Superficial Granulomatous Pyoderma Gangrenosum Involving the Face: A Case Series of Five Patients and a Review of the Literature

2021 ◽  
pp. 120347542098886
Author(s):  
Eran Shavit ◽  
Michael Cecchini ◽  
James J. Limacher ◽  
Scott Walsh ◽  
Ashely Wentworth ◽  
...  
Keyword(s):  
Pyoderma Gangrenosum ◽  
Plasma Cells ◽  
Relevant Literature ◽  
Case Series ◽  
Granulomatous Inflammation ◽  
Final Diagnosis ◽  
Giant Cells ◽  
Neutrophilic Dermatosis ◽  
The Face ◽  
Inflammatory Infiltrates

Background Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by painful and ulcerating lesions on the skin. It rarely involves the face and is often difficult to diagnose. There are few cases reported in the literature of PG involving the face. Aim To share our experience with 5 patients in whom the final diagnosis was PG involving the face, and to review the literature. Methods We report a series of 5 patients with a final diagnosis of PG involving the face and reviewed relevant literature. We searched through PubMed and EMBASE using keywords such as “face” and “pyoderma gangrenosum,” “blastomycosis-like pyoderma gangrenosum, vegetative pyoderma gangrenosum and granulomatous pyoderma gangrenosum.” Results We report 5 patients (4 females) with pyoderma gangrenosum involving the face. All 5 had a final diagnosis of superficial granulomatous PG. All cases presented with nonhealing facial ulcer most commonly on cheeks and a common histopathology of mixed inflammatory infiltrates, multinucleated giant cells, and plasma cells with some granulomatous inflammation. Conclusions PG can involve the face, and all 5 of our patients had the superficial granulomatous as the most common form.

scholarly journals Tuberculosis of the Thyroid

2017 ◽  
Vol 32 (1) ◽  
pp. 47-50
Author(s):  
Elmer F. Fabito ◽  
Mary Jane Tipayno-Lubos ◽  
Felixberto D. Ayahao
Keyword(s):  
Thyroid Gland ◽  
Granulomatous Inflammation ◽  
Inflammatory Cells ◽  
Final Diagnosis ◽  
Giant Cells ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Tumor Formation ◽  
Multiple Drug ◽  
Epitheloid Cells

Objectives: To present a case of thyroid tuberculosis and to discuss its clinical presentation, differential diagnoses and management. Methods:                         Design: Case Report                         Setting:  Tertiary Government Hospital                         Patient: One Results: A 55-year-old farmer presented with an 8-month progressively enlarging anterior neck mass, and fine needle aspiration biopsy yielded grossly turbid straw-colored aspirate admixed with blood with microscopy showing scattered inflammatory cells and macrophages set against a colloid background. After total thyroidectomy, hispathology revealed parenchymal infiltration by multiple aggregates of plump spindled to epitheloid cells forming granulomas with interspersed multinucleated giant cells, central caseation necrosis and surrounding fibrosis with chronic inflammatory infiltrates. The nodal masses also showed prominent germinal centers with interspersed epitheloid cells and foamy macrophages. Final diagnosis was chronic granulomatous inflammation consistent with tuberculosis. Conclusion: Tuberculosis (TB) of the thyroid is a rare occurrence that can present as inflammation, infection or tumor formation of the thyroid gland. Diagnosis depends on identification of the tubercle from tissues and aspirates by acid fast staining and TB culture. Treatment consists of multiple drug therapy for tuberculosis but thyroidectomy may be an option if the thyroid gland is severely diseased. Keywords: tuberculosis, endocrine; thyroid disease

scholarly journals A Partially Protective Vaccine for Fasciola hepatica Induced Degeneration of Adult Flukes Associated to a Severe Granulomatous Reaction in Sheep

Animals ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 2869
Author(s):  
Verónica Molina-Hernández ◽  
María T. Ruiz-Campillo ◽  
Francisco J. Martínez-Moreno ◽  
Leandro Buffoni ◽  
Álvaro Martínez-Moreno ◽  
...  
Keyword(s):  
Bile Ducts ◽  
Plasma Cells ◽  
Fasciola Hepatica ◽  
Vaccine Trial ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Control Group ◽  
Infected Control Group ◽  
Hepatic Lesions ◽  
Host Parasite

