ABSTRACT
BACKGROUND: Interstitial lung disease, cutaneous rash and elevated serum angiotensin converting enzyme (ACE) may suggest diagnoses other than sarcoidosis. PATIENTS AND METHODS: A 58-year-old man had presented dyspnoea for 2 years with increased angiotensin-converting enzyme, as well as an interstitial syndrome and micronodules. The possibility of sarcoidosis was raised. Systemic corticosteroids resulted in improvement of the dyspnoea although it recurred on dose reduction. We noted fluctuating eczematous macules of the limbs with a histology of aspecific folliculitis. The identification of Mycobacterium avium complex (MAC) in the bronchoalveolar wash prompted us to initiate antimycobacterial therapy, but this was to no avail. Review of the CT-scan and questioning of the patient (daily use of a Jacuzzi for 7 years) resulted in diagnosis of hypersensitivity pneumonitis due to MAC. The cutaneous lesions were taken to indicate "hot tub folliculitis". Discontinuation of hot-tub use and a short course of oral corticosteroids resulted in healing within 4 months, with no recurrence at 2 years. DISCUSSION: HTL is a form of hypersensitivity pneumonitis due to the presence of MAC in the water of Jacuzzis. This condition regresses spontaneously without treatment on discontinuation of Jacuzzi use. Hot-tub folliculitis due to Pseudomonas aeruginosa (PA) presents as macules and papules on covered skin areas (swimsuit) within 48hours of bathing and often declines within 2 weeks. CONCLUSION: Our case is original as regards the concomitant lung and cutaneous involvement associated with Jacuzzi use, with an immunoallergic mechanism for the MAC and probably an infectious mechanism for the PA.
Subject(s)
Alveolitis, Extrinsic Allergic/etiology , Baths/adverse effects , Folliculitis/etiology , Mycobacterium avium Complex/isolation & purification , Mycobacterium avium-intracellulare Infection/etiology , Pseudomonas Infections/etiology , Pseudomonas/isolation & purification , Water Microbiology , Alveolitis, Extrinsic Allergic/microbiology , Diagnosis, Differential , Dyspnea/etiology , Folliculitis/microbiology , Hot Temperature , Humans , Male , Middle Aged , Sarcoidosis, Pulmonary/diagnosisABSTRACT
Rectal leiomyosarcoma is rare. It is frequently treated by abdominoperineal resection. The role of adjuvant therapy is unclear. Two cases of rectal leiomyosarcoma are presented. Pre-operative endorectal ultrasound predicted submucosal invasion in one case treated by low restorative resection and muscularis propria infiltration in the other managed with abdominoperineal resection. In both cases, ultrasound suggested malignant characteristics as evident by heterogeneous cystic spaces, irregular outline, large size and echogenic foci. Histology was CD34 negative and desmin, alpha-smooth muscle actin and HHF-35 positive, distinguishing these tumours from gastrointestinal stromal tumours. Rectal leiomyosarcoma may be successfully treated by restorative resection and pre-operative ultrasound is useful in assisting this surgical decision by defining malignant features of the tumour. Histopathological characteristics predictive of poor prognosis include high mitotic activity, intratumoural necrosis and tumour size.
Subject(s)
Leiomyosarcoma/pathology , Rectal Neoplasms/pathology , Aged , Fatal Outcome , Female , Humans , Leiomyosarcoma/diagnostic imaging , Leiomyosarcoma/surgery , Middle Aged , Rectal Neoplasms/diagnostic imaging , Rectal Neoplasms/surgery , UltrasonographyABSTRACT
Rectal leiomyosarcoma is rare. It is frequently treated by abdominoperineal resection. The role of adjuvant therapy is unclear. Two cases of rectal leiomyosarcoma are presented. Pre-operative endorectal ultrasound predicted submucosal invasion in one case treated by low restorative resection and muscularis propria infiltration in the other managed with abdominoperineal resection. In both cases, ultrasound suggested malignant characteristics as evident by heterogeneous cystic spaces, irregular outline, large size and echogenic foci. Histology was CD34 negative and desmin, alpha-smooth muscle actin and HHF-35 positive, distinguishing these tumours from gastrointestinal stromal tumours. Rectal leiomyosarcoma may be successfully treated by restorative resection and pre-operative ultrasound is useful in assisting this surgical decision by defining malignant features of the tumour. Histopathological characteristics predictive of poor prognosis include high mitotic activity, intratumoural necrosis and tumour size
