scholarly journals Rare incidence of non-secretory myeloma with talaromycosis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Haiting Qin ◽  
Ye Qiu ◽  
Yanmei Huang ◽  
Mianluan Pan ◽  
Dong Lan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Marrow ◽  
Differential Diagnosis ◽  
Lymph Nodes ◽  
Clinical Symptoms ◽  
Subcutaneous Tissue ◽  
Community Acquired Pneumonia ◽  
Pathological Examination ◽  
Subcutaneous Nodules ◽  
Lung Lymph

Abstract Background Talaromyces marneffei (TM) primarily infects patients with co-morbidities that cause immunodeficiency, but non-secretory myeloma (NSMM) is rare. TSM and NSMM are associated with fever, osteolysis, and swollen lymph nodes, thereby making it difficult for clinicians to make differential diagnosis. In this case, we describe TM infection coexisting with NSMM. Case presentation We retrospectively reviewed the case of a male (without human immunodeficiency virus infection) with fever, thoracalgia, swollen lymph nodes, and subcutaneous nodules who presented to the First Affiliated Hospital of Guangxi Medical University in February 2014. Chest computed tomography revealed patchy infiltration and positron emission tomography/computed tomography showed increased metabolic activity in the lower-right lung, lymph nodes, left ninth rib, and right ilium. Pathological examination of the lung, lymph nodes, subcutaneous nodules, and bone marrow showed no malignancy, he was diagnosed with community-acquired pneumonia. His clinical symptoms did not improve after anti-bacterial, anti-Mycobacterium tuberculosis, and anti-non-M. tuberculosis treatment. Later, etiological culture and pathological examination of the subcutaneous nodule proved TM infection, and the patient was re-diagnosed with disseminated TSM, which involved the lungs, lymph nodes, skin, bone, and subcutaneous tissue. After antifungal treatment, the patient showed significant improvement, except for the pain in his bones. Imaging showed aggravated osteolysis, and bone marrow biopsy and immunohistochemistry indicated NSMM. Thus, we conclusively diagnosed the case as NSMM with TSM (involving the lungs, lymph nodes, skin, and subcutaneous tissue). His condition improved after chemotherapy, and he was symptom-free for 7 years. Conclusion TM infection is rare in individual with NSMM. Since they have clinical manifestation in common, easily causing misdiagnosis and missed diagnosis, multiple pathological examinations and tissue cultures are essential to provide a differential diagnosis.

Sporothrix brasiliensis meningitis in an immunocompetent patient

2021 ◽  
pp. practneurol-2020-002915
Author(s):  
Marco A Lima ◽  
Renan Vallier ◽  
Marcos M Silva
Keyword(s):  
Differential Diagnosis ◽  
Lymph Nodes ◽  
Subcutaneous Tissue ◽  
Rare Condition ◽  
Immunocompetent Patient ◽  
Diagnosis And Treatment ◽  
Chronic Meningitis ◽  
Regional Lymph Nodes ◽  
Sporothrix Brasiliensis ◽  
Immunosuppressed Patients

Sporothrix brasiliensis usually causes infection limited to the skin, subcutaneous tissue and regional lymph nodes. Contamination occurs through inhalation or accidental inoculation from animal scratches and bites. Meningitis is rare and mostly occurs in immunosuppressed patients. Here, we describe an immunocompetent person who developed chronic meningitis and discuss the diagnosis, differential diagnosis and treatment of this rare condition.

Positron emission tomography/computed tomography to improve staging and restaging in Merkel cell carcinoma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 8552-8552
Author(s):  
Elena B. Hawryluk ◽  
Kevin N. O'Regan ◽  
Niall Sheehy ◽  
Ye Guo ◽  
Andrew Dorosario ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Bone Marrow ◽  
Lymph Nodes ◽  
Emission Tomography ◽  
Merkel Cell ◽  
Regional Lymph Nodes ◽  
Positron Emission ◽  
Pet Ct ◽  
Bone Marrow Metastases

