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Uchida Y, Yokoyama K, Higashi T, Kitaguchi T, Fukuda H, Yamauchi R, Tsuchiya N, Fukunaga A, Umeda K, Takata K, Tanaka T, Takeyama Y, Shakado S, Sakisaka S, Hayashi H, Hamada Y, Nabeshima K, Hirai F. Eosinophilic Granuloma of the Liver Mimicking Metastatic Liver Tumor. Intern Med 2022; 61:1511-1517. [PMID: 34670905 PMCID: PMC9177375 DOI: 10.2169/internalmedicine.8438-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of coagulation necrosis with granulation and eosinophilic infiltration of the liver. A 37-year-old woman was diagnosed with a new mass lesion in the liver 1 month after breast cancer surgery and admitted for a further examination. Because the tumor occurred immediately after surgery, it was considered essential to determine whether or not it was a metastatic liver tumor from breast cancer. A percutaneous liver tumor biopsy revealed eosinophilic granuloma of the liver, which is considered to have a high possibility of visceral larva migrans with suspected gnathostomiasis infection. A detailed medical history and histological diagnosis are important for making a differential diagnosis.
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Affiliation(s)
- Yotaro Uchida
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Keiji Yokoyama
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Tomotaka Higashi
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Takanori Kitaguchi
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Hiromi Fukuda
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Ryo Yamauchi
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Naoaki Tsuchiya
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Atsushi Fukunaga
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Kaoru Umeda
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Kazuhide Takata
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Takashi Tanaka
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Yasuaki Takeyama
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Satoshi Shakado
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Shotaro Sakisaka
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Hiroyuki Hayashi
- Department of Pathology, Fukuoka University Faculty of Medicine, Japan
| | - Yoshihiro Hamada
- Department of Pathology, Fukuoka University Faculty of Medicine, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University Faculty of Medicine, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
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Shajil C, Sathishkumar D, George K, Thomas M. Spontaneous splenic rupture: A rare complication in eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome). Indian J Dermatol Venereol Leprol 2022; 88:392-395. [PMID: 35389026 DOI: 10.25259/ijdvl_584_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/01/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Chandana Shajil
- Department of Dermatology, Venereology and Leprology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Dharshini Sathishkumar
- Department of Dermatology, Venereology and Leprology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Krupa George
- Department of Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Meera Thomas
- Department of Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Akiyama M, Takanashi S, Takeuchi T, Kaneko Y. Salivary gland involvement in ANCA-associated vasculitis. Autoimmun Rev 2021; 20:102940. [PMID: 34509652 DOI: 10.1016/j.autrev.2021.102940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Salivary gland involvement in anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis is rare, but can lead to the misdiagnosis of other diseases. The objective of this study was to clarify the characteristics of patients with salivary gland involvement. METHODS We conducted a systematic literature review of articles reporting salivary gland involvement in ANCA-associated vasculitis from the inception dates until May 2, 2021. RESULTS We identified 58 patients with salivary gland involvement. The mean age was 52 years, and men were predominantly affected (59%). Half of the patients presented with fever. Swelling of the salivary gland was the initial manifestation in 88% of the patients, unilaterally affected in 53%, and painful in 47%. The affected salivary glands were as follows: parotid gland alone (53%), submandibular gland alone (33%), and both parotid and submandibular glands (14%). Additionally, two patients had sublingual gland involvement. The most frequent clinical diagnosis was granulomatosis with polyangiitis (83%), followed by eosinophilic granulomatosis with polyangiitis (17%), while no patient was diagnosed with microscopic polyangiitis. PR3-ANCA positivity (72%) was predominant to MPO-ANCA positivity (6%), and ANCA was negative in 22% of the patients. Among 37 ANCA-positive patients, 6 patients (16%) were initially ANCA-negative, but subsequently became positive during the clinical course. The serum C-reactive protein levels were elevated in all the examined patients. On contrast-enhanced computed tomography, a finding suggestive of necrosis, which was heterogeneous enhancement with low-density areas, was found in 33% of the patients. Vasculitis, granulomatous inflammation, necrosis, or the presence of multinucleated giant cells was found in 83% of the biopsy samples of the affected salivary gland. Glucocorticoids with or without other immunosuppressive agents, such as cyclophosphamide were effective in most patients, but twelve patients (21%) experienced a relapse of the disease and nine patients (16%) died during the clinical course. CONCLUSION Salivary gland involvement can be an initial manifestation of ANCA-associated vasculitis. The recognition of this unusual atypical presentation is important for the early and accurate diagnosis and treatment.
