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Vasculitides
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Ivy M. Obonyo, Virginia A. Jones, Kayla A. Clark, Maria M. Tsoukas
The ACR criteria delineate a urinary sediment depicting red blood cell casts or >5 red blood cells per high-power field, abnormal findings on chest x-ray, oral ulcer or nasal discharge, and the presence of granulomatous inflammation as per biopsy. The presence of two or more criteria was associated with 92% specificity and 88% sensitivity.
Immunologically Mediated Diseases and Allergic Reactions
Published in Julius P. Kreier, Infection, Resistance, and Immunity, 2022
Kim A. Campbell, Caroline C. Whitacre
From a clinical standpoint, the most significant of the DTH reactions is the granulomatous inflammation (Figure 10.9) that develops following infection with microbes such as Mycobacterium tuberculosis, Mycobacterium leprae, or Schistosoma. These pathogens persist because macrophage microbicidal mechanisms fail to effectively eliminate them from host tissues. Granulomatous inflammation results from an attempt by the host to localize and prevent the spread of the invading microorganisms. Granuloma formation involves macrophages and epithelioid cells. Contained within the granuloma core may be giant cells, which are formed by the fusion of multiple epithelioid cells or macrophages. Giant cells are visible as large cells with many nuclei located around their outer edge. Epithelioid cells and giant cells are believed to be derived from macrophages and represent a terminal stage of differentiation. Surrounding the granuloma core is an area of actively proliferating lymphocytes, and there may be an area of fibrosis (scarring) due to the body′s healing response to tissue injury. The end result is a palpable, granular mass of inflammatory tissue, the center of which contains dead tissue (referred to as caseous necrosis) due to the frustrated actions of T cells and macrophages.
Inflammatory Disorders of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Granulomatous inflammation: Infection by bacteria (brucellosis, chlamydia, tularemia), mycobacteria (tuberculosis, atypical mycobacteria), fungi (histoplasmosis, coccidioidomycosis, cryptococcosis), spirochetes (treponemal infections such as syphilis), and parasites (toxoplasmosis, leishmaniasis).Occupational and environmental exposure to organic or inorganic agents (e.g. methotrexate, talc, metals).Neoplasia (lymphoma).Autoimmune disorders (Wegener's granulomatosis, Churg–Strauss syndrome).Histiocytosis X, Erdheim–Chester disease.
Analysis of Vitreous Samples by the Cellient® Automated Cell Block System: A Six-year Review of Specimens in a Uveitis Population
Published in Ocular Immunology and Inflammation, 2022
Tine Jacobs, Dietmar Rudolf Thal, Birgit Weynand, Joachim Van Calster, Rita Van Ginderdeuren
In all diagnostic cases, CD68-positive macrophages were found; in all cases of active inflammation and malignancies, CD3-positive T lymphocytes were also present. In all cellular specimens, a routine B lymphocyte marker (CD79a/Pax5) was tested, and this marker was negative except for lymphoma cases; the only other exception was chronic inflammation of infectious origin, in which less than 5% CD138 positive plasma cells were detected. In 86 of 226 cases with active chronic inflammation, granulomatous inflammation was diagnosed. All these cases presented with clusters of epithelioid cells and/or giant cells and were confirmed with a positive CD68 staining. Of the 86 cases with granulomatous inflammation, an elevated CD4/CD8 ratio above 3 was found in 39 cases (45%) as indication of (ocular) sarcoidosis. All confirmed pulmonary sarcoidosis cases had an elevated CD4/CD8 ratio in the vitreous.
Vasculitis in a case of rupioid syphilis in HIV
Published in Baylor University Medical Center Proceedings, 2022
Connor Rodriguez, Parneet Dhaliwal, Allison Readinger
Syphilis can be challenging to identify due to the variety of cutaneous and histologic manifestations. Typical cutaneous lesions of secondary syphilis range from a maculopapular rash to condylomata lata. However, as in this case, secondary syphilis may also present as rupioid, or ostraceous, syphilis, which is an atypical malignant form of secondary syphilis. The term rupioid describes a “well-demarcated, cone-shaped plaque with thick, dark, lamellate, and adherent crusts on the skin that may resemble an oyster shell.”1 Secondary syphilis typically shows histologic findings that include lichenoid as well as superficial and deep chronic inflammation with plasma cells. Occasionally granulomatous inflammation is present. The overlying epidermis may show neutrophilic crust with parakeratosis, psoriasiform hyperplasia, and exocytosis of lymphocytes. An atypical histologic finding may be vasculitis. Even more unique is the coexistence of rupioid lesions with vasculitis, as seen in this case. Only one case of rupioid syphilis with vasculitis has been reported to date in the United States.2
Clinical Patterns and Causes of Intraocular Inflammation in a Uveitis Patient Cohort from Egypt
Published in Ocular Immunology and Inflammation, 2019
Rowayda M. Amin, Mohamed Goweida, Ahmed Bedda, Ahmed Kamel, Alaa Radwan
The data on the main clinical and demographic characteristics of the 454 uveitis patients recruited for the study are displayed in Table 1. Male to female ratio was 1.1:1. The age at presentation showed a peak in the young adult age group (mean 30 years) with a range of 4–75 years. Pediatric uveitis patients (age ≤16 years) represented 25.3% of the total patient population (115 of 454 cases), whereas 42 patients (9.25%) were ≥60 years of age. All patients were Egyptian. Patients attending the Alexandria University Hospital were inhabitants of Alexandria or referred patients from the nearby Governorate of Beheira. Referrals to the Uveitis center in Sohag included locals as well as referrals from Qena, Luxor, and the vicinity of Aswan. 62 patients were from Cairo. Uveitis was unilateral in 152 patients (33.5%) and bilateral in 302 (66.5%). The majority of patients showed a non-granulomatous inflammation (294 cases, 64.8%), whereas 160 patients had granulomatous inflammation. Non-infectious uveitis was more common in this series, where 72.9% of patients had non-infectious uveitis, while 27.1% had uveitis attributed to infectious causes (Figure 1). Among those patients with non-infectious uveitis, a specific systemic cause or diagnostic entity was identified in 247 patients (74.6%), whereas 84 patients (25.4%) had idiopathic inflammation. Figure 2 displays the most common identified causes of uveitis in our series, which were Behçet disease (20.9%), VKH (11.67%), Herpes uveitis (10.8%), and pediatric parasitic granulomas (9%).