1/34. Ocular toxocariasis: a rare presentation of a posterior pole granuloma with an associated choroidal neovascular membrane.BACKGROUND: Ocular toxocariasis is a rare infection caused by the nematode larvae of toxocara canis, which is commonly found in dogs. Human transmission is usually via geophagia, the ingestion of food contaminated with the toxocara eggs, or contact with infected puppies, often resulting in devastating ocular and/or systemic effects. Distribution is worldwide; however, a higher incidence is demonstrated in the united states. methods: A 17-year-old black woman sought treatment at a neighborhood health center with a report of gradual decrease in vision from her left eye over a 3-month period. Her ocular and systemic histories were unremarkable. Anterior segment evaluation revealed no signs of anterior uveitis. The posterior pole showed a 1.5 DD, round, raised, white, subretinal lesion adjacent to the fovea with an overlying serous retinal detachment and retinal hemorrhage. RESULTS: She was referred to a retinologist who performed both fluorescein and indocyanine green (ICG) angiographies. A serum toxocara ELISA test was also ordered. fluorescein angiography revealed hyperfluorescence consistent with the granuloma. The ICG demonstrated an occult choroidal neovascular membrane (CNV) underlying the area of hemorrhage inferotemporal to the granuloma. CONCLUSION: This paper illustrates the case presentation and includes an extensive review of the ocular and systemic manifestations of toxocariases. A description of ICG videoangiography, therapeutic approaches, and management will also be discussed.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
2/34. Orbital apex lesion as the presenting manifestation of sarcoidosis.A 32-year-old black woman presented with progressive proptosis, diplopia, and optic disc edema of the right eye. A computed tomography scan of the orbit showed a right retroorbital mass. A gallium scan showed increased radiotracer activity in the right retroorbital region. biopsy of the mass showed non-caseating granulomas that were compatible with sarcoidosis. The patient was treated with systemic steroids, and the proptosis and diplopia resolved. Seven months later, the patient presented with contralateral optic neuropathy. neuroimaging showed enlargement of the left optic nerve. The patient again responded to systemic steroid treatment and experienced complete restoration of vision. An orbital apex lesion may be the presenting manifestation of sarcoidosis.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
3/34. granulomatous mastitis in pregnancy.BACKGROUND: granulomatous mastitis, a rare, benign breast condition characterized by granulomas and abscess formation, is mistaken frequently for inflammatory breast carcinoma. Although it has been reported in reproductive-age women, it is unusual in pregnancy. CASE: A 25-year-old black gravida 4 para 2 developed a tender, indurated 20 x 15 x 15 cm multilobulated breast mass at 17 weeks' gestation. After not responding to antibiotics and incisional drainage, the biopsy-proved granulomatous mastitis improved with corticosteroid treatment. A postpartum recurrence also responded to steroid therapy. CONCLUSION: granulomatous mastitis is diagnosed clinically and histologically. Early recognition and initiation of steroid treatment might prevent repetitive, deforming breast biopsies.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
4/34. Wear debris from total hip arthroplasty presenting as an intrapelvic mass.A granulomatous reaction to the small particles worn off from an implanted prosthesis is a common complication in arthroplasty. The chronic inflammatory response to the wear debris from either the polyethylene or the metal components is thought to be responsible for osteolysis, implant loosening, and finally mechanical failure. Formation of an extra-articular granulomatous tissue mass is uncommon, however. We report a case of a huge granulomatous mass that presented as an intrapelvic tumor. The prosthesis was an Anatomical Medullary Locking (AML) hip arthroplasty with cementless fixation. The polyethylene insert was manufactured by ram extrusion and sterilized with gamma irradiation in air. Fragments of the insert were among the contents in the cystic mass together with black metallic debris. There was no loosening of the prosthesis, and the acetabulum floor was preserved.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
5/34. AAOMP case challenge: hemorrhagic gingival mass.This 24-year old black female presented with a chief complaint of this gingival mass. She states she first noticed the lesion about three months ago and it has gotten progressively larger. What is your diagnosis?- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
