Atypical parasitic lesions in slaughtered cattle in Southern Brazil / Lesões parasitárias atípicas em bovinos de abatedouro no Sul do Brasil

Abstract In this study, we described the morphological features and unusual presentations of hydatidosis, fasciolosis, and eosinophilic myositis caused by Sarcocystis species diagnosed at the slaughterhouse lines. Twenty-seven samples of atypical parasitic lesions from distinct cattle were evaluated, of which 12 corresponded to hydatidosis, 11 to fasciolosis, and 4 to eosinophilic sarcocystosis. Hydatid cysts were observed mainly in the heart, with all cases involving the left ventricle. Fasciolosis lesions involved mainly the lungs, and were characterized by a focal nodular elevated area involving the edges of the lobes. Intralesional trematodes were observed in three cases. Sarcocystosis lesions were observed in four cases, and lesions were primarily located in the skeletal and cardiac muscles. Grossly, they presented as focal or focally extensive streaks, patches, or numerous nodules that were greenish to mildly yellowish. Histologically, all the cases had intralesional ruptured cysts of Sarcocystis that were associated with severe eosinophilic myositis and myocarditis. Parasitic lesions in atypical locations and/or with aberrant responses should be promptly identified because it may mistakenly diagnosed as other potentially zoonotic diseases, such as cysticercosis and tuberculosis.

Resumo No presente estudo, são descritas as características morfológicas e as apresentações incomuns das lesões parasitárias de hidatidose, fasciolose e miosite eosinofílica por Sarcocystis spp., diagnosticadas nas linhas de abate. Foram analisadas 27 amostras de diferentes bovinos, das quais 12 correspondiam a casos de hidatidose, 11 de fasciolose e 4 de sarcocistose eosinofílica. Os cistos hidáticos foram observados predominantemente no coração, todos com localização no ventrículo esquerdo. As lesões de fasciolose envolveram principalmente os pulmões e eram caracterizadas por áreas nodulares e elevadas nos bordos dos lobos pulmonares. Trematódeos intralesionais estavam presentes em três casos. Lesões de sarcocistose foram observadas em quatro casos, com localização nos músculos esquelético e cardíaco. Macroscopicamente, observaram-se listras, manchas ou numerosos nódulos de coloração esverdeada a discretamente amarelada. Histologicamente, todos os casos apresentaram cistos intralesionais de Sarcocystis spp. rompidos e degenerados, associados à acentuada miosite e miocardite eosinofílica. A identificação das lesões parasitárias em locais poucos frequentes é de extrema importância, pois podem constituir diagnósticos diferencias de enfermidades zoonóticas, como cisticercose e tuberculose.

Focal Eosinophilic Myositis Associated with Behçet's Disease

Behçet's disease (BD) is a systemic vasculitis commonly accompanied by recurrent mucosal ulceration and other systemic manifestations, but rarely by myositis. Focal eosinophilic myositis is the most limited idiopathic eosinophilic myopathy characterized by peripheral blood eosinophilia and/or eosinophilic muscle infiltration. Clinical manifestations include myalgia, muscle weakness, and cutaneous lesions, such as subcutaneous induration and erythema. Given that BD can mimic deep vein thrombosis or pseudotumor, muscle biopsy should be performed to enhance the accuracy of diagnosis. Microscopic examination reveals extensive infiltration of eosinophils and mononuclear cells into muscle, myofiber necrosis, and regeneration. To the best of our knowledge, there have not been any published reports on MEDLINE regarding focal eosinophilic myositis associated with BD. Here, we presented a case of focal eosinophilic myositis associated with intestinal BD in a 23-year-old man who suffered from a large ulcer in the terminal ileum.

A Case of Eosinophilic Polymyositis Treated with Immunosuppressants

Eosinophilic polymyositis is a rare form of inflammatory muscle disease associated with peripheral blood and/or tissue eosinophilia. Most patients respond to glucocorticoids, however some show poor prognosis, leading to mortality. A 28-year-old female was admitted to our hospital because of myalgia and motor weakness of the upper and lower extremities. Laboratory findings showed significantly elevated levels of muscle enzymes and inflammatory lesions in both thigh muscles were demonstrated on magnetic resonance imaging. A diagnosis of eosinophilic polymyositis was based on histological findings, which showed diffuse eosinophilic infiltration into perivascular spaces in the endomysium and perimysium, and necrosis of myofibers. High-dose methylprednisolone treatment improved the clinical symptoms and muscle enzymes. However, on tapering the glucocorticoid dose, clinical and laboratory findings were exacerbated. After the addition of methotrexate and azathioprine, the symptoms and muscle enzymes recovered without relapse. Here, we report on a case of eosinophilic polymyositis, which responded to immunosuppressants.

