphadenitis namely lymphogranuloma venerum. The aim of this study was to investigate C.trachomatis by direct fluorescent antibody (DFA), polymerase chain reaction (PCR) and cell culture methods in the clinical samples sent to the microbiology laboratory with the prediagnosis of genital infections. A total of 50 swab samples obtained from adult patients (49 female, 1 male) who were admitted to Erciyes University Hospital, Kayseri, Turkey between February-March 2010, were included in the study. C.trachomatis antigens were investigated by a commercial DFA (PathoDx, Remel, USA) method. McCoy cell cultures prepared in microplate wells were used for the isolation of C.trachomatis. The growth of C.trachomatis in cell cultures was confirmed by DFA and iodine staining methods. C.trachomatis DNA was investigated by commercially available PCR (Chlamydia trachomatis 330/740 IC; Sacace, Italy) method. In our study, 4 (8%) of the 50 swab samples were found positive with DFA, 1 (2%) was positive with cell culture, and 1 (2%) was positive with PCR. The only sample that gave positive results with all of the three methods was an urethral swab. Three cervical swab samples that were found positive only with DFA method was evaluated as false positivity. When cell culture was considered as the reference method, the sensitivity and specificity of DFA method were estimated as 100% and 94%, respectively, while those rates for PCR were 100% and 100%, respectively. In conclusion, although cell culture is still the gold standard in the diagnosis of C.trachomatis. infections, since it is time consuming and difficult to apply, more rapid and reliable PCR methods may be applied in diagnosis. DFA method which is practical and cheap, is preferred largely in routine laboratory practice. However, false negative and false positive DFA results should be prevented by the maintainence of good quality clinical specimens, evaluation of the test by experienced personnel and use of quality control samples in each run.

Bacille-Calmette-Guérin vaccine-associated suppurative lymphadenitis in Hong Kong (China), 2004 to 2012

Bacille-Calmette-Guérin vaccine-associated suppurative lymphadenitis in Hong Kong (China), 2004 to 2012

Necrotic cervical nodes: Usefulness of diffusion-weighted MR imaging in the differentiation of suppurative lymphadenitis from malignancy

PurposeThe purpose of this study was to assess the efficacy of diffusion-weighted (DW) MR imaging for the differentiation between suppurative lymphadenitis and malignancy in necrotic cervical lymph nodes. Materials and methodsFifteen patients with suppurative lymphadenitis, 40 with squamous cell carcinoma (SCC), eight with lymphoma, and six with thyroid cancer were accompanied by necrotic cervical nodes. All 69 patients underwent 1.5-T MR imaging including DW and 58 underwent gadolinium-enhanced MR imaging. Necrotic area-to-spinal cord signal intensity ratios (SIR) on T1-, T2- and DW images and apparent diffusion coefficients (ADCs) [10−3mm2/s] were correlated with the pathologies. ResultsNineteen necrotic cervical nodes with suppurative lymphadenitis, 67 with SCC, 10 with lymphoma, and 12 with thyroid cancer were identified. SIR on DW images was higher in suppurative lymphadenitis (2.50±1.21) than in malignancies (1.29±0.67) (p<.01), and ADC value was lower in suppurative lymphadenitis (0.89±0.21) than in malignancies (1.46±0.46) (p<.01). SIR on T1-weighted images was higher in thyroid cancer (1.95±0.53) than in suppurative lymphadenitis (0.87±0.17), SCC (0.92±0.13), and lymphoma (0.95±0.09) (p<.01). No significant difference in SIR on T2-weighted images was found between suppurative lymphadenitis (1.46±0.50) and malignancies (1.61±0.56). ConclusionDW imaging with ADC measurements may play a supplementary role in the differentiation of necrotic cervical nodes between suppurative lymphadenitis and malignancy.

