Kikuchi-Fujimoto disease: an uncommon cause of neck swelling.

Kikuchi-Fujimoto's disease (KFD) is a rare, benign condition characterized by histiocytic necrotizing lymphadenitis predominantly in the cervical region and prolonged fever. It has a higher prevalence in the Japanese and Asian populations although it may be seen in a wide geographic distribution, but rare are the cases reported in Europe. While symptoms resolve spontaneously between 2 weeks and 2 months, complications are described in: CNS, eyes, respiratory tract, kidney and liver. KFD also described an association with systemic lupus erythematosus. This paper describes a rare case of Kikuchi-Fujimoto lymphadenitis and discusses the features of the disease. A 24-year-old man presented with fever and a swollen 3-cm lymph node in the left side of the neck. The definitive diagnosis was established, after excision of level VB nodes on the left, by histologic examination. It revealed structurally intact tissue with scalloping in the paracortical area presenting activated T cells, focal monocytoid B cells, sinus histiocytosis and normally polarized follicles. Other two samples presented focal alterations of the tissue structure due to broad areas of necrosis, conspicuous nuclear debris, large lymphoid cells as well as numerous histiocytes. Immunohistochemistry revealed CD3+ and CD8+ T lymphocytes and histiocytes expressing CD68/PGM-1 (specific for macrophage lineage) and myeloperoxidase (MPO, specific for myeloid lineage). Correct, prompt diagnosis should be established through the findings of imaging and pathologic studies to avoid unnecessary investigation and ineffective therapies.

Allergic and non-allergic rhinitis in swimmers: clinical and cytological aspects.

BACKGROUND: Rhinitis, either allergic or non-allergic, is frequent in athletes, particularly in swimmers. In this latter case, exposure to chlorine in swimming pools seems to play a relevant role, since it can exacerbate a pre-existing allergic rhinitis (AR) or produce a non-specific irritation. The aim of this study was to detail the clinical and cytological characteristics of rhinitis in swimmers, and to assess the possible role of chlorine-induced symptoms. METHODS: Elite swimmers with rhinitis symptoms underwent a complete diagnostic work-up, including allergy testing, nasal cytology and anterior rhinomanometry. Those evaluations were repeated after 1 month of use of a nasal clip during swimming. A matched group of asymptomatic swimmers was also studied. A total of 74 swimmers (54 symptomatic and 20 controls), with an age range of 9-21 years, were studied. In the control group, only mild and non-specific findings were observed, and only two had a positive skin test. RESULTS: In the symptomatic group, 24 (44%) had AR, and 19 (35%) had a predominant neutrophilic inflammation. The use of a nose clip reduced cellular infiltration and nasal resistances only in the subjects with neutrophilic rhinitis, whereas a clinical improvement was seen also in AR. CONCLUSION: A neutrophilic rhinitis occurs in a large proportion of swimmers. This seems to be irritative in its nature and can be prevented by avoiding the direct contact with chlorinated water.

When allergic rhinitis is not only allergic.

BACKGROUND: In clinical practice it can be observed that some patients with seasonal allergic rhinitis (AR) continue to have symptoms even when the exposure to allergens is expected to be low or absent. We studied the clinical and cytological characteristics of these atypical forms of (AR) in a large population of patients. METHODS: Consecutive patients with symptoms of rhinitis and with positive skin test to pollens only were interviewed for the duration of symptoms, correlation with sensitization pattern, and presence of reactivity to nonspecific stimuli. All underwent rhinoscopy and nasal scraping for cytology. RESULTS: Five hundred nineteen patients with AR were studied. Of these 519 patients 60 (11.5%) had an atypical or mixed form of rhinitis, with symptoms independent of the exposure and also elicited by nonspecific stimuli. These patients clearly differed from typical forms, especially for the nasal inflammation. They had a greater number of eosinophils and mast cells out of season (p < 0.05). Moreover, these atypical forms had, more frequently, asthma and eosinophilic polyps. CONCLUSION: In approximately 12% of patients with AR, other mechanisms of inflammation seem to intervene. Nasal cytology can be helpful in discriminating these atypical forms.

Acute airway failure secondary to thyroid metastasis from renal carcinoma.

BACKGROUND: Secondary involvement of the thyroid gland by malignant metastases is uncommon. Acute respiratory crisis due to infiltration of the upper airways is a recognised complication of anaplastic thyroid carcinoma or thyroid lymphoma. Renal cell carcinoma is a tumour that metastasizes diffusely and in an unpredictable manner. CASE PRESENTATION: We report a case of a 73-year-old man with a painful neck mass, dyspnoea, stridor and dysphonia that was evaluated in emergency. A right radical nephrectomy for renal cell carcinoma was performed 8 years previously. An emergency endotracheal intubation was followed by total thyroidectomy. Histological examination confirmed the diagnosis of thyroid metastasis from renal cell carcinoma. CONCLUSION: A literature review regarding emergency treatment for acute respiratory compromise resulting from secondary thyroid tumours was undertaken. Only two cases of metastatic colon cancer and one case of metastatic meningioma requiring emergency thyroidectomy for acute respiratory failure are reported in the literature. This appears to be the first case of emergency surgery performed for acute respiratory compromise due to thyroid metastasis from renal cell carcinoma.