Silhouette Lymphangioma: An Unknown Macular Form of Cutaneous Lymphangioma.

Unusual angiomatous or lymphangiomatous vascular malformations are rarely seen. One of them is lymphangioma (LA), which is a rare benign lymphovascular abnormality. LA is usually seen in the types of circumscriptum (or capillary), cavernous and cystic. Here, we report a unique case of LA with a patchy appearance. The patient presented due to unusual symptoms and eccentric clinical manifestation of the lesion. Here, we present a new lymphatic entity which was diagnosed as LA with its clinical, radiological and pathological findings. Written informed consent of the patient was obtained for this report. To the best of our knowledge this macular form of cutaneous LA has not been previously reported in literature. Macular LA should be kept in mind when faced with a colored long-term macular lesion on the skin.

[A negleted bacteria with a case: Bartonella henselae]. / Bir olgu ile ihmal edilen bir etken: Bartonella henselae.

Bartonella henselae the causative agent of cat scratch disease (CSD), is a gram-negative, coccobacillus, facultative intracellular bacterium CSD usually presents as a clinical form of benign local lymphadenopathy (LAP) but sometimes it may progress to severe life threatening complications. Despite the fact that CSD is known to be a common disease, which is one of the important causes of local LAPs in the world, there are few publications in our country. For the diagnosis, the clinician should suspect for CSD and has to ask to the patient whether there is a story of cat scratch or not. In our country the diagnosis of CSD is usually done by invasive pathological examination instead of simple serological tests. In this report, a 14 years old case with CSD with antibody titers of 1/384 IgM, 1/2048 IgG B.henselae antibody determined by indirect fluorescent antibody (IFA) method in serum and B.henselae positivity by polymerase chain reaction (PCR) from LAP sample of the patient with axillary LAP was presented. Even though molecular techniques have been used for the diagnosis of the previous reported cases, it is the first B.henselae positive case in our country detected with PCR. In the history of the case it was learned that the patient was scratched by a street cat few months ago and the axillary LAP developed 4-5 weeks later. Axillary ultrasonography shawed abscesses with the largest 22 x 44 mm compatible with LAP. No growth was detected in the LAP biopsy specimen culture. Leucocyte count was normal but sedimentation rate (68 mm/h), and C-reactive protein (41.7 mg/L) were higher.Therapy was started with azitromycin 500 mg/day but two weeks later as there was no regression of LAP, considering the development of resistance, the treatment was changed to doxycycline 2 x 100 mg/day and rifampicin 1 x 300 mg/day. As the LAP was in abscess formation and the titers found in IFA was higher than the predictive value of B.henselae antibody titer for endocarditis, the treatment has been extended to four weeks and the patient has been cured. Especially children and adolescents are at very high risk for zoonotic infections transmitted from pets in our country due to the intense immigration to the city from the rural areas and the unconscious and uncontrolled livelihood of friendship with street animals. We should accept that this is not a rare condition, as the cat scratch disease can change from harmless to very serious forms the diagnosis and treatment should be quickly and carefully performed. Currently, serological examinations for Bartonella are rarely done in some certain reference laboratories in our country. The number of these laboratories should be increased or the usage of the tests in these reference laboratories should be at least expanded.

Simultaneous acute deep vein thrombosis and acute brucellosis. A case report.

Brucellosis is a zoonotic disease common in developing countries. Vascular complications, including arterial and venous, associated with Brucella infection have rarely been reported. A case of deep venous thrombosis (DVT) developing after a diagnosis of acute brucellosis in a young milkman is presented. A 26-year-old man presented with pain in the right leg. The patient's medical history included a diagnosis of brucellosis in our hospital where he had presented with complaints of weakness and fever. Peripheral venous Doppler ultrasound showed DVT, and the patient was treated with anticoagulants. The patient was discharged with warfarin therapy and anti-brucellosis treatment. Although rare, some infectious agents may cause vascular pathologies. Patients presenting with symptoms of DVT or similar vascular pathologies should be assessed for infectious agents, particularly in those coming from Brucella-endemic areas.