1
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Asada T, Koda M, Teramura S, Sugita S, Matsuoka R, Yamazaki M. Cervical Myelopathy due to Odontoid Fracture Induced by Spinal Involvement of Xanthoma Disseminatum: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00004. [PMID: 35809027 DOI: 10.2106/jbjs.cc.21.00676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 47-year-old Japanese woman with a medical history of xanthoma disseminatum (XD) presented with posterior neck pain and abnormal gait without a history of trauma. Imaging studies revealed odontoid process thinning resulting in its fracture due to XD involvement in the atlantoaxial joint and subsequent cervical myelopathy. Posterior C1-C2 fusion surgery improved the patient's symptoms. An XD lesion around the odontoid process was confirmed intraoperatively. CONCLUSION We report cervical myelopathy caused by XD involvement in the C1-C2 joint, showing that early fusion surgery is critical for treating pathological fractures in patients with XD.
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Affiliation(s)
- Tomoyuki Asada
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shin Teramura
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shohei Sugita
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ryota Matsuoka
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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2
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Luo S, Tan Y, Zhang G. A Rare Case of Pediatric Xanthoma Disseminatum With Diabetes Insipidus and BRAF p.V600E Mutation. Am J Dermatopathol 2022; 44:287-290. [PMID: 34966053 DOI: 10.1097/dad.0000000000002117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Xanthoma disseminatum (XD) is a rare non-Langerhans cell histiocytosis characterized by xanthomatous lesions in the absence of hyperlipidemia. XD usually develops in young adults, and there are rare cases among children. BRAF mutations are frequent in Langerhans cell histiocytosis and Erdheim-Chester disease but absent or only rarely detected in other histiocytosis. Herein, we described a 6-year-old Chinese girl presented with generalized skin lesions and diabetes insipidus for 5 months. There were multiple periorbital xanthelasma with histopathological features of foamy histiocytes infiltration with Touton cells. Pituitary magnetic resonance imaging showed pituitary enlargement and pituitary stalk thickening. The presence of BRAF p.V600E mutation makes this case distinctive and also offers a potential therapeutic target. According to our review of the literature, this is the first pediatric XD with diabetes insipidus and BRAF mutation.
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Affiliation(s)
- Shuaihantian Luo
- Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, China
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3
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Dietz M, Debarbieux S, Righetti M, Harou O, Tordo J. Paraneoplastic Multicentric Reticulohistiocytosis on 18F-FDG PET/CT Breast Carcinoma Follow-up. Clin Nucl Med 2021; 46:e253-e255. [PMID: 33323726 DOI: 10.1097/rlu.0000000000003417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT We report the case of a 60-year-old woman who underwent 18F-FDG PET/CT to evaluate a metastatic breast carcinoma. Follow-up 18F-FDG PET/CT showed progressive disease with 18F-FDG increased in primary tumor, axillary lymph nodes, and pleural and bone diffuse metastases but also a concomitant uptake in multiples joints. The anatomopathological analysis from skin biopsy revealed a multicentric reticulohistiocytosis, considered paraneoplastic in the context. Second follow-up PET/CT after treatment showed a decrease of 18F-FDG uptake in previously affected joints, consistent with the symptoms evolution. 18F-FDG PET/CT could be helpful in the detection and the evaluation of such rare systemic disorder.
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Affiliation(s)
| | | | | | - Olivier Harou
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
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4
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Franco L, Miller K, Patel RR, Bost SJ, Ramachandran SM. Multicentric reticulohistiocytosis with arthralgia and red-orange papulonodules. Cutis 2019; 103:E20-E22. [PMID: 30758349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Loren Franco
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kristen Miller
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
| | - Rishi R Patel
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
| | - Sandra J Bost
- Affiliated Dermatologists, Morristown, New Jersey, USA
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5
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Woodruff CM, Schulman JM, Amerson EH. Progressive papular eruption on the face and groin. Cutis 2017; 99:E4-E6. [PMID: 28319628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Carina M Woodruff
- Department of Dermatology, University of California, San Francisco, USA
| | - Joshua M Schulman
- Department of Dermatology, University of California Davis Health System, Sacramento, USA
| | - Erin H Amerson
- Department of Dermatology, University of California, San Francisco, USA
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6
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Abstract
A 68-year-old man presented with polyarthritis, proximal muscle weakness, and erythema of the face, arms, neck, and anterior chest that resembled the V-neck sign. Initially, dermatomyositis (DM) was considered because of the erythema, polyarthritis, and muscle weakness. He also had mediastinal and hilar lymphadenopathy on contrast-enhanced computed tomography. Unexpectedly, a biopsy of the forehead skin revealed numerous multinucleated giant cells. A biopsy of a solitary nodule on the dorsum of his right middle finger revealed similar multinucleated giant cells with ground-glass cytoplasm, leading to the diagnosis of multicentric reticulohistiocytosis (MRH). Although MRH is rare, it should be remembered that MRH can mimic DM.
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Affiliation(s)
- Natsuki Shima
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Japan
| | - Takamasa Murosaki
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Japan
| | - Takao Nagashima
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Japan
| | - Masahiro Iwamoto
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Japan
| | - Yusuke Amano
- Department of Diagnostic Pathology, Jichi Medical University, Japan
| | - Naomi Nakano
- Department of Dermatology, Jichi Medical University, Japan
| | | | - Seiji Minota
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Japan
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7
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Cyrulnik AA, Paz KB, Amin B, Mann RE, Krishnamurthy K, Friedman AJ. Multicentric reticulohistiocytosis: contrasting presentations in 2 Hispanic patients. Cutis 2014; 93:243-246. [PMID: 24897136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Multicentric reticulohistiocytosis (MR) is a rare debilitating disease that involves the skin and joints. It most commonly affects white individuals but has been reported in other ethnic groups including black individuals, Native Americans, and Asians. The Hispanic population is largely underrepresented in the epidemiology of MR. We describe 2 Hispanic patients with contrasting presentations of MR. Prompt recognition of MR is essential to expedite treatment and prevent potentially disabling sequelae of undiagnosed disease; however, diagnosis can be challenging due to the wide range of clinical presentations of MR as well as variable laboratory findings, especially in patients with skin of color. Our case reports underscore this phenomenon and demonstrate the importance of considering MR in all ethnic groups, including Hispanic patients.
