1/63. Mast cell sarcoma with tissue eosinophilia arising in the ascending colon.Mast cell sarcoma is a rare disease. We report an unusual case of this neoplasm arising in the ascending colon of a 32-year-old Japanese woman who presented with abdominal pain. An ulcerating mass in the colon was resected, along with enlarged mesenteric lymph nodes. Two years after surgery, the neoplasm recurred as left cervical lymphadenopathy and an intra-abdominal mass. Despite predonine and radiation therapy, the disease progressed, and the patient died. The tumor cells had abundant fine granular or clear cytoplasm, and oval, lobulated, or indented nuclei. Numerous mature eosinophils were intermingled with the tumor cells. Immunohistologic studies on paraffin sections demonstrated that the majority of the tumor cells were strongly positive for CD45RB, CD68, and mast cell tryptase. They were unreactive, however, with a broad spectrum of antibodies against myelomonocytic and lymphocytic antigens. The mast cell nature of this rare type of tumor can be best identifiable by immunostains for mast cell tryptase.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/63. Eosinophilic gastritis due to anisakis: a case report.BACKGROUND: the parasite anisakis simplex is a helminth included in the nematode class. When man eats raw or rare fish and cephalopods infested by anisakis larvae, he can acquire the parasitic disease (anisakidosis). The parasite can also originate manifestations of immediate IgE mediated hypersensitivity in patients with sensitisation to it. methods AND RESULTS: we present the case of a 14 year old boy diagnosed of eosinophilic gastritis after endoscopic examination and biopsy associated to recurrent abdominal pain. After allergologic study, a type I hypersensitivity mechanism against anisakis simplex is confirmed by means of prick test, antigen specific IgE determination and antigen specific histamine release test. Sensitisation against fish proteins is ruled out as well as parasitic infestation. CONCLUSIONS: in this case report we demonstrate a type I hypersensitivity mechanism against anisakis simplex in a patient diagnosed of eosinophilic gastritis. This can be suspected in cases of gastritis or non filiated enteritis with a torpid evolution following the conventional treatment and especially if the onset of the symptoms is related with the intake of fish. The therapeutic success was reached when fish and shellfish were taken out of the diet. After two years without seafood ingestion our patient is asymptomatic and the allergologic study has been normalised.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
3/63. Hypereosinophilia induced by high-dose intratumoral and peritumoral mistletoe application to a patient with pancreatic carcinoma.A patient with inoperable adenocarcinoma of the pancreas was treated with intraperitumoral and peritumoral injections of a viscum album L. extract containing 5,700 ng/mL mistletoe lectin, mainly mistletoe lectin 1 (Abnobaviscum quercus 2) for 5 weeks (1 injection per week). After the third injection (day 22), a marked eosinophilia was observed (1,800 per microliter) that rose to 3,268 per microliter after the fifth injection (day 42). Furthermore, histology performed on day 28 revealed accumulation of eosinophils in ductal lesions and adjacent stroma in addition to the features of ductal adenocarcinoma. In order to investigate whether eosinophilia correlated with immunological features, we analyzed cytokine production of peripheral blood mononuclear cells (PBMC) from this patient after stimulation with antigens known to "unmask" an individual's predisposition for defined immunoreactions, namely purified protein derivative (PPD) as a stimulator of T-helper (TH1)1-cells and tetanus toxoid (TT) as an activator of TH2-cells. PBMC of the patient showed a strong proliferation and production of interleukin (IL)-5 and IL-10 after incubation with TT indicating a type-2 response. Simultaneously, PBMC were induced to proliferate and produce interferon gamma (IFN-gamma) by incubation with PPD suggesting also a type-1 response. These data would readily explain the eosinophilia because eosinophils are effector cells of type-2 reaction but also require type-1 cytokines. Although the overall clinical course of the patient was rapidly progressive, temporary stabilization of the patient's general condition during mistletoe treatment was observed. It is, however, still an open question whether this transient benefit was due to the induction of eosinophilia by a type-2 response. CONCLUSION: Before high-dose intratumoral and peritumoral treatment with a viscum album L. extract containing mistletoe, lectin 1 can be associated with hypereosinophilia and strong production of TH1 as TH2 cytokines as well.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
