In a study of zoonotic cutaneous leishmaniasis (CL) due to leishmania major in an endemic focus in Saudi Arabia, lymph node enlargement was observed in 66 of 643 patients (10.26%). The epitrochlear lymph nodes were most commonly involved (68%), but cervical (11%), axillary (15%), and inguinal (18%) lymph nodes were also involved. In eight patients (12%), two lymph node areas were involved. The affected lymph nodes were typically solitary, firm, mobile, nontender, only moderately enlarged, and appeared to persist beyond the clinical healing of the associated skin lesions. The results of pathologic and immunopathologic studies carried out on eight lymph nodes obtained from this group of patients supported the leishmanial etiology. Although amastigotes were only demonstrated in two lymph nodes, the leishmanial antigen was found in all eight specimens. The lymph node involvement is another manifestation of dissemination in infection with a dermotropic leishmania. It appears that in some cases, instead of the parasite, it may be the leishmanial antigen that disseminates and produces lymphadenitis.

In this report we present our experience with 76 cases of chronic idiopathic ulcerative colitis (IUC) out of 1279 consecutive colorectal biopsies (6.0%), seen during an 11-year period (1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994), in a tertiary care teaching hospital. During the same period, 12 (0.8%) patients with Crohn's disease were seen. Of the 76 patients with IUC, forty-nine were male and 27 were female, with an age range of six to 88 years, a mean of 38 ± 16 and a median of 36 years. Forty-nine patients were Saudi Nationals (27M, 22F), 21 were non-Saudi Arabs and six were Asians. In most patients, the onset of IUC was at 20 to 49 years (70%). The disease duration at diagnosis ranged from one month to five years, with a median of 12 months. The follow-up period ranged from 13 months to 11 years, with a median of three years. Diarrhea, hematochesia and abdominal pain were the dominant symptoms. The disease grade was generally of mild to moderate severity (55 patients, 72%) and was of low stage (distal involvement in 69 patients, 91%). The rarity of skin manifestations and of development of colonic cancer is to be noted in spite of the relatively short period of follow-up. Our findings compare with experience from the region, confirming the mild course of the disease as contrasted to Western experience. These findings will be discussed. Ann Saudi Med 1996;16(6):637-640. Until recently, it was generally believed that chronic idiopathic ulcerative colitis (IUC) and Crohn's disease were rarely seen in underdeveloped nations, including Middle Eastern, Asian and African countries. Only a few reports had emerged from such areas.1-3 However, during the last 12 years more cases have been encountered, particularly from the Middle East.3-7 It appears that the current frequent encounter of IUC in such countries parallels the exponential growth in development and industrialization, a tendency to more Western dietary habits and exposure to more psychological stress associated with such a life. Furthermore, increased awareness of the disease and improvement in diagnostic modalities plays a significant role. This study from Saudi Arabia further documents that idiopathic chronic ulcerative colitis exists in the Arabian Peninsula, though with much less frequency than in developed Western hemisphere countries. Material and MethodsA retrospective evaluation of all lower gastointestinal (LGI) endoscopies during the period 1983-1994 at King Fahd Hospital of the University, Al-Khobar, was performed. Of all such cases, only those who had a biopsy were included. The medical records were reviewed for age, sex, nationality, symptoms and duration, endoscopic findings and follow-up information.All pertinent histological sections and paraffin blocks were retrieved for review and evaluation. Using standard histological criteria and in light of clinical and endoscopic findings, patients were categorized into various diagnostic entities.Patients presenting with recurrent abdominal pain, chronic diarrhea with or ...

The study demonstrates the comparatively high frequency of gastric lymphoma in this population and confirms the intimate association of H-pylori infection to both gastric adenocarcinoma and MALT-lymphoma. Gastric lymphoma should always be considered in the differential diagnosis of gastric malignancy and the use of immunohistochemistry is essential for the differential diagnosis of some of these tumors.

Peripheral neural involvement in cutaneous leishmaniasis has recently been recognized. A man presented with several tender hyperesthetic skin nodules. Histopathologic examination confirmed the diagnosis of cutaneous leishmaniasis. Of most interest was the presence of a striking lymphohistocytic inflammatory infiltrate around and within cutaneous nerves in addition to demonstrable leishmania organisms in the perineural space. This observation led to a detailed histopathologic evaluation of leishmanial skin lesions that developed in 13 mice after subcutaneous injection with leishmania major promastigotes. Varying degrees of neural involvement was noted in skin lesions from nine animals. In some lesions, in addition to inflammatory cells in the nerves, organisms were demonstrable within probable schwann cells. Three pathologic stages of dermal neural involvement were identified, namely, an early, intermediate, and late stage, depending on the severity of damage; however no correlation was found between the pathologic stage and the duration of the leismanial skin lesion of a specific animal.