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Affiliation(s)
| | | | | | | | | | - Adam J Friedman
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467, USA.
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8
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Krilis M, Miyakis S. Cytophagic histiocytic panniculitis with haemophagocytosis in a patient with familial multiple lipomatosis and review of the literature. Mod Rheumatol 2011; 22:158-62. [PMID: 21732050 DOI: 10.1007/s10165-011-0487-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 06/02/2011] [Indexed: 11/25/2022]
Abstract
We report a patient with the extremely rare familial multiple lipomatosis syndrome, who developed the uncommon autoimmune disease cytophagic histiocytic panniculitis, manifested as inflammation of preexisting lipomas. Despite his initial critical condition and unsuccessful treatment with steroids, he responded to cyclosporin and remains well 15 years after diagnosis. In contrast with most previous reports, our patient stays dependent on cyclosporin; repeated attempts of discontinuing or substituting treatment were quickly followed by relapse. Haemophagocytic panniculitis is considered as a T-cell disorder, but its exact pathophysiological mechanism has not been clarified. Differential diagnosis of cytophagic histiocytic panniculitis mainly includes malignant histiocytosis, subcutaneous panniculitis-like T-cell lymphoma (SPTCL) and lupus erythematosus panniculitis (lupus profundus). We discuss the main clinical features, diagnostic challenges and treatment issues of this usually benign, but at times life-threatening autoimmune condition.
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MESH Headings
- Cyclosporine/therapeutic use
- Diagnosis, Differential
- Family Health
- Female
- Genetic Predisposition to Disease
- Histiocytic Sarcoma/diagnosis
- Histiocytosis, Non-Langerhans-Cell/complications
- Histiocytosis, Non-Langerhans-Cell/diagnosis
- Histiocytosis, Non-Langerhans-Cell/drug therapy
- Humans
- Lipomatosis, Multiple Symmetrical/diagnosis
- Lipomatosis, Multiple Symmetrical/drug therapy
- Lipomatosis, Multiple Symmetrical/genetics
- Lymphohistiocytosis, Hemophagocytic/complications
- Lymphohistiocytosis, Hemophagocytic/diagnosis
- Lymphohistiocytosis, Hemophagocytic/drug therapy
- Lymphoma, T-Cell/diagnosis
- Male
- Panniculitis/complications
- Panniculitis/diagnosis
- Panniculitis/drug therapy
- Pedigree
- Treatment Outcome
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Affiliation(s)
- Matthew Krilis
- Department of Medicine, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
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9
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Margolis S. Cutaneous xanthomatosis, diabetes insipidus, and hyperprolactinemia. Endocr Pract 2010; 16:933. [PMID: 20570806 DOI: 10.4158/ep10162.ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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10
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Sroa N, Zirwas MJ, Bechtel M. Multicentric reticulohistiocytosis: A case report and review of the literature. Cutis 2010; 85:153-155. [PMID: 20408515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We report a case of multicentric reticulohistiocytosis (MRH) demonstrating classic clinical and histologic findings. This rare idiopathic disease is manifested by severe destructive polyarthritis and papulonodular mucocutaneous lesions. The characteristic clinical and histologic findings are discussed as well as the workup and treatment of the disease.
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Affiliation(s)
- Novie Sroa
- The Ohio State University, Columbus, USA
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11
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Lee SH, Kim SD, Kim SH, Kim HR, Oh EJ, Yoon CH, Lee SH, Kim HY, Park SH. EBV‐associated haemophagocytic syndrome in a patient with Behçet's disease. Scand J Rheumatol 2009; 34:320-3. [PMID: 16195167 DOI: 10.1080/03009740510015186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We present a case of Epstein-Barr virus (EBV)-associated haemophagocytic syndrome in a patient with Behçet's disease. A 43-year-old man, who had been receiving treatment under the diagnosis of Behçet's disease for recurrent oral ulcers, genital ulcer, ileal ulcer, and arthritis, had been admitted for fever, headache, and nausea developed 3 days ago. Laboratory data showed pancytopaenia, an increase in liver enzymes, lactate dehydrogenase (LDH) and ferritin. Haemophagocytic syndrome was diagnosed from histiocytosis and haemophagocytosis by macrophages, shown in the bone marrow aspiration and biopsy, and in situ hybridization for EBV showed a positive finding. The patient recovered rapidly after steroid therapy. This is the first report of EBV-associated haemophagocytic syndrome developed in a patient with Behçet's disease.
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Affiliation(s)
- S-H Lee
- Department of Internal Medicine, Division of Rheumatology, Kangnam St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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12
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Hinchman KF, Wu JJ, Soden CE, Waldman J, Dyson SW. Multicentric reticulohistiocytosis associated with Burkitt lymphoma and adenocarcinoma. Cutis 2008; 82:113-114. [PMID: 18792542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Multicentric reticulohistiocytosis (MRH) is a rare disease of unknown etiology characterized by cutaneous nodules and destructive, sometimes crippling, polyarthritis. The diagnosis is confirmed by histopathologic features of the cutaneous nodules or synovial tissue, including an infiltrate composed of histiocytes, many of them multinucleate, with a ground glass appearance. Multicentric reticulohistiocytosis has been associated with a number of chronic conditions and various malignancies. We report a case of MRH in a patient with Burkitt lymphoma and metastatic adenocarcinoma of the gastrointestinal tract.