Spectrum Of Cytological Findings In Patients With Lymphadenopathy In Rural Population Of Southern Haryana, India - Experience In A Tertiary Care Hospital

Lymphadenopathy is of great clinical significance as underlying diseases may range from a treatable infectious etiology to malignant neoplasms. In fact, it is also essential to establish that the swelling in question is a lymph node. Fine Needle Aspiration Cytology (FNAC) plays a vital role in solving these issues, nowadays being recognized as a rapid diagnostic technique because of its simplicity, cost effectiveness, early availability of results, accuracy and minimal invasion. This study was conducted to evaluate the usefulness of FNAC as a diagnostic tool in the management of patients with superficial lymphadenopathy. The study was also carried out to know the distribution of various lesions among the different age groups. The present randomized study was undertaken to study cytological features of non-neoplastic and neoplastic lesions of enlarged lymph nodes by FNAC in 182 patients presenting with lymphadenopathy in the Maharaja Agrasen Medical College, Agroha village over a period of one year from January to December 2011. There were 100 male and 82 female patients with an age range of 1 �70 years. Tuberculous lymphadenitis, reactive hyperplasia, metastatic carcinoma, suppurative lymphadenitis and lymphomas were seen in 35.7%, 31.3%, 20.3%, 9.9% and 2.7% respectively. Reactive hyperplasia was seen most often (60%) in first two decades of life, 58.9% tuberculous lymphadenitis in the second and third decades (66%) and incidence of metastatic carcinoma are high during and after 40 years of age. Cervical lymph nodes were involved in all types of lymphadenopathy. Metastatic lesions of lymph nodes were seen to be more common in males. Squamous cell carcinoma is the most common metastatic lesion.

Granulomatous Lymphadenitis

In this review, representative types of granulomatous lymphadenitis (GLA) are described. GLA can be classified as noninfectious GLA and infectious GLA. Noninfectious GLA includes sarcoidosis and sarcoid-like reaction. The cause of sarcoidosis remains unknown, but it has good prognosis. Sarcoid-like reaction, which is considered to be a biological defense mechanism, is observed in regional lymph nodes with many underlying diseases. Infectious GLA can be classified as suppurative lymphadenitis (LA) and nonsuppurative LA. Suppurative LA generally shows follicular hyperplasia and sinus histiocytosis in the early phase. In tularemia and cat scratch disease, monocytoid B lymphocytes (MBLs) with T cells and macrophages contribute to the formation of granuloma. However, none of the epithelioid cell granulomas of Yersinia LA contains MBLs like in cat scratch disease. In addition, almost all have a central abscess in granulomas induced by Gram-negative bacteria. In terms of the lymph nodes, tularemia and cat scratch disease are apt to affect the axillary and cervical regions while Yersinia LA affects the mesenteric lymph node. Nonsuppurative LA includes tuberculosis and BCG-histiocytosis. These are induced by delayed allergic reaction of M. tuberculosis. Tuberculosis LA mainly appears in the cervical lymph node. Organisms are histologically detected by Ziehl-Neelsen staining in the necrotic area. Toxoplasmosis is also a nonsuppurative protozoan infection (Toxoplasma gondii). In toxoplasma LA, MBLs can also be seen, but round and organized, well-formed granulomas are not found in this disease. Furthermore, necrosis is not induced and there are no accompanying neutrophils, eosinophils and fibrosis. GLA described above is associated with characteristic histological findings. An accurate pathological diagnosis using the above findings can lead to precise treatment.

A case of Kawasaki disease with suspected peritonsillitis and acute suppurative cervical lymphadenitis

A case of Kawasaki disease with suspected peritonsillitis and acute suppurative cervical lymphadenitis

Nodular sclerosing classical Hodgkin lymphoma masquerading as acute suppurative‐necrotizing lymphadenitis

The diagnosis of nodular sclerosing classical Hodgkin lymphoma (NSCHL) by fine-needle aspiration (FNA) biopsy has historically been a diagnostic challenge due to the usual paucicellularity of the specimen. This case report, and other previously published reports, suggests that there is another facet to the potentially challenging diagnosis of this particular variant of Hodgkin lymphoma (HL): the presence of suppurative-necrotizing changes mimicking an infectious etiology. The patient presented here underwent FNA biopsy of an acutely enlarged supraclavicular lymph node and cytologic smears showed marked acute inflammation in a background of necrosis. A diagnosis of infectious suppurative lymphadenitis was made at that time. After a negative infectious work-up with infectious disease consultation, an excisional biopsy was performed and the patient was definitively diagnosed with NSCHL. The presence of neoplastic Hodgkin and Reed-Sternberg cells in the purulent exudate was minimal and only appropriately identified after retrospective review. This particular subtype of classical HL represents a potential pitfall in FNA biopsy cytology. Consequently, the cytopathologist and surgeon should always consider this entity in the differential diagnosis of a suppurative, lymphadenitis-like aspirate, and pursue repeat FNA or an excisional biopsy if there is any clinical index of suspicion.

