Adenitis tuberculosa: experiencia de una unidad de asistencia inmediata / Tuberculous adenitis: Experience from an immediate assistance unit

Resumen Introducción : En el consultorio de atención inmediata de clínica se concentra la atención de pacientes ambu latorios con enfermedades que requieren diagnóstico precoz, como la adenitis tuberculosa (AT). El objetivo fue describir las características clínicas, estudios com plementarios y procedimientos realizados a pacientes con diagnóstico confirmado por bacteriología o anatomía patológica de AT. Métodos : Estudio observacional, descriptivo, retros pectivo. Período: 2017-2023. Resultados : Se incluyeron 49 pacientes, con una mediana de edad de 31 años; 59% de sexo femenino, 22% con comorbilidades El 40% presentó adenopatías localizadas, la mayoría cervicales. La serología para HIV era positiva en 3 (6.1%). Al 73% se le ingresaron muestras para bacteriología, con aislamiento de M. tuberculosis en 71%. Al 79% se le realizó punción aspiración con aguja fina (PAAF) ganglionar; en el 48% los resultados de la citología fueron sugestivos de tuberculosis (TB). Al 77% se le realizó biopsia ganglionar, resultando en el 62% adenitis granulomatosa. Desde la primera consulta hasta el diagnóstico transcurrieron una mediana de 40 días. La mayoría de los tratamientos se iniciaron luego del resultado de la biopsia, seguido de cultivos, baciloscopia, PAAF y GeneXpert. Un paciente falleció. Discusión : La AT predominó en el sexo femenino en el grupo estudiado, coincidente con la experiencia local, la edad promedio de presentación fue 30 a 40 años. Puede afectar cualquier cadena ganglionar, aunque predomina la localización cervical, que coincide con los hallazgos de este trabajo. En nuestra serie, la demora diagnóstica desde la primera consulta fue menor a la referida en la bibliografía.

Abstract Introduction : In the clinical medicine's immediate assistance unit, care is focused on outpatients with dis eases that require early diagnosis, such as tuberculous adenitis (TA). The aim was to describe clinical features, complementary studies and procedures performed in patients with a diagnosis confirmed by bacteriology or pathological anatomy of TA. Methods : Observational, descriptive, retrospective. Period: 2017-2023. Results : Fourty nine patients were included, with a median age of 31 years, 59% were female, 22% with comorbidities. 40% had localized lymphadenopathy, most of them cervical. HIV serology was positive in 3 cases (6.1%). Samples for bacteriology were submitted in 73%, with isolation of M. tuberculosis in 71%. Nodal fine needle aspiration (FNA) was performed in 79%, and in 48% the cytology results were suggestive of tuberculosis. Nodal biopsy was performed in 77%, with granulomatous adenitis as result in 62%. The term between admis sion and diagnosis ranged from a median of 40 days. Most treatments were started after the biopsy result, followed by culture, bacilloscopy, FNA, and GeneXpert. One patient died. Discussion : TA predominates in the female sex in the studied group, coinciding with the local experience, the average age of presentation is 30 to 40 years, can affect any lymph node region, although the cervical location predominates, which coincides with the findings of this work. In our series, the diagnostic delay from the first consultation was shorter than reported in the literature.

Bacillus Calmette-Guerin lymphadenitis in children: an underdiagnosed entity

Background: Bacillus Calmette-Guerin (BCG) lymphadenitis is a common complication after BCG vaccination. Fine needle aspiration cytology (FNAC) is a feasible and cost-effective procedure for the diagnosis and management of this entity. Awareness of this entity in cytology is important to avoid misdiagnosis, as the cytomorphologic features are very similar to tuberculosis. The present study described the clinical presentation and detailed cytomorphologic features in patients with BCG lymphadenitis. Methods: This was a retrospective study from 2018 to 2022 involving a total of 27 patients who presented with isolated left axillary or cervical lymphadenopathy. Results: Age at presentation ranged from 1 to 24 months. The male- to-female ratio was 2.75:1. Majority of the children had enlargement of the left axillary lymph nodes followed by cervical nodes. Cytomorphology showed the presence of dense acute and chronic inflammatory cells, epithelioid cell granulomas, multinucleated giant cells, histiocytic aggregates, reactive lymphoid cells, lymphohistiocytic clusters and calcification. Necrotic background was present in 25 (92.6%) cases. Ziehl-Neelsen staining for acid-fast bacilli was positive in 17 (62.9%) cases. Conclusions: A high index of clinical suspicion for BCG lymphadenitis should be kept in mind for children who are recently vaccinated. Diagnosis of this entity is based primarily on clinical grounds. However, cytology and microbiological examination are encountered as part of clinical work up of lymph node swelling. FNAC in conjunction with clinical presentation is useful for diagnosis of BCG lymphadenitis and avoid an unwarranted tubercular treatment.

