Linfadenite recorrente. Caso clínico / Recurrent lymphadenitis. Case report

A imunodeficiência de variável comum é uma imunodeficiência primária de apresentação heterogênea, consistindo em um défice em imunoglobulinas. É caracterizada por infeções de repetição e predisposição para doenças autoimunes, granulomatosas e neoplásicas. Os autores apresentam o caso clínico de um doente com imunodeficiência comum variável manifestada por infeções cutâneas de repetição e linfadenite recorrente. Este caso tem como objetivo alertar para os aspetos clínicos desta imunodeficiência, a fim de permitir seu diagnóstico precoce, evitando-se prognósticos desfavoráveis.(AU)

Common variable immunodeficiency is a primary immunodeficiency with a heterogeneous presentation, characterized by decreased immunoglobulin levels. It is characterized by recurrent infections, predisposition to autoimmune, granulomatous and neoplastic diseases. The authors report a case of a patient with common variable immunodeficiency and history of skin infections and recurrent lymphadenitis. This case report aims to draw the attention to the clinical aspects of this immunodeficiency, in order to promote an early diagnosis, avoiding poor outcomes.(AU)

Histiocitosis de células de Langerhans presentada como adenitis aislada en un lactante: Caso clínico / Langerhans cell histiocytosis presenting as isolated adenitis in an infant: Case report

La histiocitosis de células de Langerhans es una enfermedad infrecuente en el lactante y su presentación como una adenitis cervical aislada sin otra sintomatología es excepcional en estos pacientes. Se describe el caso de una lactante de 3 meses de edad que presentaba una tumoración cervical en el ángulo mandibular derecho, con mala respuesta al tratamiento antibiótico. Se realizó una punción-aspiración con aguja fina, que confirmó el diagnóstico de histiocitosis de células de Langerhans. El estudio de extensión no mostró afectación sistémica. Debe considerarse la histiocitosis de células de Langerhans en el diagnóstico diferencial de una masa cervical subaguda de evolución tórpida en los lactantes de corta edad y se debe plantear la realización de una punción-aspiración con aguja fina de manera precoz para establecer el diagnóstico.

Langerhans cell histiocytosis in infants is a rare condition, and presentation as an isolated cervical adenitis is exceptional at this age. We describe the case of a 3-month-old female infant presenting with a neck mass in the right mandibular angle with poor response to antibiotic treatment. Fine needle aspiration was performed and confirmed the diagnosis of Langerhans cell histiocytosis with complementary tests showing no features of systemic involvement. Langerhans cell histiocytosis should be considered in the differential diagnosis of subacute neck masses with poor outcome in infants and physicians should consider performing a fine needle aspiration to establish the diagnosis.

Breast prosthesis leakage and malignant changes of the breast

A breast implant is a prosthesis used to enhance the size of a woman's breast. Silicone implants are most commonly used, but as with all surgical implants it has some complications. The question is whether it can induce breast cancer? During the last year, a case of reconstructed breast with prosthesis which leaked was presented. The aim of this report is to review current literature to evaluate whether there are reported correlations between breast cancer and breast implants. The conclusion derived from this report is that there is no available evidence directly correlating breast cancer to breast implants

Post BCG lymphadenitis in vaccinated infants in Yazd, Iran

Bacille Calmette-Gu?erin [BCG] vacination is performed as a part of expanded program of immunization [EPI].Lymphadenitis is the most common complication of BCG vaccination. The aim of this study was to determine the incidence and natural course of BCG lymphadenitis vaccinated in Yazd, Iran. In this analytical prospective follow up study a total of 480 [240 females and 240 males] consecutive newborns received 0.05 ml of BCG vaccine intradermally on right arm within the first week of life during April to July 2003. These babies were followed up when 1.5, 3, 4.5, 6 and 9 months old. A total of 26 [5.8%] cases of lymphadenitis were detected. Lymphadenitis occurred as ipsilateral axillary nodes in 24 [92.3%] cases, supraclavicular in one [3.8%] case, and supraclavicular in association with axillary nodes in one case [3.8%]. Infants developed lymphadenitis during 4 wks of life in one [3.84%] case, between first and fourth month of life in 14 [53.8%] cases, and between fourth and sixth month of life in 11 [42.3%] cases. All 26 cases of lymphadenitis were followed up for 9 months. Twenty two [84.6%] cases were simple or non-suppurative and 4 [15.4%] cases suppurative lymphadenitis. Eleven [42.3%] cases of non-suppurative lymphadennitis showed spontanous resolution and eleven [42.3%] cases had partial regression without progression or drainage. Four [15.4%] cases developed suppuration with one [3.8%] case of fistulation and drainage. The greater incidence of lymphadenopathy in our cases can probably be attributed to a more immunogenic vaccine [Pasteur institute, Tehran], young vaccinees [newborn infants], injection in the right arm or improper dilution. Non-suppurative BCG lymphadenitis is a benign condition and regresses spontanously without any treatment

