Lymphadenopathy and fever in a chef during a stay in Europe / Linfadenomegalia e febre em chefe de cozinha durante viagem à Europa

This case illustrates a rare presentation (as lymphadenopathy and fever) of one of the most common zoonotic diseases worldwide-brucellosis-in a 22-year-old Brazilian male (a chef) who had recently returned to Brazil after having lived in and traveled around Europe for one year. The histopathology, clinical history, and response to treatment were all consistent with a diagnosis of brucellosis, which was confirmed by PCR in a urine sample. We also review some aspects of brucellosis, such as the clinical features, diagnosis, and management.

Ilustramos aqui um caso de uma apresentação atípica (na forma de linfadenomegalia e febre) de uma das doenças zoonóticas mais comuns no mundo - brucelose - em um paciente brasileiro de 22 anos (chefe de cozinha) que retornara ao Brasil recentemente após ter morado e viajado na Europa por um ano. A histopatologia, a história clínica e a resposta ao tratamento foram consistentes com o diagnóstico de brucelose, que foi confirmada por PCR em uma amostra de urina. Também revisamos alguns aspectos da brucelose, como manifestações clínicas, diagnóstico e tratamento.

Comparative Study of Real-Time PCR with Culture in the Diagnosis of Tubercular Lymphadenopathy.

One-third of the world’s population is estimated to be infected with M.tuberculosis. Timely and accurate diagnosis is pivotal in the management of the disease. Conventional tests, although accurate, are time consuming as compared to the more promising latest molecular techniques like real-time PCR which are rapid, reproducible and reliable. Objective : The aim of the study is to compare the real-time PCR with culture method in the diagnosis of tubercular lymphadenopathy. Material and Methods: Present study included 40 patients belonging to the age group 0-40 years and presenting as cervical lymphadenopathy, attending the indoor and out-patient of Department of TB & Chest Diseases, S.N. Medical College, Agra (U.P.) from Jan’2009 to June’2010. All patients were subjected to routine investigations, e.g. hemogram, montoux test, Chest skiagram, AFB staining, and sputum examination. Lymph node aspirate were subjected to decontamination, DNA isolation and Real time PCR( q PCR). Also specimen were simultaneously put to culture on L.J. Media. Results of both modalities compared. Results: Conventional culture method was able to detect M.tuberculosis in 75% of the cases as compared to real-time PCR which was positive in 77.5% with comparable sensitivity (100% vs 96.7%) and specificity (100% vs 87.5%). Conclusion: Conventional culture method is gold standard in the diagnosis of tuberculosis since long but recent molecular assays like Real-time PCR is one of the latest addenda to the armamentarium for the rapid and accurate diagnosis of M.tuberculosis. Needless to say, early diagnosis is advantageous to the management of tuberculosis.

Enfermedad relacionada a IgG4, el nuevo "gran simulador": caso clínico / IgG4-related disease, the new "great mimicker": Report of one case

Due to its multisystem involvement, IgG4 -related disease should be considered in the differential diagnosis of medical conditions such as lymphadenopathies, aortitis, serositis and retroperitoneal fibrosis. It shares features with other entities historically described as "great mimickers" such as syphilis, tuberculosis, sarcoidosis, and systemic lupus erythematosus. We report a 40 year-old male with recurrent effusive - constrictive pericarditis, lymphadenopathy and aortitis. The study revealed an inactive tuberculosis with negative cultures for acid fast bacilli. The patient had high serum levels of IgG4 and a mediastinal lymph node biopsy was consistent with IgG4 -related disease. The patient was treated with prednisone 40 mg/day with an excellent response.

Nonadenomatous nonencapsulated thymic parathyroid tissue concomitant with primary hyperparathyroidism due to ectopic parathyroid adenoma / Tecido tímico paratireoidiano não edematoso e não encapsulado concomitante com hiperparatireoidismo devido a adenoma paratireoidiano ectópico

Primary hyperparathyroidism due to ectopic parathyroid adenoma is not infrequent. Primary hyperparathyroidism caused by unusual thymic nonadenomatous nonencapsulated parathyroid tissue has been reported before. Both can cause unsuccessful neck explorations. Here we presented for the first time a patient with hyperparathyroidism due to ectopic parathyroid adenoma concomitant to the presence of thymic nonadenomatous nonencapsulated parathyroid tissue.

