Subject(s)
Bites and Stings , Dermatitis , Animals , Dermatitis/etiology , Humans , Lacerations , RabbitsABSTRACT
BACKGROUND: Wells syndrome, or eosinophilic cellulitis, is an uncommon inflammatory dermatosis of unknown etiology that is characterized by clinical features of pruritic cellulitis-like plaques on the extremities and a histological picture of eosinophilic infiltrate of the dermis with "flame figures". PATIENTS AND METHODS: Herein, we report three cases of idiopathic Wells syndrome masquerading as bacterial facial cellulitis. Under treatment with oral prednisone and/or combined therapy with levocetirizine and hydroxyzine, all patients showed a dramatic improvement of their skin lesions. DISCUSSION: These cases highlight the need to consider Wells syndrome in the differential diagnosis when evaluating a patient with facial cellulitis that does not respond to an initial antimicrobial regimen. In addition, our cases suggest that combined therapy with levocetirizine and hydroxyzine may be successfully used as first-line therapy or to prevent relapse after discontinuation of corticosteroid treatment.
Subject(s)
Cellulitis/diagnosis , Eosinophilia/diagnosis , Facial Dermatoses/diagnosis , Adult , Antipruritics/therapeutic use , Bacterial Infections/diagnosis , Cetirizine/therapeutic use , Diagnosis, Differential , Drug Therapy, Combination , Female , Humans , Hydroxyzine/therapeutic use , Middle Aged , Prednisone/therapeutic useABSTRACT
We report the case of a man who presented cutaneous aseptic abscesses, a rare form of neutrophilic disease, associated with Yersinia enterocolitica infection and who was later diagnosed as having Crohn's disease (CD). Genetic analysis showed that the patient had a mutation in the caspase activation recruitment domain 15/nucleotide oligomerization domain 2 gene (R702W heterozygote). This case is in keeping with recent evidence in the literature which suggests that CD is a disease linked to abnormal immune responses to enteric bacteria in genetically susceptible individuals. Further understanding of the innate immune system should provide new insights into the pathogenesis of these inflammatory diseases.
Subject(s)
Abscess/etiology , Colitis, Ulcerative/immunology , Crohn Disease/immunology , Sweet Syndrome/complications , Yersinia Infections/complications , Yersinia enterocolitica , Abscess/diagnosis , Abscess/drug therapy , Adult , Caspases/genetics , Colitis, Ulcerative/diagnosis , Colitis, Ulcerative/drug therapy , Colitis, Ulcerative/genetics , Crohn Disease/diagnosis , Crohn Disease/drug therapy , Crohn Disease/genetics , Glucocorticoids/therapeutic use , Humans , Leg , Male , Mutation , Nod2 Signaling Adaptor Protein/genetics , Phenotype , Polymorphism, Genetic , Sweet Syndrome/diagnosis , Sweet Syndrome/drug therapy , Treatment Outcome , Yersinia Infections/diagnosis , Yersinia Infections/drug therapy , Yersinia enterocolitica/isolation & purificationABSTRACT
INTRODUCTION: Necrotising sarcoid granulomatosis is a rare clinical entity, characterised by the development of nodular pulmonary opacities, the diagnosis if which is based on the identification of characteristic pathological lesions. CASE REPORT: A 44-years-old male smoker presented with cough and fever. With the exception of a few basal crepitations clinical examination was normal. The chest x-ray showed multiple areas of alveolar consolidation scattered throughout both lung fields, some of which were cavitated. The thoracic CT scan confirmed the presence of cavitating nodules and hilar and mediastinal lymphadenopathy. Samples for mycobacteria were negative. A search for anti-neutrophil cytoplasmic antibodies was negative. Fibreoptic bronchoscopy was normal but transbronchial biopsies revealed giant cells. Lung biopsies taken by video thoracoscopy showed non-caseating granulomata with areas of fibrinoid necrosis and perivascular infiltration with lymphocytes, histology characteristic of necrotising sarcoid granulomatosis. Resolution occurred without treatment. The parenchymal lesions regressed leaving residual cavities. Four years later, following an episode of haemoptysis, the patient was found to have a squamous cell carcinoma (T1N0M0) and aspergillomas in the pulmonary cavities. CONCLUSIONS: Our observation demonstrates that the cavities of necrotising sarcoid granulomatosis may be complicated by aspergillomas.
Subject(s)
Aspergillosis/etiology , Granuloma/complications , Granuloma/pathology , Lung Diseases, Fungal/etiology , Lung Diseases/complications , Lung Diseases/pathology , Lung/pathology , Adult , Aspergillosis/pathology , Biopsy , Carcinoma, Non-Small-Cell Lung/diagnosis , Granuloma/diagnosis , Humans , Lung Diseases/diagnosis , Lung Diseases, Fungal/pathology , Lung Neoplasms/diagnosis , Male , NecrosisABSTRACT
Malakoplakia is a granulomatous inflammatory disorder occurring rarely in the prostate. We report our experience with three patients aged from 54 to 75 years old. Clinical presentations were unspecific. All patients presented with a past history of urinary tract infection. Ultrasound study revealed hypoechoic peripheral zone lesions. Histological examination showed a diffuse granulomatous inflammation with numerous histiocytes containing Michaelis-Gutmann bodies. In the prostate, malakoplakia is a histological variant of granulomatous chronic prostatitis following urinary infections. Clinically and radiologically, the differential diagnosis with adenocarcinoma is difficult. The symptoms disappear with a prolongated antibiotic treatment.
