5-aminolevulinic acid-photodynamic therapy ameliorates cutaneous granuloma by killing drug-resistant Mycobacterium marinum

Although 5-aminolevulinic acid photodynamic therapy (ALA-PDT) has been extensively used to treat to various skin disease, the application of ALA-PDT on cutaneous infection caused by Mycobacterium marinum (M. marinum), especially by drug-resistant M. marinum is still not clear. We evaluated the therapeutic efficacy of ALA-PDT on M. marinum in a mouse infection model and tested its killing effect on M. marinumin vitro. Finally, we investigated the clinical effect of ALA-PDT in treating cutaneous granuloma caused by drug-resistant M. marinum. We isolated total 9 strains of M. marinum from patients and confirmed by morphological and molecular approaches. The strains were identified by anti-mycobacterial susceptibility. Then we evaluated the killing effect of ALA-PDT on M. marinum in vitro and in a mouse model to observe the antimycobacterial effect of ALA-PDT. Therapeutic efficacy was further assessed in patients with cutaneous granuloma caused by drug-resistant M. marinum. We demonstrated that the ALA-PDT directly killed M. marinumin vitro. The paws cutaneous lesions of mice caused by M. marinum were fully recovered 2 weeks after ALA-PDT treatment. However, there was no significant difference for immune cells in peripheral blood before and after ALA-PDT therapy. Finally, ALA-PDT proved to be effective in treat two patients with cutaneous infection caused by drug-resistant M. marinum. The results suggest that ALA-PDT is effective in treating M. marinum cutaneous infections by killing M. marinum directly, independent of systemic immune responses. The data highlight the ALA-PDT as a promising therapeutic choice for M. marinum infection, especially for drug-resistant strains.

A Case of Granulomatosis with Polyangiitis with Various Breast Lesions as the Initial Symptoms: A Case-Based Review

A 44-year-old woman presenting with pus-like discharge from the nipples visited our hospital for scleritis. Subcutaneous induration and ulceration were found on her breast. She was diagnosed with granulomatosis with polyangiitis (GPA) considering scleritis, sinusitis, cutaneous granuloma formation, and antiproteinase 3-antineutrophil cytoplasmic antibodies and was successfully treated with glucocorticoids. Fifteen months later, she developed pulmonary consolidation and a right breast nodule. Biopsies of the breast nodule showed granulomatous vasculitis, and she was treated with rituximab. While breast involvement in GPA is rare, unilateral breast mass is a typical clinical feature; thus, GPA should be considered in such cases.

Granuloma-like lesion at subcutaneous immunoglobulin site in a common variable immunodeficiency patient

Immunoglobulin therapy is the main stay in the treatment of primary antibody deficiencies. Granulomatous lesions are common complication in patients with common variable immunodeficiency (CVID). We present the first case of cutaneous granuloma-like lesion at site of subcutaneous immunoglobulin injections in a patient with CVID. These lesions resolve overtime following switching treatment to intravenous immunoglobulin. Unlike granulomas associated with CVID, granulomatous lesion in this patient did not require any specific therapy, and resolved over a period of 4 weeks following switching subcutaneous immunoglobulin to intravenous immunoglobulin.

Histopathological study of cutaneous granulomas

Background: Cutaneous granulomas comprise a wide spectrum of diseases that are frequently encountered. Since clinical assessment alone is insufficient in most of the cases, skin biopsies are a basic requisite in evaluating these lesions. Histopathological examination, although helpful in deciding the nature of granulomas and etiology in most of the cases, maybe noncontributory in some cases, thus requiring further ancillary tests such as microbial culture, polymerase chain reaction. Materials and Methods: This prospective cross sectional study enrolled 109 cases of skin biopsies after histopathological confirmation of granulomatous lesions. The specimens were received at the Department of Pathology from 14th April 2017 to 13th April 2018. Results: Out of 650 skin biopsies, 109 cases (16.8%) were diagnosed as granulomatous lesions on histology. Male predilection was noted and age group of 31 to 40 years was the commonest affected. Upper extremities were more commonly involved. Leprosy was the commonest etiological agent and tuberculoid granulomas were the commonest type based on their histology. Conclusions: Leprosy was the most common cause of cutaneous granuloma followed by Tuberculosis, fungal infection and foreign body reaction. Among the cases of leprosy, borderline tuberculoid leprosy and tuberculoid leprosy were the commonest subtype.