O hiperparatireodismo primário devido a adenoma ectópico paratireoidiano não é raro. O hiperparatireodismo primário causado por tecido tímico paratireoidiano não edematoso e não encapsulado incomum já foi relatado anteriormente. Ambos podem levar à exploração cervical malsucedida. Apresentamos aqui, pela primeira vez, uma paciente com hiperparatireoidismo decorrente de um adenoma paratireoidiano concomitante com a presença de tecido tímico paratireoidiano não edematoso e não encapsulado.

Acquired multiple clotting factor inhibitors in children

Acquired childhood multiple clotting factor inhibitors are rare especially in the absence of lupus anticoagulants. They may represent multiple specific inhibitors or may be non-specific, resulting from molecular mimicry or cross-reacting antibodies. Their exact nature and natural history are not well known. To report our experience with seven children presenting with prolonged activated partial thromboplastin time [APTT], with or without bleeding, not corrected by mixing, and showing deficiency of > one clotting factor. Prospective review. Mubarak Hospital, Kuwait. Patients referred to the pediatric hematology unit between 2010 and 2012 with deranged coagulation profiles with or without bleeding, without a previous or family history of a bleeding disorder. They all had multiple clotting factor deficiencies. Prothrombin time [PT] and APTT assay. Control of bleeding and normalization of coagulation factors and APTT. The patients were aged 6 months to 8 years; three presented with mild to moderate bleeding and five had preceding viral infections. Factor IX was decreased in all cases in addition to deficiencies of factors VIII, X and / or XI in various combinations. There was spontaneous recovery in five patients in whom the factors and APTT normalized within two to five months. One patient died from massive pulmonary hemorrhage and another with nephropathy remains the same after two years. Multiple acquired inhibitors are not uncommon in children, tend to follow viral infections, and are usually transient and not associated with severe bleeding

FNAC of Lymph Node Disorders.

Introduction: Fine needle aspiration cytology (=FNAC) is most popular diagnostic aid in patients with lymphadenopathy. This paper proves it to be highly sensitive also. Materials and Methods: The study comprises 300 lymph node aspirates done at Shri Mahant Indiresh Hospital of SGRR Medical College during a period of two years from January 2009 to December 2010. Results: Cytology was unsatisfactory in 3.3% (n=3) cases; showed reactive non specific lymphadenitis in 41.7% (n=125) cases; tuberculosis in 31.7% (n=95) cases; primary lymphomas in 6.3% (n=19) cases and metastatic tumor in 10.7% (n=32) cases. Conclusion: FNAC is a very sensitive procedure in patients with lymphadenopathy; sensitivity of 96.7% reported in our study.

Fat poor angiomyolipoma with lymphadenopathy: diagnostic dilemma

A 24-year-old lady presented with left flank pain of 3 months duration. She had stigmata of tuberous sclerosis complex in the form of angiofibromas on face, ash-leaf macules on back and right upper limb and shagreen patches over back. Computed tomography scan of the abdomen showed 6.5 cm x 5.0 cm x 4.4 cm lobulated intensely enhancing exophytic mass lesion in mid pole of left kidney with significant para-aortic lymphadenopathy with no evidence of fat in the mass. She underwent radical left nephrectomy with a provisional diagnosis of renal cell carcinoma. Histopathological examination showed multicenteric angiomyolipoma involving kidney and para-aortic lymph nodes. This case report underscores the need for further research to differentiate fat-poor angiomyolipoma and lymphadenopathy from renal cell carcinoma

Role of Imprint Cytology in Diagnosis of Lymph Node Lesions.

