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Introduction Bacillus Calmette-Guerin (BCG) vaccination is given as a part of the national immunization schedule in India and its most common complication is BCG lymphadenitis. The reported incidence of BCG lymphadenitis ranges from 0.1 to 9.9% in various studies. In our country, though most babies get BCG vaccination during the neonatal period, the incidence of BCG lymphadenitis is not studied well. Aims To study the incidence of lymphadenitis following BCG vaccination at tertiary care hospital in North India. Methods It was a prospective longitudinal observational study. All newborns weighing ≥1.5 kg at birth without any significant illness who received BCG vaccination at our institute were enrolled and followed up for 16 weeks after vaccination. Babies were examined at 6, 10 and 14 weeks for the development of lymphadenopathy. Meta-analysis of studies evaluating incidence of BCG adenitis in children was also performed. Results Out of 817 babies vaccinated during the enrolment period, 605 babies could be followed up till 16.2 ± 0.9 weeks post BCG vaccination. One case of BCG lymphadenitis was detected at 14 weeks. Thus, the observed incidence of BCG lymphadenitis was 0.16% (95% CI of 0.004%–0.92%). Meta-analysis of 21 studies showed mean incidence estimate of 0.336% (95% CI: 0.315%–0.358%) using fixed effect model whereas random effect model showed mean incidence of 4.45% (95% CI: 3.02%–6.15%). Conclusion The lower incidence of lymphadenitis in our study can probably be attributed to a less immunogenic vaccine (Danish 1331), proper technique, experience of the vaccinator and good storage facilities available at our institute.

Background Recurrent episodes of painful papules and nodules, mostly located on the labia minora, have been reported under the denominations of vulvar sebaceous adenitis (14 published cases) and vulvar acne (16 published cases). Objectives The primary aim of this study was to delve further into the clinical and pathological features of this condition. The secondary aim was to collect therapeutic data. Methods In this retrospective cohort study, files and photographs of patients with papules or nodules on the labia minora or the inner labia majora were extracted from a vulvar clinic database. Clinical, pathological and therapeutic data were analysed. Results Forty-five women were included from 2002 to 2018. The median age at the time of diagnosis was 36 years (range: 16–60). The median time to diagnosis was 6.5 years. Clinical features included recurrent painful papules, pustules or nodules, suppuration (n = 22), and pitted scars (n = 10) on the labia minora (n = 41), the inner labia majora (n = 19), the outer labia majora (n = 1), and the clitoral hood (n = 1). Associated acne vulgaris was seen in 17 out of 26 patients for whom data were available. Hidradenitis suppurativa, androgenic alopecia and hirsutism were observed in 3, 1 and 1 cases respectively. Neutrophilic infiltrates were observed in the 4 available biopsies within or around the Fordyce sebaceous glands in 2 patients. Treatment with tetracyclines and oral zinc was not consistently effective. Isotretinoin led to complete remission in 4 patients unresponsive to tetracyclines. Discussion Vulvar sebaceous adenitis/vulvar acne is a clinically identifiable cause of painful recurrent inflammatory lesions affecting the labia minora and the inner labia majora, which are coincidentally sites of Fordyce granules. We therefore suggest a more specific denomination: “vulvar Fordyce adenitis”. The relationship with acne vulgaris and hidradenitis suppurativa requires further investigation. We suggest use of an oral anti-acne therapeutic strategy to reduce inflammation and to decrease the secretion of the sebaceous glands.

Autoinflammatory diseases present as multisystemic inflammation and often manifest in early childhood. In contrast, in a few diseases, e.g., the recently described VEXAS (vacuoles, E1 enzyme, X‑linked, autoinflammatory, somatic) syndrome, the first symptoms occur exclusively in adulthood. This article describes how the phenotypic expression and severity of individual autoinflammatory diseases differ depending on age. Furthermore, differences in the development of organ damage in children and adults are pointed out. In addition to the hereditary periodic fever syndromes, the clinical picture of deficiency of adenosine deaminase 2, the interferonopathies, periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome as well as VEXAS and Schnitzler syndromes are highlighted.

