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1.
Medicine (Baltimore) ; 99(50): e23579, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327319

RESUMO

Approximately 30% to 40% of all patients with adult-onset Still disease (AOSD) experience relapses, sometimes presenting as chronic damage, and these events can subsequently increase the morbidity and mortality in patients with AOSD. However, few studies are investigating the factors related to relapse in such patients. Therefore, this study aimed to explore the risk factors associated with relapse of AOSD.This cohort study enrolled 112 AOSD patients who satisfied the Yamaguchi criteria and obtained available data from Chonnam National University Hospital. The demographic, clinical, and laboratory data as well as treatment history of the patients from January 2008 to December 2019 were retrospectively reviewed. Relapse events were defined as the presence of one or more recurrent events. Multivariate logistic regression analysis was performed to investigate the possible risk factors for relapse.During a mean follow-up of 103.3 months, 47 of 112 patients (41.9%) developed a relapse. According to the results of multivariate logistic regression analysis, arthritis (odds ratio [OR] = 19.530, 95% confidence interval [CI]: 5.047-75.582, P < .001) and lymphadenopathy (OR = 6.539, 95% CI: 2.329-18.358, P < .001) predicted the development of recurrent events in patients with AOSD.Patients with AOSD had frequent relapses during the clinical course of their disease. Risk factors associated with flares were the presence of arthritis and lymphadenopathy.


Assuntos
Doença de Still de Início Tardio/etiologia , Adulto , Artrite/complicações , Feminino , Humanos , Modelos Logísticos , Linfadenopatia/complicações , Masculino , Pessoa de Meia-Idade , Recidiva , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Doença de Still de Início Tardio/epidemiologia
2.
BMC Infect Dis ; 20(1): 828, 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33176707

RESUMO

BACKGROUND: Severe and disseminated non-tuberculous mycobacterial (NTM) infections are frequently linked to a genetic predisposition but acquired defects of the interferon gamma (IFNγ) / interleukin 12 (IL-12) pathway need to be considered in adult patients with persistent or recurrent infections. Neutralizing anti-IFNγ autoantibodies disrupting IFNγ signalling have been identified as the cause of a severe and unique acquired immunodeficiency syndrome with increased susceptibility to NTM and other intracellular pathogens. CASE PRESENTATION: An adult Asian female with a previous history of recurrent NTM infections presented with persistent diarrhea, abdominal pain, night sweats and weight loss. Severe colitis due to a simultaneous infection with cytomegalovirus (CMV) and Salmonella typhimurium was diagnosed, with both pathogens also detectable in blood samples. Imaging studies further revealed thoracic as well as abdominal lymphadenopathy and a disseminated Mycobacterium intracellulare infection was diagnosed after a lymph node biopsy. Further diagnostics revealed the presence of high-titer neutralizing anti-IFNγ autoantibodies, allowing for the diagnosis of adult-onset immunodeficiency with anti-IFNγ autoantibodies (AIIA). CONCLUSIONS: We here present a severe case of acquired immunodeficiency with anti-IFNγ autoantibodies with simultaneous, disseminated infections with both viral and microbial pathogens. The case illustrates how the diagnosis can cause considerable difficulties and is often delayed due to unusual presentations. Histological studies in our patient give further insight into the pathophysiological significance of impaired IFNγ signalling. B-cell-depleting therapy with rituximab offers a targeted treatment approach in AIIA.


