Aortoarteritis: A rare pulmonary-renal disease

Takayasu arteritis (TAK) is an autoimmune disease majorly affecting young females. It alters the vascular wall, resulting in stenosis, occlusion, or dilatation. It has no distinct clinical manifestation. Here, we present the case of an 18-year-old girl who presented with generalized tonic-clonic seizure and hypoxia. Blood investigations showed deranged urea and creatinine values. Computed tomography angiography revealed bilateral artery occlusion, decreased kidney size, and pulmonary artery dilatation, confirming generalized vascular disease that caused hypertension and ischemic nephropathy in the patient. Our case represents a rare autoimmune disease, leading to pulmonary hypertension and renal artery stenosis. TAK should be considered as a differential diagnosis in young female patients presenting with pulmonary as well as renal signs and symptoms, especially if there is discrepancy in blood pressure levels in all limbs.

Lung cavities in chronic thromboembolic pulmonary hypertension

OBJECTIVES: Chronic thromboembolic pulmonary hypertension (CTEPH) is a unique form of pulmonary hypertension (PH) that arises from obstruction of the pulmonary vessels by recanalized thromboembolic material. CTEPH has a wide range of radiologic presentations. Commonly, it presents as main pulmonary artery enlargement, peripheral vascular obstructions, bronchial artery dilations, and mosaic attenuation patterns. Nevertheless, other uncommon presentations have been described, such as lung cavities. These lesions may be solely related to chronic lung parenchyma ischemia but may also be a consequence of concomitant chronic infectious conditions. The objective of this study was to evaluate the different etiologies that cause lung cavities in CTEPH patients. METHODS: A retrospective data analysis of the medical records of CTEPH patients in a single reference PH center that contained or mentioned lung cavities was conducted between 2013 and 2016. RESULTS: Seven CTEPH patients with lung cavities were identified. The cavities had different sizes, locations, and wall thicknesses. In two patients, the cavities were attributed to pulmonary infarction; in 5 patients, an infectious etiology was identified. CONCLUSION: Despite the possibility of being solely associated with chronic lung parenchyma ischemia, most cases of lung cavities in CTEPH patients were associated with chronic granulomatous diseases, reinforcing the need for active investigation of infectious agents in this setting.

Histopathological study of dermal granuloma

INTRODUCTION:The objectives of this study were to confirm the diagnosis of clinically suspected dermal granuloma- tous diseases by histopathological examination and by routine and special stains as well as to study the incidence of various types of dermal granulomas.MATERIALS AND METHODS:This study was conducted at the Department of Pathology in collaboration with De- partment of Skin and Venereal disease. A total of 90 cases from outdoor patient department of skin and venereal disease, which were clinically diagnosed as suspected dermal granulomatous diseases, were taken as the study population.RESULTS:In our study, we found that leprosy had the highest incidence (50%), followed by cutaneous tuberculosis (30%) among all dermal granulomatous diseases like syphilis, fungal, granuloma annulare, foreign body, actino- mycosis, and sarcoidosis. Dermal granulomas were most common in middle age between 21 and 40 years of age.CONCLUSION:Histopathology played an important role in the final diagnosis of dermal granulomatous lesions. Most common dermal granulomatous disease was leprosy, followed by cutaneous tuberculosis.

Role of S-100 Immunostaining in Differentiation of Borderline Leprosy from Other Granulomatous Diseases of Skin

Leprosy is a chronic granulomatous disease affecting skin, peripheral nerves and other tissues. On histopathology leprosy mimics other infectious and non-infectious lesions like tuberculosis, sarcoidosis and fungal infections, which are also common in our country. In tuberculoid and indeterminate forms, where Acid Fast Bacilli cannot be demonstrated, the diagnosis becomes more difficult. Mycobacterium leprae is the only bacterium which has the ability to infiltrate peripheral nerves leading to Schwann cell disintegration. On routine Hematoxylin and Eosin stains (H&E), the nerve fibers may not be easily identifiable in some cases , hence S-100 immunostaining is used to highlight the nerve elements and to demonstrate and compare the nerve changes in spectrum of leprosy. With widespread use of multi-drug treatment, there has been changes in the profile of disease. The aim of the present study was to observe different patterns of cutaneous nerve involvement in leprosy and to correlate these with the clinical and histopathological findings in currently referred cases for histopathological opinion. The study was conducted in the Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, over a period of 12 months (July 2016 - July 2017) Subjects were recruited from patients presenting in Dermatology OPD. A total 35 consecutive cases with clinical suspicion / diagnosis of leprosy were included in the study. Biopsies were processed and stained by H&E, Fite-Faraco as well as S100 immunostaining. It was observed that on S-100 immunostaining, 43.7% cases showed granulomas infiltrating the dermal nerves whereas these changes could not be demonstrated in 16.6% cases of Borderline leprosy on H&E staining alone. Thus S-100 staining appears to serve as an important tool to diagnose leprosy from other granulomatous diseases of skin even in current scenario of leprosy.