Miosite eosinofílica em bovinos abatidos para consumo humano / Eosinophilic myositis in cattle slaughtered for human consumption

Miosite eosinofílica é uma condição inflamatória relativamente rara que afeta os músculos estriados de bovinos e ovinos. A lesão é usualmente associada a cistos degenerados de Sarcocystis spp., principalmente S. cruzi embora esse protozoário ocorra associado às miofibras de praticamente qualquer bovino, sem provocar, na grande maioria das vezes, reação inflamatória. Esse artigo relata os achados macro e microscópicos da miosite eosinofílica em três bovinos abatidos para produção de carne para consumo humano. Macroscopicamente, as lesões consistiam de manchas ou linhas amarelo-pálidas, ocasionalmente esverdeadas, de 2-6mm no miocárdio de três bovinos e no músculo masseter de um deles. Microscopicamente, as lesões consistiam de acúmulos inflamatórios granulomatosos circundando um centro constituído por eosinófilos mortos e degenerados e ocasionais fragmentos de Sarcocystis sp. A imuno-histoquímica realizada no miocárdio de um dos bovinos com um anticorpo policlonal anti-Neospora caninum marcou cistos intactos em miofibras normais e fragmentos de cistos em meio a áreas de intensa reação inflamatória. Esse último achado corrobora a opinião dos que apontam Sarcocystis sp. como tendo participação na causa da miosite eosinofílica.

Eosinophilic myositis is a relatively rare inflammatory condition affecting striated muscle of cattle and sheep. It has been usually associated with degenerating cysts of Sarcocystis spp., mainly S. cruzi, although this protozoan occurs in the myofibers of almost every cattle without provoking an inflammatory reaction. This paper reports the gross and histopathological findings of eosinophilic myositis in three cattle slaughtered for meat production for human consumption. Grossly lesions were pale yellow, occasionally with a greenish hue, 2-6mm spots or strikes in the myocardium of the three cattle and in the masseter muscle of one of them. Microscopically there were granulomatous lesions surrounding a core of dead and degenerating eosinophils and occasional fragment components of Sarcocystis. Immunohistochemistry performed with a policlonal anti-Neospora caninum antibody in the myocardium of one of the cattle marked intact cysts in normal myofibers and intralesional fragments of disrupted cyst amidst areas with strong inflammatory reaction. This latter finding corroborates the opinion of those in favor of Sarcocystis spp. playing a role in the causation of eosinophilic myositis.

Eosinophilic Myositis Induced by Anti-tuberculosis Medication / 영남의대학술지

Eosinophilic myositis is a rare idiopathic inflammatory muscle disease, and the patients with this malady present with diverse signs and symptoms such as muscle swelling, tenderness, pain, weakness, cutaneous lesions and eosinophilia. The etiology and pathogenesis of eosinophilic myositis remain elusive. Several drugs may occasionally initiate an immune mediated inflammatory myopathy, including eosinophilic myositis. We report here on a case a 17-year-old female patient who had taken anti-tuberculosis medicine for tuberculosis pleurisy. She presented with many clinical manifestations, including fever, skin rash, proximal muscle weakness, dyspnea, dysphagia and hypereosinophilia. She was diagnosed with eosinophilic myositis by the pathologic study. The muscle weakness progressed despite of stopping the anti-tuberculosis medicine, but the myositis promptly improved following the administration of glucocorticoid. Although drug induced myopathies may be uncommon, if a patient presents with muscular symptoms, then physicians have to consider the possibility of drug induced myopathies.

Eosinophilic myositis in a slaughtered Korean native cattle

Histopathological findings of eosinophilic myositis in the carcass of a slaughtered Korean native cow are presented. Lesions contained massive fibrous septae with vacuolar changes in some lesions, and the hypercontraction and rupturing of muscle bundles, with replacement by eosinophils. Necrosis and severe eosinophil infiltration were observed. Sarcoplasmic fragmentation and atrophy developed. Typical of granuloma, calcified myofibers were focally surrounded by macrophages and numerous inflammatory cells, and multinucleated giant cell formation was evident.

Focal Eosinophilic Myositis

We report a case of focal eosinophilic myositis of the frontalis muscle in a 38-year-old man. The skin lesion was a single firm flesh-colored swollen lesion measuring 1×1.5 cm in size on the right forehead. The biopsy revealed inflammatory infiltrates composed of mainly eosinophils and a few lymphocytes in the muscles. The skin lesion subsided with intralesional injections of triamcinolone acetonide, 5 mg/ml.