Does the presence of mediastinal adenopathy confer a risk for disseminated infection in immunocompetent persons with pulmonary coccidioidomycosis?

Pulmonary coccidioidomycosis is caused by inhaling airborne arthroconidia of Coccidioides, a soil-dwelling fungus endemic to the desert southwestern United States. Although uncommon, disseminated coccidioidal infection can be associated with well-defined risk factors, such as cell-mediated immunodeficiency, certain racial heritages (e.g. African or Filipino), male sex, or pregnancy. Before widespread use of computed tomography (CT), the presence or persistence of mediastinal lymphadenopathy was postulated to be a risk factor for disseminated coccidioidal infection. To investigate the use of CT scanning to identify the presence of mediastinal lymphadenopathy in patients with pulmonary coccidioidomycosis, and to correlate such lymphadenopathy with disseminated coccidioidal infection, we performed a retrospective review of patients with pulmonary coccidioidomycosis who were evaluated by chest CT. Two radiologists independently interpreted 150 CT scans from patients with pulmonary coccidioidomycosis. Forty-nine patients met CT criteria for mediastinal lymphadenopathy, whereas 101 patients did not. Disseminated coccidioidal infection was observed in 5 (10%) of the 49 patients with mediastinal lymphadenopathy and in 6 of the 101 (6%; P = .34) without such adenopathy. Among patients with coccidioidomycosis, patients with mediastinal lymphadenopathy, as assessed by CT, had a higher rate of disseminated infection, but the difference was not statistically significant.

Radiotherapy of unicentric mediastinal Castleman's disease.

Castleman's disease is a slowly progressive and rare lymphoproliferative disorder. Here, we report a 55-year-old woman with superior mediastinal Castleman's disease being misdiagnosed for a long term. We found a 4.3 cm mass localized in the superior mediastinum accompanied with severe clinical symptoms. The patient underwent an exploratory laparotomy, but the mass failed to be totally excised. Pathologic examination revealed a mediastinal mass of Castleman's disease. After radiotherapy of 30 Gy by 15 fractions, the patient no longer presented previous symptoms. At 3 months after radiotherapy of 60 Gy by 30 fractions, Computed tomography of the chest showed significantly smaller mass, indicating partial remission. Upon a 10-month follow-up, the patient was alive and free of symptoms.

Prevalence and significance of mediastinal lymphadenopathy in patients with Severe Acute Respiratory Syndrome Corona Virus-2 infection.

Severe Acute Respiratory Syndrome Corona Virus-2 is the causative factor of Coronavirus Disease 2019. Early in the pandemic, mediastinal lymphadenopathy was not considered to be a significant radiologic finding of the SARS-COV-2 disease. Nevertheless, most recent studies associate mediastinal lymphadenopathy with more severe COVID-19 disease and poorer patient outcomes.

[The clinical application of videomediastinoscopy combined with the examination of CD(4)/CD(8) in the diagnosis of mediastinal tuberculosis and sarcoidosis].

OBJECTIVE: To evaluate the role of videomediastinoscopy combined with the examination of CD(4)/CD(8) in the diagnosis of tuberculosis and sarcoidosis of the mediastinum. METHODS: The clinical records of 90 patients who underwent videomediastinoscopy from February 2003 to September 2005 were retrospectively reviewed. The expression of CD(4)/CD(8) was studied using immunohistochemical method in the tissues from 57 cases with a diagnosis of tuberculosis or sarcoidosis and noncaseating granuloma without classical "sarcoid" pathology obtained by videomediastinoscopy. RESULTS: Sarcoidosis was diagnosed in 37 patients, tuberculosis in 14 patients, lymphoma in 15 patients, nodal metastasis in 18 patients, noncaseating granuloma without classical "sarcoid" in 6 patients. The diagnostic accuracy was 93.3% (84/90). The expression of CD(4) and CD(8) in sarcoidosis was (65 +/- 13)% and (9.4 +/- 2.6)%, respectively. While the expression of CD(4) and CD(8) in tuberculosis was (41 +/- 11)% and (11.8 +/- 3.4)%, respectively. The rate of CD(4)/CD(8) in sarcoidosis was higher than that in tuberculosis (7.3 +/- 1.8 and 3.6 +/- 1.1, respectively, t = 1.883, P = 0.000). The accuracy, specificity and sensitivity for diagnosis of sarcoidosis was 90.2%, 85.7% and 91.9%, respectively, if the cutoff value of CD(4)/CD(8) was 5. No complication or mortality was reported. CONCLUSION: Videomediastinoscopy is an effective procedure for the diagnosis of mediastinal diseases. The examination of CD(4)/CD(8) adds more information to the differentiation of tuberculosis from sarcoidosis.

[A case of Kimura's disease accompanied with bilateral, mediastinal and hilar lymphadenopathy].

