Primary oral tuberculosis in an immunocompetent patient

Primary tuberculosis of the tongue is very rare. The chronic ulceration is commonly misdiagnosed as a cancerous lesion. We report the case of a 44 years old immunocompetent woman who presented with a lingual chronic painful ulceration. The biopsy of the lesion showed a granulomatous inflammation, with caseous necrosis in the center. The ulceration healed after a 6 month tuberculosis treatment. Keywords: Tuberculosis; oral; immunocompetence; ulcer.

Leukemoid reaction causing arterial thrombus in a patient with lung adenocarcinoma

A leukemoid reaction is typically defined as white blood cell (WBC) count >50×109/L, predominantly neutrophil precursors, that are not due to tumour involvement in the bone marrow and not derived from clones. Leukemoid reactions associated with malignancy, known as paraneoplastic leukemoid reactions, are less common and are most notably seen with non-small cell lung cancer. A 64-year-old woman presented with right leg painful ulceration. On examination, she had multiple venous stasis ulcers more severe on the right, with no palpable pulses in her lower extremities. Her WBC count was 124×109/L and platelets were 517×109/L. Arterial dopplers showed limb-threatening arterial insufficiency which prompted right femoral endarterectomy. Few months earlier she was diagnosed with metastatic lung adenocarcinoma to the bone and she had leukemoid reaction with WBC 43.920× 109/L with 90% neutrophils. Repeat imaging showed progression of her malignancy and she passed shortly after. Inflammation is a key element of carcinogenesis and cancer progression. Among the different tumours, lung cancer is a non-haematologic malignancy that is most closely associated with leucocytosis. Some studies have found that leucocytosis was significantly associated with metastasis and shorter survival irrespective of other factors such as age or sex. The mechanism remains unclear however elevated levels of granulocyte colony-stimulating factor (CSF), granulocyte macrophage-CSF and interleukin 6 have been linked to this phenomena. The degree of leucocytosis seen in our patient is suggestive of CSF production leading to a paraneoplastic leukemoid reaction.

Utilization of Low-Frequency Ultrasound Therapy to Aid in the Healing of a Chronic Painful Ulceration of the Lower Extremity in an Ovarian Cancer Patient: A Case Report

The purpose of this case study was to investigate the healing capabilities of low-frequency ultrasound therapy to heal chronic painful ulceration. In this case, a 61-year-old African American female with a past medical history of hypertension, chronic venous insufficiency, and ovarian cancer on chemotherapy presented to the clinic complaining of a painful chronic ulceration to the left ankle. The patient attributed the re-ulceration of this chronic wound to her current chemotherapy treatment drug doxorubicin. After the initial consultation, patient therapy that recommended was ultrasound therapy due to the patient stating the lesion was too painful for frequent sharp debridement in the clinical setting even when utilizing a topical anesthetic. The recommended interval treatments included a seven-minute session to the wound three times a week over a period of nine months. There were noted changes in the appearance of the wound base after the first week of therapy and changes in the size by the second week of therapy. Throughout the treatment regimen, the patient’s pain tolerance to the wound improved as well. After nine-month, there was noted complete healing of the tissues without any complications. In conclusion, ultrasound therapy often referred to as MIST therapy can be a useful device to heal chronic painful wounds in immunocompromised patients when therapy options are limited.

Pathomorphological and Immunohıstochemical Evaluation of Unilateral Progressive Mooren’s Ulcer in a Cat