4/63. Spontaneous B-cell IgE production in a patient with remarkable eosinophilia and hyper IgE.BACKGROUND: The pathophysiology of eosinophilia and hyper-IgE is not fully elucidated yet. OBJECTIVE: To clarify the pathophysiology of a patient with remarkable eosinophilia and hyper IgE, we examined cytokine levels in serum, surface antigens of peripheral blood eosinophils and IgE production in vitro. RESULTS: Concentrations of tumor necrosis factor-alpha (TNF-alpha), interleukin-3 (IL-3), interleukin-4 (IL-4), interleukin-5 (IL-5), and granulocyte/macrophage-colony stimulating factor (GM-CSF) in the serum were 21 pg/mL, <15 pg/mL, <15 pg/mL, 8 pg/mL, and <5 pg/mL pg/mL, respectively. Newly expressed surface antigens CD4, CD25, CD69, and HLA-DR, but not CD54, were observed on peripheral blood eosinophils. Extremely high levels of IgE secretion was found in the patient's mononuclear cells without stimuli; this was not enhanced by IL-4 or IL-4 plus anti-CD40 monoclonal antibody stimulation. Furthermore, highly purified B cells spontaneously produced large amounts of IgE and the production was not enhanced in addition of his T cells. CONCLUSION: The eosinophils were activated, and the B cells spontaneously produced IgE independently of T cells or cytokines, suggesting that intrinsic abnormality of B cells leading to dysregulated production of IgE in this disease.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
5/63. Organic antigen-induced interstitial lung disease: diagnosis and management.BACKGROUND: Traditionally, chronic idiopathic interstitial pneumonia/fibrosis (IIP/F) had included usual interstitial pneumonia, desquamative interstitial pneumonia, and nonspecific interstitial pneumonia (NSIP). More recent classifications have included bronchiolitis obliterans-organizing pneumonia (BOOP), respiratory bronchiolitis-associated interstitial lung disease, and acute interstitial pneumonia. Some chronic eosinophilic pneumonias (CEP)/pulmonary infiltrate with eosinophilia (PIE) have obvious causes, but many lack an identifiable etiology. We felt that hypersensitivity pneumonitis (HP) was being underdiagnosed and was hidden within this large heterogeneous group of interstitial lung disorders of unrecognized cause. OBJECTIVE: We sought to prove that detailed environmental histories and investigations would reveal causative contaminations in the home or workplace of some patients with idiopathic interstitial lung disease and remediation of the contamination would stabilize the disorder. methods: Consecutive cases of IIP/F were investigated. patients were identified by compatible signs and symptoms, roentgenographic studies, pulmonary function tests, and lung biopsies. They were further evaluated with detailed environmental histories, serologic tests, and investigation into the suspected causative environment. Environmental and specific antigen challenges were done in some cases. Remediation of contaminations or moving into another environment were the methods used as therapy. RESULTS: Eighty-six consecutive patients with IIP/F were evaluated. Twelve patients were subsequently diagnosed with specific causes for interstitial lung disease. Fifty-seven of 74 patients were identified by clinical evaluation and lung biopsy with HP, CEP/PIE, NSIP, BOOP, UIP, and nonclassifiable morphologic patterns. Seventeen patients were not biopsied or had an inadequate transbronchial biopsy but had consistent findings radiographically and clinically of idiopathic interstitial lung disease. Contamination of the home was causative in 69 of 74 and the workplace in 3 of 74 cases. There were 9 positive and 33 negative environmental challenges with 4 positive and 1 negative specific challenges. Fifty of 74 (67%) patients are receiving no treatment and are free of active disease after remediation of the environmental contamination, with a mean survival of 8.2 years. CONCLUSIONS: Our data show that UIP, BOOP, NSIP, CEP/PIE, and nonclassifiable morphologic patterns represent a spectrum of interstitial lung disease that may be caused by inhalation of organic dusts in the home or workplace as described with HP. Remediation of, or moving from the contamination, can lead to arrest of the active inflammatory process and stability of the lung disorder.- - - - - - - - - - ranking = 5keywords = antigen (Clic here for more details about this article) |