Periodic Fever, Aphthous Ulcers, Pharyngitis and Adenitis (PFAPA) Syndrome’s etiology is not well understood. The objective of this study is to explore the association between vitamin D level and PFAPA syndrome. A systematic review of all publications addressing the association between vitamin D level and PFAPA syndrome prior to May 2019 was conducted. Data were collected from online medical databases namely, PubMed, Ovid Medline, Embase, Cochrane Library, Google Scholar, and Scopus. The review adhered to the PRISMA statement and was performed in 3 main phases; an initial screening review of abstracts was performed, followed by a detailed review of full articles based on inclusion and exclusion criteria, and lastly a final review to extract data from selected articles. 3 prospective review-based and one case report articles were included with a total of 281 patients, 98 of whom were cases of PFAPA, while 183 were controls. Vitamin D levels were deficient in 27% of PFAPA group as compared with the control. Vitamin D supplementation was given as an initial treatment in 25/98 of the patients. Only 1 patient received it as a second treatment. After vitamin D supplementation, a marked reduction of the number of febrile episodes and modification of the mean duration were recognized. There may be an association between Vitamin D deficiency and a higher frequency of PFAPA episodes. Vitamin D supplementation in children with PFAPA may reduce the frequency of episodes and help manage the condition.

Aim: This study aims to evaluate the utility of genetic testing of patients diagnosed with periodic fever syndromes and to assess the validity of existing scoring criteria. Methods: This study retrospectively reviewed the clinical history of patients diagnosed with periodic fever syndromes at Queensland Children's Hospital between November 2014 and June 2018. Results: Forty-three patients were diagnosed with periodic fever syndromes. Diagnoses in the cohort included periodic fever, adenitis, pharyngitis and aphthous stomatitis (10), tumour necrosis factor receptor-associated periodic syndrome (9), cryopyrin-associated periodic syndrome (6), mevalonate kinase deficiency (4) while 14 remained unspecified. No presenting symptoms were uniquely associated with any particular diagnosis. Genetic testing of between 1 and 26 genes was performed in 26 (60%) patients. Two (7.7%) patients had pathogenic variants identified. Variants of uncertain significance which were insufficient to confirm a monogenic disorder were identified in a further 7 (27%) patients. The Eurofever classification criteria correlated with clinical diagnosis for patients diagnosed with cryopyrin-associated periodic syndrome (P = 0.046) and tumour necrosis factor receptor-associated periodic syndrome (P = 0.025) but not for patients diagnosed with mevalonate kinase deficiency (P = 0.47); however, the Eurofever classification criteria were often positive for more than one diagnosis in these patients. Conclusion: The European classification criteria can form a potentially useful tool to guide diagnosis; however, clinical judgement remains essential, because the score is often positive for multiple diagnoses. The diagnostic yield of genetic testing in this cohort was low and genetic testing may be more useful to confirm a strong clinical suspicion than to clarify a diagnosis for patients with less clear symptoms.

Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome is the most common periodic fever condition in children, with most cases appearing by the age of 5. Although PFAPA is generally a self-limited condition, it can have a major impact on a child's quality of life, as well as that of their family. Recent research has continued to shed light on the genetic and immunologic factors that play a role in the pathogenesis of PFAPA. There also exists significant heterogeneity in treatment strategies, and progress has been made to develop evidence-based management strategies and establish a standard of care. This review will outline current knowledge regarding the pathogenesis of PFAPA, as well as treatment strategies and our clinical experience.