Pulmonary histoplasmoma: a disguised malady

Histoplasmosis is a mycosis caused by the dimorphic fungus, Histoplasma capsulatum, which is transmitted via dust and aerosols. Lung involvement is the most common, with a varied clinical presentation. Although it is not the only source of infection, H. capsulatum is frequently found in bat guano, which is the reason why it is highly prevalent among caving practitioners. The solitary histoplasmoma of the lung is an unusual and chronic manifestation of this entity, which mimics, or at least is frequently misconstrued, as a malignancy. Almost invariably, the diagnosis of this type of histoplasmosis presentation is achieved after lung biopsy. The authors present the case of a young woman who sought medical care because of chest pain. The diagnostic work-up revealed the presence of a pulmonary nodule. She was submitted to a thoracotomy and wedge pulmonary resection. The histologic analysis rendered the diagnosis of histoplasmoma. Thisreport aims to call attention to this diagnosis as the differential diagnosis of a pulmonary nodule.

Tuberculosis pulmonar y lingual. Presentación de un caso / A Case Report of Pulmonary and Lingual Tuberculosis

Objetivo: presentar un caso raro de tuberculosis (TB) lingual secundaria, el cual constituye el primero reportado en el hospital y en la provincia en 50 años. Caso clínico: paciente masculino de 69 años de edad con antecedentes de dos hospitalizaciones por neumonía bacteriana adquirida en la comunidad, que es ingresado debido a que desde hace 3 semanas presenta fiebre, tos seca irritativa y síntomas constitucionales acompañados de lesiones nodulares de 0,5-1 cm en el dorso de la lengua y aftas dolorosas en la base de la misma, especialmente a la palpación, que le impedían alimentarse. El estudio BAAR del esputo reporta codificación 9 en 2 oportunidades; la prueba de tuberculina, los exámenes radiológicos y la histología confirman el diagnóstico. Se aplica terapéutica antituberculosa y a los 2 meses se aprecia desaparición de los nódulos, manteniéndose asintomático en el seguimiento en consulta externa. Conclusiones: la TB de la lengua es un hallazgo infrecuente que debe ser incluido en el diagnóstico diferencial de las patologías de la cavidad oral. Este caso demuestra la importancia de mantener la alerta sobre esta entidad en la práctica médica y odontológica.

Objective: The objective of this study is to present a rare case of secondary lingual tuberculosis (TB). This was the first reported occurrence of this disease in the hospital and in the province in 50 years. Case report: A 69 year old male patient who had been hospitalized twice because of bacterial pneumonia acquired in the community was admitted to the hospital. For three weeks prior to admission the patient had suffered fever, dry irritating coughing, constitutional symptoms, 0.5 to 1.0 cm nodular lesions on the dorsum of the tongue, and canker sores at the base of the tongue. As a result the patient had been unable to eat. Two acid fast bacilli (AFB) smears both showed a rating of 9. Tuberculosis testing, x-rays and histology confirmed the diagnosis. Tuberculosis treatment was begun. After two months the nodules disappeared. The patient remained asymptomatic and continues to be monitored on an outpatient basis. Conclusions: TB of the tongue is a rare finding that should be included in the differential diagnosis of diseases of the oral cavity. This case demonstrates the importance of continued vigilance of this entity in medical and dental practice.

A 29-Year-Old Male with Borderline Lepromatous Leprosy.