6/34. cerebral amyloid angiopathy with granulomatous angiitis ameliorated by steroid-cytoxan treatment.We report a case of a 62-year-old black woman who, 8 months prior to death, developed confusion, apraxias, disorientation, and difficulties with her vision. There was no dementia. Computed tomography (CT) scan and magnetic resonance imaging (MRI) suggested a tumor in the right posterior parietal white matter. A biopsy of the lesion displayed granulomatous angiitis and severe cerebrovascular amyloidosis, but no tumor was identified. Chronic inflammation with an occasional multinucleated giant cell was seen about the amyloid-infiltrated vessels. The cortex demonstrated gliosis but no plaques or tangles. Subsequently, the patient was treated with steroids and Cytoxan, with an improvement in her neurologic status. She died of opportunistic bronchopneumonia 8 months after the initial onset of her symptoms. On postmortem examination, the biopsied area of the brain showed atrophy with gliosis. Amyloid angiopathy was present but in much lesser degree than in the biopsy. Scant perivascular inflammatory infiltrates were seen only focally, and no giant cells were observed. The amyloid, both in the biopsy and autopsy material, was of the Alzheimer A4 type. This case suggests that steroid and cytoxan treatment ameliorated the angiitis and the amyloid angiopathy as well. The pertinent literature is discussed.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
7/34. Fulminant disseminated pulmonary adiaspiromycosis in humans.A case of fulminant disseminated pulmonary adiaspiromycosis is reported. The patient, a 35-year-old black male farm worker, presented with a four-week history of generalized weakness, unproductive cough, evening fever, and a weight loss of 8 kg. He died 12 days after hospitalization of respiratory failure due to granulomatous lung disease. The clinical and radiographic findings were indistinguishable from those of miliary tuberculosis. Microscopic examination of material obtained at autopsy revealed the large fungus characteristic of adiaspiromycosis in the center of suppurative granulomas throughout the lungs. This is believed to be the first fatal case of pulmonary adiaspiromycosis reported in humans, and it may have been occupationally acquired.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
8/34. Keloidal granuloma faciale with extrafacial lesions.Granuloma faciale (GF) is a rare cutaneous disorder characterized by one to several soft, erythematous to livid papules, plaques or nodules, usually occurring on the face. Extrafacial lesions are uncommon. A 52-year-old lady with multiple asymptomatic, variously sized brownish-black colored, firm, sharply circumscribed plaques resembling keloids on both cheeks and extrafacial lesions on the right arm and the right breast is presented for its unusual keloidal appearance and typical histopathological findings. She failed to respond to oral dapsone 100 mg daily administered for 3 months. Local infiltration of triamcinolone combined with cryotherapy led to only partial flattening of the lesions. All the skin lesions were excised surgically followed by flap transfer grafting on both cheeks. The cosmetic outcome was highly satisfactory.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
9/34. Granulomatous reaction to titanium alloy: an unusual reaction to ear piercing.A 68-year-old man presented with 4 firm, flesh-colored, and slightly erythematous nodules located on the superior pole and lobule of each ear. Although reluctant to provide details, it was discovered he had pierced his ears approximately 10 years earlier, and the nodules developed at the sites of the piercings. Keloids were suggested clinically and the lesions were excised. Microscopic examination demonstrated epithelialized tracts surrounded by a granulomatous infiltrate of macrophages, lymphocytes, and plasma cells. Closer examination revealed minute brown-black particles within macrophages. Dark-field microscopy confirmed the metallic nature of the particles. Environmental scanning electron microscopy with energy dispersive spectroscopy revealed the particles to be composed of titanium, aluminum, and vanadium. It would appear that in rare circumstances titanium alloy used in body piercing may engender a granulomatous dermatitis. The rarity of such a response to titanium alloy is discussed and the literature appraised.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
10/34. Actinic granuloma-like change in exogenous ochronosis: case report.Exogenous ochronosis is caused by the longterm application of skin-lightening creams containing hydroquinone. This irreversible disfiguring cosmetic problem assumes epidemic proportions in South African blacks. Mild ochronosis is characterized clinically by coarsening and darkening of the skin and severe ochronosis by coalescing, caviar-like black papules and atrophy. histology shows ochronotic collagen fibres with eventual formation of ochronotic colloid milium. A variable cellular infiltrate, which may be granulomatous, is present. We describe a 39-year-old black woman with severe exogenous ochronosis who developed superimposed annular lesions with granulomatous histology bearing great resemblance to lesions of actinic granuloma.- - - - - - - - - - ranking = 3keywords = black (Clic here for more details about this article) |
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