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Actinomycosis, an uncommon granulomatous infection caused by the Actinomyces species, rarely targets as primary involvement the limb and is often linked to traumatic incidents. In this report, we present the case of a 44-year-old female who developed multiple small nodules on her left foot over approximately 12 months. Some nodules exhibited firmness and a violet hue, while others discharged a yellowish fluid. The patient had no significant comorbidities. Despite thorough blood paraclinical assessments, including complete blood count, serological HIV testing, and QuantiFERON-TB Gold testing, no abnormalities were detected. Bacteriological examinations and cultures of the discharge yielded negative results. Dermatoscopic examination revealed ovoid yellowish structures, with confocal microscopy highlighting granulomas. A subsequent skin biopsy confirmed characteristic changes indicative of actinomycosis. Although systemic antibiotic therapy with penicillin derivatives was initially considered, the patient’s documented allergic history to this medication class, verified through allergological testing, prompted the initiation of doxycycline treatment. Notably, significant improvement was observed at the 3-month follow-up. This case underscores the importance of reporting rare instances of actinomycosis due to its diagnostic complexity and management challenges.

Introduction: Patients with brucellosis present with nonspecific symptoms originating from different organs. In this study, we aimed to investigate the symptoms related to the head and neck region in patients with brucellosis. Materials and Methods: The retrospective study analyzed 542 patients with a definitive diagnosis of brucellosis who were admitted to our hospital between January 2015 and April 2022 and received outpatient and/or inpatient care. Clinical symptoms localized t o the ear-nose-throat and head and neck regions were evaluated. Results: A neck mass was detected in 52 out of 542 patients included in the study. The prevalence of cervical lymphadenopathy and/or abscess was 9.6%. Only lymphadenopathy was present in 30 (57.7%) patients, while both neck abscess and lymphadenopathy were detected in 22 (42.3%) patients. No significant difference was found between the two groups with regard to treatment regimens . Mean duration of treatment was 30 ± 22.1 (range, 14-70) days in the lymphadenopathy group and was 22 ± 14.7 (range, 14-60) days in the abscess group. No significant difference was found between the two groups with regard to the length of time to clinical recov ery. Conclusion: Brucellosis affects many regions of the head and neck and c an have a variety of imaging manifestations that mimic benign and malignant lesions. The diagnosis of brucellosis should be considered in the first -line differential diagnosis conducted based on imaging features in patients residing in endemic regions. [ABSTRACT FROM AUTHOR]

Genitourinary tuberculosis is a rare form of extrapulmonary tuberculosis that affects the kidneys, ureters, prostate, vas deferens, seminal vesicles, testes, and epididymis.Testicular tuberculosis is a very unusual form, We report a rare case of unilateral testicular tuberculosis that manifested as orchi-epididymitis. The main treatment for urogenital tuberculosis is antituberculosis therapy, possibly combined with surgery.

Background: Leprosy is a chronic granulomatous infection with varied clinical presentations. Dermatoscopy is a noninvasive technique that allows rapid and magnified in vivo observation of the skin with the visualization of morphologic features that are invisible to the naked eye. In our study, we aim to describe the dermatoscopic features of all types of leprosy and correlate with clinical and histopathological findings. Materials and Methods: A prospective observational study was done on all the leprosy patients attending OPD over a period of 1 year. The study patients were categorized as per Ridley–Jopling classification. The lesions of different types of leprosy were photographed and evaluated by dermatoscopy and biopsied. Results: A total of 60 patients (34 males and 26 females) were taken under the study. Of 60 patients, 6 cases of tuberculoid leprosy, 22 cases of borderline tuberculoid (3 with Type 1 reaction), 16 cases of borderline lepromatous, 12 cases of lepromatous leprosy (5 with Type 2 reaction), and 4 cases of Histoid leprosy. The dermatoscopic features seen are yellowish-orange areas and vascular structures such as linear branching vessels and crown vessels. Broken pigment network and white chrysalis like areas are also seen. Absence or diminished hair follicles and eccrine duct openings are seen in tuberculoid spectrum. Scaling and follicular plugs are seen in type 1 reaction. Conclusion: Yellowish-orange areas and vascular structures are the common dermatoscopic features seen in leprosy. Broken pigment network and paucity of appendageal structures are other features seen.

