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Li J, Wang XZ, Wang RC, Yang J, Hao HL, Xue LY. Pulmonary tuberculosis presenting as henoch-schönlein purpura: Case report and literature review. Medicine (Baltimore) 2020; 99:e22583. [PMID: 33019474 PMCID: PMC7535759 DOI: 10.1097/md.0000000000022583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Henoch-Schönlein purpura (HSP) is an extremely rare condition in patients with pulmonary tuberculosis, with only a few reported cases. Compared to patients with typical clinical symptoms, it is difficult to make a definitive diagnosis when HSP presents as an initial manifestation in pulmonary tuberculosis patients. Herein, a case of pulmonary tuberculosis that showed HSP at first was reported, and the related literatures were reviewed. PATIENT CONCERNS A 24-year-old man presented with palpable purpura on the extremities, accompanied by abdominal pain, bloody stools, and knee pain. DIAGNOSES The patient was diagnosed with pulmonary tuberculosis based on the results of interferon gamma release assays, purified protein derivative test, and computed tomography. INTERVENTIONS The patient was treated with vitamin C and chlorpheniramine for 2 weeks, and the above-mentioned symptoms were relieved. However, 3 weeks later, the purpura recurred with high-grade fever and chest pain during the inspiratory phase. The patient was then treated with anti-tuberculosis drugs, and the purpura as well as the high fever disappeared. OUTCOMES The patient recovered well and remained free of symptoms during the follow-up examination. CONCLUSION Pulmonary tuberculosis presenting with HSP as an initial manifestation is not common. Therefore, it is difficult to clinically diagnose and treat this disease. When an adult patient shows HSP, it is important to consider the possibility of tuberculosis to avoid misdiagnosis and delayed treatment.
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Affiliation(s)
- Jie Li
- Department of Hematology, Hebei General Hospital
| | - Xiao-Zi Wang
- Department of Pathology, Hebei Medical University, Shijiazhuang, China
| | | | - Jie Yang
- Department of Hematology, Hebei General Hospital
| | | | - Li-Ying Xue
- Department of Pathology, Hebei Medical University, Shijiazhuang, China
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2
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Yamauchi N, Tanda S, Kashiwagi S, Ohnishi A, Kugai M, Akazawa T, Matsumoto T, Yamauchi J, Muramatsu A, Fujimoto S. Fatal gastrointestinal bleeding due to IgA vasculitis complicated with tuberculous lymphadenitis: A case report and literature review. Clin Case Rep 2020; 8:1741-1747. [PMID: 32983488 PMCID: PMC7495800 DOI: 10.1002/ccr3.2938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/28/2020] [Accepted: 04/25/2020] [Indexed: 01/24/2023] Open
Abstract
We report a case of IgA vasculitis that developed during the treatment of tuberculosis. Patients with tuberculosis who are on antituberculosis treatment can be administered steroids for severe disease or complications.
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Affiliation(s)
| | - Shuji Tanda
- Department of NephrologyAkashi City HospitalAkashiJapan
| | - Saori Kashiwagi
- Department of GastroenterologyAkashi City HospitalAkashiJapan
| | | | - Munehiro Kugai
- Department of GastroenterologyAkashi City HospitalAkashiJapan
| | - Takako Akazawa
- Department of GastroenterologyAkashi City HospitalAkashiJapan
| | | | - Junko Yamauchi
- Department of GastroenterologyAkashi City HospitalAkashiJapan
| | - Akira Muramatsu
- Department of GastroenterologyAkashi City HospitalAkashiJapan
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3
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Wang JY, Brown RA, Pugliese S, Kwong BY, Novoa RA. Disseminated tuberculosis presenting as medium-vessel vasculitis in an immunocompromised host. J Cutan Pathol 2020; 47:725-728. [PMID: 32133689 DOI: 10.1111/cup.13678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/22/2020] [Accepted: 02/26/2020] [Indexed: 11/26/2022]
Abstract
Cutaneous tuberculosis is an uncommon entity with several clinical forms recognized. Histopathologically, most cases are characterized by granulomatous inflammation and caseating necrosis, although less common findings, including vasculitis, have also been described. We report a 55-year-old male with a history of recently diagnosed dermatomyositis receiving immunosuppression with mycophenolate mofetil and prednisone, who developed multifocal soft tissue abscesses and an indurated erythematous plaque on the back. Skin biopsy of the back revealed a necrotizing medium-vessel vasculitis. Mycobacterium tuberculosis was detected in the skin via acid-fast bacilli stain and confirmed by tissue culture and polymerase chain reaction. Cutaneous findings improved rapidly with antituberculosis therapy. This case illustrates an uncommon clinical and histopathologic presentation of disseminated tuberculosis.
