Presence of bronchial nodules, younger age, and heavier body weight are associated with a diagnosis of eosinophilic lung disease in dogs with cough

OBJECTIVE To describe the association between a diagnosis of eosinophilic lung disease (ELD) in dogs with signalment and bronchoscopic features and evaluate the accuracy of visualization of nodules for the diagnosis of ELD. ANIMALS 781 dogs with cough that underwent bronchoscopy between 2014 and 2016. PROCEDURES Data were extracted from the medical records of each included dog. Multivariable logistic regression was performed to investigate associations between ELD and patient characteristics. RESULTS ELD was diagnosed in 113 (14.5%) dogs. More than 3 nodular lesions of the bronchial mucosa were detected in 64 (8.2%) dogs. The odds of having ELD were greater in dogs with nodules (adjusted OR [aOR], 26.0; 95% CI, 13.0 to 52.0) and static bronchial collapse (aOR, 2.3; 95% CI, 1.1 to 4.6), and lower in dogs having focal versus diffuse inflammation (aOR, 0.05; 95% CI, 0.01 to 0.37). The odds of having ELD decreased for each 1-year increase in age (aOR, 0.86; 95% CI, 0.80 to 0.92), and increased for each 1-kg increase in weight (aOR, 1.04; 95% CI, 1.01 to 1.06). Visualization of nodules during bronchoscopy had a overall accuracy of 89.4% (95% CI, 87.0% to 91.4%), sensitivity of 41.6% (32.4% to 51.2%), and specificity of 97.5% (96.0% to 98.5%) for a diagnosis of ELD. CLINICAL RELEVANCE On the basis of high specificity and negative predictive value, lack of visualization of bronchial nodules during bronchoscopy can be used to preliminarily rule out ELD. However, visualization of bronchial nodules does not imply presence of ELD. This could be especially relevant when results of BAL cytology are available several days after the actual bronchoscopy.

Anisakis pegreffii Larvae in Sphyraena viridensis and Description of Granulomatous Lesions

The aim of the present study was to describe gastric granuloma caused by Anisakis pegreffii in Sphyraena viridensis caught in the central Mediterranean Sea. Sixty-eight S. viridensis specimens were collected from different fish markets on the east coast of Sicily. Coelomic organs were observed both macroscopically and with the aid of stereomicroscope. Parasite specimens and lesioned tissues were collected for identification, histological and molecular analyses. Twelve specimens (p = 17.6%) were positive for the presence of nematode larvae, morphologically identified as larvae of Anisakis sp., with values of mean abundance and mean intensity of 0.9 and 4.8, respectively. One large female specimen showed massive parasite infection associated with nodular lesions of the gastric wall. By histology, several nematode larvae encysted through the gastric wall were found. The parasite bodies were surrounded by a granulomatous reaction made up of macrophages, epithelioid cells, some lymphocytes and an external connective sheet. Molecular analysis of 18S rRNA and cox2 genes from Anisakis sp. collected larvae, identified them as A. pegreffii. The lesions here described, though macroscopically superimposable on human eosinophilic granuloma, microscopically showed significant differences in the inflammatory cells involved and in the type of immune reaction.

Mycobacterium Tuberculosis and Avium Complex In-Vestigation among Malaysian Free-Ranging Wild Boar and Wild Macaques at Wildlife-Livestock-Human In-Terface

Wild animals are considered reservoirs, contributing to the transmission of emerging zoonotic diseases such as tuberculosis (TB). A cross-sectional study was conducted by opportunistic sampling from fresh carcasses of free-ranging wild boar (n = 30), and free-ranging wild macaques (n = 42). Stained smears from these tissues were tested for acid-fast bacilli (AFB) with Ziehl–Neelsen staining. Mycobacterial culture was conducted using Lowenstein–Jensen media and Middlebrook 7H11 agar media. Polymerase chain reaction (PCR) was performed through the detection of the 16S rRNA gene, with multiple sets of primers for the detection of Mycobacterium tuberculosis complex (MTBC) and Mycobacterium avium complex (MAC). In wild boars, 30% (9/30; 95% Confidence Interval: 16.7–47.9%) of examined samples showed gross tuberculosis-like lesions (TBLLs). Multiple nodular lesions that were necrotic/miliary with cavitation were found in the submandibular lymph nodes, tonsils, lungs, kidney and liver, while single nodular lesions were found in the mediastinal lymph nodes, spleen and mesenteric lymph nodes. Conventional PCR on the submandibular lymphoid tissues of wild boar (nine samples with TBLLs and three non-TBLL samples) showed that 75% (9/12) were positive for Mycobacterium bovis (95% CI: 46.8–91.1), and 91% (CI: 64.6–98.5) were positive for Mycobacterium avium. For macaques, 33.3% (10/30) were positive for M. avium (95% CI: 19.2–51.2) but negative for MTBC.

