Late Onset Hypercalcemia in an HIV Patient as a Manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS).

Hypercalcemia in human immunodeficiency virus (HIV) patients can be challenging due to various underlying mechanisms. 1,25- dihydroxycholecalciferol (1,25 (OH)2 vitamin D)-mediated hypercalcemia due to increased activity of extrarenal 1-alpha hydroxylase is one of the well-known mechanisms of hypercalcemia described in HIV patients. Mycobacterium avium-intracellulare (MAI) is a granulomatous disease that can cause hypercalcemia due to ectopic production of alpha -1 hydroxylase and result in increased levels of 1,25 (OH)2 vitamin D. Herein, we present a case of "late-onset" hypercalcemia in a patient with HIV/AIDS and MAI infection in the setting of suspected immune reconstitution inflammatory syndrome (IRIS). The hypercalcemia workup showed an inappropriately average level of 1,25 (OH)2 vitamin D while the rest of the workup was unrevealing. Unusually normal levels of vitamin D metabolites were the driving mechanism of hypercalcemia in this case. The late presentation of hypercalcemia was likely due to IRIS unmasking an underlying granulomatous infection, and this consideration led to the successful treatment of the patient with steroid administration. This case emphasizes the importance of considering IRIS in evaluating hypercalcemia that presents late in the course of granulomatous infections in HIV patients.

Acute epididymitis revealing isolated testicular tuberculosis: A rare case report.

Genitourinary tuberculosis is a rare form of extrapulmonary tuberculosis that affects the kidneys, ureters, prostate, vas deferens, seminal vesicles, testes, and epididymis. Testicular tuberculosis is a very unusual form, We report a rare case of unilateral testicular tuberculosis that manifested as orchi-epididymitis. The main treatment for urogenital tuberculosis is antituberculosis therapy, possibly combined with surgery.

Unconstrained one-stage total knee arthroplasty PS design in patient with secondary osteoarthritis due to granulomatous infection with medial femoral condyle defect: A case report.

INTRODUCTION AND IMPORTANCE: Granulomatous Mycobacterium Tuberculosis Infection Causes Secondary Knee Osteoarthritis is still a point of contention in terms of therapy, whether it is done early in the first stage or later in the second stage of knee surgery. Early Total Knee Arthroplasty as a therapy for secondary knee osteoarthritis induced by Granulomatous mycobacterium tuberculosis infection is still performed rarely. CASE PRESENTATION: A case of left pain and swollen knee in males for 8 months. Because of pain and reduced knee range of motion, the patient now has an antalgic gait, which make him difficult to do daily activities. Treatment with medications and physiotherapy failed. Radiographs revealed juxta-articular osteoporosis, peripherally distributed osseous erosions, joint space narrowing, and a bony defect in the medial femoral condyle. This case was successfully treated using Unconstrained Knee Arthroplasty PS Design. CLINICAL DISCUSSION: Case selection for granulomatous infection case is key element to determine whether a single TKA procedure can be used to treat knee pain problems as a result of secondary osteoarthritis. CONCLUSION: This case shows secondary knee osteoarthritis caused by Granulomatous Mycobacterium Tuberculosis Infection without pyogenic pus production might allow for early one-stage total knee arthroplasty. Three months following surgery, the patient's knee was stable and painless, with good wound healing and no signs of infection.

Double Trouble: A Unique Case of Hypercalcemia Caused by Two Underlying Etiologies.

Hypercalcemia has a variety of causes, with primary hyperparathyroidism and malignancies being the most frequently reported. We present the case of a patient presenting with chronic abdominal pain, constipation, and weight loss who was found to have hypercalcemia. The patient was initially diagnosed with colonic actinomycosis, but further investigations revealed an intra-abdominal diffuse large B-cell lymphoma (DLBCL). We suspect that the leading cause of hypercalcemia was the DLBCL, likely exacerbated by actinomycosis. Actinomycosis and DLBCL can have a similar presentation, so misdiagnosis or coexistence of both conditions should be suspected when a lack of response to one specific therapy is observed.

Rhinosporidiosis-Factors predicting disease recurrence.

BACKGROUND: Rhinosporidiosis is a chronic granulomatous disease of the nose caused by Rhinosporidium seeberi. The disease is largely non-amenable to medical therapy and shows high recurrence rates requiring patients to undergo multiple surgeries often resulting in increased morbidity. OBJECTIVE: To analyse the epidemiological, clinical, histopathological characteristics, treatment and outcome in rhinosporidiosis and to identify factors which predispose to recurrence of the disease. PATIENTS/METHODS: Retrospective analysis of data of all patients with a diagnosis of rhinosporidiosis confirmed by histopathology at a tertiary care hospital from 2015 to 2019. RESULTS: There were 42 patients, 40 males and two females, with a mean age of 37.37 years. Disease showed bilateral involvement in 17 (40.48%) patients. Nineteen (45.24%) patients had more than two sites involved at initial presentation. Most patients had nasal cavity involvement followed by nasopharynx. Among the 28 patients who had a follow-up, 12 showed recurrent disease. However, 21 patients were disease free following a revision excision. Involvement of more than two sites was an independent significant factor for recurrence. On univariate analysis, other factors which showed statistically significant odds of developing recurrence were previous surgery (p = .054), involvement of nasal septum (p = .022), middle turbinate (p = .024), nasopharynx (p = .049) and posterior pharyngeal wall (p = .05). Factors which showed significantly less likelihood of developing a recurrence included patients who had less than 12 months duration from first symptom to intervention (p = .016), involvement of less than two sites (p = .0003) and unilateral disease (p = .019). CONCLUSION: Early intervention in rhinosporidiosis especially when the disease is unilateral and involves less than two sites improves the outcome.