8552 Background: Merkel cell carcinoma (MCC) is a rare (~1,500 cases per year) and highly aggressive (33% mortality) cutaneous neuroendocrine carcinoma that occurs in older white patients on the UV-exposed skin of the head, neck, and extremities. As a patient’s stage at presentation is a strong predictor of survival, and there is a high propensity for locoregional recurrence and distant progression, imaging remains crucial for initial and subsequent management. There is, however, no consensus on the timing or method of imaging for MCC. Methods: We retrospectively reviewed 270 2-fluoro-[18F]-deoxy-2-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) scans performed in 97 patients at the Dana-Farber/Brigham and Women’s Cancer Center from August 2003 to December 2010. Results: The mean SUVmax was 6.5 for primary tumors, 6.4 for regional lymph nodes, 7.2 for distant metastases (all sites), 8.0 for bone/bone marrow metastases, and 9.4 for non-regional metastases in those patients with no identified primary. PET/CT imaging performed for initial management tended to upstage patients with more advanced disease (50% of stage IIIB patients). Metastases to bone/bone marrow (12 patients, 38%) was the 2nd most common site of distant spread after non-regional lymph nodes (19 patients, 59%), followed by skin (8 patients, 25%), liver (6 patients, 19%), lung/pleura (5 patients, 16%), adrenal (3 patients, 9%), muscle (3 patients, 9%), pancreas (2 patients, 6%), and peritoneum (1 patient, 3%). In 10 of 12 patients, PET identified bone/bone marrow metastases that were not seen on CT imaging, which resulted in either upstaging or initiation of more targeted palliative therapy. Conclusions: Added value of PET over CT, such as in the detection of bone/bone marrow metastases, may lead to more accurate staging, and thus prognostication, as well as earlier detection of relapse and initiation of salvage treatment. Its use should be considered in the staging and restaging of MCC.

scholarly journals Differential diagnosis of bilateral lungs opacities in the hospital for admission of community-acquired pneumonia – not only COVID-19

2020 ◽  
Vol 24 (2) ◽  
pp. 78-95
Author(s):  
A. S. Vinokurov ◽  
O. I. Belenkaya ◽  
E. A. Zolotova ◽  
S. V. Michurina ◽  
O. O. Vinokurova ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Clinical Laboratory ◽  
Clinical Symptoms ◽  
Community Acquired Pneumonia ◽  
Lung Damage ◽  
Ground Glass ◽  
Small Areas ◽  
Radiological Data ◽  
Coronavirus Infection ◽  
To Receive

Due to the current epidemiological situation caused by the spread of the new SARS-CoV-2 coronavirus, in March 2020 several Moscow hospitals were completely or partially redesigned to receive patients with community- acquired pneumonia.Purpose. The aim of the survey is to analyze clinical, laboratory and radiological data in patients with coronavirus infection at the early stages of its spread in Russia, and to clarify diseases for differential diagnosis mainly based on CT evidence.Materials and methods. We studied data from 21 patients with verified coronavirus infection admitted to the hospital for community-acquired pneumonia. Clinical symptoms, laboratory and physical indicators, as well as typical lung changes on the CT were evaluated.Results. Major clinical symptoms in coronavirus patients are fever (100%), cough (90.5%), shortness of breath (76.1%). Laboratory indicators showed increases in CRP (85.7%), leukocytosis (66.6%), and LDG (84.6%). According to CT, 95.2% of lung changes involved both sides, and 66.7% occurred in all lung fields. The sign of “ground glass” was observed in a 100% of the cases, its combination with the “paving stone” – in 61,9%, “ground glass” coupled with small areas of consolidations were detected in 33,3% of the cases. Changes such as nodules, cavities and massive areas of consolidation were not identified.Conclusion. On the basis of our own data we confirmed the main trends of diagnostics and clinical features, which were identified by authors from Asia and Europe, who faced this infection earlier, and also considered important CT characteristics useful for differential diagnosis of coronavirus lung damage and other lung diseases.

scholarly journals Gastric Angiolipoma: A Rare Entity

2017 ◽  
Vol 141 (6) ◽  
pp. 862-866 ◽  
Author(s):  
Yong-Jun Liu ◽  
Dipti M. Karamchandani
Keyword(s):  
Differential Diagnosis ◽  
English Language ◽  
Benign Tumor ◽  
Clinical Symptoms ◽  
Subcutaneous Tissue ◽  
Correct Diagnosis ◽  
Gastric Neoplasms ◽  
Rare Entity ◽  
Accurate Preoperative Diagnosis ◽  
Ancillary Studies