Explore the Diagnosis and Treatment of Histiocytic Necrotizing Lymphadenitis Based on Insidious Pathogen Warm Disease Theory / 浙江中医药大学学报

[Objective]To explore the etiology,pathogenesis and clinical treatment of histiocytic necrotizing lymphadenitis(HNL)based on the insidious pathogen warm disease theory.[Methods]To analyze the etiology,pathogenesis,characteristics of symptoms and transmission of the disease in Chinese medicine,and summarize the treatment principles based on the descriptions about insidious pathogen warm disease in ancient literature and modern researches on HNL,and cite a clinical case for verification.[Results]The pathogenesis of the HNL is mainly characterized by deficient healthy Qi leading to latent evil.The specific manifestation is that exogenous evils are latent in the Moyuan,which causes Yang Qi to be blocked and depressed and turns into heat.Evil heat spreads from the Moyuan to the Shaoyang tri-Jiao,leading to the generation of phlegm,static blood,turbid evil and toxin in the body,which in turn leads to disease.In terms of treatment,supporting healthy Qi and eliminating the evil is regarded as the law of treatment,and the emphasis is eliminating the evil.Aiming at the three pathogenetic links of latent evil,depressed heat and internal production of pathological products,the following treatment principles are formulated:expelling evils from Moyuan,dredging tri-Jiao and promoting the flow of Qi to make the evil heat go out,clearing away endogenous pathological products,removing toxin and dispersing knots.The focus of supporting healthy Qi is the protection of Qi and Yin as well as recuperation after recovery,which prevents evil Qi from remaining and causing the disease to reoccur.The medical case cited was a patient with HNL treated by applying the theory of insidious pathogen warm disease.Damp-heat and toxin brewing,phlegm combined with static blood was the traditional Chinese medicine(TCM)pattern of this case.The the prescriptions were based on Shengjiang Powder combined with Sanren Decoction,and Ganlu Xiaodu Pill successively,added and subtracted according to the syndrome,and the case achieved a significant effect.[Conclusion]The effect of treating HNL based on the insidious pathogen warm disease theory is quite good,which can provide new ideas and methods for the diagnosis and treatment of HNL.

Kikuchi–Fujimoto disease: A rare cause of cervical lymphadenopathy

Kikuchi–Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare and generally self-limiting disease of uncertain etiology that presents with fever and cervical lymphadenopathy in both the pediatric and adult populations. Here, we present the case of a 5-year-old male who presented with acute onset of fever and cervical lymphadenopathy which was initially diagnosed and managed as staphylococcal lymphadenitis. He underwent an excisional biopsy when symptoms persisted, which confirmed the diagnosis of KFD and was managed conservatively. This case study emphasizes awareness of this entity in the differential diagnosis of fever with persistent lymphadenopathy. Due to its characteristic overlap with other disorders such as tuberculous lymphadenitis, and lymphoma, KFD remains an arduous diagnosis for physicians. Therefore, awareness about its symptoms helps in minimizing potentially harmful unnecessary evaluations and thereby preventing misdiagnosis and inappropriate treatment.