Fasciolosis is an important economic disease of livestock. There is a global interest in the development of protective vaccines since current anthelmintic therapy is no longer sustainable. A better knowledge of the host-parasite interaction is needed for the design of effective vaccines. The present study evaluates the microscopical hepatic lesions in sheep immunized with a partially protective vaccine (VAC1), a non-protective vaccine (VAC2), and an infected control group (IC). The nature of granulomatous inflammation associated with degeneration of adult flukes found in the VAC1 group was characterized by immunohistochemistry. Hepatic lesions (fibrous perihepatitis, chronic tracts, bile duct hyperplasia, infiltration of eosinophils and lymphocytes and plasma cells) were significantly less severe in the VAC1 group than in the IC group. Dead adult flukes within bile ducts were observed only in the VAC1 group and were surrounded by a severe granulomatous inflammation composed by macrophages and multinucleate giant cells with a high expression of lysozyme, CD163 and S100 markers, and a low expression of CD68. Numerous CD3+ T lymphocytes and scarce infiltrate of FoxP3+ Treg and CD208+ dendritic cells were present. This is the first report describing degenerated flukes associated to a severe granulomatous inflammation in bile ducts in a F. hepatica vaccine trial.

A 62-Year-Old African American Woman With Stable Lymphadenopathy Over 5 Years

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S110-S110
Author(s):  
Hanadi El Achi ◽  
William Glass ◽  
Miriam Velazquez ◽  
Zhihong Hu
Keyword(s):  
African American ◽  
Plasma Cells ◽  
African American Woman ◽  
American Woman ◽  
Granulomatous Inflammation ◽  
Chronic Fatigue ◽  
Giant Cells ◽  
Castleman Disease ◽  
African American Female ◽  
Mantle Zone

Abstract The patient is a 62-year-old African American female with medical history of Plummer Vinson syndrome and CT scan in 2014 showing lymphadenopathy of the porta hepatis. Needle core biopsy of enlarged lymph nodes revealed sheets of polytypic plasma cells with no aberrant B or T cells or granulomas or hyaline-like depositions identified. The findings were suspicious for unicentric Castleman disease. In 2019, the patient presented with chronic fatigue without other systemic symptoms. Contrast CT revealed persistent retroperitoneal lymphadenopathy and calcified granulomas in the liver, spleen, and lung. Excision of portal and celiac nodes showed preserved nodal architecture with mild mantle zone expansion and marked hyaline-like deposition in the follicles. Sheets of mature plasma cells and focally increased vasculatures were seen in the interfollicular areas. Focally frequent nonnecrotizing granulomas were noted. Occasional giant cells and rare asteroid bodies were identified in the granulomas. Immunohistochemistry stain workup revealed normal distribution of the B and T lymphocytes. CD138 stain highlighted marked increased plasma cells and HHV8 was negative. Immunofluorescence microscopy for kappa and lambda did not show monoclonality; IgA was positive in <10% of plasma cells; special stain for Congo red and serum amyloid associated protein (SSA) IHC stain were strongly positive in the follicles. The overall findings are consistent with reactive lymphadenopathy with interfollicular polytypic plasmacytosis, noncaseating granuloma formation, and reactive amyloidosis. The features of mantle zone hyperplasia and polytypic plasmacytosis are suggestive of HHV8-negative/idiopathic unicentric Castleman disease. This case possibly represents an example of concurrent amyloidosis, sarcoidosis, and idiopathic unicentric Castleman disease. Given that SSA was recently reported to have a pathogenic role in granulomatous inflammation of sarcoidosis through sustained inflammatory reaction, the possibility of increased SSA triggering sarcoidoisis in this patient can be considered. However, the exact pathogenesis of these concurrent findings needs further investigation and clarification.