A 52-year-old man presented with general fatigue and body weight loss. Chest X-ray and computed tomography showed bilateral, mediastinal and hilar lymphadenopathy. Laboratory tests revealed that peripheral eosinophils (1,850/microL) and serum IgE levels (1,610 U/L) were markedly increased. Cervical lymph node biopsy was performed for a definitive diagnosis. Histopathological analysis, using conventional H&E staining, showed mild infiltration of eosinophils into lymphoid follicules in the cervical lymph node. Immunohistopathological analysis, using an anti-human IgE antibody, showed mesh-like IgE positive staining in lymphoid follicles. These clinical and pathological findings are compatible with a diagnosis of Kimura's disease.

Mediastinal fibrosis is associated with human leukocyte antigen-A2.

OBJECTIVE: To determine the association between mediastinal fibrosis and human leukocyte antigen (HLA) genes. DESIGN: Case-control study. SETTING: Vanderbilt University Medical Center. SUBJECTS: Nineteen consecutive patients with mediastinal fibrosis who presented to the pulmonary clinic at Vanderbilt University Medical Center from 1987 to 1996. The control subjects were 21,086 whites who were cadaveric kidney donors from October 1987 through December 1993. MEASUREMENTS: HLA testing was performed on blood samples from all 19 cases. Information on HLA typing for the control subjects was obtained from the United Network for Organ Sharing. Frequency of HLA class I and II antigens found in the cases was compared with the frequency in the control subjects. RESULTS: The relative risk of mediastinal fibrosis among subjects with the HLA-A2 antigen was 3.32 times that of those who lacked this antigen (95% confidence interval, 1.19 to 9. 2). CONCLUSION: HLA-A2 was strongly associated with mediastinal fibrosis, suggesting that an abnormal immune response is important in the pathogenesis of this disease. Key words: Histoplasma capsulatum; human leukocyte antigen-A2; mediastinal fibrosis

Aspergillosis of the posterior mediastinum.

Invasive pulmonary Aspergillus, although rare in the general population, represents an important cause of morbidity and mortality among immunosuppressed patients. However, mediastinal invasion by Aspergillus is very uncommon, with few cases documented in the literature. Among 13 immunosuppressed pediatric patients recently diagnosed with invasive pulmonary aspergillosis, 3 have had posterior mediastinal invasion with severe complications. Rupture of a mycotic aortic aneurysm occurred in 2 patients, one of whom was operated on successfully. The infection involved the spinal cord with severe neurologic sequelae in 2 patients. We report our experience to make our colleagues aware of this problematic disease, which may be more prevalent in the current population of highly immunosuppressed pediatric patients.

Sarcoidosis following chemotherapy for Hodgkin's disease.

A case report describing persistent paratracheal lymphadenopathy after doxorubicin, bleomycin, vinblastin, and dacarbazine (ABVD) chemotherapy for a patient with Hodgkin's disease (HD) is presented. Mediastinoscopy and biopsy of the paratracheal lymph nodes showed non-caseating granulomas characteristic of sarcoidosis. The authors discuss the relationship between sarcoidosis and HD and hypothesize that the development or progression of sarcoidosis in a patient with HD is a potential consequence of chemotherapy. Two possible mechanisms are proposed. The first includes the immunosuppressive effect of chemotherapy and the second implicates the influence of a specific chemotherapy agent, bleomycin, which is known to have relatively higher lymph node, skin and lung tissue concentrations than other agents included in the ABVD regimen, and a predilection for those tissues that are prone for the development of sarcoidosis. With the incidence of sarcoidosis exceeding that of HD for the general population, the authors emphasize the importance of considering the presence of sarcoidosis in the differential diagnosis of patients who do not respond radiographically to HD chemotherapy.

Problems of diagnosis in the evaluation of mediastinal sarcoidosis.

The diagnosis of sarcoidosis can be established when the case meets the criteria of clinical course, radiologic findings, and supportive histology. When there is variation from the established criteria and the clinical course of age, systemic evidence of disease or the radiologic findings of unilateral or solitary adenopathy are encountered, then ongoing evaluation is necessary to identify a possible second disease existence. Cases have been presented which indicate some problem requiring further investigative studies before acceptance of the diagnosis of sarcoidosis.

Interstitial lattice shadow and mediastinal lymphadenopathy with an elevation of carcinoembryonic antigen in severe pulmonary alveolar proteinosis.

A case of severe pulmonary alveolar proteinosis (PAP) with interstitial involvement, mediastinal lymphadenopathy and an elevation of carcinoembryonic antigen (CEA) in the bronchoalveolar lavage (BAL) fluid and the serum is presented. Alveolar macrophages may play a major role in these rare and seemingly unrelated findings.

[Systemic sarcoidosis revealed by acute ataxic sensory polyradiculoneuropathy]. / Sarcoïdose systémique révélée par une polyradiculonévrite aiguë sensitive ataxiante.