Leprosy (Hansen’s disease) is a chronic granulomatous infectious disease that primarily affects the peripheral nerves, skin, upper respiratory tract mucosa, eyes and certain other tissues. It is diagnosable and curable if recognized early and treated adequately. A twenty nine-year-old male from Jessore, Bangladesh reported in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh with the complaints of multiple erythematous, large, raised and circumscribed lesions with loss of sensations on different parts of the body, especially distal portions of all four limbs for last eight months. Subsequently he developed ulcers on the anesthetic fingers due to smoking and few ulcerative lesions on both feet. Skin examination revealed multiple erythematous, large nodular lesions on both sides of the cheek and forehead, multiple erythematous, indurated, large plaques with raised margin and central clearing on the trunk, waist and all four limbs, few satellite lesions around the large plaques on the trunk, few hypopigmented patches and plaques on buttock and lower limbs, multiple painless ulcers on dorsal surface of fingers of both hands, both lateral malleoluses and right sole. On examination of peripheral nerves, left great auricular nerve, both ulnar nerves and both common peroneal nerves were moderately enlarged and tender. Slit skin smear for AFB (modified Z-N stain) was done and revealed that there were large number of acid and alcohol-fast bacilli arranged in straight and curved parallel bundles with globular masses (cigar-bundle appearance), morphologically resembling Mycobacterium leprae. Skin biopsy for histopathological examination revealed extensive infiltration of macrophages in the dermis, separated from epidermis by narrow grenz zone, with destruction of skin adnexa. Few foci of poorly defined granuloma in dermis were also noted. The patient was managed with rifampicin, clofazimine, dapsone, prednisolone and omeprazole.

Aspectos clínicos, morfológicos e imuno-histoquímicos da pitiose gastrintestinal canina / Clinical Aspects, contouring and immunohistochemistry of pythiosis gastrintestinal diseases of dogs

Através de um estudo retrospectivo dos casos de biópsias e necropsias de cães recebidos no Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria, constatou-se a ocorrência de dois casos confirmados e de quatro casos suspeitos de pitiose gastrintestinal canina. Os dois casos diagnosticados e publicados tiveram a etiologia confirmada através da cultura e indução de zoosporogênese ou por nested-PCR. Neste estudo utilizou-se a técnica de imuno-histoquímica com anticorpo policlonal anti-Pythium insidiosum para confirmação da etiologia dos quatro casos suspeitos. A epidemiologia, sinais clínicos, lesões macroscópicas e microscópicas, características histoquímicas e imuno-histoquímicas e diagnósticos diferenciais são relatados e discutidos.

Four suspect and two confirmed cases of gastrointestinal pythiosis were found in a retrospective study of biopsy and necropsy cases of dogs received in the Laboratório de Patologia Veterinária at the Universidade Federal de Santa Maria. The two diagnosed and published cases have had the etiology confirmed by culture and zoosporogenesis induction or by nested-PCR. On this study, the etiologic diagnosis of four suspect cases was confirmed by immunohistochemistry using anti-Pythium insidiosum policlonal antibody. Epidemiology, clinical signs, gross and microscopic lesions, histochemistry, immunohistochemistry, and differential diagnoses are reported and discussed.

Comparison of Ziehl-Neelsen Stain and TB-PCR on Detection of Mycobacterium tuberculosisin Formalin-fixed, Paraffin-embedded Tissues of Chronic Granulomatous Inflammation

BACKGROUND: TB-PCR is a faster and more sensitive method to detect mycobacterium than acid-fast bacilli (AFB) stain, which is laborious and time consuming. We compared the sensitivity and specificity of AFB stain and TB-PCR and examined the possibility of TB-PCR as a confirmative test without AFB stain in the diagnosis of tuberculosis. METHODS: We performed Ziehl-Neelsen stain and nested PCR using a commercially available TB-PCR kit amplifying IS6110 sequence in 81 cases of paraffin-embedded tissues diagnosed as chronic granulomatous inflammation. In addition, we evaluated the morphology of granuloma and the presence of caseation necrosis. RESULTS: Of the 81 cases studied, 22 (27.2%) and 40 (49.4%) were positive for AFB stain and TB-PCR, respectively. Of 49 cases accompanying caseation necrosis, 19 (38.8%) were AFB stain positive and 37 (75.5%) were TB-PCR positive; a result that is comparable with that of other reports. Of the 22 AFB-positive cases, 2 were TB-PCR negative. CONCLUSION: TB-PCR is very helpful for the diagnosis of tuberculosis in routinely processed, formalin-fixed, paraffin-embedded tissue samples. Nevertheless, AFB stain should continue to be performed at the same time.