Background: Mooren’s ulcer is a chronic and painful ulceration of the cornea. It begins progressively in the periphery and spread centrally in cornea. In human, it is seen uniaterally in most of cases. Mooren ulcer has not been reported in any kind of animals up to now. Although its aetiology is not completely enlighted, it has been suspected of the inflammatoryreaction against injuries-microbiological and immun mediated effects. Immun response in presence of accumulation of immune complexes into the limbal vessels.As a result of the deficit in the regulatory mechanism because the number of suppressor cells control over B and T lymphocytes, These situations can result in a progressive tendancy to inflammationbecause the production of autoantibodies and/or lymphokine from cytotoxic T-lymhocytes creates an immune-mediated vasculitis. Numerous immigrant inflammatory cells and proteins are evaded from vessels. After triggering inflammatory cells and releasing of meditors, corneal vascularization, scar tissue and re-epithelization develop. This regenerative-reperative process plays an important role during post-inflammatory process.Case: In this case, it was aimed to detect pathomorphological structure and immunologic relations in progressive Mooren’s ulcer (MU). A 1 year-old mix breed cat was submitted to clinic with complaints of progressive painful and eyesight loss in left eye. There were 1 cm-ulceration, opacification and old haemorrhagic areas at peripheral cornea. Histopathologically, there was wide ulceration including all layers of corneal epithelium and particularly vacuolar degeneration at suprabasal cells. In corneal stroma, numerous neutrophiles and mononuclear cells were infiltrated. Neovascularisation and fibrosis beginning from limbus were also present. This fibrotic progress was confirmed by Masson’s trichrome staining method. Immunohistochemically, Cytokeratin 3 (CK3) and cytokeratin 12 (CK12) positivities showing regenerative activity of suprabasal and basal cells were not widespread. Epidermal Growth Factor (EGF) positivities were generally weak in epithelialcells. In stroma, moderate vimentin positivities were detected proliferated in fibrocytes originating from limbus. α1-antichymotrypsin (A1AC) was mildly reacted in neutrophiles. CD3 and CD4 confirmed the presence of regulatory and helper T lymphocytes. CD3 and CD8 marked cytotoxic T lymphocytes and CD20 marked B lymphocytes in inflammatory areas. CD34 were also positive in peripheral corneal stem cells derived from limbal basal epitheliums in partly regenerated area. CD57 positivity in T lymphocytes and NK cells and CD68 positivity in macrophages were attended to the area.Discussion: CD1a positivity in T lymphocytes proved mediating lipid and microbial origin glycolipid antigens. TUNEL reactions showing DNA in situ fragmentation were present in the destructive and aging epithelial cells at periphery. In conclusion, the case has been found as unique in terms of its immunohistochemical characterization. The markers show that CD1a and CD68 expressions follow different progress in animals unlike in humanbeings even though the ulcer of pathogenetic mechanism is found identical to humanbeings.. The roles of CD20 and CD57 markers have potential roles in this ulcer. It is also concluded that insufficient epithelial regeneration, fibrosis, inflammation and apoptosis showed progressive Mooren’s ulcers having possibly microbial origin.Keywords: Mooren’s ulcer, pathomorphology, immunohistochemistry, cat.

A Two-Stage Foot Repair in a 55-Year-Old Man with Poliomyelitis

A 55-year-old man with poliomyelitis presented with a plantarflexed foot and painful ulceration of the sub–first metatarsophalangeal joint present for many years. A two-stage procedure was performed to bring the foot to 90°, perpendicular to the leg, and resolve the ulceration. The first stage corrected only soft-tissue components. It involved using a hydrosurgery system to debride and prepare the ulcer, a unilobed rotational skin plasty to close the ulcer, and a tendo Achillis lengthening to decrease forefoot pressure. The second stage corrected the osseous deformity with a dorsiflexory wedge osteotomy of the first metatarsal. The ulceration has remained closed since the procedures, with complete resolution of pain.

Fungal eye infections

Mycotic keratitis is a fungal infection of the cornea that leads to severe, painful ulceration and loss of vision, and is a major cause of blindness worldwide, particularly in the developing world. Major risk factors for mycotic keratitis include ocular trauma and contact lens use. Both yeasts and moulds can cause mycotic keratitis, with the filamentous moulds of the Fusarium and Aspergillus genera the most common aetiological agents worldwide. Fungi, particularly Candida spp. yeasts, can also cause endophthalmitis—a painful, blinding infection of the posterior eye. Treatment of these infections is challenging owing to a limited arsenal of antifungal agents and highly variable susceptibility among causative fungi. Furthermore, associated inflammation contributes greatly to tissue damage and permanent blindness. Studies using experimental models of mycotic keratitis have revealed new targets for novel antifungal agents and anti-inflammatory therapies that have the potential to reduce the impact of these devastating infections.