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Affiliation(s)
- Mitsuhiro Akiyama
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Satoshi Takanashi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan.
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Nodal Eosinophilic Granulomatosis With Polyangiitis (EGPA). J Clin Rheumatol 2019; 26:e259-e260. [PMID: 31356392 DOI: 10.1097/rhu.0000000000001110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baer AN, Okuhama A, Eisele DW, Tversky JR, Gniadek TJ. Eosinophilic sialodochitis: redefinition of 'allergic parotitis' and 'sialodochitis fibrinosa'. Oral Dis 2016; 23:840-848. [PMID: 27748012 DOI: 10.1111/odi.12595] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 12/18/2022]
Abstract
Sialodochitis fibrinosa and allergic parotitis have described rare patients with recurrent salivary gland swelling and mucus plugs, often with atopy. We have evaluated three patients with atopic disease, recurrent salivary gland swelling, and an eosinophilic sialodochitis. Two had eosinophil-rich mucus plugs. Fifty-six additional cases were identified in a medical literature database search, each defined by recurrent salivary gland swelling associated with eosinophil-rich mucus plugs or sialodochitis with periductal eosinophilic infiltration. The majority (78%) were reported from Japan. Females were predominantly affected (F:M = 2.3) with a median age of 47 years at evaluation. The parotid and submandibular glands were involved, respectively, in 71% and 46%. Allergic symptoms were present in 66%, atopic disease in 63% of those with reported allergy testing, and blood eosinophilia in 71%. Contrast sialography and other imaging modalities documented ductal dilatation in 82%. Treatments included anti-allergic medications (58%), systemic glucocorticoids (25%), duct cannulation with irrigation, steroid injection, and/or duct dilatation (36%), and glandular resection (19%). We recommend the diagnosis 'eosinophilic sialodochitis' be applied to patients who meet this case definition. The disease is a unique cause of chronic recurrent salivary gland swelling. Its likely allergic etiology may be amenable to current or future biologic therapies.
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Affiliation(s)
- A N Baer
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Okuhama
- Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - D W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J R Tversky
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T J Gniadek
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Solitary Hepatic Eosinophilic Granuloma Accompanied by Eosinophilia Without Parasitosis: Report of a Case. Int Surg 2016; 100:1011-7. [PMID: 26414822 DOI: 10.9738/intsurg-d-14-00126.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 43-year-old Japanese woman visited for a hepatic tumor incidentally found. We suspected eosinophilic granuloma of the liver (EGL) due to visceral larva migrans (VLM). However, neither past history nor medical interview indicated a risk of parasitosis. Blood testing revealed eosinophilia, serum examination showed normal results for immunoglobulin E, and enzyme-linked immunosorbent assay yielded negative for Toxocara and Anisakis. Gastric and colonic endoscopy revealed normal features. Several imagings showed central necrosis of the tumor. After informed consent, laparoscopic resection was performed. Histopathological examination showed EGL without parasites. No recurrence had occurred postoperatively. Most reports documented that EGL are caused by VLM. However, parasites are not always demonstrable on serum, histopathological, or immunochemical examinations. When acting as allergens to induce type I responses, microscopic agents other than parasites in the intestinal tract could induce eosinophilic inflammation in the liver. Accumulation of more cases should help clarify other pathogeneses for EGL.