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13
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Affiliation(s)
- K F Wong
- Institute of Pathology, Queen Elizabeth Hospital, Hong Kong
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14
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Affiliation(s)
- Gerardo Ferrara
- Pathologic Anatomy Service Gaetano Rummo General Hospital, Benevento, Italy.
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15
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Abstract
Xanthogranulomatous salpingitis is an unusual inflammatory lesion of the fallopian tube, characterized by accumulation of foamy macrophages in the wall of the fallopian tube along with other chronic inflammatory cells. Only a few cases of xanthogranulomatous salpingitis have been reported in the English medical literature, some under different nomenclature. An association, most commonly with pelvic inflammatory disease and endometriosis, has been suggested. A 41-year-old woman with prior history of breast carcinoma underwent bilateral salpingoophorectomy because of hematosalpinx. The histology revealed xanthogranulomatous salpingitis in the setting of extensive fallopian tube mucosal endometriosis, endometritis, and presence of an intrauterine contraceptive device. Multiple etiologies have been linked to the xanthogranulomatous process at this location in previously reported cases. A whole spectrum of changes may exist in this lesion and probably represent a specialized form of tissue reaction secondary to multiple etiologies. Although it has been associated with pelvic endometriosis, it has never been demonstrated through progressive changes, beginning with mucosal endometriosis to the full-blown xanthogranulomatous inflammation. To the best of our knowledge, this is the first reported case that demonstrates different stages in the pathogenesis of this lesion and provides an insight into the histogenesis of this entity.
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Affiliation(s)
- Muhammad Idrees
- The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, Mount Sinai Medical Center, New York, NY 10029-6574, USA
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16
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Abstract
Xanthogranulomatous cystitis (XC) is a rare benign chronic inflammatory disease of unknown etiology. We report a patient of XC managed with long-term antibiotics and augmentation cystoplasty. A 50-year-old man presented with urgency, frequency, hematuria and lower abdominal pain. Investigations revealed small capacity bladder with diverticula and cystoscopy showed inflamed bladder with multiple small polypoidal growth that had histological findings suggestive of XC on biopsy. Patient was treated with augmentation cystoplasty and prolonged administration of broad-spectrum antibiotics. Postoperative course was uneventful and patient remains asymptomatic at 1-year follow-up. XC is rare entity of unknown etiology. Patients may be given a trial of long-term broad-spectrum antibiotics.
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Affiliation(s)
- Rajiv Goel
- Department of Urology, Institute of Kidney Diseases and Research Centre, Civil Hospital Campus, 380016, Ahmedabad, Gujarat, India.
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17
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Abstract
Multicentric reticulohistiocytosis is a rare granulomatous disease of unknown etiology, characterized by cutaneous nodules and destructive arthritis. Skin lesions can cause significant deformity, and approximately half of affected patients develop a severe disabling arthritis. The disease is often associated with malignancy; however, the paraneoplastic nature of multicentric reticulohistiocytosis is not established. The diagnosis is confirmed by the presence of oncocytic ("ground-glass") histiocytes and multinucleated giant cells on histopathology of the cutaneous nodules and the synovial membrane.
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Affiliation(s)
- Ani L Tajirian
- Department of Dermatology, Brown Medical School, Rhode Island Hospital, Providence, RI 02903, USA.
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18
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Adamopoulos IE, Wordsworth PB, Edwards JR, Ferguson DJ, Athanasou NA. Osteoclast differentiation and bone resorption in multicentric reticulohistiocytosis. Hum Pathol 2006; 37:1176-85. [PMID: 16938523 DOI: 10.1016/j.humpath.2006.04.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 04/03/2006] [Accepted: 04/05/2006] [Indexed: 12/22/2022]
Abstract
Multicentric reticulohistiocytosis (MR) is a systemic disease of unknown cause characterized by the presence of a heavy macrophage infiltrate in skin and synovial tissues and the development of an erosive polyarthritis. The synovial fluid in MR is known to contain numerous mononuclear cells. In this study, we have determined whether these cells contribute to joint destruction in MR by differentiating them into osteoclasts. Synovial fluid mononuclear cells were isolated from the knee joint of a 44-year-old male with MR. These cells were cultured with various combinations of macrophage-colony stimulating factor, receptor activator for nuclear factor kappaB ligand (RANKL), tumor necrosis factor alpha, interleukin-1alpha, osteoprotegerin, and zoledronate. Osteoclast differentiation was assessed by expression of tartrate-resistant acid phosphatase, vitronectin receptor, and the extent of lacunar resorption. Most MR synovial fluid mononuclear cells expressed a macrophage phenotype (CD14(+), CD68(+), HLA-DR(+), CD11b(+)). Extensive osteoclast formation and lacunar resorption were noted in macrophage-colony stimulating factor/RANKL-treated cell cultures. MR synovial fluid contained increased tumor necrosis factor alpha and decreased osteoprotegerin compared with osteoarthritis synovial fluid. Lacunar resorption was inhibited in cultures containing zoledronate. Pamidronate treatment of the patient also reduced the number of synovial fluid macrophages and resulted in less osteoclast formation and lacunar resorption. MR synovial fluid contains numerous macrophages that are capable of differentiating into osteoclasts by the RANKL signaling pathway. Inhibitors of osteoclast formation and resorption activity may be of use in preventing the severe joint destruction that commonly occurs in MR.