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Affiliation(s)
- Jennifer Y Wang
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA.,Department of Pathology, Stanford University Medical Center, Stanford, California, USA
| | - Ryanne A Brown
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA.,Department of Pathology, Stanford University Medical Center, Stanford, California, USA
| | - Silvina Pugliese
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA
| | - Bernice Y Kwong
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA
| | - Roberto A Novoa
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA.,Department of Pathology, Stanford University Medical Center, Stanford, California, USA
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4
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Oxley Oxland J, Ensor J, Freercks R. Tuberculosis and pauci-immune crescentic glomerulonephritis. BMJ Case Rep 2018; 2018:bcr-2017-221948. [PMID: 29437730 DOI: 10.1136/bcr-2017-221948] [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: 11/03/2022] Open
Abstract
We report here a case that highlights tuberculosis (TB) as a possible cause for pauci-immune crescentic glomerulonephritis (c-GN), an important and often treatable cause of kidney injury. A 47-year-old HIV-negative man of mixed ethnicity presented with a 2-week history of cough, haemoptysis and unintentional weight loss. Chest examination revealed crepitations over the right upper zone and urinalysis demonstrated an active urinary sediment with red cell casts. Chest radiograph confirmed right upper lobe cavitation. Serum laboratory investigations revealed a serum creatinine of 632 µmol/L and were negative for antineutrophil cytoplasmic antibodies. A diagnosis of pauci-immune c-GN was made on renal biopsy. In addition, sputum PCR confirmed infection with drug-sensitive Mycobacterium tuberculosis Standard TB treatment and immunosuppression with prednisone and cyclophosphamide was commenced, and over the course of 6 months, renal function improved to an estimated glomerular filtration rate >60 mL/min.
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Affiliation(s)
- Jonathan Oxley Oxland
- Division of Nephrology and Hypertension, University of Cape Town, Port Elizabeth, South Africa
| | - Jason Ensor
- Division of Nephrology and Hypertension, University of Cape Town, Port Elizabeth, South Africa
| | - Robert Freercks
- Division of Nephrology and Hypertension, University of Cape Town, Port Elizabeth, South Africa
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5
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Ferrati-Fidelin G, Pham-Ledard A, Fauconneau A, Chauvel A, Houard C, Doutre MS, Beylot-Barry M. [Latent-disseminated tuberculosis revealed by atypical skin ulcerations]. Ann Dermatol Venereol 2016; 143:616-621. [PMID: 27342431 DOI: 10.1016/j.annder.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 04/01/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Cutaneous tuberculosis (CT) is rare in industrialized countries. Given the clinicopathological polymorphism and the difficulty of isolating the pathogen, diagnosis can be difficult. The condition may be associated with other known locations of the disease or in rare cases, it may be a tell-tale sign, as in our case, in which leg ulcers revealed paucisymptomatic disseminated tuberculosis. OBSERVATION A 67-year-old man was referred for rapidly extensive ulcers of the right leg contiguous to debilitating arthritis of the knee of unknown aetiology for 18 months. Earlier investigations revealed thymoma and a pulmonary nodule considered to be sarcoidosis. A skin biopsy showed a granulomatous eosinophilic-rich infiltrate and vasculitis of the small vessels. Screening of the skin sample and gastric aspirate for Koch Bacillus (BK) was negative. A diagnosis of sarcoidosis was made. A positive QuantiFERON test eventually led to the correct diagnosis. On further testing of bronchoalveolar fluid and a synovial biopsy, culture for Mycobacterium tuberculosis (MT) was positive. The PET scan showed high metabolism in the prostate, bone, spleen, liver, nodes and heart. The quad- and then dual-antibiotic antitubercular therapies produced a rapid improvement but treatment was continued over 12 months, given the persistence of high metabolism on PET-CT scan and the low blood rifampicin concentration. DISCUSSION A CT should be considered in the presence of giant-cell granulomas, even in the absence of caseous necrosis, and where both direct examination and culture for the skin are negative. Our case also underlines the importance of an extensive workup to rule out disseminated disease even if the patient is not symptomatic.