Background: Rhinosporidiosis is a chronic granulomatous disease of the nose caused by Rhinosporidium seeberi. The disease is largely non‐amenable to medical therapy and shows high recurrence rates requiring patients to undergo multiple surgeries often resulting in increased morbidity. Objective: To analyse the epidemiological, clinical, histopathological characteristics, treatment and outcome in rhinosporidiosis and to identify factors which predispose to recurrence of the disease. Patients/methods: Retrospective analysis of data of all patients with a diagnosis of rhinosporidiosis confirmed by histopathology at a tertiary care hospital from 2015 to 2019. Results: There were 42 patients, 40 males and two females, with a mean age of 37.37 years. Disease showed bilateral involvement in 17 (40.48%) patients. Nineteen (45.24%) patients had more than two sites involved at initial presentation. Most patients had nasal cavity involvement followed by nasopharynx. Among the 28 patients who had a follow‐up, 12 showed recurrent disease. However, 21 patients were disease free following a revision excision. Involvement of more than two sites was an independent significant factor for recurrence. On univariate analysis, other factors which showed statistically significant odds of developing recurrence were previous surgery (p =.054), involvement of nasal septum (p =.022), middle turbinate (p =.024), nasopharynx (p =.049) and posterior pharyngeal wall (p =.05). Factors which showed significantly less likelihood of developing a recurrence included patients who had less than 12 months duration from first symptom to intervention (p =.016), involvement of less than two sites (p =.0003) and unilateral disease (p =.019). Conclusion: Early intervention in rhinosporidiosis especially when the disease is unilateral and involves less than two sites improves the outcome. [ABSTRACT FROM AUTHOR]

Introduction: Rhinosporidiosis is a chronic granulomatous infective disease caused by Rhinosporidium seeberi which primarily affects the mucosa of the nasal cavity. Cutaneous lesions are infrequent. However, disseminated cutaneous lesions with varied presentations are very rare in routine pathology practice. Aim: The study aimed to diagnose cutaneous lesions due to rhinosporidiosis on Fine-Needle Aspiration Cytology (FNAC) and to confirm the same by histology. Materials and Methods: This was a cross-sectional study. A total of 8 cases of disseminated cutaneous Rhinosporidiosis out of 815 cutaneous lesions were observed over five years, from September 2013 to October 2018, in Department of Pathology, VIMSAR, Burla. FNAC and scrape cytology of the lesions were performed and studied after Diff-Quik and H&E stain. The lesions were excised and histopathological examination was done. Result: It was observed that the overall incidence of cutaneous rhinosporidiosis diagnosed on FNAC was very low (less than 0.1%) They were mainly seen in middle-aged males from low socio-economic status and rural areas. The skin lesions were mostly subcutaneous nodules, few wart-like growth and ulcerative growth, some of which were initially diagnosed as neurofibroma and squamous cell carcinoma. FNAC and histopathological examination helped to confirm the diagnosis of rhinosporidiosis in all cases. Conclusion: Disseminated cutaneous rhinosporidiosis has varied clinical presentations, mimicking other cutaneous lesions. Hence, proper diagnosis of the patient is necessary which can be achieved by FNAC & histopathology