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MESH Headings
- Adult
- Anti-Inflammatory Agents/therapeutic use
- Arthritis/drug therapy
- Arthritis/etiology
- Bone Resorption/etiology
- Carrier Proteins/metabolism
- Cell Differentiation/physiology
- Cells, Cultured
- Cytokines/analysis
- Diphosphonates/therapeutic use
- Glycoproteins/metabolism
- Histiocytosis, Non-Langerhans-Cell/complications
- Histiocytosis, Non-Langerhans-Cell/drug therapy
- Histiocytosis, Non-Langerhans-Cell/physiopathology
- Humans
- Immunohistochemistry
- Leukocytes, Mononuclear/cytology
- Macrophages/cytology
- Male
- Membrane Glycoproteins/metabolism
- Methylprednisolone/therapeutic use
- Microscopy, Electron, Scanning
- Microscopy, Electron, Transmission
- Osteoclasts/cytology
- Osteoprotegerin
- Pamidronate
- RANK Ligand
- Receptor Activator of Nuclear Factor-kappa B
- Receptors, Cytoplasmic and Nuclear/metabolism
- Receptors, Tumor Necrosis Factor/metabolism
- Skin Diseases/physiopathology
- Synovial Fluid/chemistry
- Synovial Fluid/cytology
- Tumor Necrosis Factor-alpha/metabolism
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Abstract
This article reports the case of a 34-year-old woman with xanthogranulomatous cholangitis who developed obstructive jaundice. Microscopically, the bile duct was surrounded and narrowed by a xanthogranulomatous lesion, but no xanthogranulomatous cholecystitis was seen. Although percutaneous cholangiograms done via the transhepatic biliary drainage showed smooth narrowing of the upper to middle bile duct, the cytology of bile was diagnosed as class V adenocarcinoma. Therefore, right extended hepatectomy and extrahepatic bile duct resection were performed. The differentiation of benign and malignant strictures at the hepatic hilum is often difficult. Xanthogranulomatous cholangitis is one possible diagnosis of a bile duct stricture. Precise review of all the preoperative information is required to make a correct diagnosis.
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MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/pathology
- Adult
- Bile Duct Neoplasms/diagnosis
- Bile Duct Neoplasms/pathology
- Bile Ducts, Intrahepatic/pathology
- Cholangitis/complications
- Cholangitis/diagnosis
- Cholangitis/pathology
- Cholangitis/surgery
- Diagnosis, Differential
- Female
- Histiocytosis, Non-Langerhans-Cell/complications
- Histiocytosis, Non-Langerhans-Cell/diagnosis
- Histiocytosis, Non-Langerhans-Cell/pathology
- Histiocytosis, Non-Langerhans-Cell/surgery
- Humans
- Jaundice, Obstructive/diagnosis
- Jaundice, Obstructive/etiology
- Jaundice, Obstructive/pathology
- Jaundice, Obstructive/surgery
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Affiliation(s)
- Susumu Kawate
- Department of Surgery, Gunma University Graduate School of Medicine, 3-39-22, Maebashi, Gunma 371-8511, Japan
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20
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Roth S, Campagni JP, Perrin C, Sanderson F, Castela J, Rosenthal E, Tieulié N, Jeandel PY, Heudier P, Fuzibet JG. Un cas de réticulohistiocytose multicentrique paranéoplasique associée à une maladie cœliaque. Rev Med Interne 2006; 27:263-5. [PMID: 16387394 DOI: 10.1016/j.revmed.2005.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Revised: 09/23/2005] [Accepted: 11/10/2005] [Indexed: 10/25/2022]
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21
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Trébol I, Acebo E, Eguino P, Gardeazabal J, Díaz-Pérez JL. [Yellowish plaques on the trunk and in the axillary folds]. Actas Dermosifiliogr 2006; 96:124-6. [PMID: 16476351 DOI: 10.1016/s0001-7310(05)73052-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Izaskun Trébol
- Departamento de Dermatología, Hospital de Cruces, Pl. de Cruces s/n, 48903 Barakaldo, Vizcaya, Spain.
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22
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Szyfter W, Wierzbicka M, Bem G. [Rare case of xanthoma disseminatum with severe dyspnoea]. Otolaryngol Pol 2006; 60:67-70. [PMID: 16821545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The unique case of xantoma disseminatum with laryngological symptoms is presented. The 64 year old female patient was admitted to ENT Department University of Medical Sciences in Poznan, Poland, because of severe dyspnoe. Xantoma progressed for five years, affectin both the skin and laryngo-pharyngeal mucosa. Numerous skin lesions, yellowish and brown spots in the nuchal region and nosolabial area have been observed for 4 years. As well, patient was under control for moderate anemia. In the ENT examination subglottic stenosis was stated in indirect and direct laryngoscopy. The mucosal scars in the mesopharynx were observed with no impairment of swallowing. The general status improved after conservative, pharmacological treatment (Encorton, Amlopin). The patient is still under control, the laryngeal stenosis is stable.
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Affiliation(s)
- Witold Szyfter
- Klinika Otolaryngologii i Onkologii Laryngologicznej AM w Poznaniu
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23
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Saez-De-Ocariz M, Lopez-Corella E, Duran-McKinster C, Orozco-Covarrubias L, Ruiz-Maldonado R. Benign cephalic histiocytosis preceding the development of insulin-dependent diabetes mellitus. Pediatr Dermatol 2006; 23:101-2. [PMID: 16445430 DOI: 10.1111/j.1525-1470.2006.00187.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Abstract
Actinomycosis, tuberculosis, and xanthogranulomatous inflammation are rare but specific causes of tubo-ovarian abscess (TOA). TOAs with these causes are frequently misdiagnosed as ovarian malignancies due to their unusual appearances at computed tomography (CT) and magnetic resonance (MR) imaging. Tubo-ovarian actinomycosis frequently has a predominantly solid appearance. A linear, solid, well-enhancing lesion extending directly from the mass is a characteristic CT and MR imaging finding. Small rim-enhancing lesions in the solid part of the mass are also suggestive of actinomycosis. Tuberculous TOAs usually mimic peritoneal carcinomatosis from ovarian cancers. The granulomatous and fibrotic nature of this infection may be reflected in the CT and MR imaging appearances, which can help in differentiation. TOAs from xanthogranulomatous inflammation demonstrate more nonspecific imaging findings than actinomycotic or tuberculous TOAs, although multiple xanthogranulomas in the mass may be seen on MR images. Knowledge of these characteristics can help one make the correct diagnosis and treat the patients appropriately.