Angiolipoma is a benign tumor composed of adipose tissue and proliferating blood vessels that is commonly found in the subcutaneous tissue of the trunk and extremities. Gastric angiolipoma is a rare entity, and to the best of our knowledge, only 4 cases have been reported in the English-language literature thus far. These tumors may present as gastrointestinal bleeding and anemia or with obstructive symptoms. Accurate preoperative diagnosis is challenging because of nonspecific clinical symptoms and lack of specific findings on imaging studies. The correct diagnosis is usually made by histopathologic examination. The clinical significance lies in being aware of this rare entity in the stomach and distinguishing it from other benign and malignant gastric neoplasms that may be in the differential diagnosis. We herein discuss the clinical presentation, radiologic and histopathologic features, ancillary studies, differential diagnosis, and treatment and prognosis of this rare entity.

scholarly journals Diagnosis of solitary eosinophilic granuloma by CT, MRI, and 18F-FDG PET/CT: two clinical cases

2021 ◽  
Vol 2 (1) ◽  
pp. 75-82
Author(s):  
Pavel B. Gelezhe ◽  
Dmitriy V. Bulanov
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Fdg Pet ◽  
Eosinophilic Granuloma ◽  
Pathological Examination ◽  
Pet Ct ◽  
18F Fdg ◽  
Eosinophilic Granuloma Of Bone ◽  
Fdg Pet Ct ◽  
Clinical Cases

This paper presents two clinical cases of eosinophilic granuloma of bone diagnosed by CT, MRI, and 18F-FDG PET/CT. In both cases the patients were admitted to the clinic with suspected primary malignant bone tumor and the diagnosis of a solitary eosinophilic granuloma was made based on the results of comprehensive radiological diagnostic examination and histological verification. Solitary eosinophilic granuloma of bone is an infrequent condition, occurring in less than 1% of cases of skeletal tumor masses. The most common eosinophilic granuloma is found in the parietal and frontal bones of the skull and is an osteolytic volumetric mass that gradually increases in size. Although most bone tumors can be detected by radiography, computed tomography is preferred, primarily because of its superior ability to detect cortical bone destruction. The diagnostic accuracy of computed tomography and magnetic resonance imaging may be different. The combined use of radiological and radionuclide methods allows us to narrow the spectrum of differential diagnosis. Unfortunately, relatively low specificity of existing radiological diagnostic studies in most cases does not allow to establish a precise diagnosis, and biopsy with subsequent pathological examination remains the method of choice. These clinical observations demonstrate the need to include eosinophilic granuloma in the differential diagnosis when a solitary osteolytic focus is detected.

Aanhoudende koorts zonder focus met lymfadenopathieën: infectie, inflammatie of maligniteit?

2021 ◽  
Author(s):  
S. DESMEDT ◽  
V. DESMEDT ◽  
T. BILLIET ◽  
C. GEORGE ◽  
W. MEERSSEMAN ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Marrow ◽  
Lymph Nodes ◽  
Unknown Origin ◽  
Lymph Node Biopsy ◽  
Positron Emission ◽  
Pet Ct ◽  
Auto Inflammatory Disease ◽  
Diagnostic Work ◽  
Cardinal Symptoms

Persistent fever without focus but with lymphadenopathy: infection, inflammation or malignancy? Adult-onset Still’s disease (AOSD) is a rare auto-inflammatory disease in which four cardinal signs have been described: rash, spiking fever, arthritis or arthralgia and hyperleucocytosis with neutrophilia. Nevertheless, diagnosis can be challenging as infectious, other inflammatory or neoplastic diseases need to be ruled out. It affects typically young adults (from 16 to 35 years). The disease can be controlled with non-steroidal anti-inflammatory agents and glucocorticoids. To date, treatments as Il-6, IL-1 or anti-TNFα can be used in glucocorticoid-dependent or refractory patients. We present a case of a 22-year old woman with all four cardinal symptoms in which all cultures and infectious serology resulted negative. Also, auto-immune markers were negative. Because of diffuse bilateral supra- and infradiaphragmatic enlarged lymph nodes up to 1.6 cm in size on computed tomography (CT), additional positron emission tomography-computed tomography imaging (PET-CT-scan) was performed. Besides the multiple enlarged lymph nodes, increased tracer capture was shown in the spleen and bone marrow. All of this was suspicious for high-grade lymphoma. Eventually, an additional bone marrow biopsy with aspiration and lymph node biopsy could rule out a lymphoproliferative process and the diagnosis of AOSD could be made. This case report highlights the importance of a profound diagnostic work-up in fever of unknown origin.

