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Annals of Dermatology May 2023A 38-year-old female with systemic lupus erythematosus (SLE) initiated belimumab treatment. One month later, she presented with a reddish painful swelling on her right...
A 38-year-old female with systemic lupus erythematosus (SLE) initiated belimumab treatment. One month later, she presented with a reddish painful swelling on her right lower leg. She was treated with ceftriaxone and vancomycin. However, novel erythematous papules and indurated nodules appeared on both her lower legs. Skin biopsy revealed microabscess formation with mixed cell granuloma surrounded by inflammatory cell infiltration within the dermis with subcutaneous fat tissue. A large number of acid-fast bacilli were observed with Ziehl-Neelsen staining. DNA sequencing of both the hsp65 and the 16S rRNA sequences showed a 100% match with the corresponding region of . Mycobacterial culture revealed satellite growth enhancement on Middlebrook 7H11 agar plates around a paper strip containing hemin. She was treated with levofloxacin, rifabutin, and ethambutol. Within 13 months, her cutaneous lesions improved markedly without any side effects. The B cell-targeted biologic belimumab, a fully humanized IgG1γ monoclonal antibody that inactivates B lymphocyte stimulator, has been considered to be beneficial for active SLE. However, this therapy could increase the risk for the development of biologic therapy-associated mycobacterial infections, both tuberculosis and nontuberculous mycobacteria infections.
PubMed: 37853868
DOI: 10.5021/ad.21.077 -
Access Microbiology 2023has been known to cause a variety of clinical manifestations ranging from mild enteric illness to bacteraemia with septic shock and extraintestinal abscesses. Patients...
INTRODUCTION
has been known to cause a variety of clinical manifestations ranging from mild enteric illness to bacteraemia with septic shock and extraintestinal abscesses. Patients with liver disease and iron overload are at risk of more severe disease manifestations.
CASE REPORT
A middle-aged male with chronic alcohol use disorder presented with confusion and jaundice, with ascites and asterixis noted on examination. His blood work was remarkable for neutrophilic leukocytosis, elevated liver enzymes and lactate. An abdominal computed tomography scan revealed splenic microabscesses and a cirrhotic liver. was recovered from his blood cultures and he was treated with ceftriaxone following susceptibility results.
CONCLUSION
should be considered in the differential diagnosis of splenic or other extraintestinal microabscesses particularly in patients with chronic liver disease.
PubMed: 37841094
DOI: 10.1099/acmi.0.000525.v3 -
Revista Da Sociedade Brasileira de... 2023
Topics: Humans; Aspergillus; Encephalitis; Abscess; Immunocompetence
PubMed: 37792845
DOI: 10.1590/0037-8682-0391-2023 -
The Nigerian Postgraduate Medical... 2023Actinomycosis of the tonsils is uncommon even though the causative organisms are normal commensal of the oropharyngeal tract that may colonise the tonsillar crypts with...
Actinomycosis of the tonsils is uncommon even though the causative organisms are normal commensal of the oropharyngeal tract that may colonise the tonsillar crypts with resultant infection in apparently healthy individuals. Diagnosis is often incidental in tonsillectomy specimens sent to the pathology laboratory for varied diseases. This is a 10-year study of tonsillectomy specimens diagnosed with actinomycosis. Specimens were formalin-fixed and paraffin processed and stained with haematoxylin and eosin, gromott methenamine silver and periodic acid-Schiff. Four cases of tonsillar actinomycosis were diagnosed from a total of 772 tonsillectomy specimens. Histologically, characteristic oeosinophilic granules with peripheral radial protuberances surrounded by microabscesses were seen. Tonsillar actinomycosis is often an incidental diagnosis; however, a high index of suspicion should be entertained in patients with recurrent tonsillitis and/or tonsillar hypertrophy of unknown cause.
Topics: Humans; Nigeria; Palatine Tonsil; Tonsillitis; Actinomycosis
PubMed: 37675704
DOI: 10.4103/npmj.npmj_325_22 -
Journal of Pharmacy & Bioallied Sciences Jul 2023In individuals with acquired immunodeficiency syndrome (HIV/AIDS), abdominal pathologies rank second in frequency only to pulmonary illnesses. An essential imaging...
INTRODUCTION
In individuals with acquired immunodeficiency syndrome (HIV/AIDS), abdominal pathologies rank second in frequency only to pulmonary illnesses. An essential imaging method for assessing abdominal diseases is ultrasonography (USG). In this study, abdominal pathologies in HIV/AIDS patients were evaluated using USG, and their relationship to CD4 count was further examined.