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Affiliation(s)
- Sun Ho Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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25
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Abstract
Xanthoma disseminatum is a rare, usually self-healing dermatologic disease of unknown etiology. Involvement of other organs and tissues including bone marrow, bone, and brain may be seen rarely in children. However, to date, hepatic involvement has not been reported. We describe a child with xanthoma disseminatum who had hepatic involvement, and discuss his course and treatment with steroid and azathioprine.
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Affiliation(s)
- Mustafa Büyükavci
- Division of Pediatric Oncology, Ataturk University, Faculty of Medicine, Erzurum, Turkey.
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26
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Terrier B, Aouba A, Vasiliu V, Charlier C, Delarue R, Buzyn A, Hermine O. Intravascular lymphoma associated with haemophagocytic syndrome: a very rare entity in western countries. Eur J Haematol 2005; 75:341-5. [PMID: 16146541 DOI: 10.1111/j.1600-0609.2005.00519.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Intravascular lymphoma (IVL) is a rare and aggressive disorder, characterised by frequent cutaneous and neurological involvement and medullary infiltration. In rare cases particularly in Asia, IVL can be associated with haemophagocytic syndrome (IVL-HS). Here, we report the case of a 61-year-old Caucasian female who presented with IVL-HS. Bone marrow biopsy showed haemophagocytic features and medullary localisation of a diffuse large B-cell lymphoma. Liver biopsy showed exclusive sinusoidal infiltration by large B cells. Treatment by polychemotherapy associated with rituximab induced a rapid complete remission. Unfortunately, death occurred as a consequence of septic shock. Early recognition of IVL-HS by performing bone marrow biopsy is critical to start rapidly appropriate treatment. The role of rituximab in the management of IVL-HS remains to be established.
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Affiliation(s)
- Benjamin Terrier
- Department of Adult Haematology, Necker Hospital, 149-161 rue de Sevres, 75743 Paris Cedex 15, France
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27
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Etzion Y, Benharroch D, Saidel M, Riesenberg K, Gilad J, Schlaeffer F. Atraumatic rupture of the spleen associated with hemophagocytic syndrome and isolated splenic peliosis. Case report. APMIS 2005; 113:555-7. [PMID: 16086827 DOI: 10.1111/j.1600-0463.2005.apm_165.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Atraumatic rupture of the spleen is an uncommon condition that may be associated with various etiologies. The hemophagocytic syndrome (HS) and isolated splenic peliosis are two rare conditions, each of which has previously been described in association with splenic rupture. We describe a unique case of atraumatic splenic rupture in which concurrent HS and splenic peliosis were diagnosed following splenectomy. Given that both these rare conditions have probably caused the splenic rupture, a possible association between these entities is discussed.
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Affiliation(s)
- Yoram Etzion
- Department of Internal Medicine E, Soroka University Medical Center and Faculty for Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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28
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Abstract
A 31-year-old woman developed necrobiotic xanthogranuloma (NXG), a thickened choroid, and syncytial giant cell hepatitis, a previously unreported association. NXG and syncytial giant cell hepatitis may have a common autoimmune pathogenesis.
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Affiliation(s)
- Radgonde Amer
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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29
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Curtò L, Cannavò SP, Lentini M, Cannavò S. Hypopituitarism and rare dermatological diseases: an intriguing case of xanthoma disseminatum. Clin Endocrinol (Oxf) 2005; 63:119-20. [PMID: 15963073 DOI: 10.1111/j.1365-2265.2005.02290.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Abstract
Leishmania-associated hemophagocytic lymphohistiocytosis is a rare clinicopathological entity. This condition is often difficult to diagnose, so treatment is often delayed. This report describes the case of a 5-year-old boy who was admitted with fever of 1 month's duration, hepatosplenomegaly, and pancytopenia. Serum testing showed elevated transaminase levels, hypertriglyceridemia, hyperferritinemia, and normal fibrinogen level. Hemophagocytic lymphohistiocytosis was diagnosed on bone marrow examination. The patient was tested for various infectious agents. He was negative for all except Leishmania, which was detected by indirect fluorescent antibody testing. Treatment with amphotericin B resulted in a dramatic resolution of all signs and symptoms within 1 week.
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Affiliation(s)
- Emel Ozyürek
- Department of Pediatrics, Başkent University, Faculty of Medicine, Adana Teaching and Medical Research Center, Adana, Turkey.