CYTOMORPHOLOGY PATTERN ON FNAC AND AFB POSITIVITY IN CASES OF TUBERCULAR LYMPHADENITIS IN A TERTIARY CARE CENTRE OF CENTRAL INDIA

Background- One of the most typical diagnoses at OPDs in a developing nation like India is tuberculous lymphadenitis. Anti-tubercular therapy, however, cannot be started based solely on clinical suspicion. Along with culture, cytomorphology with acid fast staining is an effective tool for diagnosing these cases. The purpose of the study was to examine the usefulness, limits, and relationships between Ziehl-Neelsen staining in tuberculous lymphadenitis and various cytomorphological presentations using fine needle aspiration cytology. At a tertiary care facility, the study was Materials and Methods- carried out over the course of a year with a total of 146 cases. Patients who had lymphadenopathy that was clinically suspected were chosen. There were 36.3% cases of tuberculous Resultlymphadenitis out of which 66.04% cases were overall AFB positive. The most frequent cytological finding was epithelioid cell granulomas with lymphocytes, and cases with granulomas and necrosis had the highest levels of AFB positivity. Most patients first showed up in their third or fourth decade of life. Solitary lymphadenopathy, as opposed to matted lymph nodes as reported by others, was the most frequent presentation and the cervical area was the most frequently involved site. Fine needle as Conclusion- piration cytology is a highly sensitive method for diagnosing tuberculous lymphadenitis that is inexpensive, safe, and dependable. By adding acid fast staining and culture procedures to cytomorphology, the diagnostic index can be raised even higher. However, FNAC combined with methods like ELISA and PCR would improve the current landscape of diagnostic and therapeutic options.

Kikuchi-Fujimoto disease. An unusual disease

Kikuchi-Fujimoto disease is self-limited, has a good prognosis, is diagnosed histopathologically, is more common on the Asian continent, in women and in those under the age of 40, and is usually diagnosed by exclusion. We present the case of a 20-year-old male patient with no significant medical history who consulted due to persistent fever, enlarged lymph nodes, gastrointestinal symptoms and weight loss. He debuted with pancytopenia, elevated acute phase reactants and altered liver function, and underwent an excisional lymph node biopsy, whose findings were compatible with Kikuchi-Fujimoto disease. He was treated symptomatically with NSAIDs and was followed up one month after discharge, at which time there was no evidence of recurrent fever or other additional symptoms. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2553).

La enfermedad de Kikuchi Fujimoto es autolimitada, de buen pronóstico, de diagnóstico histo-patológico, cuya incidencia es mayor en el continente asiático en mujeres, en menores de 40 años y usualmente es un diagnóstico de exclusión. Presentamos el caso de un paciente masculino de 20 años sin antecedentes patológicos, quien consultó por fiebre persistente, adenopatías, síntomas gastrointestinales y pérdida de peso; debutó con pancitopenia, aumento de reactantes de fase aguda, alteración de función hepática y en quien se le practicó biopsia excisional de ganglio, la cual evidenció hallazgos compatibles con la enfermedad de Kikuchi Fujimoto. Se hace manejo sintomático con AINES y se realiza control al mes de egreso, donde no hay evidencia de recurrencia de picos febriles u otros síntomas adicionales. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2553).

Role of FNAC in head and neck region lymphadenopathy - A tertiary care centre experience

Background: FNAC (Fine Needle Aspiration Cytology) is a well accepted technique and plays an important role in early diagnosis of head and neck lesions. It is a safe and inexpensive outdoor procedure. Materials and methods: This study was carried out over a period of 9 months (January 2021 to September 2021). A total of 60 patients with head and neck lymphadenopathy were subjected to FNAC at a tertiary care centre in Vadodara, Gujarat. All reports were recorded and data was entered and analyzed using Microsoft excel. Results: In the present study, the various causes of head and neck lymphadenopathy were classified according to cytomorphological patterns. Among the diagnostic outcome, overall prevalence of granulomatous lymphadenitis was 35% (21 cases), reactive hyperplasia was 26.67% (16 cases), secondary metastases were 18.33% (11 cases), lymphoma was 10% (6 cases) and acute non-specific lymphadenitis was 10% (6 cases). Conclusion: FNAC is simple, quick, inexpensive and safe diagnostic procedure which also is an useful adjunct to histopathology.