Objectives: To review and evaluate the clinical presentation & surgical complications of Xanthogranulomatous Pyelonephritis (XGP). Study Design: Case Series study. Setting: Department of Urology Sandeman Provincial Teaching Hospital Quetta. Period: 7 years July, 2011 to June, 2018. Material & Methods: We retrospectively reviewed all biopsy proven cases of XGP who underwent surgery in the department of Urology of a tertiary care hospital from July, 2011 to June, 2018 regarding clinical characteristics, laboratory & radiological finding, interoperate & postoperative complications. Results: There were 42 patients of XGP. The mean age was 49.8+-16.04 years. Male & female percentage was 40.50 & 59.50 respectively. Majority (88.1%) of patients were of low socio-economic status. The most common presentation was flank pain in 100% patients. Fever & dysuria in 64.28%, anorexia in 85.71% and weight loss in 83.33%. In laboratory findings, pyuria was present 88.09%, anemia in 71.42%, azotemia & abnormal liver enzymes in 14.29% each. The most common associated conditions were renal calculi in 83.33% and diabetes in 47.61%. The commonest organism isolated on culture was E-Coli in 35.48%. Intra-operatively excessive bleeding occurred in 3(7.14%), including one with tear of inferior vena cava. Two patients suffered colonic injury & another one pleural injury. Postoperatively the common complications were, wound infections in 8(19.04%) patients & Incisional hernia in 2(4.76%) patients. Conclusion: Urolithiasis and urinary tract infection are two well known risk factors for the development of XPN. Our experience in the present series, demonstrates that low socioeconomic status could be another risk factor for XPN. Early diagnosis and proper treatment of urolithiasis & urinary tract infection is important to prevent their complications including XGP [ABSTRACT FROM AUTHOR]

Background: CD-4 lymphocytopenia can occur in acquired immunodeficiency syndrome(AIDS), in severe combined immunodeficiency, with the use of corticosteroids and/or immunosuppressive drugs, and in patients with idiopathic CD-4 lymphocytopenia. The mechanism for the lymphocytopenia is different in each of these illnesses. Objective: Description of HIV-negative patients with severe disseminated tuberculosis or coccidioidomycosis and lymphocytopenia. Settings and patients: All patients were referred to a University Medical Center in Northwest Texas, USA. Four had disseminated tuberculosis, and three had disseminated coccidioidomycosis. Main outcome measures: Follow-up of lymphocyte subset counts and clinical improvement with the treatment of the underlying granulomatous infection. Results: Five patients had an increase in both CD-4 and CD-8 lymphocyte subset counts with treatment of the underlying granulomatous infection. All patients had clinical improvement with initial therapy of the granulomatous infection. One patient succumbed to disseminated tuberculosis (meningitis) and two to disseminated coccidioidomycosis. One patient was lost to follow up. Conclusions: We report a group of HIV-negative patients who had CD-4 lymphocytopenia in response to severe, disseminated, chronic granulomatous infections. With the treatment of the granulomatous infection the lymphocytopenia improved. This finding, coupled with preserved CD-4/CD-8 ratios, can help to differentiate these patients from those with other causes of lymphocytopenia or AIDS.

Introduction. Actinomycosis is an uncommon chronic granulomatous infection first described by Bollinger in 1877. The infection is caused by actinomyces species and it is characterized by slow contiguous spread and suppurative inflammation, formation of multiple abscesses and sinus tracts with possible drainage of “sulfur granules”. Case Outline. We report an unusual case of actinomycosis of the cheek that occurred 6 years after buccal odontogenic abscess. A 56-year-old male was referred to the Department of Oral Surgery because of a painless swelling of the left cheek, which initiated three weeks prior to the referral. The diagnosis of actinomycosis was confirmed by histopathologic examination. In accordance with the diagnosis oral penicillin was prescribed for four months with complete resolution. Conclusion. This case of actinomycosis is presented as a rarity. For proper diagnosis, careful examination and a high degree of clinical suspicion are necessary.

Rhinoscleroma is a rare, chronic, granulomatous infectious disease of the upper respitory tract caused by the Klebsiella rhinoscleromatis. Delayed diagnosis may increase morbidity, relapses and may decrease success rates. The most common initial complaint is nasal obstruction. Physical examination reveals foul smelling, nodular swellings covered with crusts. Its tumor-like appearance and local spread arouse suspicion of malignancy. Diagnosis of rhinoscleroma is made on the appropriate bacterial cultures with histologic identification of granulomas, fibrosis, eosinophilic Russell bodies and large vacuolated histiocytes (Mikulicz cell). There are three stages in rhinoscleroma: an exudative, a proliferative and a cicatricial stage. It can be treated with a long-term antimicrobial therapy and if necessary, surgical treatment is indicated. Until now, there has been no successful therapy accepted universally. Long-term follow-up is important because these patients can have numerous relapses. A rhinoscleroma case diagnosed in granulomatous stage is presented because of the typifying many of the features of this disease and rhinoscleroma seen rarely in our country is discussed.