Introduction: Imprint cytology is proved to be rapid inexpensive tool in the diagnosis of various lymph node lesions. Objective: The present study was conducted to correlate the diagnostic accuracy, sensitivity and specificity of imprint cytology of various lymph node lesions with histopathological diagnosis. 102 cases were included in the study comprising inflammatory lesion, tubercular lymphadenitis, lymphomas and metastatic carcinomas. Material and Method: From 102 cases of lymph node excision, imprint smears were taken and stained with Hematoxylin & Eosin and Papanicolaou stains. The findings of imprint cytology were then compared with final histopathological diagnosis. Result: When compared with final histopathological diagnosis, imprint smears showed overall diagnostic accuracy of 97.8% with sensitivity and specificity of 95.05% and 98.69% respectively. Accuracy rate for metastatic lymphadenopathy was 100%, whereas, for tubercular lymphadenitis it was 98.04% and for lymphomas 96.04%. Conclusion: Imprint cytology proved to be very useful for diagnosis of metastatic tumour as it gave 100% diagnostic accuracy, sensitivity and specificity. Imprint cytology is also considered to be useful in superficial ulcers to differentiate between benign and malignant lesions without surgical intervention.

Endobronchial Ultrasound-guided Transbronchial Needle Biopsy for Diagnosis of Mediastinal Lymphadenopathy in Patients with Extrathoracic Malignancy

Mediastinal lymphadenopathy associated with extrathoracic malignancy or a metastasis of unknown origin (MUO) requires pathological verification. Surgical exploration or endoscopic ultrasound-guided fine needle aspiration is limited to application. We investigated the effectiveness of endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) for evaluating mediastinal lymphadenopathy in patients with an extrathoracic malignancy. We retrospectively analyzed data from 59 patients who underwent EBUS-TBNA with a core biopsy because of a suspected mediastinal metastasis between September 2008 and August 2010. All patients had previously been diagnosed with an extrathoracic malignancy (n = 39, 66.1%) or a suspected MUO without a thoracic lesion (n = 20, 33.9%). A total of 88 lymph nodes was analyzed. EBUS-TBNA findings indicated malignancies in 34 patients (57.6%). The EBUS-TBNA sensitivity and specificity for the detection of mediastinal malignancy in patients with a previous extrathoracic malignancy were 96.3% and 100%, respectively. For MUO patients without a thoracic lesion, the sensitivity and specificity were 61.5% and 100%, respectively. The overall sensitivity and specificity were 81.0% and 100%, respectively (P = 0.053). EBUS-TBNA is a safe and effective modality for evaluating mediastinal lymphadenopathy in patients with a previous extrathoracic malignancy or a MUO without a thoracic lesion. The application of this diagnostic tool is likely to have significant clinical implications.

Yield of cervical mediastinoscopy in diagnosis of indeterminate mediastinal lymphadenopathy/masses and staging of lung cancer

To determine the yield of cervical mediastinoscopy in indeterminate antero-superior mediastinal lymphadenopathy or masses and in staging of non small cell carcinoma lung. Descriptive prospective study. Thoracic Surgical unit of Combined Military Hospital Rawalpindi from Jan 2007 to June 2009. Patients were placed in group I for diagnostically indeterminate antero superior mediastinal lymphadenopathy/masses and in group II for staging of non small cell lung cancer [NSCLC] with enlarged mediastinal lymph nodes on CT scan [greater than 10 mm on short axis]. All patients underwent the procedure under general anaesthesia. A plane anterior to trachea was developed using blunt finger dissection until carina. Biopsies of the mass or lymph nodes were taken and sent for histopathology. In case of staging for Carcinoma lung, lymph node stations 2L, 2R, 4L, 4R and 7 were searched and biopsied and sent in appropriately labelled containers for histopathology. Patients were usually discharged on the same day. Forty eight cases were included in this study during the course of 2 1/2 years of period. Twenty nine cases were included in group I and nineteen in group II. In group I chronic caseating granulomas due to tuberculosis were the most cause in 45% of cases followed by 24% cases of lymphoma. In group II, 4 [21%] cases revealed no evidence of malignancy in any lymph nodes and in 11 [57.9%] cases only ipsilateral mediastinal lymph nodes were involved by tumor making it N2 disease. In 4 [21%] cases contra lateral mediastinal lymph nodes were involved by tumor making it N3 disease. Mortality in this study was only one case [3 4%] Mediastinoscopy is minimally invasive cost effective and simple procedure in trained hands for both diagnosis and staging purpose