We present the case of a 35-year-old man who developed bilateral uveitis and acute ataxic sensorial polyradiculoneuropathy with sphincter dysfunction. The patient had multiple mediastinal adenopathies. Pathology examination led to the diagnosis of sarcoidosis. The patient improved partially spontaneously and totally after oral corticosteroid therapy. This case illustrates an unusual presentation of acute polyradiculoneuritis which is usually a predominantly motor disorder in sarcoidosis. Sensorial and ataxic neuropathy is uncommon. The course is more chronic and progressive.

[Mediastinal bronchogenic cyst associated with high serum level of CA19-9--a surgical case report].

We reported a case of mediastinal bronchogenic cyst in a patient with a high serum level of CA19-9. The patient, a 41-year-old man, presented with a complaint of persistent fever. Chest X-ray examination, computed tomography and magnetic resonance imaging showed a subcarinal mass shadow which was diagnosed preoperatively as a bronchogenic cyst. The serum level of CA19-9 was 73 U/ml. The cyst was partially removed via right thoracotomy. Histopathological findings were compatible with bronchogenic cyst. The CA19-9 level in the specimen was 134,00 U/ml. The serum level of CA19-9 decreased to normal postoperatively. The postoperative course was uneventful.

[Mediastinal adenopathies and presence of anti-cytoplasmic antibodies of diffuse type polynuclear neutrophils]. / Adénopathies médiastinales et présence d'anticorps anti-cytoplasme des polynucléaires neutrophiles de type diffus.

We report a case of sarcoidosis with mediastinal and pulmonary localizations associated with diffuse antineutrophil cytoplasmic antibodies (c-ANCA). This led to discuss the differential diagnosis with vascularitis and the specificity of c-ANCA in Wegener's granulocytosis.

Mediastinal abscess after lung transplantation secondary to Burkholderia gladioli infection.

Burkholderia gladioli is an unusual organism that has become increasingly responsible for infections in patients who are immunosuppressed, including patients who have undergone solid organ transplantation. This article presents a patient in whom a mediastinal mass due to Burkholderia gladioli developed after lung transplantation. A review of the literature is also presented.

Does peripheral blood T-lymphocyte population distribution in sarcoidosis provide a prognostic clue?

In its pulmonary form, sarcoidosis generally resolves spontaneously, but it may lead to fibrosis of the lung. The clinical, radiological and functional tests, as well as activity markers such as the serum angiotensin converting enzyme, intrathoracic uptake of 67Gallium and the cytological data provided by bronchoalveolar lavage are only the expressions at any given time of a disease which is constantly progressing and only partly express its evolutive potential. The authors studied the distribution of T-lymphocyte subsets in the peripheral blood and from bronchoalveolar lavage. 32 patients were included in the study. They were suffering from acute or chronic sarcoidosis of the mediastinum and lungs and were divided into 2 groups according to clinical, radiological and pulmonary function criteria; Group A (n = 19) included regressive forms (minimum follow up 2 years) and group B (n = 13) the progressive untreated forms. Lymphopenia with a decrease in the percentage of CD3 cells was found in both groups. The percentage of CD4 cells is significantly lower in group B (28 +/- 11%) than in group A (45 +/- 8%) (p < 0.01) or in the control population (46 +/- 8%) (p < 0.01). The percentage of CD8 cells is higher in group B (30 +/- 8%) than in group A (18 +/- 6%). This results in a CD4/CD8 ratio which is significantly reduced in group B (1 +/- 0.5) when compared with group A (2.72 +/- 0.8) (p < 0.01) and the control group (2.17 +/- 0.8) (p < 0.01), the difference between group A and the controls being minimal.(ABSTRACT TRUNCATED AT 250 WORDS)

[Immunological diagnosis of hilarmediastinal lymphadenopathies (author's transl)]. / Sulla diagnostica immunologica delle linfoadenopatie ilomediastiniche

In the last few years, we have adopted the following immunological techniques for the study of hilarmediastinal lymphadenopathies: the E and EAC rosette tests (composition of the lymphocyte population) for an evaluation of the general immunological picture, the delayed-type cutaneous tests to reveal the specific picture of cell-mediated immune responses, and the leucocyte migration inhibition test against related and unrelated antigens. This cellular technique was integrated with the determination of precipitating and agglutinating antibodies against the same antigens. Data are reported regarding tubercular and sarcoid lymphadenopathies, Hodgkin's disease, and secondary neoplastic lymphadenopathy with prevalent intratoracic localization. The techniques used demonstrated that tubercular lymphadenopathy is associated with a well defined immunological profile which is both humoral and cellular. Sarcoid lymphadenopathy (thoracic sarcoidosis) showed a specific, well characterized immunological picture as regards cell-mediated immune responses. In Hodgkin's disease (hilarmediastinal lymphadenopathy) the immunological technique showed up a general, depressed immunological picture, particularly as regards the cell-mediated immunitary response, presumably partly due to the treatment given (physical and pharmacological therapy). Secondary neoplastic lymphadenopathy showed a similar pattern, as far as the immunological parameters used until now are concerned. On the basis of experience gained to date, we believe that the immunological techniques can make a contribution to diagnostic and clinical studies of tubercular and sarcoid lymphadenopathies.