Assuntos
Autoanticorpos/imunologia , Infecções por Citomegalovirus/diagnóstico , Citomegalovirus/isolamento & purificação , Síndromes de Imunodeficiência/diagnóstico , Interferon gama/imunologia , Linfadenopatia/diagnóstico , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Infecções por Salmonella/diagnóstico , Salmonella typhimurium/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Autoanticorpos/sangue , Biópsia , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/virologia , Diagnóstico Tardio , Feminino , Seguimentos , Humanos , Síndromes de Imunodeficiência/complicações , Síndromes de Imunodeficiência/tratamento farmacológico , Fatores Imunológicos/uso terapêutico , Interferon gama/metabolismo , Interleucina-12/metabolismo , Linfadenopatia/complicações , Linfadenopatia/tratamento farmacológico , Linfadenopatia/patologia , Infecção por Mycobacterium avium-intracellulare/complicações , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Infecção por Mycobacterium avium-intracellulare/microbiologia , Infecções por Salmonella/complicações , Infecções por Salmonella/tratamento farmacológico , Infecções por Salmonella/microbiologia , Resultado do Tratamento
3.
Rev Mal Respir ; 37(9): 752-755, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-32888731

RESUMO

INTRODUCTION: Hypersensitivity pneumonitis (HP) is an interstitial lung disease due to an immunological reaction to exposure, by inhalation, to a large variety of antigens. The patho-physiological mechanism remains poorly understood. The diagnosis can be challenging and requires a detailed medical history taking especially when the clinical presentation is atypical or when the causal agent remains unknown. CASE REPORT: We report the case of a 75-year-old woman with a history of mammary carcinoma who presented with recently identified intramammary adenopathy. Biopsy of the adenopathy revealed non-necrotising, giant cell epithelioid granuloma. A diagnosis of hot tub lung with extra-pulmonary granulomatous lymph node involvement was made based on the clinical, functional, radiological and microbiological investigations. The evolution was favorable following antigen avoidance. CONCLUSION: Extrapulmonary lymph node involvement is rare in HP, suggesting a systemic inflammatory involvement.


Assuntos
Alveolite Alérgica Extrínseca/complicações , Alveolite Alérgica Extrínseca/diagnóstico , Neoplasias da Mama/complicações , Carcinoma Ductal de Mama/complicações , Linfadenopatia/diagnóstico , Idoso , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/patologia , Diagnóstico Diferencial , Feminino , Humanos , Linfadenopatia/complicações , Complexo Mycobacterium avium/imunologia , Infecção por Mycobacterium avium-intracellulare/complicações , Infecção por Mycobacterium avium-intracellulare/diagnóstico
6.
J Med Virol ; 92(7): 891-902, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32314805

RESUMO

OBJECTIVE: We systematically reviewed the computed tomography (CT) imaging features of coronavirus disease 2019 (COVID-19) to provide reference for clinical practice. METHODS: Our article comprehensively searched PubMed, FMRS, EMbase, CNKI, WanFang databases, and VIP databases to collect literatures about the CT imaging features of COVID-19 from 1 January to 16 March 2020. Three reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies, and then, this meta-analysis was performed by using Stata12.0 software. RESULTS: A total of 34 retrospective studies involving a total of 4121 patients with COVID-19 were included. The results of the meta-analysis showed that most patients presented bilateral lung involvement (73.8%, 95% confidence interval [CI]: 65.9%-81.1%) or multilobar involvement (67.3%, 95% CI: 54.8%-78.7%) and just little patients showed normal CT findings (8.4%). We found that the most common changes in lesion density were ground-glass opacities (68.1%, 95% CI: 56.9%-78.2%). Other changes in density included air bronchogram sign (44.7%), crazy-paving pattern (35.6%), and consolidation (32.0%). Patchy (40.3%), spider web sign (39.5%), cord-like (36.8%), and nodular (20.5%) were common lesion shapes in patients with COVID-19. Pleural thickening (27.1%) was found in some patients. Lymphadenopathy (5.4%) and pleural effusion (5.3%) were rare. CONCLUSION: The lung lesions of patients with COVID-19 were mostly bilateral lungs or multilobar involved. The most common chest CT findings were patchy and ground-glass opacities. Some patients had air bronchogram, spider web sign, and cord-like. Lymphadenopathy and pleural effusion were rare.