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Affiliation(s)
- G Ferrati-Fidelin
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - A Pham-Ledard
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - A Fauconneau
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - A Chauvel
- Service d'anatomopathologie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France
| | - C Houard
- Service de médecine nucléaire, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France
| | - M-S Doutre
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - M Beylot-Barry
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France.
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6
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Mendiratta V, Gaur N, Sud R, Agarwal S, Chander R. Cutaneous leucocytoclastic vasculitis and pulmonary tuberculosis: an uncommon association. Indian J Dermatol 2014; 59:614-5. [PMID: 25484400 PMCID: PMC4248507 DOI: 10.4103/0019-5154.143542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vibhu Mendiratta
- Department of Dermatology, Lady Hardinge Medical College and Smt. S.K. Hospital, New Delhi, India
| | - Niti Gaur
- Department of Dermatology, Lady Hardinge Medical College and Smt. S.K. Hospital, New Delhi, India
| | - Ritika Sud
- Department of Medicine, Lady Hardinge Medical College and Smt. S.K. Hospital, New Delhi, India. E-mail:
| | - Soumya Agarwal
- Department of Dermatology, Lady Hardinge Medical College and Smt. S.K. Hospital, New Delhi, India
| | - Ram Chander
- Department of Dermatology, Lady Hardinge Medical College and Smt. S.K. Hospital, New Delhi, India
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7
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Walsh TL, Baca V, Stalling SS, Natalie AA, Veldkamp PJ. Mycobacterium avium-intracellulare pulmonary infection complicated by cutaneous leukocytoclastic vasculitis in a woman with anorexia nervosa. Infection 2013; 42:559-63. [PMID: 24363210 DOI: 10.1007/s15010-013-0574-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 12/13/2013] [Indexed: 11/29/2022]
Abstract
A 53-year-old Caucasian woman with a history of anorexia nervosa developed a bilateral lower extremity rash comprised of palpable red to violaceous, sub-centimeter papular lesions that increased in quantity rapidly. She also noted a 2-month history of non-productive cough. Imaging modalities revealed a thin-walled cavitary lesion in the right lung apex and scattered nodular opacities. Acid fast bacilli (AFB) were found in sputum and subsequently identified by culture as Mycobacterium avium-intracellulare (MAI). Punch biopsies of her skin lesions yielded a histological diagnosis of small-to-medium vessel vasculitis. Stains and cultures for organisms were negative. Her skin lesions resolved quickly after the initiation of antimicrobial therapy for MAI. Hypersensitivity vasculitis associated with an atypical mycobacterial infection is unusual. The postulated underlying mechanism is the deposit of immune complexes and not the bacillus itself. While cutaneous leukocytoclastic vasculitis (CLV) due to MAI is certainly a rare entity, it should be entertained in patients with vasculitic skin lesions and a concomitant pulmonary disease.
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Affiliation(s)
- T L Walsh
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Falk Medical Building, Suite 3A, 3601 Fifth Avenue, Pittsburgh, PA, 15213, USA,
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8
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Yao Y, Liu B, Wang JB, Li H, Liang HD. Tuberculosis should not be ignored in patients with peripheral gangrene. J Vasc Surg 2010; 52:1662-4. [PMID: 20843626 DOI: 10.1016/j.jvs.2010.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 07/04/2010] [Accepted: 07/09/2010] [Indexed: 11/25/2022]
Abstract
Peripheral gangrene, characterized by distal ischemia of the extremities, is a rare complication in patients with tuberculosis (TB). We diagnosed a female patient with gangrene of her left toe caused by TB infection. She presented with fever, lymphadenectasis, and peripheral gangrene of the left toe. Lymph node biopsy confirmed tuberculous lymphadenitis and the computer tomography angiography showed vasculitis. The patient underwent antituberculous therapy and her condition was gradually improved. Although it is rare, TB should be considered as a possible cause of peripheral gangrene.