Bacille Calmette-Guérin vaccine induced lymphadenitis in infants and children masquerading with tubercular lymphadenitis at tertiary care hospital in North India

Background: Bacille calmette–guerin (BCG) vaccine containing live-attenuated Mycobacterium bovis was first used in humans to prevent tuberculosis in 1921. It is a safe vaccine. However, there can be minor adverse reactions such as pain, swelling, and redness at local injection site. The lesser known severe adverse reactions such as lymphadenitis, BCG osteitis, and disseminated BCG infection can be present after BCG vaccination. Aims and Objectives: The aim of the study was to report the cases of BCG lymphadenitis diagnosed by fine needle aspiration cytology (FNAC) after BCG vaccination in infants and children. Materials and Methods: All the infants and children (1 month–2 years) who presented with regional lymphadenopathy for FNAC after BCG vaccination were included in the study. Results: Total 21 patients with BCG lymphadenitis were recruited. In all the cases, the lymphadenitis involved ipsilateral left axillary lymph nodes. In three patient sites of involvement included the left supraclavicular lymph nodes and in other three patients left cervical lymph nodes along with left axillary lymph node. Sixteen patients had suppurative granulomatous lymphadenitis (SGLA) on FNAC and positive for Ziehl–Neelsen (ZN) staining for acid fast bacilli (AFB), while rest nine had non-suppurative granulomatous lymphadenitis (NSGLA) with negative for ZN staining for AFB. Conclusion: Early diagnosis of BCG lymphadenitis can help in proper management. Furthermore, it can prevent unnecessary anti tubercular treatment in children.

Kikuchi Fujimoto disease: a rare case report

Kikuchi disease, also known as Kikuchi histiocyticnecrotizing lymphadenitis, was initially described in young Japanese women. It is a rare benign self-limiting disease of unknown cause usually characterized by fever and cervical lunphadenitis. It is diagnosed by doing excisional biopsy of affected lymph node. A case of young 20 years old female presented with complaint of fever and weight loss for 20 days along with cervical and axillary lymphadenopathy. Complete physical examination, radiological investigations and biochemical tests were done to rule outsystemic lupus erythematous, non-Hodgkin lymphoma and tuberculosis.Only symptomatic treatment was done along with corticosteroids. Its diagnosis is important as it can be easily mistaken for other form of lymphadenitis. Clinician and pathologists’ awareness of this disorder is very necessary.

Histoplasmosis masquerading as tuberculosis: A report of three cases in immunocompetent children

The most common cause of granulomatous lymphadenitis in countries like ours is mycobactrium tuberculosis followed by atypical mycobacterial infection, fungal infections, parasitic infection, cat scratch disease, lymphogranuloma venereum (inguinal lymphadenopathy), and leprosy Here, we present three cases of lymphadenopathy due to histoplasmosis in immunocompetent children. Two of them presented with fever, lymphadenopathy, initially diagnosed as granulomatous lymphadenitis consistent with tuberculosis on FNAC and were put on antitubercular drugs. However, their condition gradually became worse. As the patients continued to deteriorate, subsequent lymph node biopsies were done and diagnosed as histoplasmosis. Third case presented with acute loss of vision with hepatosplenomegaly and lymphadenopathy. Initially considered as acute leukemia, but eventually established as histoplasmosis. Histoplasmosis should be considered as one of the possible causes of granulomatous lymphadenitis in children.

Incidence Of Tuberculosis In Otorhinolaryngology - Our Experience From A Tertiary Care Centre In Western India

Background:Tuberculosis (TB) is a worldwide leading public health problem even today. It affects all tissues of the body, but pulmonary tuberculosis is the most common type of tuberculosis (80% total tuberculosis cases). Extrapulmonary TB (EPTB) has major challenge for its clinical detection, definitive diagnosis and treatment. Out of all extrapulmonary cases, TB occurring in head and neck region is uncommon.Material And Methods:A prospective analytical studyof 50 patients who presented toENT OPD setupof ourtertiary carehospital with extra pulmonary TB. We look at the various clinical and laboratory aspects of tuberculosis of theotorhinolaryngeal region that would help to diagnose this uncommon but important form of extra pulmonary tuberculosis.Result:Male: Female ratio was 1.8:1 exhibiting male preponderance. Majority of the patients belonged to the age group of 20-40 years. Our study included patients with tuberculous cervical lymphadenopathy (84%), laryngeal TB (2%), tuberculous otitis media (12%), and retropharyngeal abscess (2%). FNAC seems to be de finitive and easier mode to diagnose TB of cervical nodes and Excision Biopsy can be done when FNAC is inconclusive.Conclusion:Extra pulmonary TB is significant health problem worldwide. It presents as a challenging task for diagnosis and overall surveillance of the treatment. The ear, nose, PNS, pharynx, larynx and cervical nodes are very important anatomical sites of extra pulmonary affliction. Its early diagnosis and definitive management will seize its sequence and further complications. The practical implications of an awareness of ENT tuberculosis are a benefit of anti-tubercular therapy and hence conservative management usually suffices.