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31
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Kapelari K, Fruehwirth M, Heitger A, Königsrainer A, Margreiter R, Simma B, Offner FA. Loss of intrahepatic bile ducts: an important feature of familial hemophagocytic lymphohistiocytosis. Virchows Arch 2005; 446:619-25. [PMID: 15906086 DOI: 10.1007/s00428-005-1238-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2004] [Accepted: 02/18/2005] [Indexed: 02/08/2023]
Abstract
Familial hemophagocytic lymphohistiocytosis (FHL) is a rare, fatal disorder of early infancy. We report two siblings with FHL whose symptoms were dominated by hepatic failure. Both presented with sudden-onset fever and hepatosplenomegaly with progressive abnormalities of clinical biochemistry indices of liver function. One died of hepatorenal failure. The other underwent liver transplantation. Autopsy and explant liver displayed portal and periportal infiltrates of T lymphocytes and histiocytes; an activation of the hepatic mononuclear phagocytic system with focal hemophagocytosis; and almost complete loss of interlobular bile ducts. Paucity of bile ducts dominated in a pre-transplant liver biopsy specimen (and transiently obscured the diagnosis of FHL). Disease recurred in the allograft, again with lymphohistiocytic infiltration and destruction of interlobular bile ducts. Consequently the patient underwent haploidentical peripheral stem cell transplantation. This patient is alive 5 years later. Loss of bile ducts may be an important feature of hepatic involvement by FHL.
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Affiliation(s)
- Klaus Kapelari
- Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria
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32
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Rintels P, Sambandam S. Hemophagocytic lymphohistiocytosis (HLH). Med Health R I 2005; 88:168. [PMID: 16052961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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33
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Sipahi T, Tavil B, Oksal A. Visceral leishmaniasis and pseudomonas septicemia associated with hemophagocytic syndrome and myelodysplasia in a Turkish child. Turk J Pediatr 2005; 47:191-4. [PMID: 16052865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
An 18-month-old boy presented with fever, hepatosplenomegaly, jaundice, pancytopenia, hyperferritinemia, hypertriglyceridemia and evidence of hemophagocytosis and trilineage myelodysplasia in the bone marrow aspiration. Appropriate treatment was begun but he died after 12 hours of hospitalization due to Gram-negative septicemia. Post-mortem examination of liver biopsy revealed diffuse hemaphagocytic lymphohistiocytosis and Leishmania-donovani bodies in macrophages.
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Affiliation(s)
- Tansu Sipahi
- Dr. Sami Ulus Children's Disease Center, Ankara, Turkey
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34
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35
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Bain BJ. Hemophagocytosis evolving into acute lymphoblastic leukemia. Am J Hematol 2005; 78:246-7. [PMID: 15726603 DOI: 10.1002/ajh.20291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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36
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Abstract
PURPOSE To describe the ocular involvement in xanthoma disseminatum. DESIGN Case report and literature review. METHODS Histopathologic study of excised conjunctival tumor and clinical follow-up. RESULTS A 29-year-old woman with normal serum lipoproteins developed widespread xanthomas of the skin, throat, and episclera. There were no signs of recurrence 12 months after removal of the conjunctival xanthomas. CONCLUSIONS Xanthoma disseminatum is a rare condition for which there is no medical treatment. The distinction between the normolipemic xanthomatoses awaits a better understanding of their pathogenesis. Surgical removal of episcleral xanthomas can be successful, but long-term follow-up of such patients has been limited.
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Affiliation(s)
- Laura L Wayman
- Eye Care Clinic, Watson Clinic, LLP, Lakeland, Florida 33805, USA
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37
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Abstract
This case report describes the neuro-opthalmologic and respiratory manifestations of xanthoma disseminatum, a rare histiocytosis syndrome characterized by disseminated lesions in a young male adult. Multimodality management of this disease, including the role of local radiotherapy, is discussed accompanied by a review of the literature.
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Affiliation(s)
- A S Alexander
- Department of Oncology, Division of Radiaion Oncology, Cross Cancer Institute, University of Alberta, 11560 Univerisity Avenue, Edmonton, Alberta T6G 1Z1, Canada
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38
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Albisetti M, Lauener RP, Güngör T, Schär G, Niggli FK, Nadal D. Disseminated Fusarium oxysporum infection in hemophagocytic lymphohistiocytosis. Infection 2005; 32:364-6. [PMID: 15597228 DOI: 10.1007/s15010-004-3135-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2003] [Accepted: 12/29/2003] [Indexed: 10/26/2022]
Abstract
The portal of entry of disseminated Fusarium spp. infections is still not clearly defined. We report on a disseminated Fusarium oxysporum infection occurring during a long period of severe neutropenia in a child with hemophagocytic lymphohistiocytosis. A nasogastric feeding tube was the possible source of entry of the fungus.
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Affiliation(s)
- M Albisetti
- Division of Immunology, University Children's Hospital of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
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39
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Cárdenas-Lailson LE, Torres-Gómez B, Medina-Sánchez S, Mijares-García JM, Hernández-Calleros J. [Epidemiology of xanthogranulomatous cholecystitis]. CIR CIR 2005; 73:19-23. [PMID: 15888266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE In order to study patients with a diagnosis of xanthogranulomatous cholecystitis (XGC), we analyzed their demographics, epidemiology and clinical data. MATERIAL AND METHODS We analyzed the clinical records of XGC during a period of 6 years, obtaining demographic, epidemiologic and clinical data. RESULTS Of a total of 1425 cholecystectomies performed between January 1991 and December 1996, we found 35 cases of XGC (2.4%). Twenty six (74%) were women (median age: 44 years), 60% were from a low socioeconomic group, 34% has a history of alcoholism and smoking, and 25 patients (71%) had a blood type of O positive. Thirteen patients (37%) presented obstructive jaundice, 11 had dilatation of the choledocus and were treated with ERCP. Of the 35 cholecystectomies, 15 were urgent and 20 elective. Eight were operated laparoscopically and two were converted because of firm adhesions. We had 5 transoperative complications. DISCUSSION Pre-operative XGC diagnosis is difficult, often mistaken for gall bladder cancer. The incidence in our study (2.4%) is higher than reports in industrialized countries (0.7-1.8%), with a female predominance. The most frequent clinical presentation is that of chronic cholecystitis, but we found a high percentage of patients with obstructive jaundice. We had 0% mortality and 26% morbidity, and no association was found between XGC and gallbladder cancer.