Assuntos
Betacoronavirus/patogenicidade , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico por imagem , Linfadenopatia/diagnóstico por imagem , Pandemias , Derrame Pleural/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Betacoronavirus/genética , Biomarcadores/análise , China/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Linfadenopatia/complicações , Linfadenopatia/epidemiologia , Derrame Pleural/complicações , Derrame Pleural/epidemiologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
9.
J Investig Med High Impact Case Rep ; 7: 2324709619892724, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808363

RESUMO

This is a rare case of sarcoidosis-like granulomatous lymphadenopathy that was initially mistaken for a neoplastic process due to the degree of hypermetabolic changes observed on positron emission tomography (PET) scan. Sarcoid-like granulomatous pulmonary disease is a disorder that has been described in WTC (World Trade Center) Rescue Workers, and also known as post 9/11 sarcoidosis. We present an interesting case of a man who presented with several months of progressive dyspnea and was later discovered to have significant bilateral hilar adenopathy, which was PET avid. Even more interesting, this patient's symptoms completely resolved without the use of systemic steroids or immune suppressants. This is a condition that requires awareness in order to avoid repeating unnecessary tests of performing interventions on a benign condition that may resolve on its own.


Assuntos
Granuloma/diagnóstico por imagem , Linfadenopatia/diagnóstico por imagem , Trabalho de Resgate , Sarcoidose Pulmonar/diagnóstico por imagem , Tolerância a Antígenos Próprios , Diagnóstico Diferencial , Dispneia/etiologia , Granuloma/complicações , Humanos , Linfadenopatia/complicações , Masculino , Pessoa de Meia-Idade , Sarcoidose Pulmonar/complicações , Ataques Terroristas de 11 de Setembro , Procedimentos Desnecessários
15.
Cir. plást. ibero-latinoam ; 45(3): 225-234, jul.-sept. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-184395

RESUMO

Introducción y Objetivo. El linfoma anaplásico de células grandes asociado a implantes mamarios es un subtipo de linfoma de células T periférico que se puede encontrar en la cápsula periprotésica, el fluido entre implante y cápsula en forma de seroma o en casos avanzados como enfermedad metastásica. Aportamos 4 casos clínicos de este tipo de linfoma diagnosticados en la provincia de Alicante, España, siendo de interés por ser escasa la incidencia reportada y pocos los trabajos científicos publicados a nivel nacional sobre esta patología. Material y método. Describimos estos 4 casos registrando: edad, antecedentes, indicación del implante, detalles de la cirugía previa, tipo de superficie y marca del implante, presentación clínica del cuadro y tratamiento administrado. Resultados. Dos casos correspondieron a cirugía estética y 2 a cirugía reconstructiva, la presentación clínica en 3 casos fue como seroma tardío y en 1 como linfadenopatía. Tres implantes eran de superficie texturizada y 1 de poliuretano. En todos los casos se realizó capsulectomía bilateral. Conclusiones. La aportación de nuestra serie contribuye a destacar la importancia de reportar los casos diagnosticados dada la escasa incidencia de la enfermedad y el reducido número de publicaciones sobre la misma en el ámbito iberolatinoamericano


Background and Objective. The anaplastic large cell lymphoma associated with breast implants is a subtype of peripheral T cell lymphoma that can be found in the periprosthetic capsule, the fluid between the implant and the capsule in the form of a seroma, or in advanced cases such as metastatic disease. We provide 4 clinical cases diagnosed in the province of Alicante, Spain, being of interest because of the low incidence reported and few published scientific papers nationwide. Methods. We describe these 4 clinical cases and recorded: age, history, implant indication, previous surgery details, implant type of surface and brand, clinical presentation of the pathology and treatment. Results. Two cases corresponded to cosmetic surgery and 2 to reconstructive surgery; clinical presentation in 3 cases was late seroma and lymphadenopathy in 1. Three implants had textured surface and one was of polyurethane. Bilateral capsulectomy was performed in all cases. Conclusions. The main contribution of our cases is to highlight the importance of informing about diagnosed cases, because of the rare incidence of the disease and the lack of publications about this theme in the Ibero-Latinamerican environment


