ABSTRACT
BACKGROUND: There are only few cases of renal pathology induced by Lyme borreliosis in the literature, as this damage is rare and uncommon in humans. This patient is the first case of minimal change glomerular disease associated with chronic Lyme borreliosis. CASE PRESENTATION: A 65-year-old Caucasian woman was admitted for an acute edematous syndrome related to a nephrotic syndrome. Clinical examination revealed violaceous skin lesions of the right calf and the gluteal region that occurred 2 years ago. Serological tests were positive for Lyme borreliosis and skin biopsy revealed lesions of chronic atrophic acrodermatitis. Renal biopsy showed minimal change glomerular disease. The skin lesions and the nephrotic syndrome resolved with a sequential treatment with first ceftriaxone and then corticosteroids. CONCLUSION: We report here the first case of minimal change disease associated with Lyme borreliosis. The pathogenesis of minimal change disease in the setting of Lyme disease is discussed but the association of Lyme and minimal change disease may imply a synergistic effect of phenotypic and bacterial factors. Regression of proteinuria after a sequential treatment with ceftriaxone and corticosteroids seems to strengthen this conceivable association.
Subject(s)
Acrodermatitis/etiology , Lyme Disease/complications , Nephrosis, Lipoid/etiology , Nephrotic Syndrome/etiology , Acrodermatitis/diagnosis , Acrodermatitis/pathology , Aged , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Chronic Disease , Female , Glucocorticoids/therapeutic use , Humans , Kidney/pathology , Lyme Disease/diagnosis , Lyme Disease/drug therapy , Nephrosis, Lipoid/diagnosis , Nephrosis, Lipoid/drug therapy , Nephrosis, Lipoid/pathology , Nephrotic Syndrome/diagnosis , Prednisolone/therapeutic use , Skin/pathologyABSTRACT
OBJECTIVES: Fibrous dysplasia is a congenital bone disease, where normal bone is replaced by a fibrous-like tissue with immature osteogenesis. The cephalic extremity is affected in one out of three cases. The aim of this study was to describe a case of fibrous dysplasia and review workup and management of this pathology. MATERIAL AND METHODS: We reviewed relevant publications using the Medline database and presented a case of isolated paranasal sinus fibrous dysplasia to illustrate this disease. RESULTS: The clinical onset was headache and left palpebral oedema in a twelve-year old. Imaging showed a left fronto-ethmoidal bone lesion with epidural empyema. No other radiological anomaly or phosphor-calcic disorder was present. The clinical course was positive using intravenous antibiotics, with a two-year follow-up. DISCUSSION: Fibrous dysplasia is diagnosed using CT-scan, without the need for histologic confirmation in most cases. Initial workup includes axial skeleton X-rays and hormonal dosages. The efficiency of biphosphonates drugs has significally reduced the number of surgical procedures. CONCLUSIONS: Fibrous dysplasia is often a multifocal disease and should be treated medically first. Management requires a multi-disciplinary team.
Subject(s)
Ethmoid Bone/pathology , Fibrous Dysplasia of Bone/diagnosis , Frontal Bone/pathology , Child , Edema/diagnosis , Edema/etiology , Ethmoid Bone/diagnostic imaging , Female , Fibrous Dysplasia of Bone/complications , Fibrous Dysplasia of Bone/diagnostic imaging , Fibrous Dysplasia of Bone/pathology , Fibrous Dysplasia, Monostotic , Frontal Bone/diagnostic imaging , Headache/diagnosis , Headache/etiology , Humans , Tomography, X-Ray ComputedABSTRACT
An 8-year-old intact male cat was presented with a subcutaneous mass in the region of the right jugular vein. Cytologic and histopathologic examinations revealed cells with multilobulated nuclei (flower cells). Immunochemistry using a panel of markers showed vimentin-positivity on cytologic specimens, and postive staining for CD79a and BLA36 on histologic specimens. The final diagnosis was lymphoma of B-cell origin. We have observed similar multilobulated cells in ascites fluid, thoracic fluid, and peripheral blood from dogs and cats with a variety of lymphoid and myeloid neoplasms. Cells with multilobulated nuclei that resemble flower petals also have been described in humans. These cells are infrequently observed in canine and feline cytology specimens and require immunochemistry to determine their cell of origin.