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Affiliation(s)
- Yuan Yao
- Department of Rheumatology, The Affiliation Hospital of QingDao University Medical College, No.16 Jiang Su Lu, Shi Nan District, QingDao City, Shandong Province, China
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9
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Bedient TJ, Schwarz MI, Groshong SD, Chan ED. A 45-year-old man with a history of hepatitis C and testicular cancer presents with cavitary lung lesions and palpable purpura. Chest 2009; 136:1168-1174. [PMID: 19809061 DOI: 10.1378/chest.09-0627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Timothy J Bedient
- Divisions of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Denver, CO.
| | - Marvin I Schwarz
- Divisions of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Denver, CO
| | | | - Edward D Chan
- Divisions of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Denver, CO; Denver Veterans Administration Medical Center, Denver, CO; Division of Pulmonary Medicine, National Jewish Health, Denver, CO
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10
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Tuberculous cerebrovascular disease: A review. J Infect 2009; 59:156-66. [DOI: 10.1016/j.jinf.2009.07.012] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 07/19/2009] [Indexed: 11/22/2022]
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11
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Carvalho M, Dominoni RL, Senchechen D, Fernandes AF, Burigo IP, Doubrawa E. Cutaneous leukocytoclastic vasculitis accompanied by pulmonary tuberculosis. J Bras Pneumol 2009; 34:745-8. [PMID: 18982211 DOI: 10.1590/s1806-37132008000900014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 12/05/2007] [Indexed: 12/17/2022] Open
Abstract
We report the case of a 50-year-old male with a rare combination: pulmonary tuberculosis and cutaneous leukocytoclastic vasculitis. The patient sought emergency treatment presenting with headache, arthralgia, cutaneous rash, and weight loss (4 kg) in the last 20 days. A chest X-ray, performed in a previous outpatient visit, revealed cavitation in the middle and upper lobes of the right lung, as confirmed by computed tomography. Sputum smear microscopy (Ziehl-Neelsen staining) was positive in three consecutive samples, and the result of the skin lesion biopsy was consistent with cutaneous leukocytoclastic vasculitis. The patient was therefore diagnosed with cutaneous leukocytoclastic vasculitis accompanied by pulmonary tuberculosis. Our objective was to describe a combination rarely reported in the medical literature and to discuss the possible pathogenic mechanisms of this combination.
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12
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Guisado Espartero ME, Domínguez Castellano A, Fernández Alba MD, Muniain Ezcurra MÁ. [Not Available]. REUMATOLOGIA CLINICA 2007; 3:278-279. [PMID: 21794448 DOI: 10.1016/s1699-258x(07)73705-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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13
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Kim HM, Park YB, Maeng HY, Lee SK. Cutaneous leukocytoclastic vasculitis with cervical tuberculous lymphadenitis: a case report and literature review. Rheumatol Int 2006; 26:1154-7. [PMID: 16830160 DOI: 10.1007/s00296-006-0152-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2005] [Accepted: 05/06/2006] [Indexed: 11/28/2022]
Abstract
Cutaneous leukocytoclastic vasculitis (CLV) is a small-vessel vasculitis localized to the skin. Many possible causes exist for this pathological condition, including drugs, infection, collagen vascular disease, and malignancy. However, Mycobacterium tuberculosis is rarely reported to be associated with CLV. Here, we report a 49-year-old male patient that presented with fever, myalgia, and multiple palpable purpura on both of his legs. The biopsy from the purpura yielded a histologic diagnosis of leukocytoclastic vasculitis. The patient had several enlarged lymph nodes on his right neck, and the biopsy revealed tuberculous lymphadenitis. There were no signs of vasculitis present in the internal organs. After anti-tuberculosis treatment, his fever declined and the skin purpura were completely resolved. Although incidence is rare, tuberculosis should be considered as a possible cause of CLV.