Guttural pouch empyema is usually a consequence of upper respiratory tract infections, especially those caused by Streptococcus equi. In adult horses, empyema is a common disease, whereas considered rare in foals. The aim of this work was to report a case of unilateral guttural pouch empyema in a filly, with a focus on diagnostic and treatment approaches. A 1-month-old filly, 68 kg, Mangalarga Marchador, was admitted because of respiratory distress and enlargement caudally in the head. Clinical examination revealed dyspnea, dysphagia, lymphadenopathy, unilateral enlargement in the retropharyngeal area, and mucopurulent nasal discharge. Further, endoscopic examination confirmed the presence of purulent material inside the left guttural pouch and a diagnosis of empyema was arrived at. Drainage was performed surgically, a catheter was inserted for guttural pouch lavage. The animal received bromexin, dexamethasone, flunixin meglumine, ceftiofur, probiotics, vitamin complexes, and ringer lactate solution. Hematological evaluation performed every 24-72h, showed a decrease in total leukocytes, fibrinogen, platelets, total plasma protein, hematocrit, hemoglobin, and erythrocytes. Eleven days after drainage, the filly’s clinical condition was stable and the wound has healing. The animal was discharged following a good prognosis. Differential diagnoses can include other respiratory diseases, such as guttural pouch timpanism, strangles, and Rhodococcus, which are excluded due to the clinical signs and complementary examinations. In the present case early diagnosis, based on physical examination, hematological parameters, and radiography, combined with adequate treatment methods, including surgical procedures, lavages, antibiotics, and anti-non-steroidal inflammatory therapy, contributed to resolving the guttural pouch empyema in the filly. Empiema de la bolsa gutural és consecuencia de infección del tracto respiratorio superior, especialmente por Streptococcus equi. En los caballos adultos, empiema es la enfermedad más común, mientras que en potros es rara. Apuntamos reportar un caso de empiema de bolsa gutural unilateral en potra, enfocándonos en los métodos de diagnóstico y tratamiento. Una potranca, 1 mes edad, 68 kg, Mangalarga Marchador, fue atendida por dificultad respiratoria y agrandamiento caudal de la cabeza. Durante el examen clínico se constató disnea, disfagia, adenopatías, agrandamiento unilateral en zona retrofaríngea, secreción nasal mucopurulenta. El examen endoscópico confirmó la presencia de pus dentro de la bolsa gutural y los diagnósticos de empiema. Se realizó drenaje por cirugía y se mantuvo el catéter en bolsa para lavado. La potranca recibió bromexina, dexametasona, flunixina meglun, ceftiofur, probióticos, complejo vitamínico y solución de ringer. Se realizó evaluación hematológica cada 24-72h, observándose disminución de leucocitos totales, fibrinógeno, plaquetas, proteínas plasmáticas totales, hematocrito, hemoglobina y eritrocitos. Once días después del drenaje, el estado clínico de la potranca era estable y la herida cicatrizaba adecuadamente, siendo el paciente dado de alta, con buen pronóstico. Los diagnósticos diferenciales incluyen enfermedades respiratorias, como timpanismo de la bolsa gutural, adenita, rodococos, siendo estas enfermedades excluidas por signos clínicos y exámenes complementarios. El diagnóstico precoz, basado en el examen físico, hematológico y radiografía, combinado con métodos de tratamiento adecuados, basados ​​en procedimiento quirúrgico, lavados, terapia antibiótica y antiinflamatoria no esteroideo, evoluciona para resolver el caso de empiema de bolsa gutural en la potranca. Empiema da bolsa gutural é geralmente uma consequência de infecção do trato respiratório superior, especialmente por Streptococcus equi. Em equinos adultos, o empiema é uma doença comum, enquanto em potros é considerada rara. O objetivo deste trabalho foi relatar um caso de empiema de bolsa gutural unilateral em potra Mangalarga Marchador, com foco nos métodos de diagnóstico e tratamento. Uma potra, 1 mês de idade, 68kg, Mangalarga Marchador, foi atendida devido a desconforto respiratório e aumento na região da cabeça. Ao exame clínico, notou-se dispneia, disfagia, linfadenopatia, aumento unilateral em região retrofaríngea, secreção nasal mucopurulenta. O exame endoscópico confirmou presença de material purulento no interior da bolsa gutural esquerda e diagnóstico de empiema. A drenagem por cirurgia foi realizada e um cateter foi mantido para lavagem da bolsa gutural. O animal recebeu bromexina, dexametasona, flunixina meglumina, ceftiofur, probióticos, complexo vitamínico e solução de ringer lactato. A avaliação hematológica foi realizada cada 24-72h, mostrando diminuição de leucócitos totais, fibrinogênio, plaquetas, proteína plasmática total, hematócrito, hemoglobina e eritrócitos. Onze dias após drenagem, o quadro clínico da potra era estável e a ferida cicatrizando adequadamente. O animal recebeu alta, com prognóstico favorável. Os diagnósticos diferenciais incluem doenças respiratórias, destacam-se timpanismo de bolsa gutural, adenite, rhodococcus, sendo essas excluídas devido aos sinais clínicos e exames complementares. O diagnóstico precoce, baseado no exame clínico, hematológico e radiográficos, aliado a métodos de tratamento adequados, baseados em procedimento cirúrgico, lavagem da bolsa gutural, antibioticoterapia e anti-inflamatórios não-esteroidais, contribuiram para resolução do empiema de bolsa gutural na potra.

