Majocchi's granuloma after antithymocyte globulin therapy in a liver transplant patient.

Majocchi's granuloma (MG) is an atypical and uncommon presentation of dermatophytic infection involving the invasion of dermal and subcutaneous tissue by fungal organisms. It usually begins as a suppurative folliculitis and may culminate in the development of widespread granulomas. Immunosuppressed patients are at increased risk, especially those with T-cell deficiencies. We describe a case of inguinal MG in a liver transplant patient who had received antithymocyte globulin for acute rejection.

Progressive nodular histiocytosis: a case report with literature review, and discussion of differential diagnosis and classification.

Histiocytoses are a heterogeneous group of disorders which are difficult to categorize because of overlapping clinical and microscopic features, and incompletely understood mechanisms of cellular origin and triggers of proliferation. Progressive nodular histiocytosis (PNH) is a rare non-Langerhans cell histiocytic (NLH) disorder. We present the case of a 34-year-old woman with PNH, who has involvement of the back, head and neck, face, and uniquely, extensive involvement of the posterior pharynx and larynx, which has shown progressive worsening and deformity over a 7-year course. Clinically it is best classified as PNH, although it microscopically closely resembles juvenile and adult xanthogranulomatosis. This study reinforces the concept that the NLH is a closely related group of disorders, possibly representing a spectrum of a single underlying process.

Macroscopic pathology of the lungs in Legionnaires' disease.

We used the whole lung section technique to review the macroscopic pathology in 12 patients who died with Legionnaires' disease. None of these patients had been treated with erythromycin. Consolidation was evenly distributed throughout all lobes without a consistent segmental distribution. The smallest lesions were around bronchioles or bounded by lobular septa. In most cases there was confluent involvement of multiple lobules. Extensive consolidation made distinction between a lobar and confluent lobular distribution difficult. Abscesses were present in two cases and nodular infiltrates in two others. In five additional patients, Legionnaires' disease had been treated with erythromycin. Four had a clinical response to treatment, and the fifth had diffuse staphylococcal pneumonia as the predominant lesion. Because the lungs of all five patients contained bacteria other than the Legionnaires' disease bacterium at the time of autopsy, it was difficult to ascertain the role of Legionnaires' disease bacterium in the pathology.

Ultrastructure of lung in Legionnaires' disease. Observations of three biopsies done during the Vermont epidemic.

Open lung biopsies from three patients with Legionnaires' disease were examined by light and transmission electron microscopy. The patients had serious underlying disease. All developed a rapidly progressive pneumonia unresponsive to penicillin, oxacillin, and gentamicin. One patient, who received erythromycin, survived. Light microscopy in all three showed severe acute bronchopneumonia. The Legionnaires' disease bacterium was seen in tissue sections and confirmed by direct immunofluorescence. Transmission electron microscopy showed numerous rod-shaped intracellular organisms that were morphologically similar to other gram-negative bacteria and the Rickettsieae. They were within phagolysosomes, free in the cytoplasm, and rarely within structures resembling dilated rough endoplasmic reticulum. Lung tissue changes included marked detachment and necrosis of alveolar pneumocytes, septal and alveolar exudate with lysis, and prominent endothelial cell swelling and degeneration. Capillary and epithelial basement membranes were consistently intact, suggesting that the tissue changes are potentially capable of reverting to normal structure and function.

The pathology of Legionnaires' disease. Fourteen fatal cases from the 1977 outbreak in Vermont.

Fourteen fatal cases from the 1977 Vermont outbreak of Legionnaires' disease have been analyzed. Serious underlying diseases were present in all patients. The only consistent lesions were in the lungs. Bronchopneumonia was present in all cases and was confluent in most. No lobe of the lung was preferentially involved and consolidation was usually bilateral. Abscesses were evident macroscopically in only two cases. Microscopically, there was an extensive alveolar infiltrate of polymorphonuclear neutrophils and macrophages. Lysis of the inflammatory cells was frequently present and was associated with an increased number of bacteria. Coagulative necrosis of lung was present in a few cases, and the possibility of a bacterial toxin must be considered. Bacteria were well stained by the Dieterle stain and appeared Gram-negative in tissue imprints from the unfixed lung.