Chronic Laryngotracheal Granulomatous Disease Secondary to Sporothrix schenckii in an Immunocompromised Patient

Objective: To describe a rare presentation of laryngotracheal granulomatous disease secondary to sporotrichosis. Methods: The authors report a case of laryngeal sporotrichosis in an immunocompromised patient, with accompanying endoscopic images and pathology. Results/case: A 72-year-old immunocompromised female with a history of rose-handling presented with a year of hoarseness and breathy voice. Flexible nasolaryngoscopy showed diffuse nodularity; biopsy of the lesions demonstrated granulomatous inflammatory changes, and fungal culture grew Sporothrix schenkii. Long-term itraconazole treatment was initiated, with improvement in dysphonia and few residual granulomas on follow-up examination. Conclusion: When evaluating granulomatous disease of the airway, a broad differential including infectious or inflammatory etiologies should be considered, especially in immunocompromised patients. Adequate tissue samples should be collected to facilitate special staining. The current recommendations for laryngeal sporotrichosis include treatment with a prolonged course of itraconazole.

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Beware of cryptococcomas when treating Cryptococcal meningitis

Journal of Neurology & Stroke ◽

10.15406/jnsk.2020.10.00435 ◽

2020 ◽

Vol 10 (5) ◽

pp. 183-184

Author(s):

Rafael Ferreira Nascimento ◽

Diogo Raposo André, ◽

Fabiana Gouveia ◽

Nancy Faria ◽

Ana Paula Reis

Keyword(s):

Immunocompromised Patient ◽

Brain Mri ◽

Hiv Positive ◽

Rare Presentation ◽

Neck Stiffness ◽

Viral Loads ◽

Hiv Rna ◽

Neurological Exam ◽

History Of ◽

The Brain

Introduction: The authors describe a rare presentation of central nervous system cryptococcosis in an immunocompromised patient. Case description: An HIV-positive patient, with poor adherence to the treatment, presented with a seventeen days history of severe headache. On the neurological exam there was only evidence of neck stiffness, he had a CD4 count of 23 cells/μl and plasma HIV RNA viral loads of 364,000 copies/ml. Lumbar puncture revealed positive for cryptococcal antigen virus and so treatment with amphotericin B was started. During his admission the patient developed an expressive aphasia with visual hallucinations and the brain MRI revealed cerebral cryptococcomas. After 98 days of treatment general and neurological examination was normal and the patient was discharged home. Conclusion: This case highlights a rare and severe complication of Cryptococcus neoformans infection in immunocompromised patients.

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Lytic lesion of skull: a rare presentation of chronic granulomatous disease

BMJ Case Reports ◽

10.1136/bcr-2020-235423 ◽

2020 ◽

Vol 13 (9) ◽

pp. e235423

Author(s):

Gurinder Kumar

Keyword(s):

Chronic Granulomatous Disease ◽

Serratia Marcescens ◽

Gene Mutation ◽

Lytic Lesion ◽

Granulomatous Disease ◽

Case Scenario ◽

Rare Presentation ◽

History Of ◽

Work Up

An 18-month-old boy presented with lytic lesion of skull and recurrent abscesses with Serratia marcescens. The extensive work up revealed a gene mutation confirming the diagnosis of chronic granulomatous disease (CGD). This case scenario underscores the importance of exploring the possibility of immunodeficiency if there is a history of recurrent abscesses with atypical organism. The case also demonstrates that CGD can present as lytic lesion of skull.

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Pulmonary fungal ball due to Trichophyton successfully managed with oral itraconazole: a case report

Journal of International Medical Research ◽

10.1177/03000605211066250 ◽

2021 ◽

Vol 49 (12) ◽

pp. 030006052110662

Author(s):

Hsu-Lin Lee ◽

Li-Mien Chen ◽

Chen-Chu Chang ◽

Guan-Liang Chen

Keyword(s):

Fungal Infection ◽

Left Lung ◽

Lavage Fluid ◽

Lung Field ◽

Fungal Culture ◽

Lung Lobe ◽

Recommended Treatment ◽

History Of ◽

Oral Itraconazole

Pulmonary fungal balls are caused by long-term fungal infection of the lung. They are sometimes a complication of previous cavitary pulmonary tuberculosis. Pulmonary fungal balls caused by Trichophyton are extremely rare. A 65-year-old man who worked in a leather recycling factory was admitted because of a productive cough and shortness of breath. He had a history of tuberculosis with lung destruction. A chest radiograph showed an opacity surrounding an air lucency over the left lung field, and chest computed tomography showed a mass within a cavity, producing a ball-in-hole appearance, over the left upper lung lobe. Bronchoalveolar lavage was performed, and fungal culture of the lavage fluid yielded Trichophyton. After 6 months of treatment with oral itraconazole, the patient’s general condition improved. This case emphasizes the importance of awareness of fungal infection within cavitary lesions of the lung and shows that Trichophyton may be the etiologic organism in such cases. Itraconazole is a recommended treatment of pulmonary fungal balls.