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MESH Headings
- Adolescent
- Adult
- Antitubercular Agents/therapeutic use
- Female
- Humans
- Male
- Middle Aged
- Skin/pathology
- Skin Diseases, Vascular/diagnosis
- Skin Diseases, Vascular/drug therapy
- Skin Diseases, Vascular/microbiology
- Treatment Outcome
- Tuberculosis, Lymph Node/complications
- Tuberculosis, Lymph Node/drug therapy
- Tuberculosis, Lymph Node/pathology
- Vasculitis, Leukocytoclastic, Cutaneous/diagnosis
- Vasculitis, Leukocytoclastic, Cutaneous/drug therapy
- Vasculitis, Leukocytoclastic, Cutaneous/microbiology
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Affiliation(s)
- Hee Man Kim
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-ku, Seoul 120-752, Republic of Korea.
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14
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Kutukculer N, Genel F, Aksu G, Karapinar B, Ozturk C, Cavusoglu C, Casanova JL, Fieschi C. Cutaneous leukocytoclastic vasculitis in a child with interleukin-12 receptor beta-1 deficiency. J Pediatr 2006; 148:407-9. [PMID: 16615980 DOI: 10.1016/j.jpeds.2005.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Revised: 08/11/2005] [Accepted: 10/03/2005] [Indexed: 11/25/2022]
Abstract
We report a patient with complete interleukin-12 receptor beta-1 deficiency associated with cutaneous leukocytoclastic vasculitis. The patient experienced Bacille Calmette Guérin, Mycobacterium chelonae, and Salmonella enteritidis infection. Vasculitis affecting both small arteries and postcapillary venules due to deposition of immune complexes was probably caused by S. enteritidis and/or M. chelonae infection.
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MESH Headings
- Animals
- Cattle
- Child
- Consanguinity
- Female
- Humans
- Mycobacterium Infections, Nontuberculous/diagnosis
- Mycobacterium Infections, Nontuberculous/drug therapy
- Mycobacterium bovis/isolation & purification
- Mycobacterium chelonae/isolation & purification
- Psoas Abscess/microbiology
- Receptors, Interleukin/deficiency
- Receptors, Interleukin-12
- Salmonella Infections/diagnosis
- Salmonella Infections/drug therapy
- Salmonella enteritidis/isolation & purification
- Splenomegaly/surgery
- Tuberculosis, Bovine/diagnosis
- Tuberculosis, Bovine/drug therapy
- Vasculitis, Leukocytoclastic, Cutaneous/drug therapy
- Vasculitis, Leukocytoclastic, Cutaneous/microbiology
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Affiliation(s)
- Necil Kutukculer
- Department of Pediatrics, Ege University Medical School, Izmir, Turkey.
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15
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Chen HA, Cheng NC, Lin KP, Liao HT, Chen CH, Huang DF. Mononeuropathy multiplex and chylothorax as earlier manifestations of pulmonary tuberculosis. J Intern Med 2005; 257:561-3. [PMID: 15910561 DOI: 10.1111/j.1365-2796.2005.01495.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Mononeuropathy multiplex (MNM) and chylothorax are rare clinical disorders. The concurrence of these two disorders with Mycobacterium tuberculosis infection has not been reported. We herein report a patient who was initially diagnosed with fever of unknown origin and MNM, and then developed chylothorax. Pulmonary tuberculosis was proved 1 month after chylothorax appeared. With low-dose prednisolone 15 mg day(-1) and anti-tuberculosis drugs, all these disorders completely resolved 1 year later.
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Affiliation(s)
- H-A Chen
- Section of Allergy, Veterans General Hospital-Taipei, Taipei, Taiwan
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16
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Chen HH, Hsiao CH, Chiu HC. Successive development of cutaneous polyarteritis nodosa, leucocytoclastic vasculitis and Sweet's syndrome in a patient with cervical lymphadenitis caused by Mycobacterium fortuitum. Br J Dermatol 2005; 151:1096-100. [PMID: 15541094 DOI: 10.1111/j.1365-2133.2004.06201.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mycobacterium fortuitum is a rapidly growing mycobacterium found in soil and water throughout the world. It can cause diseases in immunocompetent patients, usually resulting in localized skin and soft tissue infections. Cervical lymphadenitis caused by M. fortuitum is rare. We report a 46-year-old woman in whom skin lesions of cutaneous polyarteritis nodosa, leucocytoclastic vasculitis and Sweet's syndrome had successively developed before the diagnosis of cervical lymphadenitis caused by M. fortuitum was made. The skin lesions responded to colchicine and systemic corticosteroids but recurred intermittently. After establishment of the diagnosis, she received treatment with clarithromycin and ciprofloxacin. The cervical lymph nodes decreased in size 6 months later and no more new skin lesions were found.