MATERIALS AND TECHNIQUES
400 HIV+ subjects with aberrant abdominal USG participated in the current investigation. The subjects were assessed and graded as per the CD4 counts. Later the comparisons were drawn between the USG, and its relationship to CD4 count using SPSS 16.0 software, and all data were examined using appropriate statistical tools.
RESULTS
Men were over 60% of the 400 subjects. The average age of these subjects was 35.6 years; the range for this age group was 6 to 63 years. Spleen involvement was found on ultrasonographic examination in 45.1% of subjects, while liver and lymph node involvement was seen in 43.6% of subjects. Substantial correlations between CD4 counts and findings such as periportal & mesenteric lymphadenopathy, localized pancreatic lesion, splenic microabscess, splenomegaly, and hepatomegaly were found. One percent of individuals had lymphoma, which affected the retroperitoneal lymph nodes, pancreas, and liver.
CONCLUSION
Present research demonstrates the significance of abdominal ultrasonographic examination in HIV+ patients. CD4 counts have a big impact on how an HIV/AIDS patient's differential diagnosis is determined. The interpretation of USG results in relation to CD4 levels may aid in accurate diagnosis.
PubMed: 37654380
DOI: 10.4103/jpbs.jpbs_461_22 -
Yonago Acta Medica Aug 2023Psoriasis is a common chronical inflammatory skin disease with a prevalence of 2%-4% worldwide. In contrast, porocarcinoma is a relatively rare cutaneous neoplasm and an...
Psoriasis is a common chronical inflammatory skin disease with a prevalence of 2%-4% worldwide. In contrast, porocarcinoma is a relatively rare cutaneous neoplasm and an associated localization of both lesions is rare. Here, we describe the first case of porocarcinoma in a patient with psoriasis. A 71-year-old Japanese man was referred to our clinic for evaluation of nodule within a keratotic plaque of 20-years history on his leg. Histopathological examination showed that the plaque revealed acanthosis with regular elongation of rete ridges, agranulosis and the presence of Munro microabscesses. In contrast, massive proliferation of atypical poroid cells and a few cuticular cells in the dermis were seen in the nodule. We speculated that it is likely the porocarcinoma was caused by the elevated risk of skin cancer due to chronic inflammatory process of psoriasis itself in our patient.
PubMed: 37621981
DOI: 10.33160/yam.2023.08.005 -
Langenbeck's Archives of Surgery Aug 2023Weighing the perioperative risk of elective sigmoidectomy is done regardless of the specific diverticulitis classification. The aim of this study is to evaluate surgical...
OBJECTIVE
Weighing the perioperative risk of elective sigmoidectomy is done regardless of the specific diverticulitis classification. The aim of this study is to evaluate surgical outcomes according to the classification grade and the indication.
METHODS
All patients who underwent elective colonic resection for diverticulitis during the ten-year study period were included. They were divided into two groups: relative surgery indication (RSI) and absolute surgery indication (ASI). RSI included microabscess and recurrent uncomplicated disease. ASI included macroabscess and recurrent complicated disease. Propensity score-matching (PSM, 1:1) was performed.
RESULTS
585 patients fulfilled criteria for RSI and 318 patients fulfilled criteria for ASI. In the univariate analysis, RSI patients were younger (62 vs. 67.7 years, p < 0.001), had a higher physical status (ASA score 1 or 2 in 80.7% vs. 60.8%, p < 0.001), were less immunosuppressed (3.4% vs. 6.9%, p = 0.021) and suffered less often from coronary heart disease (3.8% vs. 7.2%, p = 0.025). After PSM, 318 RSI vs. 318 ASI patients were selected; baseline characteristics results were comparable. The proportion of planned laparoscopic resection was 93% in RSI versus 75% in ASI (p < 0.001), and the conversion rate to open surgery for laparoscopic resection was 5.0% and 13.8% in RSI versus ASI, respectively (p < 0.001). Major morbidity (Clavien/Dindo ≥ IIIb) occurred less frequently in RSI (3.77% vs. 10%, p = 0.003). A defunctioning stoma was formed in 0.9% and 11.0% in RSI vs ASI, respectively (p < 0.001).
CONCLUSION
The lower risk for postoperative morbidity, the higher chance for a laparoscopic resection and the decreased rate of stoma formation are attributed to patients with recurrent uncomplicated diverticulitis or diverticulitis including a microabscess as compared to patients with complicated diverticulitis or diverticulitis and a macroabscess, and this applies even after PSM.