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Refractory feline sporotrichosis: a comparative analysis on the clinical, histopathological, and cytopathological aspects

Pesquisa Veterinária Brasileira ◽

10.1590/1678-5150-pvb-6923 ◽

2022 ◽

Vol 42 ◽

Author(s):

Francine S. Silva ◽

Simone C.S. Cunha ◽

Vanessa A. Moraes ◽

Juliana S. Leite ◽

Ana M.R. Ferreira

Keyword(s):

General Condition ◽

Moderate Intensity ◽

Clinical Aspects ◽

Fungal Culture ◽

Poor General Condition ◽

Cutaneous Lesions ◽

Good General Condition ◽

Cutaneous Form ◽

Itraconazole Treatment

ABSTRACT: Sporotrichosis is a chronic fungal infection caused by Sporothrix species. The occurrence of cases that are resistant to long-term treatment, especially in the nasal planum of cats, emphasizes the importance of studying its pathogenesis. The purpose of this study was to analyze and compare the inflammatory process of cutaneous lesions of feline refractory sporotrichosis to clinical aspects through cytopathological and histopathological examination. Moreover, the study included 13 cats with cutaneous lesions that had been resistant to itraconazole treatment for more than a year. Cutaneous lesions samples were collected for cytopathological, histopathological, and fungal culture analyses. Tissue fragments were processed and stained with hematoxylin-eosin (HE) and Grocott methenamine silver (GMS). Further, two clinical presentations had the highest occurrence: the localized cutaneous form in animals with good general condition and stable disease (n=9, 69.2%) and the disseminated cutaneous form in cats with poor general condition (n=4, 30.8%). In cats with refractory sporotrichosis, the nasal planum (84.6%) was the most common location of lesions. In the cytopathological study, cats with fewer than two lesions and in good general condition (n=9, 69.2%) showed absence or mild yeast intensity (up to 5 yeasts per field), lower intensity of macrophages and neutrophils, and higher intensity of epithelioid cells, lymphocytes, plasma cells, and eosinophils. On the other hand, (n=4, 30.8%) of the cats with disseminated sporotrichosis and a poor general condition had a marked intensity of yeasts, which were mostly phagocytosed by an increased number of macrophages and neutrophils. Of those animals with good general condition, the majority (n=6, 66.7%) had higher eosinophil intensity. In histopathology, malformed suppurative granuloma was the predominant type (n=9, 69.2%) in feline sporotrichosis lesions, followed by well-formed granulomas (n=4, 30.8%). Malformed granulomas showed mild to moderate fungal intensity (55.6%) in animals with good general condition and localized lesions while marked fungal intensity (44.4%) in cats with the disseminated form of the disease and poor general condition. Well-formed granulomas (n=4, 30.7%) had mild to moderate intensity of fungal load, and 75% of the animals with this type of granuloma had only one lesion and were in good general condition. Long-term itraconazole treatment in these cats with refractory sporotrichosis can keep the infection under control and localized lesions stable; however, fungus reactivation can occur, resulting in an exuberant and inefficient immune response.

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Profound diarrhoea and weight loss in an immunocompromised patient

BMJ Case Reports ◽

10.1136/bcr-2020-236913 ◽

2021 ◽

Vol 14 (1) ◽

pp. e236913

Author(s):

George Ashton ◽

Alan Shand ◽

Ian Arnott ◽

Shahida Din

Keyword(s):

Weight Loss ◽

Complete Resolution ◽

Immunocompromised Patient ◽

Acute Illness ◽

Chronic Diarrhoea ◽

Infectious Gastroenteritis ◽

Immunosuppressed Patients ◽

History Of ◽

Stool Samples

A 75-year-old man was admitted with a 3-month history of worsening diarrhoea and weight loss. He was on long-term immunosuppression following cardiac transplantation. Investigations revealed herpes simplex oesophagitis and stool samples were positive for norovirus. Treatment with acyclovir and nitazoxanide resulted in a complete resolution of symptoms. Norovirus is a common cause of infectious gastroenteritis, but immunosuppressed patients may present with chronic diarrhoea rather than an acute illness. This case highlights the importance of a low clinical threshold for testing for norovirus infection in immunocompromised patients.

