Primary diffuse large B-cell lymphoma of testis: a single centre experience and review of literature

Primary testicular lymphoma constitutes 1-2% of Non-Hodgkin's lymphomas affecting elderly men >60 years of age. Most often it is a Diffuse large B cell lymphoma [DLBCL] and treatment involves multimodality approach involving surgery, chemotherapy and radiotherapy. Outcome remains poor in spite of aggressive therapy. We retrospectively reviewed 286 registered cases of DLBCL [aged >14 years] from 2007 to 2011 and found nine primary testicular involvement patients. These cases were analyzed for baseline clinical features, investigations, staging, treatment and outcome. Median age was 58 [46-76] years. All patients presented with testicular swelling, two had the presence of B symptoms, and three with abdominal lymphadenopathy. Six had stage IE disease and three patients had stage IIE. All patients underwent orchiectomy. Eight patients received combination chemotherapy and six completed three or more cycles. Four achieved complete response, among these three relapsed after 32, 42, 70 months and one was lost to follow up. Two had a progressive disease, among these one died of disease and one alive with disease. Complete follow up was available from five patients and median survival was 36 months [11-78 months]. Primary testicular DLBCL is uncommon, needs multimodality treatment and central nervous system prophylaxis to improve the survival. The outcome needs to be further investigated using biological approaches [Rituximab based] and/or more aggressive management

A case report of herpetic and candidal esophagitis in an immunocompetent adult

Reports of combined candidal and herpetic esophagitis in immunocompetent states are rare and sporadic. A 44-year-old previously healthy lady presented with a one week history of progressive dysphagia, odynophagia and fever. Esophagogastroduodenoscopy (EGD) showed extensive desquamation of the entire esophagus except for distal 4 cm. Histopathological examination revealed ulcerated and inflamed squamous epithelium with the margin of ulcer showing a few overhanging squamous cells with dense eosinophilic cytoplasm, multinucleated and faceted nuclei with glassy chromatin, and an occasional Cowdry type A intranuclear inclusion bodies. Few candidal spores were seen in the underlying stroma. Intravenous acyclovir, fluconazole and pantoprazole were initiated. Oral analgesics were given for pain relief. She was treated for a total of 14 days. She showed significant improvement and was tolerating oral intake after discharge. The patient was asymptomatic with no evidence of recurrence at a 2-month follow-up.

A rare case of hepatic cysticercosis

Human cysticercosis is an infection with the larval stage of Taenia solium and is commonly seen in developing countries. It usually involves the central nervous system but other organs like the heart, skeletal muscle and the orbit can also be involved. Rarely, the liver can also be the site of involvement. We report a case of a 25-year-old male with no premorbid illness but with a history of headache and vomiting. His physical and laboratory examinations suggested a diagnosis of tubercular meningitis. However, the high resolution ultrasound imaging of his abdomen showed that there were multiple cysticerci with scolices. IgG of cysticercosis detected by ELISA was also strongly positive, which supported the diagnosis of hepatic cysticercosis. He was managed with albendazole. This kind of cases has only been reported twice before in medical literature. It highlights the need to use high resolution ultrasonography in patients with a high index of suspicion of hepatic cysticercosis because of its occult presentation.

Clinical profile of brucellosis from a tertiary care center in southern India

OBJECTIVE@#To highlight the spectrum of clinical manifestations, labs, complications, treatment and outcome of brucellosis.@*METHODS@#Retrospective study was conducted in Kasturba Medical College, Manipal University, Karnataka, India which included 68 confirmed cases of brucellosis from January 2006- April 2010. Diagnosis of brucellosis was made by culturing the sera/body fluids by standard BACTEC method (or) by testing the sera for Brucella agglutinins using the standard agglutination test (SAT). A titer of 1:320 or more was considered as significant. SPSS 16 was used for statistical analysis and Microsoft Excel for graphical representation.@*RESULTS@#Of the 68 patients, 46 (68%) were male and 22 (32%) were female patients with age distribution of 9-75 years. Forty four (64.7%) had history of contact with unpasteurized dairy products or infected animals. Symptoms included fever (68, 100%), myalgia (21, 31%), musculoskeletal symptoms (23, 34%), headache (16, 24%), gastrointestinal symptoms (19, 28%) and altered sensorium (3, 4%). Co-morbidities and associations included HIV positivity (2, 3%), type 2 diabetes mellitus (13, 19%), steroid therapy (3, 4%) and HBsAg positivity (8, 12%). Ten (15%) patients had cervical lymphadenopathy, 4(6%) had splenic enlargement, 6 (7%) had hepatomegaly, 19 (28%) had hepatosplenomegaly and 2(3%) got meningeal signs. Anaemia was observed in 39 (57.3%) cases, high erythrocyte sedimentation rate (ESR) was present in 55 (80.8%) cases, leucocytosis in 10(14.7%), leucopenia in 10(14.7%), thrombocytopenia in 23 (33.82%) and thrombocytosis in 2 (2.94%) cases.@*CONCLUSIONS@#In countries like India, where brucellosis and tuberculosis are endemic; rapid, sensitive and highly specific diagnostic methods are required to make early diagnosis and prevent resistance as there is an overlap in therapy.