A Case of Eosinophilic Granulomatosis with Polyangiitis Mimicking Cutaneous Tuberculosis and Tuberculous Lymphadenitis

Summary@#Eosinophilic granulomatosis with polyangiitis (EGPA), or Churg-Strauss Syndrome (CSS) is a rare granulomatous necrotizing vasculitic disease characterized by the presence of asthma, sinusitis, and hypereosinophilia. We describe a patient who was initially diagnosed with tuberculous lymphadenitis and later diagnosed with EGPA.

Screening of susceptibility genes and an immunological study in a patient with recurrent cervical lymphadenitis caused by Candida albicans / 中华皮肤科杂志

Objective:To explore genetic etiology and evaluate antifungal immunity in a patient with recurrent cervical lymphadenitis caused by Candida albicans. Methods:Next-generation sequencing was performed to screen susceptibility genes for mycosis in a patient with recurrent cervical lymphadenitis caused by Candida albicans and his parents. Peripheral blood mononuclear cells (PBMCs) and neutrophils were extracted from the patient and 6 healthy controls, and subjected to in vitro co-culture with Candida albicans. Western blot analysis was performed to determine the expression of caspase recruitment domain-containing protein 9 (CARD9) in PBMCs of the patient, enzyme-linked immunosorbent assay to detect levels of tumor necrosis factor-α (TNF-α), interleukin (IL) -6, IL-17A, IL-1β and granulocyte-macrophage colony-stimulating factor (GM-CSF) in the co-culture medium, and a colony-counting method was used to detect the survival rate of Candida albicans after treatment with neutrophils. Statistical analysis was carried out by using t test for comparisons between two groups. Results:Two compound heterozygous mutations were identified in the CARD9 gene of the patient, including c.68C>A (p.S23X) in exon 2 inherited from his father and c.820dupG (p.D274Gfs*61) in exon 6 inherited from his mother. Western blot analysis showed that the relative expression level of CARD9 protein in the PBMCs was 0.41 ± 0.07 in the healthy control group, but CARD9 expression was absent in the patient. After stimulation with heat-inactivated Candida albicans spores, the levels of TNF-α, IL-6, IL-17A, IL-1β and GM-CSF secreted by PBMCs of the patient were significantly lower than those by PBMCs of the healthy controls (all P < 0.001). After 30- and 120-minute in vitro co-culture with neutrophils, the survival rates of Candida albicans were significantly higher in the patient (78.00%, 74.00%, respectively) than in the healthy controls (70.91% ± 1.75%, 34.55% ± 5.35%, t = 3.74, 6.99, respectively, both P < 0.05) . Conclusion:Compound heterozygous mutations were identified in the CARD9 gene of the patient with recurrent cervical lymphadenitis caused by Candida albicans, which led to the absence of CARD9 protein expression, and the patient had a defect in the immunity against Candida albicans.

Ultrasonographic analysis of cat-scratch disease associated lymphadenitis of the elbow / 中国医师杂志

Objective:To analyze the ultrasonographic features of lymphadenitis caused by cat-scratch disease (CSD) of the elbow, and to improve the diagnosis and differentiation of CSD by sonologist.Methods:According to the inclusion and exclusion criteria, we retrospectively collected the patients who visited Changsha Third Hospital from March 2015 to October 2021 due to elbow mass, and divided them into CSD group and non CSD group according to the pathological source. We compared and analyzed the ultrasonic manifestations inside and around the mass in the two groups, and summarized the ultrasonic image characteristics of CSD.Results:In 90 cases of elbow mass, there were 14 cases in CSD group and 76 cases in non CSD group. There were 8 cases of cat scratch history and 2 cases of bite history in CSD group. The incubation period ranged from 4 days to 3 months. There were 4 cases of denied cat scratch and bite history or close contact history. Eight patients were treated with antibiotics, and 6 patients did not receive any treatment. 14 patients with CSD were followed up after 1-3 months. There was statistically significant difference between CSD group and non CSD group in tumor location (χ 2=14.507, P<0.05), the masses in CSD group were all located in the medial elbow; The specificity of internal ultrasound in CSD lymphadenitis was not high, but the ultrasonic changes outside the mass had certain characteristics, such as lymphadenitis and localized superficial phlebitis. There was also a statistical difference between CSD group and non CSD group in the ultrasonic changes outside the mass (χ 2=34.070, P<0.05). Conclusions:CSD lymphadenitis usually occurs in the medial epitrochlear region of the elbow. Ultrasound can be highly suggestive when there is a relevant epidemiological history and typical intra and extra-nodal sonographic changes, thus reducing the unnecessary invasive manipulation of the elbow mass.