Kawasaki Disease Presenting as Retropharyngeal Cellulitis

Objective: Kawasaki disease (KD), which occurs in infants and children, is an acute multisystemic vasculitis of unknown etiology. Several reports mentioned retropharyngeal cellulitis as a rare manifestation of KD. The purpose of this study is to investigate the population and characteristics of KD manifested by retropharyngeal soft tissue swelling. Method: A retrospective review of 213 patients (mean age of 2 years, age range of 7 months to 10 years) diagnosed as KD between 2005 and 2010. Results: Enhanced computed tomography showed an abnormal low density area without ring enhancement in the retropharyngeal space in 9 cases (4.2%). All of them had fever and cervical lymphadenopathy as the first symptom. Though cervical lymphadenopathy is one of the 6 diagnostic features of KD (fever, skin rash, cervical lymphadenopathy, conjunctivitis, fissuring of lips, and strawberry tongue), the occurrence is reported to be the lowest (about 50%). They were treated by a pediatrician as suppurative lymphadenitis in 6 cases and as retropharyngeal cellulitis in 3 cases, and they were finally diagnosed as KD owing to ineffectiveness of antibiotics or emergence of the other symptoms. Conclusion: A low density area on computed tomography in the retropharyngeal space was identified in 4.2% of KD. Early diagnosis is essential in KD because coronary artery lesions emerge in 50% of patients without treatment. If a young child has fever, cervical lymphadenopathy and swelling of the retropharyngeal space, KD should be within differential diagnoses.

Cephalosporin-induced recurrent aplastic anemia

Cephalosporin-induced recurrent aplastic anemia

Primary Bilateral Pontine Demyelination in a Cat With Similarity to Central Pontine Myelinolysis

An adult cat was presented with the history of 3 months' weight loss and more recent loss of balance and ataxia. An abdominal mass was palpable; results of neurologic examination suggested a brainstem disorder. The owners elected euthanasia. Postmortem findings included suppurative jejunal lymphadenitis and bilateral demyelination in the ventral pons with sparing of axons and neuronal soma. The location and character of the lesion mimicked those of human central pontine myelinolysis, an iatrogenic condition that may follow rapid correction of hyponatremia or develop spontaneously in patients with malnutrition or energy deprivation. In this cat, the poor nutritional state may have contributed to the development of this novel pontine lesion.

Incomplete Kawasaki disease in a patient with chronic granulomatous disease

Chronic granulomatous disease (CGD) is a rare inherited immunodeficiency characterized by microbicidal dysfunction due to a defect in nicotinamide adenine dinucleotide phosphate oxidase in neutrophils. Patients with CGD have abnormalities in cytokine production and apoptosis leading to prolonged inflammation, which is related to the susceptibility to autoimmune or inflammatory diseases such as sarcoidosis, Crohn’s disease, systemic lupus erythematosus, Behcet’s disease, and Henoch‐Schonlein purpura. 1

Surto de listeriose sistêmica em chinchilas

A listeriose é uma doença infecciosa que afeta uma grande variedade de espécies animais, causando septicemia, encefalite e aborto. As chinchilas são os animais mais susceptíveis à infecção sistêmica por Listeria monocytogenes. Este relato descreve um surto de listeriose sistêmica em uma criação de chinchilas da região central do Estado do Rio Grande do Sul, onde cerca de 16% das chinchilas morreram. Na necropsia, havia múltiplos focos brancos, pequenos e de distribuição aleatória nas superfícies capsular e de corte do fígado e aumento de volume do linfonodo hepático. Histologicamente, observaram-se hepatite necrossupurativa e linfadenite supurativa multifocais, com numerosos bacilos intralesionais. L. monocytogenes foi o agente etiológico do surto de listeriose sistêmica, sendo o diagnóstico confirmado por meio das lesões de necropsia e histopatológicas, das características fenotípicas e genotípicas da bactéria e da técnica de imuno-histoquímica.