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40
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Abstract
Xanthoma disseminatum (XD) is a rare normolipemic mucocutaneous xanthomatosis due to the proliferation of non-x histiocytes. Occasional involvement of the upper respiratory system has been reported, but lower respiratory tract involvement is very rare. Here, we present a child with severe involvement of the upper and lower respiratory tract by XD and bronchiectasis in the lower lobes of both lungs. The patient was an 8-year-old boy who was admitted to our hospital because of red-brown papules which developed on the skin and progressive dyspnea. He was diagnosed as having XD by skin biopsy. Physical examination revealed disseminated, numerous yellow-reddish brown papular xanthomas on the forehead and eyelids, around the neck and axillary area, and in the oral cavity and pharynx. He had respiratory distress and clubbing of the fingers. Chest x-rays showed hyperaeration and segmental atelectasis. High-resolution CT of the thorax revealed diffuse thickening of the whole tracheal and bronchial wall, and bronchiectasis in the lower lobes. Flexible fiberoptic bronchoscopy revealed numerous xanthomatous lesions in the nasal cavity, nasopharynx, oropharynx, subglottic area, trachea, bifurcation, both main bronchi, and smaller bronchi. To the best of our knowledge, this is the first report of a child with typical lesions of XD with severe involvement of the lower respiratory tract and bronchiectasis.
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Affiliation(s)
- U Ozçelik
- Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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41
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Rekik R, Morazin F, Lumbroso A, Stirnemann J, Montravers P, Gauzit R. Syndrome d’activation macrophagique réactionnel : une cause sous-estimée de défaillance multiviscérale en réanimation ? ACTA ACUST UNITED AC 2004; 23:1189-91. [PMID: 15589361 DOI: 10.1016/j.annfar.2004.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2004] [Accepted: 10/01/2004] [Indexed: 11/23/2022]
Abstract
The incidence of the haemophagocytic syndrome in the ICU patients with multiple organ failure seems to be high. The haemophagocytic syndrome can be considered as the consequence of the initial aggression leading to multiple organ failure. On the contrary the haemophagocytic syndrome could be the cause of multiple organ failure. A case of haemophagocytic syndrome is presented which led to rapidly fatal multiple organ failure.
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Affiliation(s)
- R Rekik
- Département d'anesthésie-réanimation, CHU Jean-Verdier, 93143 Bondy, France
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42
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Kashiwagi Y, Kawashima H, Kanetaka Y, Ioi H, Takekuma K, Hoshika A, Matsubayashi J, Mukai K. Sudden infant death syndrome due to parainfluenza virus 2 associated with hemophagocytic syndrome. J Infect 2004; 49:329-32. [PMID: 15474632 DOI: 10.1016/j.jinf.2003.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2003] [Indexed: 11/17/2022]
Abstract
We report a child with Sudden Infant Death Syndrome (SIDS), aged 16 months. The histological findings of tonsils, spleen, and bone marrow revealed many hemophagocytic cells. Parainfluenza virus type 2 (PIV2) was cultured in the nasopharynx and detected by reverse-transcription (RT)-PCR in liver tissue and bone marrow. His laboratory data of elevated level of ferritin and IL-6 suggested hemophagocytic syndrome (HPS). It is suspected that PIV2 infection in infants is a risk factor for SIDS.
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Affiliation(s)
- Yasuyo Kashiwagi
- Department of Pediatrics, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
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43
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Abstract
Sickle-beta(+) (beta(+)) thalassemia is a double heterozygous genetic disorder characterized by both a qualitative and quantitative abnormality. We present a case of an African American male who was first diagnosed with sickle cell disease (SCD) at the age 23 years when he presented with generalized bone pain, fever, and hepatosplenomegaly. Laboratory findings included thrombocytopenia, microcytic anemia, and markedly elevated ferritin. He was subsequently diagnosed with a sickle-beta thalassemia hemoglobinopathy. Findings in the bone marrow aspirate and biopsy were consistent with hemophagocytic lymphohistiocytosis (HLH). HLH resolved with the resolution of sickle cell bone pain crisis without use of immunosuppressive therapy. To the best of our knowledge this is the first documented case of HLH associated with sickle cell bone pain crisis.
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Affiliation(s)
- Ebenezer Kio
- Hematology/Oncology Division, Medical University of South Carolina, Charleston, South Carolina 2425, USA
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44
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Vieira R, Cordeiro MR, Mariano A, Reis JP, Tellechea O, Figueiredo A. Multiple cutaneous reticulohistiocytomas in a patient with rheumatoid arthritis. Dermatol Online J 2004; 10:11. [PMID: 15530301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
A 64-year-old woman with a long-standing peripheral symmetric polyarthritis with positive rheumatoid serology was evaluated for multiple asymptotic papulonodules of fingers, mentum, lower lip, ears, and eyelids. Histopathologic examination showed a dermal infiltrate composed of histiocytes, multinucleate giant cells with ground-glass cytoplasm, and lymphocytes, suggestive of reticulohistiocytoma. The possibilities of multicentric reticulohistiocytosis with positive rheumatoid serology or coexistence of multiple cutaneous reticulohistiocytomas and rheumatoid arthritis are discussed.
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Affiliation(s)
- Ricardo Vieira
- Department of Dermatology, University Hospital, Coimbra, Portugal.