Hemophagocytic syndrome as the first presentation of histiocytic necrotizing lymphadenitis: report of 1 case and review of literature / 白血病·淋巴瘤

Objective:To investigate the diagnosis and treatment of histiocytic necrotizing lymphadenitis (HNL) complicated with hemophagocytic syndrome (HPS).Methods:The clinical characteristics, diagnosis, treatment process, and therapy response of a patient with HNL complicated with HPS admitted to the Institute of Hematology & Blood Diseases Hospital Chinese Academy of Medical Sciences in March 2019 were retrospectively analyzed, and the literature was reviewed.Results:This 17-year-old female patient had fever with bilateral cervical lymphadenopathy as the first presentation, accompanied by cough and expectoration. After admission, the disease progressed rapidly, and the serum ferritin increased progressively.The regimen of hormone and etoposide was used to control the disease condition. The bone marrow smear revealed atypical lymphocytes and hemophagocytic phenomenon, and the pathological features of HNL in lymph node biopsy were observed. This patient was finally diagnosed as HNL complicated with HPS. The patient's condition was stable at 3-month follow-up after discharge.Conclusions:The clinical manifestations of HNL patients complicated with HPS are similar to other hematologic malignant diseases, and application of multiple laboratory and pathological examination methods can help with early diagnosis. In the event of a progressive rise in serum ferritin, timely application of hormone therapy combined with etoposide if necessary can rapidly control the progression of the disease.

Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome in children: a brief literature review / Síndrome da febre periódica, estomatite aftosa, faringite e adenite em crianças: uma breve revisão de literatura

ABSTRACT Objective: To describe clinical, diagnostic and therapeutic characteristics of the periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome. Data source: Literature review in the PubMed database by using specific descriptors to identify all articles published in the English language in the last three years; 38 articles were found. After performing selection of titles and abstract analysis, 13 out of the 38 articles were fully read. Relevant studies found in the references of the reviewed articles were also included. Data synthesis: The PFAPA syndrome (Periodic Fever, Aphthous Stomatitis, Pharyngitis and cervical Adenitis) is a medical condition grouped among the periodic fever syndromes. The etiology is uncertain, but possibly multifactorial, and its symptoms are accompanied by recurrent febrile episodes although weight and height development are preserved. It is a self-limiting disease of benign course with remission of two to three years without significant interference in the patient's overall development. Treatment consists of three pillars: interruption of febrile episodes, increase in the interval between episodes, and remission. Conclusions: Despite several attempts to establish more sensitive and specific criteria, the diagnosis of PFAPA syndrome is still clinical and reached by exclusion, based on the modified Marshall's criteria. The most common pharmacological options for treatment include prednisolone and betamethasone; colchicine may be used as prophylaxis, and surgical treatment with tonsillectomy can be considered in selected cases.

RESUMO Objetivo: Descrever as características clínicas, diagnósticas e de tratamento da síndrome de febre periódica, estomatite aftosa, faringite e adenite (PFAPA). Fontes de dados: Revisão de literatura na base de dados PubMed, feita por meio de descritores específicos para identificar todos os artigos publicados em língua inglesa nos últimos três anos. Dos 38 artigos encontrados, foram encaminhados para leitura integral 13 publicações após seleção de títulos e análise de abstract. Estudos relevantes encontrados nas referências dos artigos revisados também foram incluídos. Síntese dos dados: A PFAPA é traduzida do inglês periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis. Caracterizada por etiologia ainda incerta e possivelmente multifatorial, seus sintomas são acompanhados por episódios recorrentes de febre associados a um desenvolvimento pôndero-estatural preservado. É uma doença autolimitada de curso benigno, com remissão em dois a três anos, sem interferências significativas no desenvolvimento do paciente pediátrico. O tratamento consiste em três pilares: interrupção da crise febril, aumento do intervalo entre crises e remissão. Conclusões: Apesar de várias tentativas de estabelecer critérios atuais mais sensíveis e específicos, o diagnóstico da síndrome PFAPA ainda é clínico e de exclusão com base nos critérios de Marshall modificados. As opções farmacológicas mais utilizadas para o tratamento são a prednisolona e betametasona; colchicina pode ser utilizada como profilaxia e o tratamento cirúrgico com tonsilectomia pode ser considerado em casos selecionados.