Immunity status in children with Bacille Calmette-Guerin adenitis: a prospective study in Tehran, Iran

To determine the immunity status of children with Bacille Calmette-Guerin [BCG] lymphadenitis [patient group] and unaffected children [control group] in Iran. We performed this longitudinal case-control study on 75 children between 2 months to 14 years old in Rasool Akram and Markaz Tebbi Hospital, Tehran, Iran during the period of 2 years [2000-2002]. Ninety percent of patients had normal immunoglobulin, 10% had low level, 96.1% had normal nitro blue tetrazolium test and 3.9% had lower activity. There was a significant difference in the total lymphocyte CD3, CD8, CD19, CD16/CD56 and natural killers [NK] cell but no significant difference in the CD4/CD8 ratio and CD4 between case [n=75] and control [n=100] groups. Thirty-eight cases with mild lymphopenia, isolated CD4, CD3, CD19, NK cells [CD16/CD56] deficiency in 3 [22%]; idiopathic disseminated BCG infection [unknown immunodeficiency type] in 3 [22%] patients were observed. Thirty-eight cases were diagnosed as mild immune deficient without any previous recurrent infections [mild lymphopenia; Isolated CD4; CD3 or CD19 deficiency. Natural killers [CD16/CD56] deficiency in 3 [22%]; idiopathic disseminated BCG infection [unknown immunodeficiency type] in 3 [22%] patients. The natural killers [CD16/CD56] deficient cases responded well to 3 antimycobacterial drugs without immunomodulator. Natural killers cell deficiency not yet reported as a risk factor for progression and complication of BCG infection. All cases of idiopathic disseminated BCG infection [unknown immunodeficiency type] with nonlethal and indulgent BCG infections responded well to needle aspiration and antimycobacterial drugs with immunomodulator [gamma interferon]. In cases with multiple and recurrent BCG lymphadenitis without any previous recurrent infection complete immunological studies should be carried out. Most cases with mild immune deficiency usually response well to needle aspiration alone or combine with antimycobacterial drugs. The combination of IFN-gamma and chemotherapy in cases of idiopathic disseminated infections caused by BCG and without previous recurrent other infection except mycobacterium species, can limit the disease

Intraabdominal Cryptococcal Lymphadenitis in a Patient with Systemic Lupus Erythematosus

Cryptococcal infection is a rare, yet well recognized complication of systemic lupus erythematosus (SLE). We present a case of mesenteric and retroperitoneal cryptococcal lymphadenitis resulting in the obstruction of the stomach and proximal duodenum in a patient suffering from SLE, while recently she did not receive any immunosuppressive treatment. A 42-yr-old woman was admitted due to high fever and diffuse abdominal pain for three weeks. Abdominal computed tomography (CT) scan showed multiple conglomerated lymphadenopathies in the retroperitoneum and the mesentery resulting in luminal narrowing of the third portion of the duodenum. Cryptococcal lymphadenitis was proven by needle biopsy and she was treated with intravenous liposomal amphotericin B, followed by oral fluconazole. After fourteen-month antifungal therapies, the clinical symptoms and follow-up images improved. This case emphasize that the intrinsic immunological defects of SLE may be directly responsible for the predisposition to fungal infections.

Síndrome adenitis-celulitis: una presentación infrecuente de infección tardía por streptococcus agalactiae / Adenitis-cellulitis syndrome: an infrequent presentation of a late onset infection by Streptococcus agalactiae

A pesar de los avances en las estrategias de prevención en décadas anteriores, las infecciones por Streptococcus agalactiae constituyen una causa importante de infecciones neonatales. La mayoría ocurren durante la primera semana de vida (enfermedad precoz). Las infecciones tardías ocurren en niños mayores de una semana hasta los tres meses de edad. Entre estas últimas, el síndrome adenitis celulitis es usa manifestación inhabitual de las infecciones tardías por S. agalactiae transformándose en un marcador de infección invasora. Reportamos el curso clínico de un lactante con un síndrome adenitis celulitis de localización inguinal asociado a bacteriemia por S. agalactiae y discutimos la presentación clínica, hallazgos de laboratorio y evolución de esta condición basados en una revisión de la literatura.

Linfadenitis causada por Mycobacterium malmoense en paciente infectado con virus de inmunodeficiencia humana / Lymphadenitis caused by Mycobacterium malmoense in HIV infected patient

Se reporta el primer caso cubano de micobacteriosis causada por Mycobacterium malmoense en un paciente infectado por el virus de inmunodeficiencia humana (VIH), el cual presentaba adenopatías ulcerativas submandibulares. A partir de las muestras tomadas de las lesiones ulceradas, se aisló una cepa de micobacteria no pigmentada de crecimiento lento, perteneciente al grupo I de Runyon, posteriormente fue clasificada por test bioquímico y por el análisis de las fracciones de ácidos micólicos, como Mycobacterium malmoense.

Cryptococcal lymphadenitis and meningitis in human immunodeficiency virus infection--a case report.