Equine Granulomatous Enteritis

1974 ◽  
Vol 11 (6) ◽  
pp. 535-547 ◽  
Author(s):  
R. E. Cimprich
Keyword(s):  
Weight Loss ◽  
Mycobacterium Tuberculosis ◽  
Plasma Cells ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Gut Content ◽  
Epithelioid Cells ◽  
History Of ◽  
Microscopic Change ◽  
Granulomatous Enteritis

The gross abnormalities in the intestines of 10 horses with a history of chronic weight loss varied greatly. The principal microscopic change was granulomatous inflammation characterized by lymphocytes, plasma cells, macrophages, epithelioid cells and giant cells. Mycobacterium tuberculosis, avian type, was isolated from the gut content of one horse, but no cause was found in the others. Horses previously reported to have tuberculosis had lesions similar to those described here. These lesions are also similar to those in Crohn's disease of man.

scholarly journals Recent advances in managing and understanding pyoderma gangrenosum

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 2092 ◽  
Author(s):  
Josh Fletcher ◽  
Raed Alhusayen ◽  
Afsaneh Alavi
Keyword(s):  
Pyoderma Gangrenosum ◽  
Randomized Clinical Trials ◽  
Traditional Approach ◽  
Wound Care ◽  
Case Reports ◽  
Case Series ◽  
Adaptive Immune System ◽  
Neutrophilic Dermatosis ◽  
Recent Advances ◽  
No Gold Standard

Pyoderma Gangrenosum (PG) is a rare neutrophilic dermatosis with multiple different clinical presentations and associated comorbidities. PG has historically been a challenging disorder to diagnose, leading to the development of new diagnostic criteria rather than the traditional approach of a diagnosis of exclusion. The pathophysiology is thought to involve both innate and adaptive immune system dysregulation, neutrophilic abnormalities, environmental, and genetic factors. As of today, no gold standard therapy exists for the treatment of PG, and the literature is restricted to mainly case reports, case series, and 2 small randomized clinical trials. Topical, systemic, and biologic therapy, as well as adequate analgesia and proper wound care all play a role in the management of PG. Recent studies have identified additional cytokines and signalling cascades thought to be involved in the pathogenesis of PG, ultimately leading to the development of new targeted therapies. This review will focus on recent advances in the pathophysiology, clinical presentation and associated comorbidities, diagnosis, and management of PG.

scholarly journals  Infection in a female Komodo dragon (Varanus komodoensis) caused by Mycobacterium intracellulare: a case report

2012 ◽  
Vol 57 (No. 3) ◽  
pp. 163-168 ◽  
Author(s):  
M. Skoric ◽  
V. Mrlik ◽  
J. Svobodova ◽  
V. Beran ◽  
M. Slany ◽  
...  
Keyword(s):  
Environmental Samples ◽  
Plasma Cells ◽  
Histopathological Examination ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Tissue Samples ◽  
The Czech Republic ◽  
Mycobacterium Intracellulare ◽  
Granulomatous Pneumonia ◽  
Variable Layer

In early 2002, a bean-like whitish nodule 2 &times; 1 &times; 1 cm in size was diagnosed on the tongue of a female Komodo dragon (Varanus komodoensis) kept in a zoological garden in the Czech Republic. The nodule was removed at surgery and histopathological examination revealed a specific granulomatous inflammation. The granuloma contained a necrotic mass surrounded by a variable layer of palisading epithelioid macrophages and multinucleated giant cells with a variable admixture of lymphocytes and plasma cells. Signs of mineralisation within the granuloma were not observed. Using Ziehl-Neelsen (ZN) staining the presence of acid-fast rods (AFR) was determined and the presence of mycobacteria was confirmed by PCR. Four years later, this female died after multiple injuries caused by a male during mating. Necropsy and histopathological examinations revealed granulomatous pneumonia and myocarditis with ZN-positive AFR within granulomas. Mycobacteria were cultured from 13 of 19 tissue samples: Mycobacterium intracellulare was confirmed by sequencing of isolates from multiple affected organs including the respiratory tract, tail muscle, inguinal lymph nodes and blood; Mycobacterium sp. were also isolated from the tongue. In addition, mycobacteria were detected in 15 (46.9%) of 32 environmental samples examined in both years. M. intracellulare was detected in water sediment from the female&rsquo;s terrarium in 2002, and in faeces and peat from the terrarium and in water sediment from the male terrarium in 2006. Except for M. intracellulare (n = 4), M. smegmatis (n = 1), M. a. hominissuis (n = 3), M. fortuitum (n = 2), M. interjectum (n = 1), M. peregrinum/alvei/septicum (n = 1) and Mycobacterium sp. (n = 2) were also isolated from different environmental samples. &nbsp; &nbsp;

scholarly journals  Avian tuberculosis in a captured Ruppell's griffon vulture (Gyps ruppellii): a case report

