Recurrent vulvovaginal candidiasis: could it be related to cell-mediated immunity defect in response to candida antigen?

Background: Recurrent vulvovaginal candidiasis [RVVC] is a common cause of morbidity affecting millions of women worldwide. Patients with RVVC are thought to have an underlying immunologic defect. This study has been established to evaluate cell-mediated immunity defect in response to Candida antigen in RVVC cases

Materials and Methods: Our cross-sectional study was performed in 3 groups of RVVC patients [cases], healthy individuals [control I] and known cases of chronic mucocuta-neous candidiasis [CMC] [control II]. Patients who met the inclusion criteria of RVVC were selected consecutively and were allocated in the case group. Peripheral blood mon-onuclear cells were isolated and labeled with CFSE and proliferation rate was measured in exposure to Candida antigen via flow cytometry

Results: T lymphocyte proliferation in response to Candida was significantly lower in RVVC cases [n=24] and CMC patients [n=7] compared to healthy individuals [n=20, P<0.001], but no statistically significant difference was seen between cases and control II group [P>0.05]. Family history of primary immunodeficiency diseases [PID] differed significantly among groups [P>0.0l], RVVC patients has family history of PID more than control I [29.2 vs. 0%, P=0.008] but not statistically different from CMC patients [29.2 vs. 42.9%, P>0.05]. Prevalence of atopy was greater in RVVC cases compared to healthy individuals [41.3 vs. 15%, P=0.054]. Lymphoproliferative activity and vaginal symptoms were significantly different among RVVC cases with and without allergy [P=0.01, P=0.02]

Conclusion: Our findings revealed that T cells do not actively proliferate in response to Candida antigen in some RVVC cases. So it is concluded that patients with cell-mediated immunity defect are more susceptible to recurrent fungal infections of vulva and vagina. Nonetheless, some other cases of RVVC showed normal function of T cells. Further evaluations showed that these patients suffer from atopy. It is hypothesized that higher frequency of VVC in patients with history of atopy might be due to allergic response in mucocutaneous membranes rather than a functional impairment in immune system components

Orf disease following "Eid ul Adha": a rare cause of erythema multiforme

Orf, also known as contagious pustular dermatitis, is anexanthemous disease caused by a parapox virus. It is usuallya benign locally self-limiting illness; it can have systemiccomplication or progressive infected locations can include thefinger, hand, arm, and face. Development of erythema multiforme following Orf infection is very rare. In Islamic populations suchas those of Iran, Orf can be observed in individuals who are notoccupationally involved, but may be in contact with sheep or goatsafter the Islamic worship as an "Eid ul-Adha." Here we reportan erythema multiforme associated with multiple lesion of Orfdisease following the "Eid ul-Adha" in Iranian housewives

Fatal disseminated mucormycosis in an immunocompotent patient: a case report and literature review

Disseminated mucormycosis is a rare entity most frequently seen in neutropenic patients with hematologic malignancies, post transplants or in patients on deferoxamine therapy. We report a 64-year-old immunocompetent male with an acute pneumonia and a generalized jaundice who died within 24 h. In the autopsy, extensive perforations of spleen and multiple hemorrhage foci on the pancreas were two significant findings. Histopathological study of tissue sections revealed typical zygomycetes hyphae in the left lung, pancreas, spleen and brain. Involvement of pancreas in this patient was one of the rare features of mucormycosis reported occasionally in the literature. Our case implies an unusual clinical presentation of disseminated mucormycosis and highlights that disseminated mucormycosis should be regarded even in the immunocompetent patients

[Simultaneous deep vein thrombosis and acute brucellosis: case report]

Brucellosis is a zoonotic disease that is common in developing countries such as Iran which is a serious medical impact. Vascular complications, including arterial and venous associated with Brucella infection, have rarely been reported. In a review of articles, it is clear that, only five cases of deep venous thrombosis [DVT] of the lower extremities and just one case of cerebral venous thrombosis, associated with brucellosis have been reported so far. In this article a case of DVT of the left leg in association with acute Brucella infection was reported. Apparently, this case report is the first case of DVT due to brucellosis in Iran. Patient is a 28-year-old male who presented with clinical manifestations of fever, unilateral calf pain and swelling. Peripheral venous doppler ultrasound showed DVT and patient was treated with anti coagulants. Through controlling the fever and decreasing the lower extremity. The patient discharged with warfarin therapy. During follow up, the patient came back with repeated fever, sweating, myalgia and bilateral knee swelling. Because of patient clinical manifestation and epidemiologic status, brucellosis serology test was recommended, which was positive in high titer. He was discharged with a prescription of anti-brucellosis treatment. In the course of treatment, the patient referred to hospital due to sudden dyspnea, cough, hemoptysis, pleuretic chest pain. In spiral CT with protocol PTE, pulmonary thrombo emboli was detected and standard therapy for PTE was administered. In the course of his hospitalization other etiologies of thrombo phelebitis were excluded. Finally, the patient's clinical presentation subsided with warfarin therapy and anti brucellosis multi drug regimen. Early detection and appropriate treatment of Brucellosis are crucial measures to prevent problematic complications of the disease. The authors' case and those previously reported, suggest that brucellosis should be included among the etiologies and the infections which are taken into account in patients suffering from DVT, particularly in those coming from Brucella-endemic areas.

Precise recognition of liver inflammatory pseudotumor may prevent an unnecessary surgery

Liver inflammatory pseudotumor [IPT] is considered a benign inflammatory lesion mostly presented as a solitary solid mass in the right hepatic lobe. It may clinically and radiologically mimic a malignant liver tumor or an abscess. Accordingly, diagnoses of most of the reported cases have been established after surgical resection. In this report, we describe a 52-year-old woman with a 1-year history of fever of unknown origin. In the following investigation, abdominal computed tomography [CT] scan showed infiltrative lesion in the right hepatic lobe. The patient underwent a CT-guided needle biopsy of the hepatic lesion. Histopathologic study of biopsy specimen revealed the features of IPT. The patient was discharged and followedup for 6 months. After 6 months she had no complaint of fever and control liver ultrasonography disclosed no lesion. As liver IPT has favorable response to conservative therapy and may also resolve spontaneously, precise recognition of this condition with the help of fine-needle biopsy may help to avoid unnecessary surgery