P.114 Benign tumors of peripheral nerves in children at a tertiary-care pediatric hospital

Background: Tumors affecting peripheral nerves in children are rare. Accurate diagnosis ensures that management is appropriate and timely. Methods: We review the clinical presentation and utility of investigations of children with intrinsic tumors affecting peripheral nerves at the Children’s Hospital of Eastern Ontario (CHEO). Results: From 2009-2019, 14 cases were identified. Mean age of symptom onset was 8.2 years (range 0.3 to 17.3 years). Presenting symptoms included painless muscle wasting (2/14), focal muscle weakness (7/14), contracture (1/14), pain (1/14) or a painless, palpable mass (3/14). MRI was useful at differentiating benign pediatric nerve tumors. Peripheral nerve lipomatosis demonstrated a classic “spaghetti string” appearance. Patients with perineurioma showed evidence of enhancing, nodular lesions while intraneural ganglionic cysts display cystic lesion within the nerve. Neurofibromas appear like a “bag of worms” while schwannomas are more eccentrically positioned around the nerve. Nerve conduction studies (NCS) or electromyography (EMG) were performed in 11/14 patients. Biopsies were performed in 9 patients and surgical management in 4 patients. Conclusions: The rare nature of peripheral nerve tumors in children can pose diagnostic challenges. NCS/EMG are important to assist with localization, and MRI important at distinguishing benign tumors. Key MRI, clinical and NCS features can guide management, potentially avoiding invasive procedures.

Three-Dimensional Computed Tomography Follow-Up on Spontaneous Bone Healing after Excision of Periorbital Dermoid Cyst: A Case Report

Dermoid cysts are among the most common periorbital and orbital tumors presenting in childhood. Several studies have shown that dermoid cysts may deform adjacent bones; however, few studies have followed the course of bone regeneration after the excision of a cyst. We report a case of a 29-month-old female infant who presented with a palpable mass over her right lateral eyebrow. Ultrasonography findings suggested a dermoid cyst, and computed tomography revealed a 2.1-cm round bony defect in the right zygoma. After surgical excision of the dermoid cyst, we successfully applied fibrin sealant to eliminate the dead space. Pathological findings showed nodular lesions with flat cystic walls containing lamellated keratin and sebaceous glands, supporting the diagnosis of dermoid cyst. At 6 months postoperatively, a follow-up computed tomography scan confirmed complete recovery of the bone defect in the right zygoma.

Kimura Disease: A Rare Cause of Head and Neck Tumour in Children- A Case Report

Background: Kimura disease is a rare inflammatory condition classically manifested as painless subcutaneous nodules in the head and neck region and associated with regional cervical lymphadenopathy and salivary gland involvement. Objective: The purpose of this report is to illustrate the diagnostic difficulty due to its rarity and non-specific clinical presentation. Case Presentation: We present a case of Kimura disease with bilateral eyelid swelling, parotid involvement, and cervical lymphadenopathy in a young boy. Computed Tomography (CT) showed ill-defined enhancing masses in both upper eyelids with lacrimal gland infiltration, multiple nodular lesions in both parotid glands, and bilateral enlargement of cervical nodes. After several multidisciplinary discussions and trials of medications, Kimura's disease was finally confirmed by histology examination. Conclusion: In conclusion, a rare disease such as Kimura must be considered earlier if the patient is not responding to the treatment.

Infrared light heat therapy of port wine stain in adult patients as new innovative technique

Background: Port wine needs early age intervention, most effectively by pulse dye laser where about 40-45% improves only and by at least 75% after 5 to 25 sessions. Objectives: To try therapy of port wine stain in adult patients using flame of infrared light. Patients and Methods: Twenty adult patients with facial port wine stain were treated during the period from 2014-2017 years, 11 females and 9 males with ages ranged from 16-35 years with a mean of 25 years. After local anesthesia with 2% xylocaine, direct flame of infrared light that generated from heated red head of needle of diathermy was used. This light therapy was delivered with about 1-2cm away from the port wine and the time of exposure was decided by greyish blanching of the lesion, usually 1-2 minutes needed. Only one session of infrared was delivered. The response to therapy and according to the reduction rate was estimated as follow: 0-25%,>26-50%,>51-75%,>76-100%. Results: Immediately after session, there was edema, swelling. Reduction of erythema of port wine started immediately after infrared exposure and was obvious after two weeks and then slowly faded, with more improvement in the next few months. The reduction rate of port wine stain was ranged between 50-70% after only one session in 19 patients while one patient showed 25% reduction. It was noticed that, whenever the color of the port wine stain is dusky red with thickened nodular lesions, it responded quickly and better to this therapy. Conclusion: Infrared light heat therapy from diathermy needle was an effective mode of therapy in all adult patients with port wine stain. This new technique is easy to be used and non -costly procedure especially when compared with pulse dye laser.

Progressive Nodular Histiocytosis: Report of a Case and Review of the Literature

Progressive nodular histiocytosis (PNH) is a rare condition characterized by progressive eruption of multiple yellowish-brown papules and nodules on the skin and mucous membranes. We present the case of a 37-year-old Caucasian man with gradually increased appearance of nodular lesions on the forehead and right temple. These lesions were initially diagnosed as xanthomas and did not respond to intralesional injections of triamcinolone. Additional biopsy revealed an intense dermal infiltrate of foamy mononuclear epithelioid cells with a minor admixture of plasma cells, lymphocytes, and scattered multinucleated giant cells. On immunohistochemical staining, the lesional cells were positive for CD163 and CD68 and negative for CD1a, thus confirming a mononuclear-macrophage lineage. The clinical presentation and the histological impression lead to the diagnosis of PNH. This condition could be challenging, mimicking microscopically similar lesions of the non-Langerhans cell histiocytosis group. Although uncommon, PNH stands out due to its clinical and microscopic features and should be taken into consideration in the differential diagnosis of cutaneous histiocytoses.