Multifocal cryptococcal disease in an HIV-infected patient: from diagnostic pursuit to management peculiarities.

Cryptococcosis is a life-threatening fungal infection that affects immunocompromised patients, causing predominantly meningoencephalitis and pneumonia. Lymph node involvement is rare and its identification may not be obvious. We report the case of a patient recently diagnosed with AIDS and previously treated for cryptococcal meningitis who developed multifocal cryptococcal disease despite antifungal treatment, expressed as cervical and mediastinal lymphadenitis and constitutional symptoms. The difficulty of the diagnosis was based on the fact that cryptococcal meningitis was resolved after treatment, and the new manifestations were more typical of other conditions such as tuberculosis and malignancy. Final diagnosis was established after fine-needle aspiration cytology of a lymph node with Cryptococcus identification. Such cases may be difficult to manage, and the possibility of clinical relapse versus cryptococcal immune reconstitution inflammatory syndrome is discussed. Induction therapy was restarted and maintained for a longer period, and the total duration was based on clinical response.

Mesenteric lymphadenitis as a presenting feature of Whipple's disease: Value of PCR analysis.

Whipple's disease (WD) is a rare chronic and systemic infection caused by the ubiquitous actinomycete Tropheryma whipplei. A case of localized infection with mesenteric adenopathy associated with a prolonged unexplained fever is reported herein. Screening by PCR on saliva and stool was positive, and T. whipplei was formally identified by specific PCR on duodenal and mesenteric adenopathy biopsies. Histological analysis did not demonstrate periodic acid-Schiff-positive macrophages or positive T. whipplei immunochemistry in either the duodenal mucosa or mesenteric nodes. Treatment with hydroxychloroquine and doxycycline allowed a rapid resolution of symptoms, and subsequent saliva and stool PCR results were negative.

Cavitating mesenteric lymph node syndrome: a rare complication of refractory celiac disease.

Celiac disease is an immune-mediated enteropathy characterized by mucosal inflammation and villous atrophy of the small bowel upon exposure to ingested gluten. Refractory celiac disease (RCD), defined as persisting villous atrophy with crypt hyperplasia despite strict gluten-free diet, is a rare form of celiac disease with poor prognosis due to a higher rate of severe complications such as life-threatening malnutrition or the development of intestinal T-cell lymphoma. The cavitating mesenteric lymph node syndrome (CMLNS) represents a rare complication of celiac disease with unknown pathogenesis which is associated with but not restricted to RCD and not necessarily associated with a malignant course. We here report a 64-year-old patient who was referred to us with a history of refractory celiac disease. During further diagnostic work-up multiple intraabdominal cystic structures were detected by a computed tomography scan and magnetic resonance imaging. A laparotomy was performed to exclude T-cell lymphoma. Histology of the intraabdominal cysts revealed the diagnosis of cavitating mesenteric lymph node syndrome as the underlying cause of the masses. Steroid therapy was initiated which led to complete regression of diarrhoea but did not induce a diminution of mesenteric lymph nodes. Three years after the diagnosis of CMLNS, the patient presented with an acute abdomen due to a small bowel perforation caused by an enteropathy associated T-cell lymphoma. We discuss the differential diagnoses of intraabdominal masses in celiac disease and review the current literature on CMLNS.

A case of mesenteric lymphadenitis with long-acting symptom, showing marked response to corticosteroid.

A 17-year-old girl who had right lower abdominal pain with multiple swelling of lymph nodes in the ileocecal region and she was admitted to a neighboring hospital. Since there was no improvement of condition with antibiotic resistance, we were consulted. Lymph node biopsy under laparoscopy demonstrated nonspecific findings. She then developed erythema nodosum, suggesting the presence of autoimmune etiology. Treatment with systemic corticosteroid resulted in symptomatic improvement. Mesenteric lymphadenitis like this case is rare.

Effects of somatostatin analogues and vitamin C on bacterial translocation in an experimental intestinal obstruction model of rats.

The passage of viable endogenous bacteria and their products across the intact intestinal mucosal barrier, disseminating to the mesenteric lymph nodes, peritoneal cavity, spleen, liver, and circulation, is defined as bacterial translocation. Intestinal obstruction induces bacterial translocation due to mucosal disruption, motility dysfunction, and increased intestinal volume, leading to bacterial overgrowth. In a rat model of intestinal obstruction, the effects of both high-dose vitamin C (350 microg/kg), an antioxidant agent known to have a cytoprotective effect in ischemia-reperfusion injury, and somatostatin (20 microg/kg), a gastrointestinal antisecretory agent, in preventing bacterial translocation were studied. Both intestinal and liver samples from the rats was observed, and it was found that the rate of bacterial translocation was 100% in the control group, and only 43% for the rats who were given intraperitoneal vitamin C and somatostatin. The difference was statistically significant. In conclusion, we are convinced that vitamin C and somatostatin analogues may have protective effects against bacterial translocation in mechanical bowel obstruction.

Penicillium marneffei mesenteric lymphadenitis in human immunodeficiency virus-infected children.

UNLABELLED: Disseminated P. marneffei infection is one of the common opportunistic infections seen in HIV-infected patients in Southeast Asia. We report 3 cases of HIV-infected children with mesenteric lymphadenitis presented with prolonged fever and abdominal pain. The first two patients were diagnosed as peritonitis and acute appendicitis prior to exploratory laparotomy. Operative findings revealed multiple enlarged mesenteric lymph nodes. Histopathologic findings of mesenteric lymph nodes biopsy were characteristic for P. marneffei infection. Mesenteric lymphadenitis in the last patient was diagnosed by abdominal ultrasound. All three cases had positive blood and bone marrow cultures for P. marneffei. These patients were treated with amphotericin B. Fever declined in 3-6 days. The first two patients survived but the last one subsequently died from underlying hemophilia A (GI bleeding). CONCLUSION: Acute mesenteric lymphadenitis can be one of the unusual manifestations caused by P. marneffei. Southeast Asia is an endemic area for P. marneffei and is severely affected by acquired immunodeficiency syndrome epidemic. Therefore, mesenteric lymphadenitis should be considered in HIV-infected persons who present with prolonged fever and abdominal pain.

Massive tuberculous mesenteric lymphadenopathy.

Abdominal tuberculosis accounts for 10% of all tuberculosis seen in Papua New Guinea. Nodal tuberculosis is usually associated with intestinal or peritoneal lesions. A case of massive tuberculous mesenteric lymphadenopathy with recurrent intestinal obstruction is presented here with a review of the relevant literature.

[Lymphotropic chemotherapy of patients with tuberculosis of the lymph nodes, skin and abdominal organs]. / Limfotropnaia khimioterapiia bol'nykh tuberkulezom limfaticheskikh uzlov, kozhi, organov briushnoi polosti.

Experience gained as a result of indirect endolymphatic chemotherapy of patients with tuberculosis of the skin, peripheral and mesenteric lymph nodes is presented. The above treatment is tolerated well by the patients and causes no local or general complications. The clinical effect is achieved 1-3 months earlier than with a traditional therapy which provides a significant drop in the inpatient period and the drug load. Incidence of exacerbations also becomes less. It is worthwhile to include lymphotropic chemotherapy into a complex of therapeutic measures both at the beginning of the treatment and in a torpid course of the disease.