Analogies or differences of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome in children and adults are barely known. The aim of our study was to compare the overall characteristics of a large cohort of patients, both children and adults, diagnosed with PFAPA syndrome. In the last decade, we identified 120 children and 63 adults with periodically recurring fevers, who fulfilled the criteria for PFAPA diagnosis. The two subcohorts were analyzed according to demographic features, clinical manifestations, laboratory data, and responses to therapies. The mean age of onset was 2.4 ± 1.5 and 19.7 ± 10.3 years, respectively, in children and adults, while attacks occurred every 3.8 ± 0.8 and every 4.3 ± 2.3 weeks, respectively, in children and adults. A higher prevalence of exudative pharyngitis was observed in children (58.8%), and the majority of children had only two cardinal signs during flares. In adults, there was a higher interpersonal variability of the intercritical periods. Inflammatory markers measured during non-febrile periods were normal in children but altered in the totality of adults during febrile periods. A strong efficacy of corticosteroids in controlling the pediatric syndrome was observed, but response rates to steroids were less brilliant in adults. Colchicine and interleukin-1 inhibitors were used in the management of the steroid-resistant adult syndrome. Conversely, tonsillectomy was performed in a very low number of children, but was effective in 60.7% of adults when treated after 16 years. The mean age of disappearance of PFAPA symptoms has been 6.4 ± 2.4 years in children, while only 27% of adults have shown a complete drug-free symptom regression. A linear conformity of the PFAPA syndrome has been observed between pediatric and adult patients. PFAPA symptoms tended to disappear with no sequelae in 94.1% of children, while the disease was still active in almost 3/4 of adults at the time of our assessment.

To evaluate the ethnic distribution of Israeli patients with the syndrome of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA).The medical records of patients with PFAPA attending 2 pediatric tertiary medical centers in Israel from March 2014 to March 2019 were retrospectively reviewed. Patients with concomitant familial Mediterranean fever were excluded. Ethnicity was categorized as Mediterranean, non-Mediterranean, and multiethnic. Findings were compared with patients with asthma under treatment at the same medical centers during the same period.The cohort included 303 patients with PFAPA and 475 with asthma. Among the patients with PFAPA, 178 (58.7%) were of Mediterranean descent (Sephardic Jews or Israeli Arabs), 96 (33.0%) were multiethnic, and 17 (5.8%) were of non-Mediterranean descent (all Ashkenazi Jews). Patients with PFAPA had a significantly higher likelihood of being of Mediterranean descent than the patients with asthma (58.7% vs 35.8%; P .0001). The Mediterranean PFAPA subgroup had a significantly earlier disease onset than the non-Mediterranean subgroup (2.75 ± 1.7 vs 3.78 ± 1.9 years, P .04) and were younger at disease diagnosis (4.77 ± 2.3 vs 6.27 ± 2.9 years, P .04).PFAPA was significantly more common in patients of Mediterranean than non-Mediterranean descent. Further studies are needed to determine the genetic background of these findings.