Topics: Humans; Cohort Studies; Diverticulitis, Colonic; Propensity Score; Diverticulitis; Colon, Sigmoid; Laparoscopy; Elective Surgical Procedures; Abscess; Treatment Outcome
PubMed: 37535118
DOI: 10.1007/s00423-023-03034-9 -
Annals of Ibadan Postgraduate Medicine Jun 2023Clinical and histopathologic observations have indicated that psoriasis is not rare in our population as previously thought. The initial rarity also led to paucity of...
BACKGROUND
Clinical and histopathologic observations have indicated that psoriasis is not rare in our population as previously thought. The initial rarity also led to paucity of studies on the disorder including histopathologic features in our practice setting. To date, there is no report on the histopathologic features of psoriasis indigenous to our practice environment.
OBJECTIVE
To evaluate the frequency of occurrence of the various histopathologic features of psoriasis in patients from this environment and identify any peculiarities that exist in black African patients.
METHODS
A cross-sectional study of patients diagnosed clinically with psoriasis at the University College Hospital, Ibadan between January 2015 and October 2016. After baseline sociodemographic data, all patients had baseline clinical examination and were offered skin biopsy after obtaining informed consent. The biopsy specimen was examined for histopathologic features of psoriasis after routine processing and staining using a pretested proforma with the frequencies of each diagnostic feature reported in percentages.
RESULTS
Forty-four patients with plaque psoriasis were analyzed. The mean age of the patients studied was 39.84 ± 20.97 years with a male to female ratio of which was almost equal. The most consistent epidermal changes in decreasing other of frequency were acanthosis, hypogranulosis, hyperkeratosis followed by elongation of rete ridges while dermal features were dermal infiltration by inflammatory cells, and dilatation of superficial dermal vessels. Munro's microabscesses were found in less than half of the patients biopsied. Some of the patients were found to have atypical changes.
CONCLUSION
Histopathological features of psoriasis in the study is similar to what has been previously established universally but typical features such as Munro's micro abscesses and Kogoj's spongiform pustules are less frequently seen than expected. Atypical changes such as dermal melanophages and periadnexal infiltration by inflammatory cells may also be seen.
PubMed: 37528824
DOI: No ID Found -
Journal of Education & Teaching in... Jan 2023Small bowel diverticulitis is an uncommon subset of acute diverticulitis and can mimic many other intra-abdominal processes. As a result, imaging modalities such as...
UNLABELLED
Small bowel diverticulitis is an uncommon subset of acute diverticulitis and can mimic many other intra-abdominal processes. As a result, imaging modalities such as ultrasound and computed tomography (CT) scan are especially important for timely recognition of diverticulitis and can expedite diagnosis and treatment and reduce complications. In the case described in this report, an 81-year-old male with history of esophageal cancer and recurrent diverticulitis with history of multiple bowel resections presented to the emergency department (ED) with right lower quadrant abdominal pain and constipation. Findings on ultrasound were suggestive of diverticulitis, and findings on CT of the abdomen and pelvis showed ileitis with phlegmon and micro-abscess suspicious for small bowel diverticulitis. ED providers should familiarize themselves with ultrasound findings of diverticulitis and be aware that diverticulitis can also present in the small bowel. Treatment of small bowel diverticulitis is similar to colonic diverticulitis.
TOPICS
Ileitis, small bowel diverticulitis, abdominal ultrasound.
PubMed: 37465035
DOI: 10.21980/J8F078 -
Clinical, Cosmetic and Investigational... 2023We present the case of a 37-year-old male diagnosed with Mycosis fungoides (MF) after gradually developing multiple skin tags and brownish lichenoid papules. The patient...
We present the case of a 37-year-old male diagnosed with Mycosis fungoides (MF) after gradually developing multiple skin tags and brownish lichenoid papules. The patient had pre-existing erythema over his entire body, especially his face, upper extremities, and trunk, for over 1.5 years. Microscopic examination of the papule and the skin tag (ST) exhibited similar features mainly characterized by superficial dense band-like lymphoid infiltrates and epidermotropism of atypical lymphocytes (Pautrier's micro-abscesses). Immunohistochemistry further revealed the lymphoid infiltrates predominantly expressed LCA, CD3, CD4, and CD45RO but lacked CD7, CD8, CD30, CD20, and CD79a. The finding of this study that reports MF characterized by unusual STs suggests that some causes and effects have not been previously described in MF.
PubMed: 37441694
DOI: 10.2147/CCID.S411041