Cases reported "Granuloma"

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1/7. Scopulariopsosis and hypersensitivity pneumonitis in an addict.

    Granulomatosis caused by fungal spores of a soil saprophyte is a newly recognized pulmonary complication of intravenous drug addiction. Brown, non-budding spores were histologically identified in necrotic tissue, inside giant cells of sarcoidlike granulomata, and in the vicinity of focal angiitic lesions. The fungus was identified by culture as the dematiaceous scopulariopsis brumptii. Cultural and histopathologic studies of lung biopsy specimens established the diagnosis. We showed precipitating antibodies to fungal antigen in the serum, prepared from the patient's isolate. Similar granulomatous pulmonary lesions were experimentally produced in mice by a single intravenous injection of spores of S. brumptii. The spores remained viable but did not show evidence of growth in the animal's tissue. Precipitating antibodies to fungal antigen and immediate wheal and late necrotizing type of skin reactions were shown in the challenged mice. The studies support the notion that pulmonary hypersensitivity to fungal spores was mediated by an Arthus'-type phenomenon.
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2/7. Disseminated and recurrent sarcoid-like granulomatous panniculitis due to bovine collagen injection.

    Three to five percent of patients treated with injectable collagen implants have adverse local reactions. Systemic signs or symptoms are infrequent. We describe the case of a 53-year-old woman who developed local and general complaints 2 months after receiving two collagen injections in both nasolabial folds. She presented asthenia, malaise, polyarthralgia and inflammatory nodular panniculitis in the places of injection as well as on the forearms and lower extremities. skin testing was compatible with hypersensitivity to collagen. This case raises the question as to whether the injection of animal-derived collagen induces manifestations similar to those observed in connective autoimmune diseases or human adjuvant disease.
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3/7. Human labial orf: a case report.

    A case of orf in a 59-year-old man with no direct contact with farm animals is reported. The patient presented with an ulcerating lesion on the upper lip and the diagnosis was confirmed by electron microscopy from a smear of the lesion. The unusual case history, differential diagnosis and method of diagnosis are discussed.
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4/7. Alveolitis due to hair-spray. Ultrastructural observations in two patients and the results of experimental investigations.

    observation of two patients with hair-spray induced lung disease have prompted us to study the ultrastructure of the lung lesion. We have compared the results with experimental lesions in animals injected with hair-spray extracts and with human monocyte cell cultures exposed to hair-spray. The lungs show a chronic alveolitis with a striking granulomatous reaction including macrophages and multinucleated giant cells of the foreign body type. The intraalveolar and interstitial macrophages and the giant cells all contain PAS-positive material. Ultrastructurally distinct lamellar inclusions are found in the secondary lysosomes of the macrophages and giant cells. Identical structures can be produced in animals injected with hair-spray extracts and with polyvinyl-pyrrolidone and -acetate (PVP/PVA), which are regular ingredients of hair-sprays. Large, presumeably polymeric particles (PVP/PVA) are ingested by giant cells. This "gigantophagocytosis" is associated with the fusion of mononuclear phagocytes and leads to the genesis of giant cells. In cell cultures of human blood monocytes hair-spray extracts and PVP/PVA induce maturation and aggregation of these cells, with PAS-positive cytoplasmatic inclusions. The development of multinuclear giant cells in these monocyte cell cultures is also seen. These observations suggest that hair-spray induced lung disease is caused by the prolonged and extensive body response of the local mononuclear phagocyte system (MPS). Overstimulation of the MPS leads to a quantitative and qualitative change which is followed by a partial blockade of this system. The alveolitis is a consequence of the foreign body response to inhaled hair-spray substances.
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5/7. Systemic complications of MER immunotherapy of cancer: pulmonary granulomatosis and rash.

    BCG immunotherapy often has severe complications in cancer patients despite lack of toxicity in the immunocompetent individual. MER, a cell wall fraction of BCG, has been reported to cause immunopotentiation similar to that of BCG without equivalent toxicity. Recently, animal models have been reported to develop MER complications, especially disseminated granuloma formation, like those of BCG. For the past several years, MER has been used as adjuvant immunotherapy for treatment of malignant tumors with minimal systemic toxicity reported. A patient with malignant melanoma was treated with intralesional MER at the site of local metastases. He developed military pulmonary granulomatosis and a severe cutaneous eruption in association with MER therapy. The toxicities of BCG and MER therapy were compared with the pathogenesis of granuloma formation reviewed. This patient's complications were consistent with a hypersensitivity reaction to MER. Pulmonary granulomatosis and rash must be added to the list of known MER toxicities.
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6/7. Infections caused by Rhodochrous.

    Organisms conforming to "rhodochrous taxon" were isolated from three immunocompromised patients, suggesting a pathogenic role for the organisms. The organisms are partially acid-fast, gram-positive catalase positive rods which form orange or red colonies aerobically in three or four days on Sabouraud, Mueller-Hinton and Middlebrook 7H-10 agars. They are differenitated from nocardia by morphology and ability to degrade ethylene glycol in 7H-10 media. Two of these clinical isolates and a reference strain were injected intraperitoneally into guinea pigs, half of which received methylprednisolone intramuscularly beginning three days prior to inoculation. Steroid-treated animals exhibited clinical illness, diffuse peritonitis and recovery of inoculated organisms whereas one of three nonsteroid-treated animals exhibited a localized abscess without recovery of organisms. This study suggests that rhodochrous may be pathogenic under conditions of immune compromise.
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7/7. Muscle granulomas following intramuscular injection.

    An 8-month-old child underwent a muscle biopsy because of hypotonia. The biopsy showed centronuclear myopathy and, in addition, an unusual granulomatous inflammatory infiltrate. The child died of respiratory complications and a complete autopsy failed to reveal further evidence of granulomatous disease. The lesion was reproduced in experimental animals by intramuscular injection of diphtheria and tetanus toxoids and pertussis vaccine. Granular material present in histiocytes in these lesions was shown histochemically to be an aluminum salt.
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