Actinomycosis is a chronic infection due to anaerobic filamentous bacteria (Actinomyces), which occurs mostly in the cervicofacial region as a chronic granulomatous infection. We report the case of Mr KI, 17 years old, without past medical history, presented a painful ulceration on the right side of the chest wall which evolved since 2 months. The examination objectified ulcerated and burgeoning lesion in right parasternal region from what came yellowish pus mixed with sulphur granule. A painful subcutaneous nodule was noted under the right breast. An examination of the oral mucosa was entirely normal as well as the rest of the physical examination. Histopathologic studies revealed the presence of inflammatory cells surrounding basophilic sulfur granules which were composed of a large number of filaments arranged in a radiating pattern. The chest x-ray was normal. The chest scan showed an infiltration of the anterior and right lateral wall without bone and lung injury. The results of aerobic and anaerobic culture showed mixed flora. The histopathologic findings led to the diagnosis of actinomycosis of the wall chest. Treatment was based on oral amoxicillin + clavulanic acid (1g+125 mg 3 times daily). The size of the ulcerative lesion gradually decreased and completely healed by 4 weeks. No evidence of recurrence of this lesion was found after 24-month of follow-up.

Granulomatous Mycobacterium Tuberculosis Infection Causes Secondary Knee Osteoarthritis is still a point of contention in terms of therapy, whether it is done early in the first stage or later in the second stage of knee surgery. Early Total Knee Arthroplasty as a therapy for secondary knee osteoarthritis induced by Granulomatous mycobacterium tuberculosis infection is still performed rarely. A case of left pain and swollen knee in males for 8 months. Because of pain and reduced knee range of motion, the patient now has an antalgic gait, which make him difficult to do daily activities. Treatment with medications and physiotherapy failed. Radiographs revealed juxta-articular osteoporosis, peripherally distributed osseous erosions, joint space narrowing, and a bony defect in the medial femoral condyle. This case was successfully treated using Unconstrained Knee Arthroplasty PS Design. Case selection for granulomatous infection case is key element to determine whether a single TKA procedure can be used to treat knee pain problems as a result of secondary osteoarthritis. This case shows secondary knee osteoarthritis caused by Granulomatous Mycobacterium Tuberculosis Infection without pyogenic pus production might allow for early one-stage total knee arthroplasty. Three months following surgery, the patient's knee was stable and painless, with good wound healing and no signs of infection. • Granulomatous Mycobacterium Tuberculosis Infection Knee Osteoarthritis is still a point of contention in decision of one or two stage knee arthroplasty surgery • Case selection is the most important to determine whether the patient is proper for one stage total knee arthroplasty in patient granulomatous knee infection • This case showed good outcome 3 month following single stage total knee arthroplasty in in patient granulomatous knee infection without pus formation. [ABSTRACT FROM AUTHOR]

Spondylodiscitis is among the most frequent and serious complications of brucellosis, and the lumbar spine is the most frequently involved region. This report describes the clinical characteristics of 37 cases and discusses the management problems of brucellar spondylodiscitis. [ABSTRACT FROM AUTHOR]