A 1-year-old Maine Coon female spayed cat was presented for a 7-week history of bilateral pinkish masses located over the dorsotemporal conjunctival quadrants. Ophthalmic examination revealed the presence of bilateral temporal, slightly hyperemic, subconjunctival masses, fluctuant, and nonpainful. The remainder of the ocular examination was unremarkable. Ultrasound biomicroscopy and B-scan ultrasonography confirmed the presence of a bilateral cavitated and tubular structure, extending within the temporal orbit, with anechoic fluid-like content. Surgical removal was performed. Histopathology described the lesions as lacrimal gland tissue, markedly infiltrated by inflammatory cells, associated with cavitated structures filled with proteinaceous debris, and lined by flattened bilayered cuboidal epithelial cells. Bilateral adenitis of unknown origin and dacryops of the temporal lacrimal glands were diagnosed. Both surgical sites healed uneventfully, and no recurrence was reported on either eye during a 12-month follow-up period.

Infectious disease epidemics may overshadow and exacerbate existing challenges in diagnosing lymphoma. We describe pragmatic strategies we have implemented to overcome diagnostic obstacles caused by the local tuberculosis (TB) and HIV epidemics in South Africa, which may serve as a guide to minimize diagnostic delay during the COVID-19 pandemic. We report on the diagnostic utility of a rapid-access lymph node core-biopsy clinic, where lymph node biopsies are taken from outpatients at their first visit. Analysis of tissue biopsies (n = 110) revealed the three most common conditions diagnosed were TB adenitis (34%), lymphoma (29%), and disseminated malignancy (20%). A first-attempt core-biopsy was able to diagnose lymphoma in 27/32 (84%) of cases. Compared with a historical cohort, the diagnostic interval (time from first health visit to diagnostic biopsy) for patients with lymphoma was significantly shorter, 13.5 vs 48 days (p = 0.002).

Background Bacille Calmette-Guerin (BCG) adenitis is a common complication of post-BCG vaccination. Awareness of this lesser known entity in fine-needle aspiration (FNA) is important to prevent misdiagnosis. Aim This study described the clinical presentation, cytomorphological features and disease pattern in patients with BCG adenitis. Materials and methods We analyzed a series of 15 patients with BCG adenitis seen from July 2017 to July 2019. The detailed clinical and cytomorphology of these cases were studied. Results Age of presentation ranged from 3 to 12 months. Male to female ratio was 2.75:1. A total of four children were diagnosed with primary immunodeficiency. Three children had acyanotic heart disease. Most of the children had left axillary lymph node enlargement. Cytomorphology showed the presence of polymorphs (66.7%), histiocytic aggregates (80%) and reactive lymphoid population (60%). Epithelioid granulomas (26.7%) and giant cells (6.7%) were present. The necrotic background was present in all but one case. Ziehl-Neelsen stain for acid-fast bacilli was positive in all but two cases. Conclusion A high index of clinical suspicion for BCG lymphadenitis should be kept in mind for patients who are recently vaccinated. FNA cytology, combined with clinical correlation, is useful for diagnosis and management.

AIM: To evaluate the Cytomorphological patterns in cervical lymph nodes by using fine needle aspiration cytology, and analyze the usefulness of the fancy procedure.Materials and methods: In this study total 100 patients with cervical lymph node swelling were included in the study, who had presented to the department of pathology in our tertiary care center.Results: Out of 100 clerical lymphadenopathy cases majority were Tuberculous lymphadenitis 32 (32%), Reactive lymph adenitis 30(30%), Granulomatous lymphadenitis 22(22%), Nonspecific lymph adenitis 7(7%), Necrotizing Lymph adenitis (5%), Metastatic Deposits 2(2%), Lymphoma 2(2%).Conclusion: FNAC is a cheap, reliable, easy procedure for the early detection of disease pathology in lymph nodes.

