Background: Accuracy in the clinical diagnosis of asbestosis has significant implications for the future health of affected patients as well as serious medicolegal implications for both patients and asbestos-associated industries. The radiographic gold-standard for diagnosis of asbestosis has been the plain chest radiograph, and in many asbestosis-screening clinics, chest radiograph abnormalities in conjunction with a history of asbestos exposure have been the mainstay of diagnosis. No studies have yet compared the antemortem chest radiographic diagnosis of asbestosis with the subsequent presence of pulmonary fibrosis and lung tissue ferruginous bodies at autopsy.
In pediatric patients, Kluyvera spp. has emerged as a cause of disease ranging from soft tissue infections to sepsis with multiorgan failure. Successful treatment options include third-generation cephalosporins, tetracycline, aminoglycosides, and fluoroquinolones, but resistance to first- and second-generation cephalosporins persists. Clinicians should be aware of the spectrum of disease and increasing clinical importance associated with this emerging pathogen.
ER is a facultative, non-spore-forming, non-acid-fast, gram-positive bacillus. It is a ubiquitous commensal in wild and domestic animals, birds, and fish and has an enormous economic impact on animal husbandry and marine industry, causing animal erysipelas. Human infections are extremely rare, occupationally acquired zoonosis. Human infections are acquired through wounds, contact with sick animals, and carriers and commonly includes localized or generalized self-limited cutaneous erysipelas. Seldom, systemic infection and septicemia occur. We present here, a case of a 50-year-old immunocompetent retired shipyard welder who enjoyed fishing in his spare time and presented to the emergency room with fever, chest pain, significant weight loss, and dry cough lasting 2 to 3 months. He did not report any bites or injuries, intravenous drug abuse, or travel history. An echocardiogram showed mobile vegetation on aortic valve with severe regurgitation. Blood and tissue cultures grew E rhusiopathiae, identified by MALDI-TOF method. He was treated with empiric vancomycin followed by penicillin and aortic valve replacement with a mechanical valve. Cases of E rhusiopathiae–induced native valve endocarditis and septicemia are extremely infrequent in immunocompetent individuals, especially when occupation-related exposure is not noted. Even after surgery, it may entail fatality rates as high as 40%, higher than endocarditis caused by other bacteria. While some current reports suggest incidences of human infections are declining due to technological advances in animal industry, infection still occurs in specific environments. Additionally, it may be underdiagnosed due to its resemblance to other infections and problems encountered in isolation and identification. The natural resistance of E rhusiopathiae to glycopeptides underlines the importance of a prompt microbiological diagnosis of such an uncommon human infection, especially when presented in an unusual clinical presentation. Clinicians and microbiologists working with exposed population should be aware of this microbe and its manifestations.
Introduction Clear cell sarcoma of kidney (CCSK) is a rare malignancy accounting for <0.5% of all primary renal tumors, commonly diagnosed between 2 and 4 years of age and rarely occurring in early infancy. The challenging differentiation between CCSK and blastemal Wilms tumor is important because of the distinct clinical pattern of CCSK to recur and metastasize to bone and brain. The aim of this study is to discern subtle features that could assist pathologists in diagnosing CCSK in infancy. Method In-depth comparison of clinical, histological, and immunohistochemical findings in a case of CCSK diagnosed at 5 months of age with two cases of CCSK diagnosed at 2 and 3 years of age. Results Both groups were male, and each presented with an abdominal mass. Grossly, a single, firm, well-demarcated tumor, morphologically comprising monotonous small primitive round-to-polygonal/spindle cells, was seen in both groups. The major differences between the study groups were growth patterns and stromal reactions. In infancy, the growth pattern was diffusely uniform sheets of malignant cells with no entrapment of tubules and inconspicuous stromal changes. However, in childhood cases, the growth pattern included well-defined tubular entrapment, as well as focal microcyst formation, myxomatous stroma, palisading bodies, and anaplastic and/or rhabdoid histology. In both study groups, the immunohistochemistry showed strong immunoreactivity with cyclin D1 and nonspecific positivity for vimentin, CD99, and BAF47. Conclusion CCSK has notoriously diverse histological heterogeneity and mimics other pediatric renal tumors, making diagnosis treacherous, and commonly erroneous as Wilms tumor with unfavorable histology. Despite the advent of immunohistochemical and molecular techniques, a thorough morphologic analysis remains key in accurately diagnosing CCSK at any age, especially in early infancy. This small in-depth comparison of CCSK by age groups suggests that tubular entrapment and stromal changes may be less conspicuous in CCSK in early infancy than at older ages.
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