Cryptococcal meningitis (CM) is the commonest life threatening opportunistic fungal disease in Human Immunodeficiency Virus (HIV) infected individuals. But there are very little reports of lymphadenopathy along with cryptococcal meningitis, although cases of pulmonary, Intestinal, Bone marrow and retinal involvement have been described earlier. Here we report a case of cryptococcal meningitis associated with generalized lymphadenopathy and hepatosplenomegaly.

Cytokine gene polymorphism in BCG lymphadenopathy

Tumor necrosis factor-beta or lymphotoxin-alpha [LT-alpha], IL-4 and IL-10 are determining factors in immunity against BCG. Allelic polymorphisms in the regulatory regions of their genes affect the rate of cytokine production and therefore, the host's ability in BCG containment. To study the prevalence of -590 [C/T] and -592 [C/A] allelic distribution of IL-4 and IL-10 promoter regions, respectively, and +282 [G/A] polymorphism in the first intron of LT-alpha in BCG vaccinees with lymphadenopathy comparing to those of controls. Polymorphisms in the promoter region of IL-4 and IL-10 were determined by primer induced restriction site PCR and the polymorphism in the first intron of LT-alpha was investigated using PCR-RFLP method. Forty patients with BCG adenitis and 42 healthy age-matched infants without reactions were included in this study. No significant differences existed between allele and genotype frequencies of IL-4 or LT-alpha genes from patients as compared to the controls. A significant difference in genotype distribution of the IL-10 -592 C-to-T polymorphism was observed between patients and controls [p<0.05]. In this respect, the AA and AC genotypes with lower ability in IL-10 production were found more frequently in the control group. The lower frequency of AA genotype at position -592 of IL-10 promoter region in patients may have resulted in more IL- 10 production leading to weaker immune response that allows bacterial burden and occurrence of lymphadenitis

BCG vaccine and post-BCG complications among infants in Gaza Strip, 1999

The relationship between post-BCG complications and the practices of administration and/or use of certain batches of BCG vaccine was investigated. A questionnaire were given to nurses administering BCG vaccination. An abstraction sheet was used to analyse cases with BCG complications among infants [n = 552] and schoolchildren [n = 97]. The rate of complications was 14.7/1000 among infants and 2.5/1000 among schoolchildren in 1997. The complications rate was 19.1/1000 at UNRWA and 8.3/1000 at governmental health services. It was found that a single batch of BCG 2611-11 combined with incorrect administering of the vaccine was responsible for this outbreak of complications. Therefore, the establishment of a surveillance system to monitor adverse events following immunization is needed

¿Cuando debe sospecharse que las adenopatías en un niño son de origen neoplásico? / When must we suspect a neoplastic origin of adenopathies in child?

Las adenopatías son un hallazgo frecuente en niños tanto en masas o tumores malignos como no malignos, incluyendo entre estos principalmente a las adenopatías de origen infeccioso. La presencia de adenopatías, sean localizadas o generalizadas, son percibidas con cierto grado de aprensión, que también en alguna medida puede ser compartida por el médico en la atención primaria. Los ganglios aumentados de tamaño que muchos niños presentan pueden significar simplemente una reacción normal a nuevos antígenos ambientales o una respuesta limitada a una infección transitoria. No obstante, la adenopatía puede presentar el inicio de una enfermedad de mayor gravedad. Desde un punto de vista fisiopatológico, el aumento de volumen de los ganglios resulta de uno de dos procesos básicos, la proliferación de células propias del tejido ganglionar y que es secundaria a estimulación antigénica por infecciones virales o bacterianas no complicadas, o a la infiltración por células malignas o por leucocitos polinucleares en respuesta a una infección localizada

Adenopatías: su evaluación en niños / Adenopathies: assessment in children

La presencia de adenopatías es un motivo de consulta frecuente en niños y un hallazgo aún más común al examen físico. Estas pueden ser aisladas o generalizadas e incluso pueden ser manifestación del proceso fisiológico de aprendizaje inmunológico. Las etiologías son numerosas, por lo cual es importante tener un enfrentamiento adecuado y organizado ante el paciente

Enfermedad de Kikuchi y Fujimoto / Kikuchi-Fujimoto disease

Se describen cuatro casos de linfadenitis necrotizante subaguda (enfermedad de Kikuchi-Fujimoto) en Costa Rica. Los cuatro casos se presentaron en mujeres jóvenes (20-44 años), como linfadenopatía. Tres de ellas asociaron cuadro febril y pérdida de peso; todas demostraron leucopenia. Un caso asoció además rash, hipergamaglobulinemia policlonal, hipoalbuminemia, multiples autoanticuerpos y diferentes anticuerpos contra antígenos externos, cuadro compatible con un lupus eritematoso sistémico (LES). Las biopsias de ganglio linfático de los cuatro casos mostraron una linfadenitis necrotizante subaguda, en diversas fases: proliferativa, necrotizante y xantomatosa. Aunque se ha postulado un posible origen viral, la etiología de la enfermedad de Kikuchi-Fujimoto no está bien esclarecida