Aims: To formulate evidence based histopathological criteria for the diagnosis of acquired toxoplasmic lymphadenitis, in an area of high tuberculosis prevalence. Methods: Multiple histopathological parameters were assessed in a consecutive sample of biopsies from 68 patients presenting with lymphadenopathy with a duration of less than six months. Serum IgM enzyme linked immunosorbent assay was used as the standard reference test for the diagnosis of toxoplasmic lymphadenitis. The sensitivity, specificity, and likelihood ratios of various histological parameters were estimated. Results: The presence of microgranulomas (p , 0.0001), paracortical widening (p = 0.006), paracortical hyperplasia (p = 0.02), monocytoid B cells in sinuses (p = 0.007), lower than grade 2 macrogranuloma (p = 0.002), and the absence of giant cells (p = 0.05) were found to discriminate between IgM positive cases and IgM negative controls. Using a composite criterion-(1) presence of microgranulomas, (2) lower than grade 2 macrogranuloma, (3) absence of giant cells, and (4) follicular hyperplasia-toxoplasmic lymphadenitis can be diagnosed with a high degree of sensitivity (100%), specificity (96.6%), and positive likelihood ratio (29). Conclusion: Toxoplasma lymphadenitis can be diagnosed with a high degree of confidence using the specific histopathological criteria identified here.
Normocytic anaemia is caused either by hypoproliferation of haemopoietic tissue or increased destruction of red cells. Osteopetrosis is a rare cause of anaemia. Infantile osteopetrosis (also called malignant osteopetrosis) is diagnosed early in life. But it is the adult osteopetrosis (also called benign osteopetrosis) which is diagnosed in late adolescence or adulthood that present as anaemia which is difficult to diagnose and treat. Approximately one half of patients are asymptomatic, and the diagnosis is made incidentally, often in late adolescence because radiologic abnormalities start appearing only in childhood. In other patients, the diagnosis is based on family history. Still other patients might present with osteomyelitis or fractures. We are presenting here an unusual case of osteopetrosis which was referred to us for the evaluation of anaemia.
Chronic pulmonary blastomycosis is often misdiagnosed and treated as tuberculosis in disease-endemic and non–disease-endemic areas. We report the case of a 32-year-old man who after visiting Chicago, Illinois, USA, returned to India and received treatment for tuberculosis for 12 months before receiving the correct diagnosis of blastomycosis.
Introduction:Bacillus cereus is a gram positive bacilli found commonly in the soil and environment. It is a bacteria rarely associated with endocarditis.Case History:Intravenous drug abuse, presence of valvular defects, pacemakers, immunodeficiency are some of the known risk factors for B.cereus endocarditis. We present here a case series of two patients with B.cereus endocarditis along with a review of the literature.Conclusion:This is the first report of B.cereus endocarditis from India to the best of our knowledge.
Eosinophilic pustular folliculitis or Ofuji's disease is a non-infectious eosinophilic infiltration of hair follicles, which usually presents with itchy papules and pustules in a circinate configuration. We report this case of an immunocompetent patient with erythematous papules and plaques without macropustules diagnosed as eosinophilic pustular folliculitis—a rarely reported entity outside Japan. He was successfully treated with oral dapsone.
<p class="abstract"><strong>Background:</strong> Amyloidosis is defined as extracellular deposits of heterogenic, misfolded proteins, amyloid fibrils, in various tissues. The term primary cutaneous amyloidosis (PLCA) usually includes macular amyloidosis (MA), lichen amyloidosis (LA) and nodular amyloidosis. Primary cutaneous amyloidosis is very common in Kerala probably due to socio-cultural practices. There has been no published data on PLCA from Kerala thus we undertook this study. The objectives of the study were to correlate clinical features of primary localized cutaneous amyloidosis with histopathologic findings; to evaluate the sensitivity of Congo red staining with polarized light in histopathologically proven primary localized cutaneous amyloidosis)</p><p class="abstract"><strong>Methods:</strong> We undertook an observational analysis for a period of 2 years from May 2012 to April 2014 in the Department of Dermatology, Amrita Institute, Cochin. All cases clinically diagnosed as cutaneous amylodosis were included in the study. After informed consent, skin biopsy was taken. The histopathologic sections were stained with Congo red and seen under polarized microscopy for apple green birefrengance.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 70 patients were included in the study. Of the 70 cases, there were 20 males and 50 females. The most common clinical type was lichen amylodosis observed in 32 patients followed by macular amylodosis (28) and biphasic amyloidosis (10) cases. Histopathological compatibility was seen in 71% of MA and 89% cases of LA. Congored positivity was seen in 53.8%. Congored stain under immunofluorescence microscopy was done for 30 patients which gave a positivity of 85% which indicates that it is more sensitive that polarizing microscopy.</p><p><strong>Conclusions:</strong> Our study showed that the most common type is lichen amylodosis. Histopathology and congo red staining with polarized light is a valuable aid in diagnosis. Congo red stain under immunofluorescence microscopy has greater sensitivity and improves the diagnostic yield. </p>
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