ABSTRACT
A 46-year-old man presented with nonproductive cough and lower limb swelling. Chest radiograph showed a left lower lobe lung mass and multiple subpleural nodules. Other investigations revealed that he had nephrotic syndrome. Core biopsies of the left lower lobe lung mass showed features of inflammatory pseudotumor with endarteritis obliterans and a lymphoplasmacytic infiltrate. Immunohistochemical stain for Treponema pallidum was positive. Resolution of the lung mass and nephrotic syndrome was achieved after treatment with intramuscular benzathine benzylpenicillin. The differential diagnosis of pulmonary inflammatory pseudotumor, manifestations of pulmonary syphilis, and a literature review of secondary syphilis of the lung are discussed.
Subject(s)
Lung/microbiology , Plasma Cell Granuloma, Pulmonary/diagnosis , Syphilis/diagnosis , Treponema pallidum/isolation & purification , Biopsy , Humans , Immunohistochemistry , Injections, Intramuscular , Lung/diagnostic imaging , Lung/pathology , Lung Neoplasms/diagnosis , Male , Middle Aged , Penicillin G Benzathine/administration & dosage , Plasma Cell Granuloma, Pulmonary/blood , Plasma Cell Granuloma, Pulmonary/drug therapy , Plasma Cell Granuloma, Pulmonary/microbiology , Sarcoma/diagnosis , Syphilis/complications , Syphilis/drug therapy , Syphilis/microbiology , Syphilis SerodiagnosisABSTRACT
We report a case of liver transplant patient who presented with lung masses, found to be Mycobacterium spindle cell pseudotumors. The masses demonstrated hypermetabolic activities on positron emission tomography. Core biopsy revealed sheets of spindle histiocytic cells with abundant acid-fast bacilli identified as Mycobacterium avium-intracellulare complex. This finding is a rare presentation of Mycobacterium infection, mainly nontuberculous Mycobaterium. It is characterized by a benign, spindle cell mass-forming reaction. Most of the reported cases had acquired immune deficiency syndrome or organ transplant. Histopathology illustrating the proliferation of spindle cell shaped histiocytes containing numerous acid-fast bacilli is the gold standard for diagnosis. The standard treatment has not been well established; previously reported cases followed the standard treatment for Mycobacterium based on organ involvement. Our case is the first case to our knowledge that reports pulmonary Mycobacterium spindle cell pseudotumors in a liver transplant recipient.
Subject(s)
Liver Transplantation , Mycobacterium avium Complex/isolation & purification , Mycobacterium avium-intracellulare Infection/pathology , Plasma Cell Granuloma, Pulmonary/microbiology , Aged , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Antitubercular Agents/administration & dosage , Antitubercular Agents/therapeutic use , Azithromycin/administration & dosage , Azithromycin/therapeutic use , Ethambutol/administration & dosage , Ethambutol/therapeutic use , Female , Humans , Mycobacterium avium-intracellulare Infection/drug therapy , Mycobacterium avium-intracellulare Infection/microbiology , Plasma Cell Granuloma, Pulmonary/diagnosis , Plasma Cell Granuloma, Pulmonary/drug therapyABSTRACT
A 58-year-old man was admitted because of respiratory failure, episodic fever with chilling, cough, malaise, fatigue, myalgia and weight loss lasting for at least one month. Chest x-rays and CT scan of the chest showed bilateral pulmonary consolidations in upper lobes, the left lower lobe, and mediastinal lymphadenopathy. Bronchoscopy with cytology was unremarkable. A needle CT-guided lung biopsy documented an inflammatory pseudotumor, lymphoplasmacytic type. Serology showed high titer antibodies to phase II Coxiella burnetii infection. Therapy with doxycycline and hydroxychloroquine for three months led to a complete resolution of symptoms and radiological findings, and a marked decrease in titers to Q fever.
Subject(s)
Coxiella burnetii/pathogenicity , Plasma Cell Granuloma, Pulmonary , Anti-Bacterial Agents/therapeutic use , Antibodies, Bacterial/blood , Antibodies, Bacterial/immunology , Coxiella burnetii/immunology , Doxycycline/therapeutic use , Humans , Hydroxychloroquine/therapeutic use , Male , Middle Aged , Plasma Cell Granuloma, Pulmonary/diagnostic imaging , Plasma Cell Granuloma, Pulmonary/drug therapy , Plasma Cell Granuloma, Pulmonary/microbiology , Q Fever/drug therapy , Q Fever/microbiology , RadiographyABSTRACT
Mycobacterial spindle cell pseudotumor (MSP) is a rare benign lesion characterized by local proliferation of spindle-shaped histiocytes containing acid-fast mycobacteria. Most reported cases of MSP occur in the lymph nodes, skin, spleen, and brain in patients who are immunocompromised, particularly following solid organ transplant and in those with AIDS. This is a case report of a patient with AIDS who presented with cough, generalized weakness, and fatigue, who was found to have multilobar lung masses that were MSP, which to our knowledge has not yet been reported in the literature.