2010 ◽  
Vol 55 (No. 7) ◽  
pp. 348-352 ◽  
Author(s):  
M. Skoric ◽  
P. Fictum ◽  
L. Frgelecova ◽  
P. Kriz ◽  
I. Slana ◽  
...  
Keyword(s):  
Plasma Cells ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Body Cavity ◽  
The Body ◽  
Multinucleated Giant Cells ◽  
Quantitative Real Time Pcr ◽  
Griffon Vulture ◽  
Avium Infection ◽  
Variable Layer

Avian tuberculosis was diagnosed in a captured female Ruppell's griffon vulture (Gyps ruppellii) with granulomatous splenitis and hepatitis. At necropsy, whitish to yellow nodules of various sizes were found in the spleen and liver, and fibrinous coelomitis was present in the body cavity. Histopathologically, the granulomas appeared to be typical of avian tuberculosis. In some granulomas, necrotic centres surrounded by a variable layer of palisading epithelioid macrophages and multinucleated giant cells with variable admixture of lymphocytes and plasma cells were present. Signs of mineralization in granulomas were not observed. Using Ziehl-Neelsen staining the presence of acid-fast bacilli was demonstrated in organs affected by granulomatous inflammation. A diagnosis of Mycobacterium avium subsp. avium infection was confirmed by culture and quantitative Real-Time PCR examination for the presence of specific insertion sequences for avian tuberculosis (IS901 and IS1245) in the liver and spleen. &nbsp;

scholarly journals IgG4-related intracranial disease

2018 ◽  
Vol 32 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Shahine Goulam-Houssein ◽  
Jeffrey L Grenville ◽  
Katerina Mastrocostas ◽  
David G Munoz ◽  
Amy Lin ◽  
...  
Keyword(s):  
Plasma Cells ◽  
Surgical Intervention ◽  
Case Series ◽  
Hypertrophic Pachymeningitis ◽  
Diagnostic Challenge ◽  
Perineural Spread ◽  
Related Disease ◽  
The Third ◽  
Igg4 Related Disease ◽  
Intracranial Involvement

IgG4-related disease (IgG4-RD) is a multi-organ chronic inflammatory process caused by infiltration of IgG4-positive plasma cells in one or more organs. Intracranial involvement has only recently become better recognized. Our case series adds to the growing literature on the varying presentations of intracranial IgG4 by describing the clinical and imaging findings of three patients who presented to our institution with intracranial involvement. Our first patient presented with a mass-forming IgG4 pachymeningitis mimicking a sphenoid wing meningioma, which is to our knowledge the largest mass-forming pachymeningitis published in the literature. Our second case depicts another presentation of extensive IgG4 pachymeningitis involving both cavernous sinuses and surrounding Meckel’s caves. The third case describes a patient with presumed lymphocytic hypophysitis, which was later determined to be IgG4-related hypophysitis with concomitant pachymeningitis and perineural spread along the optic nerves. The delayed diagnoses in our cases illustrates the diagnostic challenge that clinicians face in differentiating intracranial IgG4-RD from other infiltrative diseases such as sarcoidosis, granulomatous disease, tuberculosis and lymphoma. Earlier consideration of IgG4-related hypophysitis and hypertrophic pachymeningitis in the differential diagnosis can prevent significant morbidity including unnecessary surgical intervention and organ failure secondary to extensive fibrosis.

scholarly journals Hepatocellular carcinoma with regional lymphadenopathy caused by sarcoid-like reaction: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Tomoko Mizota ◽  
Masato Suzuoki ◽  
Saya Kaku ◽  
Kenichi Mizunuma ◽  
Kazuto Ohtaka ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Epithelioid Cell ◽  
Imaging Modalities ◽  
Hepatoduodenal Ligament ◽  
Regional Lymph Nodes ◽  
Multiple Imaging