We describe the case of a 75-year-old woman with textured silicone implants who was referred to our institution with concern for implant rupture and Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). After explantation and pathologic evaluation, she was diagnosed with silicone granuloma and adenitis, though her presentation mimicked BIA-ALCL.

A 2-year-old creole filly was referred to us for evaluation because of the clinical suspicion of infection by Streptococcus equi. It presented with progressive weight loss and increased volume of the submandibular, retropharyngeal, and precrural lymph nodes. General clinical examinations and laboratory tests revealed dehydration, anemia, leukopenia, hyperfibrinogenemia, and thrombocytopenia. The initial treatment for equine adenitis did not achieve significant results, and new hematological and biochemical tests and lymph node cytology by puncture were performed. Cytology revealed cells compatible with neoplastic lymphocytes, resulting in the suspicion of lymphoma. The animal died from general weakness and was sent for autopsy. Macroscopically, generalized lymphadenomegaly and splenomegaly were observed, with multiple nodules and tumor lesions in the splenic parenchyma. There was an irregular nodule in the medullary layer of the right kidney. The liver and lungs were slightly enlarged, with petechiae and multifocal suffusions. Histopathological evaluation of different organ specimens revealed intense proliferation of the neoplastic lymphoid cells, invading the adjacent tissues, with moderate cellular pleomorphism. Immunohistochemistry of the lymph node sections with neoplastic infiltration revealed multicentric T-cell lymphoma. In horses, cases of lymphomas are rare and should be differentiated from other causes that induce lymphadenomegaly in this species.

Objective Recently a new set of criteria proposed for the classification of auto inflammatory recurrent fevers including familial Mediterranean Fever (FMF). We aimed to compare the sensitivity and specificity of the new Eurofever/PRINTO classification criteria with those of the Tel Hashomer and Yalcinkaya–Ozen criteria. Methods 151 consecutive FMF patients between February and May 2019 who were followed at Hacettepe University Department of Pediatric Rheumatology were included in this study. A group of 82 patients with periodic fever 66 periodic fever, aphthosis, pharyngitis and adenitis syndrome (PFAPA), nine cryopyrin-associated periodic syndrome (CAPS) and seven mevalonate kinase deficiency/hyperimmunoglobulin D syndrome (MKD/HIDS) patients) served as controls. GraphPad 6.0 was used for statistical analysis. Results Three different classification criteria were analyzed in 151 FMF patients with a median age at diagnosis of 5 years and in 82 controls with a median age at diagnosis of 3 years. The sensitivity of the new Eurofever/PRINTO criteria (96%) was highest (Tel Hashomer criteria-88.4% and Yalcinkaya–Ozen criteria-93.4%). However, the specificity of these criteria (73.1%) was lowest (Tel Hashomer criteria-92.6% and Yalcinkaya–Ozen criteria-84.1%). The new Eurofever/PRINTO criteria achieved the highest sensitivity (100%) in biallelic exon 10 mutation patients (Tel Hashomer criteria-87.4% and Yalcinkaya–Ozen criteria-94.2%). However, the new set had the lowest sensitivity (88.2%) in heterozygote exon 10 mutation patients (Tel Hashomer criteria 94.1% and Yalcinkaya–Ozen criteria 94.1%). Conclusion In this Turkish cohort, the new Eurofever/PRINTO criteria have a better sensitivity but lower specificity with higher misclassifications than other two well-known criteria. The combination of clinical manifestations with genotype increased the sensitivity. The lower specificity may be due to the high carrier rate in our population. Although the ethnicity information lowers the specificity, ‘clinical-only’ criteria set may still guide the clinician to perform appropriate genetic testing in patients with recurrent fever.