Mediastinal Lymphadenopathy

Chest Imaging ◽  
2019 ◽  
pp. 481-485
Author(s):  
Brett W. Carter
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Lymph Nodes ◽  
Metastatic Disease ◽  
Metabolic Activity ◽  
Disease Process ◽  
Mediastinal Lymphadenopathy ◽  
Short Axis ◽  
Active Infection ◽  
Pet Ct

Lymphadenopathy represents the pathologic enlargement of lymph nodes. Within the chest, the mediastinum is the most commonly affected region. Mediastinal lymphadenopathy may result in loss of normal mediastinal contours or thickening of lines and stripes. On computed tomography (CT), lymph nodes measuring greater than 1 cm in short-axis dimension are typically considered enlarged. Although many disease process may result in mediastinal lymphadenopathy, including lymphoma, metastatic disease, infections, and sarcoidosis, specific characteristics such as attenuation, enhancement, and calcification help narrow the differential diagnosis. PET/CT demonstrates the metabolic activity of structures such as lymph nodes and may help in identifying pathologic lymphadenopathy. However, PET/CT cannot reliably differentiate between lymphadenopathy due to active malignancy and certain benign processes such as active infection or sarcoidosis.

scholarly journals GRANULOMATOUS LESIONS IN THE BONE MARROW IN INFECTIOUS MONONUCLEOSIS

Blood ◽  
1950 ◽  
Vol 5 (3) ◽  
pp. 209-232 ◽  
Author(s):  
RUTH F. HOVDE ◽  
R. DOROTHY SUNDBERG
Keyword(s):  
Bone Marrow ◽  
Differential Diagnosis ◽  
Lymph Nodes ◽  
Infectious Mononucleosis ◽  
Granulomatous Inflammation ◽  
Epithelioid Cells ◽  
Lymphatic Leukemia ◽  
Granulomatous Lesions

Abstract 1. The findings in the blood and in aspirated bone marrow in 23 cases of infectious mononucleosis have been described. 2. Unequivocal evidence of involvement of the bone marrow has been found in 70 per cent of the cases. 3. Evidence of granulomatous inflammation of the marrow was found in 48 per cent of the cases. 4. Epithelioid cells were found in the films of bone marrow in 48 per cent of the cases. These cells appear morphologically identical with those seen in imprints of lymph nodes from infectious mononucleosis and sarcoidosis and with the epithelioid cells seen in films of the marrow in brucellosis, sarcoidosis and tuberculosis. 5. The granulomatous lesions of infectious mononucleosis seem most similar to those of brucellosis, but they also resemble the small granulomatous lesions of sarcoidosis and tuberculosis. 6. Lymphocytosis of the marrow as well as of the blood was demonstrated in all cases. Evidence of formation of lymphocytes in the marrow was presented, and the altered lymphocytes of infectious mononucleosis were found in films of the marrow. The degree of lymphocytosis of the marrow in infectious mononucleosis was shown to be less than that in lymphatic leukemia. Lymphocytosis of the marrow was not found in brucellosis, sarcoidosis or tuberculosis. The lymphocytic reaction demonstrable in the marrow in infectious mononucleosis is believed to be of value in differential diagnosis.

scholarly journals Langerhans cell histiocytosis; an institutional study

2017 ◽  
Vol 7 (2) ◽  
pp. 1192-1195
Author(s):  
Shovana Karki ◽  
Aasia Rajbhandari
Keyword(s):  
Bone Marrow ◽  
Differential Diagnosis ◽  
Dendritic Cell ◽  
Lymph Nodes ◽  
Langerhans Cell Histiocytosis ◽  
Frontal Bone ◽  
Langerhans Cell ◽  
Female Ratio ◽  
Uncommon Disease ◽  
Male To Female

Background: Langerhans cell histiocytosis is a complex rare disease of the dendritic cell system.The disease can occur at any age, with a peak at 5-10 years. Here, we present the spectrum of this uncommon disease with different sites of involvement and its histopathological differential diagnosis. Material and Methods:  Study included 24 cases of Langerhans cell histiocytosis out of approximately 50,000 biopsies received in the department.Results: The male to female ratio was 1.6:1 with mean age of 12 years. Commonest site of involvement was skin 37.5%, followed by bone 33.4%. Lymph nodes 20.9%, bone marrow 4.1% and thyroid 4.1% involvement was seen. Among the 9 cases of bone involvement, commonest site was humerus (3 cases), sternum (2 cases) and one case each in frontal bone, fibula, temporal bone and rib.Conclusion: Langerhans cell histiocytosis should be considered in the differential diagnosis of histiocytic lesions involving various organs, especially in childhood. 

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