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Affiliation(s)
- H-H Chen
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, Taiwan
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17
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Abstract
A 57-year-old woman presented with bloody sputum and high grade fever. She had been treated for Mycobacterium avium-intracellulare complex (MAC). High grade fever slightly decreased and bloody sputum disappeared after two weeks, but low grade fever persisted. After 3 days of recurrence of bloody sputum, she suddenly complained of palpable pururitic lesions on the bilateral lower extremities with bilateral gonalgia. Although there are some reports of direct skin lesions due to MAC, there are no reports of hypersensitivity vasculitis, Henoch-Schönlein purpura, in MAC. It is necessary to consider MAC infection as a potential cause of Henoch-Schönlein purpura.
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Affiliation(s)
- Shuichi Yano
- Department of Pulmonary Medicine, Matsue National Hospital, Matsue
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18
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Kumasaka T, Mitani K, Izumi H, Miyamoto H, Takahashi K, Fukuchi Y, Suda K. Small vessel vasculitis limited to pleuropulmonary manifestations, possibly induced by endotoxin. Histopathology 2003; 43:189-93. [PMID: 12877735 DOI: 10.1046/j.1365-2559.2003.01662.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIMS We investigated a rare case of small vessel vasculitis (SVV) limited to pleuropulmonary manifestations, possibly induced by endotoxin, to determine the activation of immuno-mediated cells and endothelia in the pleuropulmonary circulation. METHODS AND RESULTS A 44-year-old man with a high fever was X-rayed, revealing bilateral pleural effusion and atelectasis in the chest. His laboratory data were within normal limits except for a high white blood cell count and a high C-reactive protein level. Autoantibodies including anti-neutrophil cytoplasmic antibody were negative. Endotoxin was detected in his sera, but repeated cultures of sputa, urine, blood and the pleural effusion were negative for bacteria. Video-assisted thoracic surgery was performed and lung and parietal pleura specimens were obtained. Histology showed arterioles or small arteries infiltrated by monocytes or neutrophils with fibrinoid necrosis and acute or chronic venulitis. A diagnosis of SVV in the lung and pleura was made. Immunohistochemistry revealed that interleukin (IL)-1beta was expressed in monocytes and vascular cell adhesion molecule (VCAM)-1 on endothelial cells in the vasculitic lesions in the lung. CONCLUSIONS Endotoxin possibly induced the inflammation in this apparently unique case of pleuropulmonary small vessel vasculitis. Immunohistochemistry revealed the expression of IL-1beta and VCAM-1 which may have caused activation of monocytes and endothelial cells within the vasculitic lesions.
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Affiliation(s)
- T Kumasaka
- Department of Pathology I, School of Medicine, Juntendo University, Tokyo, Japan.
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19
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Schattner A, Gilad A, Cohen J. Systemic granulomatosis and hypercalcaemia following intravesical bacillus Calmette-Guérin immunotherapy. J Intern Med 2002; 251:272-7. [PMID: 11886488 DOI: 10.1046/j.1365-2796.2002.00957.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ami Schattner
- Department of Medicine, Kaplan Medical Center, Rehovot, Israel.
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20
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Abstract
BCG immunotherapy for bladder carcinoma has been a long-standing treatment modality that has proved itself efficient and safe. Most of the side-effects of this treatment are minor and of short duration. There have been, nevertheless, several reports regarding more severe and long-term complications of BCG therapy-namely inflammatory arthritis, and occasionally systemic autoimmune manifestations. Here, we present four cases of patients who received intravesical instillation with BCG for bladder carcinoma and developed long-standing inflammatory arthritis. One of these patients developed Reiter's syndrome. We also refer to the possible immune mechanisms by which BCG can trigger arthritis, as well as to the link between mycobacterial infection, BCG immunotherapy and autoimmunity.
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Affiliation(s)
- Y Shoenfeld
- Department of Internal Medicine B and C and the Research Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.
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