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[Parotid involvement in Churg-Strauss syndrome]. ACTA ACUST UNITED AC 2014; 115:188-91. [PMID: 24797730 DOI: 10.1016/j.revsto.2014.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 03/31/2014] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Churg-Strauss syndrome is a rare systemic vascularitis. This disease causes eosinophilic tissue infiltration. The most frequent manifestations are cortico-dependent asthma, mono- or polyneuropathy, paranasal sinus polyposis, and digestive and renal dysfunction. Salivary glands are very rarely involved. OBSERVATION We describe a case of CSS in a patient presenting with bilateral parotid swelling. The morphological study of salivary glands revealed an unusual thickening of the salivary duct walls. DISCUSSION Salivary gland involvement in Churg and Strauss syndrome can be difficult to demonstrate histologically; it does not usually present in the clinical foreground of the disease, and can be a source of misdiagnosis. The biopsy should be performed in the symptomatic gland, away from any previous corticoid treatment.
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Tovoli F, Vannini A, Masi C, Balbi T, Bolondi L, Cavazza M. Eosinophilic granulomatosis with polyangiitis of the major salivary glands: a case of sialadenitis in a young patient. Intern Med 2013; 52:2131-4. [PMID: 24042527 DOI: 10.2169/internalmedicine.52.0674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A 23-year-old man was referred to our Emergency Department due to an acute-onset hemoptysis and the associated bilateral swelling of all of his major salivary glands. The elevated levels of systemic inflammatory markers with hypereosinophilia and the concurrent presence of multiple lung infiltrates made it difficult to perform a differential diagnosis, as these symptoms can also be indicative of infectious, autoimmune or hematologic disorders. A histological examination of the patient's left submandibular gland revealed strong clues as to the final diagnosis of eosinophilic granulomatosis with polyangiitis with an atypical clinical presentation, thus allowing for the administration of early and successful conservative therapy. The outcome of our case suggests that systemic vasculitis represents a rare but possible cause of acute bilateral sialadenitis in young patients.
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Affiliation(s)
- Francesco Tovoli
- Department of Medical and Surgical Sciences, University of Bologna, Italy
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Visentin MS, Salmaso R, Modesti V, Ometto F, Ruffatti A, Punzi L, Doria A. Parotid, breast, and fascial involvement in a patient who fulfilled the ACR criteria for Churg–Strauss syndrome. Scand J Rheumatol 2012; 41:319-21. [DOI: 10.3109/03009742.2012.672593] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tan CL, Raju GC, Petersson F. A case of coexisting Warthin tumor and langerhans cell histiocytosis associated with necrosis, eosinophilic abscesses and a granulomatous reaction in intraparotid lymph nodes. Rare Tumors 2011; 3:e16. [PMID: 21769315 PMCID: PMC3132120 DOI: 10.4081/rt.2011.e16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 04/05/2011] [Accepted: 04/07/2011] [Indexed: 11/22/2022] Open
Abstract
We present a patient (50-year-old male) with coexisting Warthin tumor and involvement of two intraparotid lymph nodes by Langerhans cell histiocytosis associated with necrosis, eosinophilic abscesses and a granulomatous reaction. This is the second documented case of this unusual combination of histological changes in nodal Langerhans cell histiocytosis and the first case involving intraparotid lymph nodes occurring together with an ipsilateral Warthin tumor.
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Affiliation(s)
- Char Loo Tan
- Department of Pathology, National University Health System, Singapore
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Falkensammer J, Bonatti H, Dickson RC, Norman K, Nguyen J, Hinder R, Aranda-Michel J. Successful liver transplantation and treatment of recurrent hepatitis C using pegylated alpha-interferon in a patient with Churg-Strauss disease. Transpl Int 2007; 20:190-4. [PMID: 17239028 DOI: 10.1111/j.1432-2277.2006.00415.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Churg-Strauss disease (CSD) is a rare allergic disorder that is associated with vasculitis, peripheral eosinophilia and allergic asthma. We report on successful liver transplantation in a patient with CSD who suffered from chronic hepatitis C. Recurrent hepatitis C and CSD were ultimately managed by the application of pegylated interferon.