Needle aspiration as therapeutic management for suppurative cervical lymphadenitis in children

PurposeThis study aimed to evaluate the usefulness of the needle aspiration alternative to open surgical drainage of children with suppurative cervical lymphadenitis requiring surgical drainage.MethodsFrom January 1998 to June 2008, we retrospectively reviewed 38 children treated with needle aspiration as management with suppurative cervical lymphadenitis instead of open surgical drainage.ResultsAll 38 children underwent only 1 puncture. Two patients (5.2%) out of 38 patients experienced reformation of an abscess and all recovered completely after re-treatment with antibiotics. Minor complications were detected in 2 patients (5.2%). One complication originated from remnant necrotic tissue and the other involved formation of a small scar in two patients, which resolved spontaneously. There were no major complications.ConclusionNeedle aspiration can be a simple, safe, and effective alternative procedure to open surgical drainage of children with suppurative cervical lymphadenitis requiring surgical drainage.

A case of Kawasaki disease with coexistence of a parapharyngeal abscess requiring incision and drainage

Kawasaki disease (KD) causes multisystemic vasculitis but infrequently manifests with deep neck infections, such as a peritonsillar abscess, peritonsillar or deep neck cellulitis, suppurative parapharyngeal infection, or retropharyngeal abscess. As its etiology is still unknown, the diagnosis is usually made based on typical symptoms. The differential diagnosis between KD and deep neck infections is important, considering the variable head and neck manifestations of KD. There are several reports on KD patients who were initially diagnosed with retropharyngeal abscess on on computed tomography scans (CT). However, the previously reported cases did not have abscess or fluid collection on retropharyngeal aspiration. Therefore, false-positive neck CT scans have been obtained, until recently. In this case, suspected neck abscess in patients with KD unresponsive to intravenous immunoglobulin could signal the possible coexistence of suppurative cervical lymphadenitis.

Tokyo-172 BCG Vaccination Complications, Taiwan

Tokyo-172 BCG Vaccination Complications, Taiwan

Suppurative lymphadenitis

Suppurative lymphadenitis is an important and common form of soft tissue infection. Most acute cases of suppurative lymphadenitis are caused by Staphylococcus aureus or by Streptococcus pyogenes. Empiric antibiotic therapy is frequently successful in the early stages of the disease process, but increasing prevalence of methicillin-resistant S. aureus in particular has necessitated a shift in antibiotic choice that is dictated primarily by specific local resistance patterns. Several other organisms and noninfectious inflammatory processes may give rise to a clinical syndrome suggestive of suppurative lymphadenitis. Failure to respond to empiric antibiotics should trigger a diagnostic re-evaluation to determine the need for surgical intervention and/or the possibility of alternative microbiologic diagnoses.

Suppurative iliac lymphadenitis masquerading as appendicitis in an HIV-infected patient

An HIV-infected man presented with acute onset of right iliac fossa pain. Initial assessment of clinical and computed tomography findings suggested a diagnosis of appendicitis. A macroscopically normal appendix was removed. Further imaging performed postoperatively because of persistent symptoms showed a right iliac fossa mass; culture of pus aspirated from the mass grew group A beta-haemolytic Streptococcus confirming a diagnosis of suppurative iliac lymphadenitis.

Coccidioidomycosis in a Black Rhinoceros (Diceros bicornis)

A 5-yr-old female black rhinoceros (Diceros bicornis) was euthanized 11 mo after arrival at the Milwaukee County Zoo (Milwaukee, Wisconsin, USA) from Glen Rose, Texas (USA) for a severe progressive rear leg lameness of 6-mo duration. Gross necropsy revealed complete rupture of the capital ligament of the left femur with synovitis and osteomyelitis. Multifocal lymphadenopathy with chronic suppurative lymphadenitis of the tracheobronchial, left supramammary, and iliac lymph nodes was present. Granulomatous pneumonia with a focal abscess was also noted. Histologically, fungal elements were seen in the lung, lymph nodes, and synovium, and Coccidioides immitis was isolated on fungal culture. Coccidioides immitis is not endemic to Wisconsin; therefore, the animal had to have been infected, although asymptomatic, at the time of arrival at the Milwaukee County Zoo. Whether the disease was active at the time of arrival or whether it was quiescent and then became active with the stress of shipment or injury is unknown.