We report a case of bilateral and primary tubal carcinoma associated with granulomatous inflammation and long-standing primary infertility. A 38-year-old woman with a 17-year history of primary infertility presented with lower abdominal pain and granulomatous inflammation in the endometrial biopsy. Bilateral adnexal masses measuring 4 and 6 cm in size were detected and the serum cancer antigen 125 level was 141 IU/ml. Laparoscopic surgical exploration and frozen section on the resected tubes revealed bilateral fallopian tube adenocarcinoma and then a staging laparotomy was performed. Histopathological examination showed a primary bilateral Grade 2 tubal serous adenocarcinoma of Stage 1b associated with granulomatous salpingitis. Primary fallopian tube carcinomas in young women are extremely rare gynecological tumors that are infrequently diagnosed prior to surgical exploration and their cause is unknown. A definitive diagnosis could be made on the histopathological examination in our case with the evidence of chronic pelvic inflammation. Our findings suggest that chronic pelvic inflammation may play a role in carcinogenesis in the tubes of infertile women. [ABSTRACT FROM AUTHOR]

Cat-scratch disease (CSD) may appear as a solitary mass in the breast and give the impression of a breast carcinoma. In this case, further clinical and laboratory investigation is required to rule out malignancy. We present three cases of CSD of the breast in women of 64, 31 and 61 years old. Each presented with enlarged lymph-nodes in the breast, which were clinically mistaken for solitary tumours. In the first two patients, the mammography was negative. The third patient had a mammogram which indicated a well-defined solid mass in the parenchyma without calcifications. We discuss the clinical, histological and histochemical findings, analyze the differential diagnosis and review the literature. [Copyright &y& Elsevier]

Actinomycetous infections typically involve either the head and neck or the extremities following a traumatic implantation. Classic clinical associations are draining sinus tracts. This case report describes the pathologic and MR findings of a relatively acute mycetomatous process involving the soft tissues. Pathologic findings in this case included an occasional granule composed of gram positive, thin branching elements. These and other findings were consistent with actinomycetes bacterium infection. The discussion centers around the use of MR, both with and without gadolinium, in evaluating this type of granulomatous infection. Infiltration of the adjacent subcutaneous tissues was easier to appreciate on both the T1-weighted images without gadolinium and the T1-weighted images with gadolinium when compared to the T2-weighted images. Signal characteristics as described in this case report may suggest a granulomatous process. [ABSTRACT FROM AUTHOR]

Abstract: We report a case of Azospirillum infection manifestating as granulomatous tenosynovitis of the right hand, in an immunocompetent middle-aged female. We highlight the unusual source of the infection, the diagnostic workup, as well as the treatment approach. [Copyright &y& Elsevier]

Abdominal hysterectomy was performed in a patient because of complaints of dysmenorrhoea and menorrhagia and the uterus was sent for histopathological analysis. Besides adenomyosis an extensive granulomatous infection with Schistosoma mansoni eggs was found. [Copyright &y& Elsevier]

The article presents a case 17 years old man presented to hospital with symptoms of painful ulceration on right side of chest wall and mentions that histopathological findings of patient reveals diagnosis of actinomycosis of wall chest along with treatment with oral amoxicillin + clavulanic acid.

A third of the world's population is exposed to Mycobacterium tuberculosis in their lifetime. Over eight million people develop a tuberculosis (TB) illness and 1.3 million people die from the disease every year. Acquired immunity (cytotoxic CD8+ T cells (CBT), Th1 CD4+ helper T cells) macrophages, and dendritic cells all play important roles in TB infection. Recently, it is well established that innate immunity as well plays a definitive role in the development of TB immunity under the effects of several cytokines, microbicidal proteins and Toll-like receptors. Meanwhile, the introduction and widespread use of biological disease-modifying anti-rheumatic reagents over the last 15 years worldwide has dramatically advanced and improved the standard care and prognosis of patients with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). However, as clinical experience with these drugs has grown, the risk of granulomatous infections, especially disseminated TB and fungal infections, has become apparent, especially because having RA or JIA may innately increase the risk of infection (bacterial, viral and fungal). The knowledge of basic immunology has also advanced over the past 10 years and adult and pediatric rheumatologists should increase their understanding of this dynamic between arthritis diseases, anti-TNF-α medications, and TB. This review will provide an up-to-date discussion of both the immunology of the TB organism in the human host and the pathophysiologic mechanisms of the TNF-α blockers in the development of secondary (disseminated) tuberculosis.