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Boin F, Sciubba JJ, Stone JH. Churg-Strauss syndrome presenting with salivary gland enlargement and respiratory distress. ACTA ACUST UNITED AC 2006; 55:167-70. [PMID: 16463394 DOI: 10.1002/art.21708] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Francesco Boin
- Vasculitis Center, The Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle 1B.23, Baltimore, MD 21224, USA
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Stemmler HJ, Hoelzl M, Moosmann N, Becker C, Lennertz A, Babaryka G. [Lymphadenopathy and constitutional symptoms. Progress of a low-grade follicular lymphoma?]. Internist (Berl) 2006; 47:528-32. [PMID: 16601988 DOI: 10.1007/s00108-005-1563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Atypical presentation of Churg-Strauss syndrome includes lymph-node and parenchymatous organ involvement which mimics the clinical presentation of lymphoproliferative disorders.A 54-year old man with a history of a low-grade follicular lymphoma presented with rapidly growing abdominal lymph-nodes and hepatic, renal and pulmonary infiltrations. CT guided biopsies to verify either lymphoma or infections showed eosinophilic, necrotizing, granulomatous vasculitis leading to the diagnosis of atypical Churg-Strauss syndrome. Within a few days of cyclophosphamide and prednisone treatment the clinical presentation improved and imaging studies detected regression of all manifestations during follow-up.
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Affiliation(s)
- H J Stemmler
- Medizinische Klinik III, Klinikum Grosshadern der LMU München.
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Bennett AN, Sangle SR, Jan W, Jenner M, Cavenagh J, Hughes G, D'Cruz DP. Hepatomegaly as a rare presentation of Churg–Strauss syndrome. Rheumatology (Oxford) 2005; 44:1458-9. [PMID: 16105912 DOI: 10.1093/rheumatology/kei021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Abstract
Churg-Strauss syndrome is a systemic vasculitis characterized by asthma, tissue and blood eosinophilia, and granulomatous vasculitis. Lymph node involvement as part of systemic disease or as the primary site of involvement is rare. We report a single case of primary (isolated) nodal Churg-Strauss syndrome occurring in an 11-year-old boy with asthma, fever, night sweats, and cervical adenopathy. The clinical diagnosis was lymphoma. The unusual presentation of Churg-Strauss syndrome limited to lymph nodes is important to recognize and diagnose correctly because the administration of steroid therapy is associated with a favorable outcome.
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Affiliation(s)
- M Casey
- Department of Pathology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10467, USA
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Abstract
OBJECTIVES To assess the major reports of splenic involvement in the rheumatic diseases and to highlight several conditions in which potentially life-threatening splenic complications may occur. METHODS A search of the Medline database ('SilverPlatter': 1966 to 1997) was conducted for all English-language entries related to the spleen and the major rheumatic diseases. Original articles were reviewed from the bibliographies of these Medline-sourced articles. The major rheumatological textbooks were also reviewed for original references. RESULTS Patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and polyarteritis nodosa (PAN) are at risk of experiencing spontaneous splenic rupture. Splenomegaly is common in both uncomplicated RA and as a feature of Felty's syndrome, in which the patient may be at risk of splenic abscess formation, again a possible complication of SLE and also PAN. Massive splenomegaly appears to be specific to SLE and may be confused with a malignant process. Abnormal splenic function has been documented in RA, SLE, and Wegener's granulomatosis. The spleen may show areas of infarction in several conditions, notably SLE and Wegener's granulomatosis. Splenic atrophy is not uncommon in SLE and may be associated with functional asplenia and a co-incident risk of potentially fatal infection with capsulated organisms. CONCLUSIONS Serious and occasionally fatal complications within the spleen occur in many rheumatic diseases. Prompt recognition of these complications is important.
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Affiliation(s)
- D Fishman
- Bloomsbury Rheumatology Unit, Department of Medicine, University College London Medical School, England
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