Palatal rhinosporidiosis: an unusual case report and review of the literature.

Rhinosporidiosis is a chronic, granulomatous, mucocutaneous infection caused by Rhinosporidium seeberi . The infection is non-contagious and sporadic in humans. The site most commonly affected is the mucous membrane of the nose and nasopharynx, followed by the oropharynx, trachea, bronchi, ear, eye, and genitourinary tract. It can also spread to other areas through blood and lymph. Here, we report a case of rhinosporidiosis affecting the palate in a 60-year-old female patient.

Palatal rhinosporidiosis: an unusual case report and review of the literature

Rhinosporidiosis is a chronic, granulomatous, mucocutaneous infection caused by Rhinosporidium seeberi . The infection is non-contagious and sporadic in humans. The site most commonly affected is the mucous membrane of the nose and nasopharynx, followed by the oropharynx, trachea, bronchi, ear, eye, and genitourinary tract. It can also spread to other areas through blood and lymph. Here, we report a case of rhinosporidiosis affecting the palate in a 60-year-old female patient.

Pulmonary histoplasmosis simulating metastasis: two cases report and review of the literature / Histoplasmose pulmonar simulando metástases: relato de dois casos e revisão de literatura

Introduction and objectives: Systemic mycoses are of great importance in immunosuppression-associated conditions. Histoplasmosis can produce different symptoms that may simulate metastasis. We aim to demonstrate the importance of histopathological confirmation of lesions suggestive of metastases in patients with malignant neoplasm. Cases report: Two patients undergoing cancer treatment, whose chest computed tomography (CT) revealed pulmonary nodules, compatible with metastases. The lesions were biopsied, confirming histoplasmosis granuloma. Conclusion: In patients with cancer, clinical and radiological findings are not limited to metastatic dissemination of tumors, requiring histopathological confirmation of lesions suggestive of metastasis, excluding other diseases and preventing inappropriate treatment. .

Introdução e objetivos: Micoses sistêmicas assumem grande importância nas situações de imunodepressão. A histoplasmose pode produzir diversas manifestações clínicas, podendo simular metástases. Objetivamos demonstrar a importância da confirmação histopatológica de lesão sugestiva de metástase em portadores de neoplasia maligna. Relatos dos casos: Dois pacientes com neoplasias em tratamento, nos quais tomografias de tórax de controle revelaram nódulos pulmonares compatíveis com metástases. As lesões foram biopsiadas, confirmando-se granulomas por histoplasmose. Conclusão: Em portadores de malignidade, aspectos clinicorradiológicos não se limitam à disseminação das neoplasias, sendo necessária a confirmação histopatológica de lesões sugestivas de metástases, excluindo-se outras doenças e evitando-se tratamentos inadequados. .

Immunity against Mycobacterium tuberculosis and the risk of biologic anti-TNF-α reagents.

A third of the world's population is exposed to Mycobacterium tuberculosis in their lifetime. Over eight million people develop a tuberculosis (TB) illness and 1.3 million people die from the disease every year. Acquired immunity (cytotoxic CD8+ T cells (CBT), Th1 CD4+ helper T cells) macrophages, and dendritic cells all play important roles in TB infection. Recently, it is well established that innate immunity as well plays a definitive role in the development of TB immunity under the effects of several cytokines, microbicidal proteins and Toll-like receptors. Meanwhile, the introduction and widespread use of biological disease-modifying anti-rheumatic reagents over the last 15 years worldwide has dramatically advanced and improved the standard care and prognosis of patients with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). However, as clinical experience with these drugs has grown, the risk of granulomatous infections, especially disseminated TB and fungal infections, has become apparent, especially because having RA or JIA may innately increase the risk of infection (bacterial, viral and fungal). The knowledge of basic immunology has also advanced over the past 10 years and adult and pediatric rheumatologists should increase their understanding of this dynamic between arthritis diseases, anti-TNF-α medications, and TB. This review will provide an up-to-date discussion of both the immunology of the TB organism in the human host and the pathophysiologic mechanisms of the TNF-α blockers in the development of secondary (disseminated) tuberculosis.

Granulomatous infection of the hand and wrist due to Azospirillum spp.

We report a case of Azospirillum infection manifestating as granulomatous tenosynovitis of the right hand, in an immunocompetent middle-aged female. We highlight the unusual source of the infection, the diagnostic workup, as well as the treatment approach.

Primary tuberculosis of the breast presented as multiple discharge sinuses.

Breast tuberculosis is a rare form of tuberculosis (TB). It is mainly classified as primary and secondary forms. Primary form is rare. We are reporting a case of primary TB breast with history of breast lump and multiple sinuses. TB was diagnosed on FNAC. Patient was put on anti-tubercular drugs.

Primary gingival tuberculosis: A rare clinical entity.

Tuberculosis is a specific granulomatous infectious disease and a major cause of death in developing countries. Primary gingival tuberculosis is extremely rare and forgotten entity. Oral lesions usually appear as secondary to primary tuberculosis infection elsewhere. The lesion may take the form of nodules, ulcers, or elevated fissures. We report a case of primary tuberculosis of gingiva, manifesting as gingival enlargement with ulceration and discharge. Diagnosis was based on histopathologic examination, complete blood count, chest X-ray, and immunologic investigations with detection of antibodies against Mycobacterium tuberculosis. With the recent increase in the incidence of tuberculosis, this case report also emphasizes the need for clinicians to be aware of this possibility, consider tuberculosis in the differential diagnosis of gingival enlargement, and thus, play a role in the early detection of this disease.