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45
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Huang DB, Wu JJ, Hamill RJ. Reactive hemophagocytosis associated with the initiation of highly active antiretroviral therapy (HAART) in a patient with AIDS. ACTA ACUST UNITED AC 2004; 36:516-9. [PMID: 15307589 DOI: 10.1080/00365540410020569] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Reactive hemophagocytosis has been associated with neoplasia, bacteria, parasitic, and viral infections including human immunodeficiency virus (HIV). Here we present a case of reactive hemophagocytosis associated with the initiation of highly active antiretroviral therapy (HAART), probably representing a syndrome termed the immune reconstitution inflammatory syndrome (IRIS) or immune reconstitution syndrome.
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Affiliation(s)
- David B Huang
- Department of Medicine, Division of Infectious Diseases, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas 77030, USA
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46
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De Armas R, Sindou P, Gelot A, Routon MC, Ponsot G, Vallat JM. Demyelinating peripheral neuropathy associated with hemophagocytic lymphohistiocytosis. An immuno-electron microscopic study. Acta Neuropathol 2004; 108:341-4. [PMID: 15243760 DOI: 10.1007/s00401-004-0897-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2004] [Revised: 06/02/2004] [Accepted: 06/02/2004] [Indexed: 11/29/2022]
Abstract
We report the case of an 11-year-old male who developed subacute diffuse polyradiculoneuropathy, associated with digestive symptoms and Epstein-Barr virus infection. Parental consanguinity was present. The laboratory findings including bone marrow smear were consistent with hemophagocytic lymphohistiocytosis (HLH). Electrophysiological study of peripheral nerves revealed an intense and diffuse demyelinating process. The histological nerve lesions were severe and purely demyelinating. Most axons were intact. There was a diffuse infiltration of the nerve parenchyma by mononuclear cells. Immuno-electron microscopic study evidenced entry of macrophages into Schwann cell cytoplasm with dissociation of myelin sheaths. This boy died several months after the onset of the neuropathic symptoms. HLH is a rare genetic or acquired disorder in childhood characterized by abnormal immune activation, which induces an uncontrolled inflammatory response with sustained hyperactivation of T lymphocytes and macrophages. Only very rare cases of peripheral nerve involvement have been described in HLH. This is the first case showing that peripheral nerves, as other viscera, may be destroyed by the macrophagic infiltration, which characterizes HLH.
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Affiliation(s)
- R De Armas
- Department of Neurology, Dupuytren University Hospital, 2 Avenue Martin Luther King, 87042 Limoges, France
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47
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Abstract
Multicentric reticulohistiocytosis (MR) is an uncommon disease with joint and cutaneous manifestations most commonly affecting women in middle age. The diagnosis must be confirmed by the histological evidence of typical mononuclear histiocytes and multinucleated giant cells. Many conditions have been described in association with MR, and the clinician should be aware that in many cases the disease is associated with malignancy. This eventuality must be accurately ruled out. If the typical nodular manifestations are missing at the onset, the arthritic complaints-usually localized but not confined to the interphalangeal joints-may be confused with those of more common rheumatic disorders. At this stage, a careful clinical and radiological evaluation may offer the key to the correct diagnosis. The natural course of the disease may develop into a severe, destructive arthropathy and disfiguring cutaneous lesions. In these cases an aggressive treatment with immunosuppressive drugs is strongly recommended. On the basis of recent reports, anti-tumor necrosis factor alpha agents and alendronate may also be added to the list of the drugs used in the treatment of this disease.
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Affiliation(s)
- Francesco Trotta
- Sezione di Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Ferrara, Corso della Giovecca 203, 44100 Ferrara, Italy.
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48
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King RS, Preston GG, Berenberg JL, Fraser SL, Gress FM. Hemophagocytic lymphohistiocytosis: a rare cause of pancytopenia. Hawaii Med J 2004; 63:262-3, 277. [PMID: 15540522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
A 36-year-old man with fever and pancytopenia due to Hemophagocytic Lymphohistiocytosis is reported. The patient was started on the HLH-94 based treatment. Two weeks after the initiation of therapy the patient's pancytopenia had resolved and he was discharged to complete treatment as an outpatient. The initial clinical presentation, diagnostic criteria, pathophysiology and treatment will be discussed.
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Affiliation(s)
- Robert S King
- Department of Medicine, Tripler Army Medical Center, Honolulu, HI 96859, USA.
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49
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Kaneko K, Matsuda M, Sekijima Y, Hosoda W, Gono T, Hoshi K, Shimojo H, Ikeda SI. Acute respiratory distress syndrome due to systemic lupus erythematosus with hemophagocytic syndrome: an autopsy report. Clin Rheumatol 2004; 24:158-61. [PMID: 15338452 DOI: 10.1007/s10067-004-0985-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2004] [Accepted: 06/18/2004] [Indexed: 10/26/2022]
Abstract
This report concerns a patient with systemic lupus erythematosus (SLE) who died of acute respiratory distress syndrome (ARDS) 1 day after the onset of pulmonary symptoms. Autopsy demonstrated severe hemophagocytosis in the bone marrow and histopathology indicating a marked increase in vascular permeability in both lungs and kidneys. In this patient, active SLE and associated hemophagocytic syndrome may have induced an increase in the production of inflammatory cytokines, which immediately induced ARDS. Since fatal ARDS can occur as a life-threatening complication of SLE, careful observation is necessary, particularly when there are clinical findings suggestive of associated hemophagocytic syndrome.
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Affiliation(s)
- Kazuma Kaneko
- Third Department of Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621 Matsumoto, Japan
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50
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Tamaki C, Miyatake J, Yamagata T, Nozaki Y, Yu H, Sugiyama M, Ikoma S, Kinoshita K, Funauchi M, Kanamaru A. [Case of acne fulminans associated with hemophagocytosis]. Nihon Naika Gakkai Zasshi 2004; 93:1632-3. [PMID: 15384693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Chise Tamaki
- Department of Hematology, Nephrology and Rheumatology, Kinki University School of Medicine, Osakasayama
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