Background: The periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome is the most common periodic fever syndrome in childhood. Its pathogenesis and etiology remain unknown. This study aimed to determine whether or not the neutrophil-to-absolute lymphocyte ratio (NLR) and thrombocyte indices could be used as subclinical inflammation markers in healthy control group children and children with PFAPA syndrome during the attacks and attack-free periods. Materials and Methods: Twenty-eight children with PFAPA syndrome that presented to our clinic were enrolled in this study. As a control group, healthy children that presented to the general pediatrics polyclinic with the exact same age and sex as the patient group were recruited. The medical records of all participants were evaluated retrospectively. Results: The leukocyte and neutrophil counts, NLRs, platelet count-to-absolute lymphocyte ratios (PLRs), and C-reactive protein levels of the patients with PFAPA syndrome during the attack period were found to be significantly higher than during the attack-free period. Similarly, during the attack period, the leukocyte and neutrophil counts, NLRs, and PLRs were significantly higher compared to the healthy control group. Patients with PFAPA syndrome during the attack-free periods were compared with the control group, and their mean platelet volume (MPV) values were significantly lower than the control group. Conclusions: MPV in PFAPA syndrome patients was significantly lower during the inflammation. We observed a significant decrease in MPV values during the attack-free period compared to the control group, suggesting that subclinical inflammation continues in the attack-free period in PFAPA syndrome.

We studied 11 cases of culture-proven Listeria-associated lymphadenitis reported to the French National Reference Center for Listeria from 1994 to 2019 and 8 additional published cases. Listeria-associated lymphadenitis is rare, but it is associated with a mortality as high as for invasive listeriosis, and it is frequently diagnosed with concomitant neoplasia., We studied 11 cases of Listeria-associated lymphadenitis reported to the French Reference Center for Listeria, and 8 published cases. Listeria-associated lymphadenitis is rare but associated with a mortality as high as for invasive listeriosis, and frequently diagnosed with concomitant neoplasia.

Periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome is characterised by episodes of fever lasting a few days that classically exhibit clockwork periodicity. Since the initial description of PFAPA syndrome by Gary Marshall in 1987, it has been recognised that stomatitis, pharyngitis and adenitis are variably present.1 Its phenotype is consistent with an autoinflammatory condition of unknown genetic aetiology possibly involving an infectious/environmental trigger, given that a family history is present in approximately 27% of cases.2 The natural history is onset before 6 years old, followed by spontaneous resolution by 15 years. Treatment with colchicine can reduce the frequency of episodes and tonsillectomy is usually curative.3 The diagnosis of PFAPA syndrome is clinical but can be challenging because it predominantly affects young children who typically experience frequent febrile viral infections. We hypothesised that reduced transmission of viruses due to COVID-19 public health control measures …

Tuberculosis (TB) is one of the communicable diseases with high morbidity to the patient. TB is divided into pulmonary and extrapulmonary TB. In extrapulmonary TB, isolated axillary TB is rare and sometimes creates diagnostic difficulty, particularly in female patients. The axillary lymph nodes are affected in around 3% of tuberculous lymphadenitis. Our case presented with isolated axillary tuberculous lymphadenitis which is rare without evidence of TB elsewhere in the body. It is more common in females compared to males, and it commonly involves the left side. Most of the cases do not show systemic manifestations. Chest X-ray and ultrasound are useful primary investigations for the diagnosis. Histopathological examination of the lymph node is the confirmatory test for axillary tuberculous adenitis. Hence, tuberculous lymphadenopathy should be considered one of the differential diagnoses in a female patient with isolated axillary lymphadenopathy even without clinical manifestations of TB.