Hemorragia digestiva alta por linfadenitis mesentérica tuberculosa que fistuliza a la pared gástrica / Upper gastrointestinal bleeding due to tuberculous mesenteric lymphadenitis that fistulizes the gastric wall

RESUMEN La linfadenitis tuberculosa es la entidad más frecuente de la tuberculosis abdominal, que ocurre por reactivación de un foco latente. Su diagnóstico requiere un alto grado de sospecha, para lo cual requiere estudios endoscópicos, radiológicos e histopatológicos. En la evaluación de las linfadenopatías, la punción y aspiración guiada por ultrasonido endoscópico cumple un rol importante. Presentamos el caso de un paciente varón de 22 años, quien ingresa a Emergencia del Hospital Nacional Arzobispo Loayza por hemorragia digestiva alta secundaría a linfadenitis mesentérica tuberculosa que comprometió la pared gástrica. (AU)

ABSTRACT Tuberculous lymphadenitis is the most common entity of abdominal tuberculosis, which occurs due to reactivation of a latent focus. Its diagnosis requires a high degree of suspicion, for which it requires endoscopic, radiological, and histopathological studies. In the evaluation of lymphadenopathies, endoscopic ultrasound-guided aspiration puncture plays an important role. We present the case of a 22-year-old male patient who was admitted to the Emergency Department of the Arzobispo Loayza National Hospital due to upper gastrointestinal bleeding secondary to tuberculous mesenteric lymphadenitis that compromised the gastric wall. (AU)

Paradoxical Reaction in Lymph Node Tuberculosis Presented as Shoulder Osteomyelitis

Paradoxical reactions (PRs) can be viewed as an abnormal immune response toward the anti-tubercular treatment (ATT). It is characterized by clinical worsening of the patient’s symptoms and signs following an initial improvement despite definitive treatment with ATT. Tubercular lymphadenitis is the most common extrapulmonary manifestation seen under PR. Other sites of involvement include the pleura, central nervous system, bones, and muscle. Although some paradoxical events may not require any intervention, studies have shown to have good outcomes using glucocorticoid therapy. This case reports a PR that involves tubercular lymphadenitis and osteomyelitis, which showed marked improvement of patient ailment following a 1-month course of oral steroid

Reto Diagnóstico: Hipoacusia, Enteropatía Autoinmune y Linfadenopatia de Kikuchi ­ un Debut Inusual de LES / Diagnostic challenge: hearing loss, autoimmune enteropathy and Kikuchi lymphadenopathy - An unusual debut of SLE

El lupus eritematoso sistémico (LES) puede presentarse de muchas maneras y puede ser difícil de diagnosticar. En ocasiones puede ser difícil distinguir la enfermedad subyacente, ya que se sabe que el LES mismo causa síntomas gastrointestinales e incluso malabsorción. Este caso refleja los desafíos de diagnóstico que enfrentamos durante la larga y complicada hospitalización de una adolescente con compromiso sistémico, síndrome febril, malabsorción, marcadores inflamatorios elevados, hipoacusia, nefritis, linfadenitis necrotizante histiocítica

Systemic lupus erythematosus (SLE) can present in many ways and can be difficult to diagnose. It can sometimes be difficult to distinguish the underlying disease, as SLE itself is known to cause gastrointestinal symptoms and even malabsorption. This case reflects the diagnostic challenges we faced during the long and complicated hospitalization of an adolescent with systemic compromise, febrile syndrome, malabsorption, elevated inflammatory markers, hearing loss, nephritis, histiocytic necrotizing lymphadenitis