RESUMEN
A rare spindle cell pseudotumor in the skin, lymph nodes, and bone marrow has been previously reported in immunosuppressed transplant patients and patients with acquired immunodeficiency syndrome. All reported cases were caused by Mycobacterium avium-intracellulare or other nontuberculous mycobacteria. We are reporting spindle cell pseudotumors in the lungs caused by Mycobacterium tuberculosis. The patient had insulin-dependent diabetes mellitus and was status post cadaveric renal and pancreatic transplants. His hospital course was complicated by pulmonary tuberculosis due to M. tuberculosis. At autopsy, the lungs showed numerous bilateral gray nodules ranging from 0.2 to 2.5 cm. Microscopic examination uncovered a cellular proliferation composed of spindle cells arranged in fascicles. There were no granulomata. An acid-fast stain showed numerous acid-fast bacilli within the spindle cells. To our knowledge, this is the first case of spindle cell pseudotumor caused by M. tuberculosis of the lungs. Awareness of this unusual manifestation of mycobacterial infection in immunosuppressed patients underscores the need for acid-fast staining of biopsies with spindle cell proliferation even in the absence of overt granulomatous lesions in order to prevent misdiagnosis.
Asunto(s)
Huésped Inmunocomprometido , Trasplante de Riñón/inmunología , Enfermedades Pulmonares/patología , Trasplante de Páncreas/inmunología , Tuberculosis Pulmonar/patología , Adulto , Humanos , MasculinoRESUMEN
A case of asymptomatic urinary tract infection with Neisseria subflava biovar perflava in a 10-year-old male patient with congenital structural abnormalities of the urinary bladder is presented. The organism was recovered from three catheter urine specimens collected over a seven-month period. A brief review of the role of saprophytic Neisseria species in infectious processes is presented and the likely source of this unusual urinary tract isolate is discussed.
Asunto(s)
Bacteriuria/microbiología , Neisseria/aislamiento & purificación , Vejiga Urinaria/anomalías , Niño , Humanos , Masculino , Neisseria/clasificaciónRESUMEN
Using stereological techniques we have estimated the volume density of melanin and counted the number of pigmented and non-pigmented neuronal cell bodies in the pars compacta of the substantia nigra of 12 autopsied patients with acquired immune deficiency syndrome (AIDS) who did not have inflammation or necrosis of the midbrain or clinical parkinsonism. The total number of neuronal cell bodies was 25% lower in AIDS (P less than 0.01) than in 12 age-matched controls, although the volume density of neuronal melanin did not differ from that of controls because the percentage of pigmented cell bodies was higher (P less than 0.01) and the cell bodies were more fully packed with melanin in AIDS. Also, the expected increase with age of the volume density of neuronal melanin (P less than 0.02) and the percentage of pigmented neurons (P less than 0.01) occurred in the controls but not in AIDS patients. Importantly, our histopathological examination showed unequivocal nigral degeneration with neuronal loss, small neuronal cell bodies packed with melanin, reactive astrocytosis and extra-cellular melanin in the AIDS patients but not in controls. Our study shows that a subclinical nigral degeneration is common in AIDS and could possibly explain the heightened susceptibility of some patients to drug-induced parkinsonism.