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Pneumomediastinum: A Rare Presentation of Inflicted Injuries in Infants

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1716857 ◽

2020 ◽

Author(s):

Adam Lee ◽

Adam Bajinting ◽

Abby Lunneen ◽

Colleen M. Fitzpatrick ◽

Gustavo A. Villalona

Keyword(s):

Literature Review ◽

Retrospective Review ◽

Review Of The Literature ◽

Rare Presentation ◽

Spontaneous Pneumomediastinum ◽

Nonaccidental Trauma ◽

Comprehensive Literature Review ◽

Healthy Infants ◽

History Of

AbstractReports of incidental pneumomediastinum in infants secondary to inflicted trauma are limited. A retrospective review of infants with pneumomediastinum and history of inflicted trauma was performed. A comprehensive literature review was performed. Three infants presented with pneumomediastinum associated with inflicted trauma. Mean age was 4.6 weeks. All patients underwent diagnostic studies, as well as a standardized evaluation for nonaccidental trauma. All patients with pneumomediastinum were resolved at follow-up. Review of the literature identified other cases with similar presentations with related oropharyngeal injuries. Spontaneous pneumomediastinum in previously healthy infants may be associated with inflicted injuries. Clinicians should be aware of the possibility of an oropharyngeal perforation related to this presentation.

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Atypical Femoral Fracture in McCune-Albright Syndrome

Journal of Research in Orthopedic Science ◽

10.32598/jrosj.7.3.711.1 ◽

2020 ◽

Vol 7 (3) ◽

pp. 147-152

Author(s):

Salman Ghaffari ◽

◽

Mehran Razavipour ◽

Parastoo Mohammad Amini ◽

◽

...

Keyword(s):

Femoral Fracture ◽

Dynamic Compression ◽

Plate Fixation ◽

Medullary Canal ◽

Mccune Albright Syndrome ◽

Café Au Lait Spots ◽

History Of ◽

Albright Syndrome ◽

Mccune Albright

McCune-Albright Syndrome (MAS) is characterized by endocrinopathies, café-au-lait spots, and fibrous dysplasia. Bisphosphonates are the most prescribed treatment for reducing the pain but their long-term use has been associated with atypical fractures of cortical bones like femur in patients. We present a 23-year-old girl diagnosed with MAS. She had an atypical mid-shaft left femoral fracture that happened during simple walking. She also had a history of long-term use of alendronate. Because of the narrow medullary canal, we used 14 holes hybrid locking plate for the lateral aspect of the thigh to fix the fracture and 5 holes dynamic compression plate (instead of the intramedullary nail) in the anterior surface to double fix it, reducing the probability of device failure. With double plate fixation and discontinuation of alendronate, the complete union was achieved five months after surgery

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European Integration

10.3366/edinburgh/9781474455893.001.0001 ◽

2020 ◽

Author(s):

Johann P. Arnason

Keyword(s):

European Integration ◽

Eastern European ◽

The European Union ◽

Historical Processes ◽

History Of ◽

External Conditions ◽

Eastern European Countries ◽

Totalitarian Regimes ◽

The Eu

Different understandings of European integration, its background and present problems are represented in this book, but they share an emphasis on historical processes, geopolitical dynamics and regional diversity. The introduction surveys approaches to the question of European continuities and discontinuities, before going on to an overview of chapters. The following three contributions deal with long-term perspectives, including the question of Europe as a civilisational entity, the civilisational crisis of the twentieth century, marked by wars and totalitarian regimes, and a comparison of the European Union with the Habsburg Empire, with particular emphasis on similar crisis symptoms. The next three chapters discuss various aspects and contexts of the present crisis. Reflections on the Brexit controversy throw light on a longer history of intra-Union rivalry, enduring disputes and changing external conditions. An analysis of efforts to strengthen the EU’s legal and constitutional framework, and of resistances to them, highlights the unfinished agenda of integration. A closer look at the much-disputed Islamic presence in Europe suggests that an interdependent radicalization of Islamism and the European extreme right is a major factor in current political developments. Three concluding chapters adopt specific regional perspectives. Central and Eastern European countries, especially Poland, are following a path that leads to conflicts with dominant orientations of the EU, but this also raises questions about Europe’s future. The record of Scandinavian policies in relation to Europe exemplifies more general problems faced by peripheral regions. Finally, growing dissonances and divergences within the EU may strengthen the case for Eurasian perspectives.

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An unusual presentation of epigastric pain due to thrombophlebitis of a recanalised umbilical vein – case report

Perspectives in Surgery ◽

10.33699/pis.2019.98.8.326-327 ◽

2019 ◽

Vol 98 (8) ◽

pp. 326-327 ◽

Cited By ~ 1

Keyword(s):

Liver Cirrhosis ◽

Abdominal Pain ◽

Case Report ◽

Portal Hypertension ◽

Liver Disease ◽

Epigastric Pain ◽

Umbilical Vein ◽

History Of ◽

Clinically Significant ◽

Inflammatory Changes

Introduction: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. Case report: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patient’s abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. Conclusion: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.

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