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Infections in Solid Organ Transplant Recipients Admitted to the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Almudena Burillo, Patricia Muñoz, Emilio Bouza
Clostridium difficile is more common in SOT patients who frequently receive antimicrobial agents, and up to 20%–25% of patients may experience relapse [96–98]. The incidence of C. difficile infection is increasing. The SOT recipients have many risk factors for developing C. difficile-associated diarrhea (CDAD): Surgery, frequent hospital admissions, the use of proton pump inhibitors, antimicrobial exposure, and immunosuppression. The most common clinical presentation is diarrhea, which may be unusually severe [99,100]. In a recent series, 5.7% of KT or PT patients developed fulminant CDAD presenting with toxic megacolon, and these patients underwent colectomy [88]. The absence of diarrhea is a poor prognostic factor. Significant leukocytosis may be a useful clue. Occasionally, patients present with an acute abdomen [101] or an inflammatory pseudotumor [102]. Fresh stool samples should be analyzed for the presence of toxin producing C. difficile. The reference method for diagnosis is NAAT alone or a multistep testing algorithm (e.g., glutamate dehydrogenase (GDH)-plus toxin and NAAT-plus toxin) [103]. C. difficile-associated diarrhea may occur in coincidence with CMV GI infection [96,104].
Unexplained Fever Associated with Diseases of the Gastrointestinal Tract
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Cellular inflammatory pseudotumor is a variant of retractile mesenteritis. It is a rare, solitary, expansile, well-circumscribed inflammatory mass situated in various anatomical regions, usually the ileal mesentery, to which it is attached by a short, broad pedicle. An interesting case is described of a 31-year-old male, who suffered for 3 months from an illness characterized by fever, Campylobacter enteritis, weight loss, abdominal mass, anemia, and liver dysfunction. After a thorough investigation the final diagnosis was found to be cellular inflammatory pseudotumor.87
Nonmalignant Versus Malignant Proliferations on Lung Biopsy
Published in Philip T. Cagle, Timothy C. Allen, Mary Beth Beasley, Diagnostic Pulmonary Pathology, 2008
Inflammatory pseudotumors must be differentiated from bronchiolitis obliterans organizing pneumonia (BOOP). BOOP differs from inflammatory pseudotumors in that the spindle cell proliferation of BOOP involves airspaces, and the underlying pulmonary framework is preserved rather than destroyed. Organization of a prior necrotizing pneumonia may be difficult to differentiate from inflammatory pseudotumor. However, at the periphery, active inflammatory exudate can be seen and changes of BOOP can also be seen. Inflammatory fibrosarcoma is an aggressive tumor capable of metastasizing in about 10% of the cases. Histologically, increased cellularity, mitotic activity, and multifocal necrosis are features that help to distinguish between these two conditions. Malignant fibrous histiocytoma (MFH), currently regarded as an undifferentiated sarcoma, should also be considered in the differential diagnosis of inflammatory pseudotumor. In this pleomorphic malignant tumor, the main distinguishing features are the cellular pleomorphism, large cells with bizarre nuclei, and foamy cytoplasm. Immunoreactivity with the so-called histiocytic markers represent added differentiating features, with most MFHs being positive for CD-68, α-1-antitrypsin, and α-1-anti-chymotrypsin. Inflammatory pseudotumor also needs to be differentiated from malignant intrapulmonary solitary fibrous tumor (SFT). A rare neoplasm, SFT may occur either in the lung or the overlying pleura. SFTs enter the differential diagnosis of inflammatory pseudotumor primarily on the basis of its occasional intrapulmonary location. Nearly 10% of SFTs have distinct histologic malignant features. Most SFTs do not stain with cytokeratin. Most SFTs do stain positively with vimentin, while only few stain with desmin, actin, CD34, and α-1-anti-chymotrypsin. Rarely, inflammatory pseudotumors may occur in association with invasive fungal organisms. Figure 11 shows an inflammatory pseudotumor removed from a 14-year old girl at the University of Massachusetts Medical Center. In this patient, the inflammatory pseudotumor was centrally cavitated and contained numerous aspergilli. Table 3 shows major histopathologic features that help to separate inflammatory pseudotumor from pulmonary sarcoma and sarcomatoid carcinoma.
Mycobacterial spindle cell pseudotumor in a woman with HIV
Published in Baylor University Medical Center Proceedings, 2020
John R. Krause, Sarah K. Findeis
A 42-year-old woman with a long-standing history of human immunodeficiency virus (HIV) infection presented to the emergency department with fever, chills, night sweats, weight loss, and abdominal fullness over the past several weeks. On admission, she had a hemoglobin of 9.8 g/dL, hematocrit of 27.6%, and white blood cell count of 9.2 × 103/μL, with a differential of polys/bands 75%, lymphocytes 10%, monocytes 11%, and eosinophils 4%. Her CD4 count was low at 56 cells/mm3 (reference range, 500–1600). Imaging studies revealed a large abdominal mass and splenomegaly worrisome for an underlying lymphoproliferative disorder. A bone marrow biopsy was normocellular but revealed small noncaseating granulomas (Figure 1a). An acid-fast stain was negative. Because a lymphoproliferative disorder was still in the differential diagnosis, a biopsy of the abdominal mass was done. The mass consisted of numerous spindle cells in a background of fibrosis (Figure 1b, Figure 1c). The initial impression was that of an inflammatory pseudotumor. There was no evidence of a lymphoproliferative process. Because of the patient’s history of HIV, an acid-fast stain for mycobacteria and a Gomori silver stain for fungal organisms were done. The acid-fast stain revealed numerous positive bacilli (Figure 1d). The fungal stain was negative. Cultures from the mass were subsequently positive for mycobacterium avian complex.
Imaging in pancreatitis: current status and recent advances
Published in Expert Opinion on Orphan Drugs, 2018
Itegbemie Obaitan, Umar Hayat, Hiba Hashmi, Guru Trikudanathan
CP has been defined as ‘a continuing inflammatory disease of the pancreas, characterized by irreversible morphological change, and typically causing pain and/or permanent loss of function’ [37]. Common features of well-established advanced CP include pancreatic atrophy, fibrosis, pain syndromes, duct distortion and strictures, calcifications (Figures 1 and 2), pancreatic exocrine insufficiency, pancreatic endocrine dysfunction and dysplasia [37]. It has been postulated that CP progresses from minimal patchy focal disease characterized by mononuclear infiltrate and fibrosis to a more diffuse distribution with overt signs of chronic inflammation such as calcification [38]. Very frequently acute exacerbation of chronic pancreatitis may result in focal edema making it indistinguishable from a neoplastic mass. Imaging is critical to distinguish such inflammatory pseudotumor from malignancy which is common in this population.
Overview and recent advances in incidental meningioma
Published in Expert Review of Anticancer Therapy, 2023
Olivia Näslund, Per Sveino Strand, Thomas Skoglund, Ole Solheim, Asgeir S. Jakola
Meningiomas are often clinically and radiologically classified according to their location within the CNS and several different anatomical classifications are in use [31]. Although radiological findings are usually characteristic, some lesions can mimic the appearance of meningiomas on imaging [31]. Especially hemangiopericytoma and dural metastases may be differential diagnoses to meningioma. However, numerous other diseases can also mimic meningioma, such as schwannoma, craniopharyngioma, lymphoma, ependymoma, sarcoma, periosteal osteoblastoma, and inflammatory pseudotumor [32–38]. Table 1 summarizes common causes for diagnostic radiological examinations that led to finding of incidental meningioma.