Subject(s)
Albendazole/therapeutic use , Anthelmintics/therapeutic use , Enterobiasis/diagnosis , Enterobius/isolation & purification , Granulation Tissue/parasitology , Ivermectin/therapeutic use , Adult , Animals , Emperipolesis , Enterobiasis/drug therapy , Enterobiasis/parasitology , Enterobiasis/pathology , Female , Granulation Tissue/pathology , Humans , Larva , Lymphocytes/pathology , Macrophages/physiology , Neutrophils/physiology , Plasma Cells/physiology , Rectum/parasitology , Rectum/pathology , Treatment OutcomeABSTRACT
Cystic neutrophilic granulomatous mastitis (CNGM) is a histologically characterized variant of granulomatous lobular mastitis that is associated with lipophilic Corynebacterium species. It remains a largely underrecognized entity in India. Our aim was to study CNGM in the Asian Indian population and explore if 16s rRNA sequencing could be used on formalin-fixed paraffin-embedded (FFPE) tissue to identify the causative organism. We studied 24 cases with histological features of CNGM with hematoxylin and eosin, Gram, Ziehl-Neelsen, and Periodic acid-Schiff stains. Tuberculosis-polymerase chain reaction and 16s rRNA gene sequencing on DNA extracted from FFPE was attempted (N = 23). Gram-positive bacilli were seen in 20/24 cases. Routine culture with prolonged incubation yielded Corynebacterium species in 8 cases; 7 of these cases were evaluated by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for species identification. C matruchotti was identified in one case by BD Phoenix. MALDI-TOF MS identified the remaining 7 cases as C kroppenstedtii (N = 4) and C tuberculostearicum (N = 2), with no identification in one. Corynebacteria were identified by 16s rRNA sequencing on DNA extracted from FFPE in 12/23 cases using a primer targeting the V5-V6 region that was found to be more conserved in Corynebacterium species. All cases were negative for the diagnosis of tuberculosis. CNGM can be identified by routine stains. Culture using routine media with prolonged incubation is often adequate to isolate the organism. 16s rRNA sequencing on DNA extracted from FFPE tissue can help make an etiological diagnosis in some cases where only paraffin blocks are available.
Subject(s)
Breast/pathology , Corynebacterium/isolation & purification , Granulomatous Mastitis/diagnosis , Molecular Diagnostic Techniques/methods , Adult , Breast/microbiology , Corynebacterium/genetics , DNA, Bacterial/isolation & purification , Feasibility Studies , Female , Granulomatous Mastitis/microbiology , Granulomatous Mastitis/pathology , Humans , India , Middle Aged , Paraffin Embedding , Polymerase Chain Reaction , Prospective Studies , RNA, Ribosomal, 16S/genetics , Retrospective Studies , Sequence Analysis, DNA , Young AdultABSTRACT
Toxoplasmosis is generally asymptomatic in immunocompetent individuals, but it can be life-threatening in immunocompromised patients. We present a case of a 62-year-old man with clinical features of acute appendicitis. Histology showed a transmural infiltrate of eosinophils. In addition, there were reactive lymphoid follicles with histiocytes in the submucosa and tachyzoites in the muscularis propria. Immunohistochemistry confirmed the diagnosis of toxoplasma appendicitis. Serological evaluation yielded negative results. Retrospective review of the history revealed that the patient was on long-term immunosuppressive therapy with methotrexate. The patient was treated with sulfamethoxazole-trimethoprim and is asymptomatic at 7-month follow-up. Toxoplasma appendicitis must be considered in the differential diagnosis of appendicitis in immunosuppressed patients.