6/63. Isolated chronic cough with sputum eosinophilia caused by Humicola fuscoatra antigen: the importance of environmental survey for fungus as an etiologic agent.We report here a 35-year-old man with isolated chronic cough associated with sputum eosinophilia in which Humicola fuscoatra (H. fuscoatra) antigen was an etiologic agent. He was admitted for the diagnosis and the treatment of his severe nonproductive cough. Although 80% of the nucleated cells in his induced sputum were eosinophils, he did not have bronchial hyperresponsiveness to methacholine or heightened bronchomotor tone. Bronchodilator therapy was not effective against his coughing. His cough worsened on his return home, suggesting the existence of some etiologic agent in his house. H. fuscoatra was isolated from his house, and the bronchoprovocation test with H. fuscoatra antigen was positive: i.e., development of coughing and decrease in capsaicin cough threshold (capsaicin concentration causing five or more coughs) from the prechallenge value of 31.3 microM to 1.95 microM at 6 and 48 hr, respectively, after the challenge. In addition, repeated environmental survey for fungi was suggestive of the importance of H. fuscoatra in the sputum eosinophilia. This is the first report concerning chronic cough with sputum eosinophilia caused by allergic reaction to H. fuscoatra antigen.- - - - - - - - - - ranking = 7keywords = antigen (Clic here for more details about this article) |
7/63. Recurrent bacterial infections in four siblings with neutropenia, eosinophilia, hyperimmunoglobulinemia A, and defective neutrophil chemotaxis.Four siblings with recurrent bacterial infections, neutrophil chemotactic defect, neutropenia, and eosinophilia were studied. During periods of infection the peripheral neutrophil count increased to normal, while the eosinophilia disappeared. In addition, these children had high levels of serum IgA and poor antibody responses to tetanus and polio vaccinations. A defect in cell-mediated immunity was demonstrated by an absent or weak reactivity to various skin test antigens and by abnormal lymph node histology. Thus these siblings had an unusual combination of defective inflammatory response and immunologic abnormalities.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
8/63. Pruritic eosinophilic papular eruption revealing hiv infection.Eosinophilic folliculitis (EF) is a rare follicular pruritic papular eruption observed in association with human immunodeficiency virus (hiv). The diagnosis of eosinophilic folliculitis is based on the histologic findings consisting of a sterile inflammatory infiltrate rich in eosinophils involving hair follicles. EF in hiv patients is believed to be an immunoinflammatory response directed either at follicular or skin flora antigens in the late-stage of hiv infection. In this stage, immune response is characterized by a shift from a Th1- to a Th2-dominant cytokine profile and an increased secretion of interleukin-4 and interleukin-5, both known to promote eosinophilia. We describe a case of hiv-associated eosinophilic folliculitis in a 30-year-old black woman referred to us for a pruritic follicular eruption without any other clinical symptom related to the acquired immunodeficiency syndrome. hiv infection presenting with EF has been rarely reported and its occurrence in women is also very rare.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
9/63. Wells' syndrome following thiomersal-containing vaccinations.A 3 1/2-year-old boy presented on three occasions with painful, itchy, oedematous plaques on his limbs. On two occasions he had received hepatitis b vaccination 11-13 days previously, and on the third occasion received triple antigen (DTP) vaccination 10 days earlier. skin biopsy revealed a prominent infiltrate of eosinophils involving the entire thickness of the dermis. In addition there were prominent 'flame figures' consisting of eosinophilic necrotic collagen surrounded by granular basophilic debris. The clinical and histological pictures were consistent with Wells' syndrome. The eruption settled on the second and third occasions with 0.1% mometasone furoate cream. Subsequent patch testing showed 2 reaction to preservative thiomersal at 96 hours. This is the first description of Wells' syndrome with typical clinical and histopathological features associated with thiomersal in two different vaccines.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
10/63. Eosinophilic prostatitis and prostatic specific antigen.Eosinophilic prostatitis is a rare form of abacterial prostatitis with uncertain aetiology. Its clinical presentation, like other types of abacterial prostatitis, commonly mimics carcinoma of the prostate. Transrectal ultrasound may be helpful in the diagnosis of prostatitis but histological confirmation is necessary. Prostatic specific antigen has been widely used in the diagnosis and follow-up of patients with prostatic carcinoma. High levels of this antigen (greater than 30 micrograms/l) have been claimed to be highly specific for prostate cancer, although lesser elevations may also occur in patients with large benign prostate glands and in bacterial prostatitis. We report 3 patients with histologically proven eosinophilic prostatitis and high levels of prostatic specific antigen. This diagnosis may closely mimic carcinoma of the prostate and must be excluded by histological examination of biopsy material before treatment for presumed prostate carcinoma is initiated.- - - - - - - - - - ranking = 7keywords = antigen (Clic here for more details about this article) |
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