Clinical challenges and images in GI. Yersinia enterocolitica mesenteric adenitis and terminal ileitis.
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Bulky mesenteric lymphadenopathy and B symptoms in a patient with a prior history of relapsed histologically aggressive non-Hodgkin's lymphoma would usually be attributed to recurrent disease. In the case described here, recurrent lymphadenopathy was found to be due to probable Yersinia infection, highlighting the need for rebiopsy of tissue in these circumstances wherever possible.
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The incision of DNA at apurinic/apyrimidinic sites (AP-sites) by chloro-6-methoxy-2 [(adenyl-9)-11)-4,8 diazadecyl]amino-9 acridine (Ade-Z-Acr), a 9-aminoacridine linked to an adenine, at nanomolar concentrations is described. Moreover, this drug, Ade-Z-Acr, is one of the most efficient drugs which cleaves DNA at AP-sites. The high activity is the result of the composition of the drug, since the individual components have no incising activity in the concentration range studied. The termini left by the Ade-Z-Acr molecule are a 3'deoxyribose and a 5'nucleotide. The termini and the inability of the Ade-Z-Acr to incise DNA with reduced AP-sites suggest that the mechanism of cleavage is beta-elimination.
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Rapidly growing mycobacteria, an infrequent cause of human disease, are increasingly being recognized as human pathogens rather than mere colonizers. Rapidly growing mycobacteria infrequently cause disease in patients with acquired immunodeficiency syndrome (AIDS). It is unclear whether patients with AIDS are more predisposed than others to infection by these organisms. The optimal regimen and duration of treatment is similarly uncertain. Mycobacterium fortuitum is a rare cause of lymphadenitis or neck abscess. We report two cases of M fortuitum neck abscesses in patients with AIDS which were successfully treated with antibiotics after initial drainage. In one of these patients, M fortuitum neck abscess was the AIDS-defining illness. We also present a review of the cases reported in literature. It appears that such infections may be treated with a combination of ciprofloxacin and clarithromycin after incision and drainage of the abscess.
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