Subject(s)
Histiocytes/microbiology , Histiocytes/pathology , Mycobacterium avium Complex/isolation & purification , Plasma Cell Granuloma, Pulmonary/diagnostic imaging , Plasma Cell Granuloma, Pulmonary/microbiology , Acquired Immunodeficiency Syndrome/epidemiology , Biopsy , Comorbidity , Female , Histiocytes/diagnostic imaging , Humans , Lung/diagnostic imaging , Lung/microbiology , Lung/pathology , Middle Aged , Plasma Cell Granuloma, Pulmonary/epidemiology , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Actinomycosis is an uncommon chronic suppurative bacterial infection caused by anaerobic bacteria. Pulmonary actinomycosis is even more infrequent and generally simulates a wide variety of pulmonary disorders including tuberculosis and lung cancer. Therefore delayed diagnosis and misdiagnosis is common. Here, actinomycosis was initially confused with pulmonary carcinoma. METHODS: We report on three cases of inflammatory tumors caused by pulmonary actinomycosis. All three patients were male and had a history of alcoholism and poor oral hygiene associated with dental disease. Clinical symptoms were nonspecific and radiographic imaging showed tumor-like mass lesions not distinguishable from neoplasms. Preoperative bronchoscopy, sputum culture, laboratory tests and bronchoalveolar lavage neither confirmed an infectious disease nor ruled out lung cancer. Hence all patients underwent thoracotomy for both diagnosis and definitive treatment. Intraoperatively we encountered a necrotizing infection forming cavitary as well as tumorous lesions and a lobectomy was performed due to destroyed lung tissue. In one case the tumorous lesion involved the chest wall so that partial resection of the 3rd rib with the adjacent soft tissue was mandatory. RESULTS: Histological examination of the pulmonary specimen established the diagnosis of pulmonary actinomycosis. All patients recovered well and received antibiotic therapy with oral penicillin. CONCLUSIONS: The diagnosis of pulmonary actinomycosis remains challenging. In cases of an inflammatory tumor imitating lung cancer, surgical resection is mandatory, both to confirm the diagnosis and for the definitive treatment in cases with irreversible parenchymal destruction. Here, surgery in combination with medical treatment offered reliably excellent results.
Subject(s)
Actinomycosis/surgery , Lung Diseases/surgery , Plasma Cell Granuloma, Pulmonary/surgery , Pneumonectomy , Thoracotomy , Actinomycosis/complications , Actinomycosis/diagnosis , Actinomycosis/microbiology , Adult , Alcoholism/complications , Anti-Bacterial Agents/therapeutic use , Biopsy , Diagnosis, Differential , Humans , Lung Diseases/complications , Lung Diseases/diagnosis , Lung Diseases/microbiology , Lung Neoplasms/diagnosis , Male , Middle Aged , Osteotomy , Plasma Cell Granuloma, Pulmonary/microbiology , Predictive Value of Tests , Ribs/surgery , Stomatognathic Diseases/complications , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
A 44-year-old woman who had recently been on immunosuppressive therapy presented with malaise, cough, fever, weight loss, lymphadenopathy, severe hypercalcaemia and a paratracheal mass on imaging. The initial impression was of disseminated malignancy, and lymphoma was suspected. A mediastinal biopsy showed a mycobacterial spindle cell pseudotumour containing acid and alcohol fast bacilli (AAFB). Sputum microscopy demonstrated AAFBs, confirmed as Mycobacterium tuberculosis complex by PCR. Prolonged culture grew Mycobacterium microti, an organism often associated with disease in small rodents and llamas. M microti isolates from postmortem samples of an alpaca at a nearby farm were genetically indistinguishable. Although the patient had not visited the farm, concurrent illness in her adopted stray cat suggested a possible zoonotic connection. The patient responded to antituberculous therapy, and rehydration and pamidronate for hypercalcaemia. We believe the hypercalcaemia was caused by a similar mechanism to raised calcium levels sometimes seen in tuberculosis.
Subject(s)
Antitubercular Agents/therapeutic use , Histiocytes/microbiology , Hypercalcemia/microbiology , Mycobacterium/isolation & purification , Plasma Cell Granuloma, Pulmonary/microbiology , Tuberculosis/microbiology , Adult , Animals , Biopsy , Camelids, New World/microbiology , Cats/microbiology , Diagnosis, Differential , Female , Humans , Immunocompromised Host , Polymerase Chain Reaction , Sputum/microbiology , Tuberculosis/diagnosis , Tuberculosis/drug therapyABSTRACT
Inflammatory myofibroblastic tumor (IMT) is an uncommon cause of solitary or multifocal lung nodules and can also be rarely found in various other extrapulmonary sites. Although this pseudotumor is benign, it can be locally very aggressive. The pathogenesis of IMT remains unclear; autoimmune or infectious origins have been hypothesized, so far. Here, we report a case of inflammatory pseudotumor of the lung secondary to invasive pulmonary aspergillosis in a patient with chronic graft-vs.-host disease. The 42-year-old patient presented with coughing and hemoptysis as major clinical signs 1 yr after successful HLA-identical stem cell transplantation. Aspergillus fumigatus was cultured from the bronchoscopic lavage, but intensive antifungal treatment could only initially improve the clinical situation. Diagnostic re-evaluation by open-chest biopsy surprisingly revealed an inflammatory pseudotumor responsible for clinical and radiographical deterioration. Both clinical and radiographical signs resolved under long-term steroids and secondary antifungal prophylaxis.
Subject(s)
Aspergillosis/pathology , Graft vs Host Disease , Lung Diseases, Fungal/pathology , Plasma Cell Granuloma, Pulmonary/pathology , Stem Cell Transplantation , Adult , Antifungal Agents/therapeutic use , Aspergillosis/diagnostic imaging , Aspergillosis/prevention & control , Graft vs Host Disease/complications , Humans , Lung Diseases, Fungal/diagnostic imaging , Lung Diseases, Fungal/prevention & control , Male , Plasma Cell Granuloma, Pulmonary/drug therapy , Plasma Cell Granuloma, Pulmonary/microbiology , Steroids/therapeutic use , Tomography, X-Ray ComputedABSTRACT
Disseminated nocardiosis has never been described before in a patient with Waldenstrom macroglobulinemia. We report an unusual case of disseminated nocardiosis in a patient with Waldenstrom macroglobulinemia who presented with pulmonary non-caseating granulomas. The patient was successfully treated with trimethoprim-sulfamethoxazole (TMP-SMX) for 1 year.