Abstract Background Sarcoid-like reaction (SLR) is a histological pattern of granulomatous inflammation that is clinically differentiated from sarcoidosis. Since SLR is known to occur in several neoplasias and occasionally causes lymphadenopathy and mimics metastatic malignancy, it needs to be considered whether lymphadenopathy is due to metastasis or SLR for the choice of cancer treatment. Few cases of hepatocellular carcinoma (HCC) with SLR have been reported. Here, a case of HCC with lymphadenopathy diagnosed as SLR without metastasis is presented. Case presentation A 69-year-old woman was admitted to our hospital because of upper abdominal pain. She tested positive for hepatitis C virus ribonucleic acid. Imaging modalities showed an 81 × 65-mm-sized tumor with multiple nodules in segment 3 and a 17 × 12-mm-sized tumor in segment 5 with a common HCC enhancement pattern. In addition, a lymph node in the hepatoduodenal ligament was enlarged at 13 mm in size, suggesting the metastasis of HCC. Hepatectomy of the lateral segment and segment 5 and lymph node dissection in the hepatoduodenal ligament were performed. Both tumors in segments 3 and 5 were pathologically diagnosed as HCC without vessel invasion. The tumors contained necrotic cells and epithelioid cell granulomas with multinucleated giant cells, which is typically observed in sarcoidosis. The dissected lymph nodes also contained epithelioid cell granulomas, as well as giant cells with asteroid bodies. There was no malignancy in the lymph nodes. The pathological findings suggested the coexistence of malignancy and sarcoidosis. However, since the patient did not show any typical findings of pulmonary or cardiac sarcoidosis, the case was diagnosed as HCC with SLR in the primary lesion and regional lymph nodes. Conclusions SLR needs to be considered in the differential diagnosis when a cancer patient develops lymphadenopathy. However, lymphadenopathy due to SLR is indistinguishable from that due to metastasis even when using multiple imaging modalities. Pathological examinations may be helpful for the diagnosis.

scholarly journals LARYNGOTRACHEITIS VIRUS IN CHICKENS

1967 ◽  
Vol 125 (3) ◽  
pp. 409-428 ◽  
Author(s):  
Betsy G. Bang ◽  
Frederik B. Bang
Keyword(s):  
Alcian Blue ◽  
Plasma Cells ◽  
Giant Cells ◽  
Functional Restoration ◽  
Nasal Fossa ◽  
Blue Staining ◽  
Alcian Blue Staining ◽  
Cell Nuclei ◽  
Histochemical Change ◽  
Laryngotracheitis Virus

Infectious laryngotracheitis can be produced in chickens as an experimental model of severe nonfatal rhinitis and sinusitis. Inoculated intranasally into unanesthetized baby chicks it remains limited to the nasal fossa, produces acute desquamation of all nasal epithelia, results in functional recovery of the respiratory epithelium, but leaves important residual abnormalities. From the earliest recognizable lesions through 4½ months' convalescence, the principal changes are as follows: 1. Initial lesions, or small syncytia of intranuclear "inclusions", first identifiable in the mucociliated cells of the shallowest portion of the epithelium at about 21 hr postinoculum (the inner surface of the maxillary conchal scroll). 2. Acute sloughing, (about 3 to 7 days), marked by: (a) spread of lesions from cell to cell via multinucleated "giant cells" which progressively slough and desquamate respiratory, olfactory, and sinus epithelia, epithelial neural elements and blood vessels; (b) appearance of numbers of eosinophilic leukocytes along the basement membrane at the sites of lesions just previous to sloughing; intensive infiltration of the submucosa with small lymphocytes after sloughing begins; (c) histochemical change in the intracellular mucus of the cells which comprise the syncytia: this mucus stains with Alcian blue alone when stained with AB-PAS; and (d) all cartilages of the maxillary conchae become flaccid, and the cell nuclei and matrix lose both basophilic and Alcian blue staining properties, effects which recede by about the 8th day. 3. Repair (about 8 to 21 days), marked by rapid initial spread of a sheet of epithelial cells over the infiltrated subrmucosa, appearance of numbers of plasma cells circulating in the tissues, formation of encapsulated secondary nodules, and mucosal adhesions. 4. Convalescence (about 1 to 4½ months when experiments terminated), marked by functional restoration of the mucociliary lining of the nasal fossa. However, at 4½ months eight specimens all show complete metaplasia of the olfactory organ (end nerves, supporting cells, and glands of Bowman) to mucociliated epithelium, all show abnormal formation and alignment of mucous acini, and about 50% have severe persistent sinusitis.

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