Granulomatous amoebic encephalitis caused by Acanthamoeba in a patient with systemic lupus erythematosus.

A 25-year-old chronically immunosuppressed woman with systemic lupus erythematosus (SLE) died after developing subacute granulomatous encephalitis caused by Acanthamoeba. Amoebic trophozoites were also found in the lung, suggesting a primary pulmonary focus of infection. The infectious encephalitis was difficult to differentiate from a flare-up of central nervous system lupus. This case illustrates that Acanthamoeba can cause fatal encephalitis in lupus patients, as well as in patients with acquired immunodeficiency syndrome as previously reported. To our knowledge, this is the first reported case of granulomatous amoebic encephalitis due to Acanthamoeba in a patient with SLE.

[Quality control of fine needle aspiration cytology of breast lesions].

From 1988 to 1993 we treated 1,310 cases of fine needle aspiration cytology of breast lesions. The results were positive for malignancy in 218, suspicious in 134, negative in 857, and inadequate specimen in 101. Histological examinations were performed in 461 cases; 243 malignancies and 218 benign lesions. The cytological diagnosis of these cases was positive in 211, suspicious in 91, negative in 142 and inadequate specimen in 17. The cytologic diagnosis of the cases of histological malignancy was positive in 198, suspicious in 24, negative in 17 and inadequate specimen in 4. Therefore we have 17 false negative cases. The histological diagnoses in these cases were scirrhous carcinoma (7), papillotubular carcinoma (6), invasive lobular carcinoma (2), mucinous carcinoma (1) and angiosarcoma (1). There were 13 cases of cytologically false positive cases; the histological diagnoses were fibroadenoma (4), mastopathy (4), papilloma (3), adenosis (1) and xanthogranuloma (1). For over six years, we have used a computer system incorporating both cytologic and histologic records. This system is very useful in quickly review the correlations of cytologic-histologic diagnoses. In addition to this system, a close relationship between clinical to pathological department is necessary in the quality control of diagnostic cytology.

[A case of tropical eosinophilia associated with pleural effusion].

A 52-year-old man was admitted to Keio University Hospital for determination of the etiology of a bilateral pleural effusion associated with marked eosinophilia (10200 cells/mm3). He had been in Vietnam for three years and had returned to Japan in May 1993. He was suffering from tropical eosinophilia, as clearly indicated by eosinophilia, elevation of serum IgE level (708 IU/ml), the presence of anti-dirofilarial antibodies, and the absence of microfilaria in the blood. The pleural effusion was an exudate and 51% of the cells in the effusion were eosinophils. In the effusion, no parasites were detected but anti-dirofilarial antibodies were found (the titer was as high as that in the serum). Diethylcarbamazine was given, and a steroid had to be superimposed because of wheezing. These treatments successfully reduced the bronchoconstriction, eosinophilia and accumulation of pleural effusion. Tropical eosinophilia has generally been thought not to be associated with pleural effusion. This is only the third case report of tropical eosinophilia with authentic pleural effusion.