Linfadenopatia cervical na infância: etiologia, diagnóstico diferenciale terapêutica: [revisão] / Cervical lymphadenopathy in children: etiology, differential diagnosis and management: [review]

Linfadenopatia é o termo empregado em qualquer alteração em tamanho e consistência de linfonodos. A linfadenopatia cervical é um problema muito frequente nos pacientes da faixa etária pediátrica e, em geral, representa reação transitória a processos inflamatórios ou infecciosos locorregionais ou sistêmicos. Porém, em uma pequena parcela, há neoplasias como fator etiológico. Na grande maioria das vezes, esses pacientes são efetivamente tratados pelo pediatra, porém, quando não há resposta à terapia inicial ou quando há suspeita de malignidade, o cirurgião pediátrico ou de cabeça e pescoço deve ser consultado. Este trabalho teve por objetivo revisar a etiologia, o diagnóstico diferencial e a terapêutica da linfadenopatia cervical na infância.

Lymphadenopathy refers to any alteration in size and consistency involving lymph nodes. Cervical lymphadenopathy is a very frequent problem in the pediatric group and, in general, represents a transitory reaction to locoregional or systemic inflammatory or infectious process. However, in a few cases, there is neoplasia as etiologic factor. Although most patients are successfully treated by their pediatrician, the pediatric or head and neck surgeon should be consulted for patients who fail to respond to initial therapy or for those in whom there is a suspiciousness of malignancy. The aim of this article was to review the etiology, the differential diagnosis, and the management of cervical lymphadenopathy in children.

Penicillin V-induced drug rash with eosinophilia and systemic symptoms / Erupción cutánea inducida por la penicilina V con eosinofilia y síntomas sistémicos

DRESS syndrome (drug reaction with eosinophilia and systemic symptoms), previously named "drug hypersensitivity syndrome", is a severe adverse drug reaction characterized by skin rash, fever, lymph node enlargement and internal organ involvement. We report on a 7-year old girl who developed DRESS syndrome caused by penicillin V treatment.

El síndrome DRESS (así llamado por las indíciales del inglés "drug reaction with eosinophilia y systemic symptoms ") es una reacción a medicamentos, acompañada por eosinofilia y síntomas sistémicos. Conocida anteriormente como "síndrome de hipersensibilidad a los medicamentos, se trata de una reacción adversa severa a los medicamentos, caracterizada por erupción cutánea, fiebre, agrandamiento de los ganglios y compromiso de órganos internos. El presente trabajo reporta el caso de una niña de 7 años de edad, que desarrolló el síndrome DRESS a partir de un tratamiento con penicilina V.

Drenagem linfática em paciente com dermatofibrose e flebite de membro inferior: relato de caso / Lymph drainage in patients with dermatofibrosis and phlebitis of the lower limb: case report

O presente estudo objetivou avaliar a drenagem linfática como forma coadjuvante de tratamento, em uma paciente idosa com dermatofibrose, flebite de membro inferior e queixa de dores na perna, localizada em região pós-flebítica. Foi realizado tratamento clínico inicial por três meses com drogas venotônicas (diosmin), anti-inflamatórios, analgésicos e repouso, porém com pouca melhora clínica. Foi, então, associada ao tratamento clínico, a drenagem linfática manual e mecânica. Os resultados obtidos incluíram a redução dos sintomas dolorosos e da hiperpigmentação do local acometido. Este trabalho sugere que a drenagem linfática obteve melhora do quadro clínico de paciente portadora de dermatofibrose, sugerindo novas pesquisas para caracterização mais específica dessa abordagem.

This study aimed at evaluating lymphatic drainage as a complementary form of treatment in an elderly patient with dermatofibrosis and phlebitis of the lower limb. The patient complained of pain in the post-phlebitic region. Initially three months of clinical treatment was performed using vasotonic(diosmine), anti-inflammatory and analgesic drugs and the patient was told to rest. However this treatment was not very effective. Manual and mechanical lymph drainage was associated to the clinical treatment. The results gave a significant improvement in the symptoms and the hyperpigmentation of the affected area. This study suggests that lymph drainage obtained improves the clinical of patient with dermatofibrosis, suggesting new research for more specific characterization of this approach.