[Interstitial lung disease of unclear etiology].
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A granulomatous inflammatory response develops in jirds with lymphatic or intraperitoneal infections of Brugia pahangi. Light, histochemical, and ultrastructural microscopy were used for comparative studies of the reactions in these 2 locations. The reactions observed were categorized into 3 types: (1) an initial response in which lymphocytes, monocytes, macrophages, and eosinophils were present; (2) an intermediate one which consisted of macrophages, epithelioid cells, lymphocytes, eosinophils, collagen, and mesothelial/endothelial cells with central areas of necrosis; and (3) a terminal reaction consisting of degenerating, necrotic cells. Microfilariae and adult worms were associated with these reactions. Macrophages were the predominant cell type in the lesion and were often found attached to the surface of the parasite. The inflammatory responses to B. pahangi in the lymphatics and in the peritoneal cavity appear to be similar, and thus, the peritoneal cavity may be useful in studying specific cell-parasite interactions to further define the pathogenesis of filarial disease.
A 22-year-old man developed erythematous nodules and an ulcer mimicking sporotrichosis on his right hand and forearm, which was subsequently diagnosed as lymphocutaneous nocardiosis caused by Nocardia asteroides. To our knowledge, 21 cases of lymphocutaneous nocardiosis have been reported, with the majority of those cases, except for a few that remain uncertain, being due to Nocardia brasiliensis. The case reported herein, the first known definitive case caused by N asteroides (to our knowledge), showed a more chronic course and less inflammatory manifestation compared with that caused by N brasiliensis. This is probably because N brasiliensis has a stronger virulence than N asteroides.
A case of cutaneous lymphangitic sporotrichosis in a 63-year-old Sicilian woman is reported. The diagnosis of sporotrichosis was made using a direct smear preparation and confirmed by the findings of histological studies and those obtained via culture ketoconazole therapy led to a significant reduction of the lesions.
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We studied the clinical and radiological features of pulmonary metastases present in 4 out of 22 patients with medullary carcinoma of thyroid. Two patients presented with common metastases: macronodules in one, and micronodules in the other one. The other two patients presented initially with reticulonodular perihilar lesions on chest X-ray, leading to the diagnosis of sarcoidosis in both of them. The observation of such pulmonary metastases is original: initially latent, they progress very slowly, and they correspond to a lymphangitic spread of the tumour with amyloid deposition in peribronchovascular structures without alveolar involvement, as shown in one of our cases with pathologic study.
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We report a rare case of primary lymphocutaneous Nocardia brasiliensis infection occurring in an elderly diabetic man maintained on long-term therapy with prednisone. The mode of inoculation was that of a puncture wound caused by a contaminated needle that occurred one month prior to the development of the clinically apparent infection. The course of this patient's infection was protracted and required two surgical procedures and several months of antibiotic therapy. A review of 15 previously reported cases is presented as well as a discussion of appropriate medical therapy.
Based on a series of 18 cases of elephantiasis of male genital organs and a literature review, the principal features of this lymphatic system disease are described.
From May 1983 to June 1985 the authors performed a thoracoscopy as a diagnostic and therapeutic objective in 83 patients with chronic recurrent pleurisy; amongst these patients, 69 had know intra or extra thoracic cancer and the other 14 presented with an isolated pleurisy. Eight other patients had pleural carcinomatosis proven by needle biopsy and had pleural talc introduced by thoracoscopy. The examination was performed under local anaesthesia with neuroleptanalgesia; a rigid 7 mm diameter thoracoscope was used; the biopsies were performed uniquely on the parietal pleura using tropical forceps. The outcome was uncomplicated with no deaths nor any serious complications due to the method. The sensitivity of the pleural biopsy was 91.5% or 76 positive biopsies out of 83. 73 biopsies were metastatic and 3 were tuberculous pleurisies. The macroscopic appearance was strongly suggestive of malignancy in 78 patients and appeared inflammatory in 13, of whom 9 cases were positive on biopsy. The authors performed a pleural talcage in every case; a lasting pleural adhesion was obtained in 66 patients but regrettably there were 14 failures, the effusion recurring after removal of the drain. The authors stress the reduced number of incidents of pleural effusion, which confirms the good tolerance of pleural endoscopy.
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