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Linfoma Anaplásico de Células Grandes/complicações , Linfoma Anaplásico de Células Grandes/diagnóstico , Implantes de Mama/efeitos adversos , Neoplasias da Mama/diagnóstico por imagem , Mamoplastia/métodos , Espanha , Seroma/complicações , Seroma/patologia , Seroma/cirurgia , Linfadenopatia/complicações , Linfadenopatia/cirurgia , Estudos Retrospectivos , Imuno-Histoquímica
18.
Int J Mol Sci ; 20(13)2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31277406

RESUMO

Cutaneous metastases from internal malignancies are uncommon. Umbilical metastasis, also known as Sister Joseph nodule (SJN), develops in patients with carcinomatous peritonitis or superficial lymphadenopathy, while non-SJN skin metastases develop after surgery, injury, and lymphadenopathy. In this review, the possible mechanisms of skin metastases are discussed. SJNs develop by the contiguous or lymphatic spread of tumor cells. After surgery and injury, tumor cells spread by direct implantation or hematogenous metastasis, and after lymphadenopathy, they spread by extranodal extension. The inflammatory response occurring during wound healing is exploited by tumor cells and facilitates tumor growth. Macrophages are crucial drivers of tumor-promoting inflammation, which is a source of survival, growth and angiogenic factors. Angiogenesis is promoted by the vascular endothelial growth factor (VEGF), which also mediates tumor-associated immunodeficiency. In the subcutaneous tissues that surround metastatic lymph nodes, adipocytes promote tumor growth. In the elderly, age-associated immunosuppression may facilitate hematogenous metastasis. Anti-VEGF therapy affects recurrence patterns but at the same time, may increase the risk of skin metastases. Immune suppression associated with inflammation may play a key role in skin metastasis development. Thus, immune therapies, including immune checkpoint inhibitors reactivating cytotoxic T-cell function and inhibiting tumor-associated macrophage function, appear promising.


Assuntos
Linfadenopatia/complicações , Peritonite/complicações , Neoplasias Cutâneas/secundário , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Humanos , Nódulo da Irmã Maria José/patologia , Nódulo da Irmã Maria José/secundário , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia
19.
Gan To Kagaku Ryoho ; 46(4): 739-741, 2019 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-31164520

RESUMO

We report a patient who had Castleman's disease with lymphadenopathy during the treatment of gastric cancer. In May 2017, a 63-year-old man underwent gastrointestinal endoscopy, which revealed a tumor on the posterior wall of the lower part of the stomach. Based on a biopsy, he was diagnosed with suspected adenocarcinoma, Group 4. In June 2017, he visited our hospital, and endoscopic submucosal dissection(ESD)was performed. The pathological diagnosis of the resected specimens was L, Less, 20×10 mm, Type 0-Ⅱc, tub1, pT1a(M), UL(-), ly(-), v(-), pHM0, pVM0, pStage ⅠA. He was referred to our department for the treatment of abdominal lymphadenopathy. His lymphadenopathy was localized in the gastric lesser curvature as an enlarged lymph node 15mm in size, based on the findings of contrast-enhanced CT. On FDG- PET/CT, we found a slight accumulation of SUVmax 2.4 in the early phase in the same lymph node. We could not confirm a diagnosis, and we performed laparoscopic dissection of the lymph node for diagnosis and treatment. The size of the specimen was 14×14mm, surface was smooth, and lymph node was elastic and soft. We found lymphoid follicles with atrophic germinal center using HE staining. We also found increased hyperplastic blood vessels around the germinal center, and he was diagnosed with hypervascular Castleman's disease.


Assuntos
Hiperplasia do Linfonodo Gigante , Linfadenopatia , Neoplasias Gástricas , Hiperplasia do Linfonodo Gigante/complicações , Hiperplasia do Linfonodo Gigante/diagnóstico por imagem , Humanos , Linfadenopatia/complicações , Linfadenopatia/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Gástricas/complicações , Neoplasias Gástricas/terapia
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