Objectives Nontuberculous mycobacterial (NTM) lymphadenitis is a rare disease of children under 5 years. Its treatment is not standardized, even a “wait-and-see” approach is shown to be effective in the literature. Here, we discuss the diagnostic and therapeutic strategies employed in our departments. Methods Records of pediatric patients treated for NTM cervical lymphadenitis from 2010 to 2015 in our tertiary center were retrospectively reviewed. Patients underwent cervical echotomography and/or CT scan. Every patient but one had microbiological explorations (NTM polymerase chain reaction [PCR] and culture) on fine needle aspiration of pus and/or adenitis biopsy. Differential diagnoses (tuberculosis, cat scratch disease) were excluded with serologies, chest X-Ray, and PCR on adenitis samples. Patients were classified as “proven diagnosis” (NTM detected), “highly probable” (suggestive clinical and anatomopathological aspect) or “possible” infection (suggestive adenitis alone). Treatments, follow-up and adverse events were reviewed. Results Thirty-one patients were treated for NTM, median age 2.40 years (Interquartile Range IQR = [1.85–3.16]). Twenty-nine patients (96.77%) had an isolated cervico-facial localization. Median follow-up was 8.00 months (IQR = [4.20–13.43]). We found 17 “proven diagnosis” (58.62%), 5 “highly probable” (17.24%) and 7 “possible” infections (24.14%). “Proven” infections were due to: Mycobacterium avium (n = 12, 66.67%) and M. intracellulare (n = 5, 27.78%). All 29 patients received antibiotics, which were effective for 10 (34.48%, group 1); 10 underwent surgical excision for a poor outcome with antibiotics (34.48%, group 2); spontaneous or surgical drainage occurred in 9 on antibiotics (31.03%, group 3). The median times to resolution for group 1, 2 and 3 were respectively 6.33 months, 6.22 months and 9.53 months. Antibiotics treatment was mostly clarithromycin (n = 27, 93.10%) and/or rifampicin (n = 19, 65.52%); 18 patients (62.07%) received both. Median antibiotics duration was 6.23 months (IQR = [5.17–7.46]), with good compliance (79.31%). The observed adverse effects were 3 (13.04%) isolated transient transaminase elevations, 1 case (4.35%) of minor creatinine elevation, and 1 case (4.35%) of transient diarrhea. Surgical drainage caused 1 transient marginal mandibular nerve palsy, resolutive after 1 month. Conclusion Antibiotics in NTM adenitis lead to resolution in 7 months, with good tolerance and compliance. The efficacy of “wait-and-see” attitude in the literature make excision surgery a second line treatment.

Retraction: Mediterranean fever gene variants and colchicine therapy in periodic fever, aphthous stomatitis pharyngitis, adenitis syndrome in a Mediterranean regionWe, the Editor and Publisher of E...

Background Mycobacterium canettii forms part of the Mycobacterium tuberculosis complex. Mycobacterium canettii infections are mainly described in the Horn of Africa. The permanent presence of French soldiers in Djibouti raises the question of the risk of being infected with M. canettii. Here, we describe M. canettii infections among French military and their families between 1998 and 2015. Methods This retrospective study relied on 3 sources of data: the reference center for mycobacteria in the Biology Department at Percy Military Hospital in Paris, the French Military Center for Epidemiology and Public Health, and the scientific literature. After an exhaustive census of the strains, we studied the epidemiological data on 20 cases among French soldiers and their families. Results Twenty cases of M. canettii infections are reported, including 5 unpublished cases. Adenitis predominates (n = 15), especially in the cervico facial area and among children; 1 case was observed 1 month after dental care in Djibouti. The pulmonary forms were less frequent (n = 6), and 3 atypical forms are described. All patients had stayed in Djibouti. Conclusions Cases of M. canettii infection among the French military consisted mainly of adenitis; disseminated forms were possible with immunodeficiency. Their evolution under specific treatments was comparable to that of tuberculosis. The presumed origin of the infection seemed to be environmental, possibly a water reservoir, and not due to human-to-human contagion.