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Resumen Introducción : La enfermedad por arañazo de gato (EAG) es producida por Bartonella henselae y debido a que afecta principalmente niños, es poco reconocida en adultos. El cua dro evolutivo es generalmente benigno y autolimitado, aun que ocasionalmente puede haber compromiso sistémico. Métodos : Estudio observacional, descriptivo y re trospectivo realizado en un hospital de tercer nivel del conurbano bonaerense. Se incluyeron pacientes mayores de 15 años con diagnóstico de EAG en un período de 5 años (2016-2021). Resultados : Se analizaron 30 pacientes adultos, con una mediana de edad de 20.5 años (17-29), el 73% (n = 22) fueron varones. El 96% (n = 27) presentó contacto estre cho con gatos. La presentación clínica más frecuente fue adenopatías periféricas (90%); el porcentaje de compli caciones fue de 33% (n = 10). La indicación de antibio ticoterapia fue de 86.7% (n = 26), con una mediana de duración de 5 días (5-10). La evolución fue favorable en el 83% (n = 25), en el 16% (n = 5) se perdió seguimiento. Discusión : La EAG es poco reconocida en adultos; las características clínicas de este grupo etario se en cuentran poco descriptas en la literatura. Es un desafío diagnóstico debido a que su forma de presentación más frecuente es la adenopatía localizada.

Abstract Introduction : Cat-scratch disease (CSD) is caused by Bartonella henselae and it is under-recognized in adults because it mainly affects children. Clinical course is commonly benign and self-limited; occasionally, there may be systemic involvement. Methods : Case-series study carried out in a tertiary care hospital in Buenos Aires suburbs. Patients older than 15 years diagnosed with CSD over a 5-year period were included (2016-2021). Results : 30 adult patients were analyzed, with a median age of 20.5 years (IQR 17-29), 73% (n = 22) were male; 96% (n = 27) had history of exposure to cats. The most common clinical presentation of CSD was periph eral lymphadenopathy (90%), the average complication rate was 33% (n = 10), 86.7% (n = 26) received antimi crobial therapy, with a median duration of 5 days (IQR 5-10). Outcome was favorable in 83% (n = 25), 16% (n = 5) were lost to follow-up. Discussion : Clinical features of CSD in adults are poorly described in the worldwide literature. Diagnosis can be challenging because the clinical hallmark is re gional lymphadenopathy.

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Resumen Introducción : En el consultorio de atención inmediata de clínica se concentra la atención de pacientes ambu latorios con enfermedades que requieren diagnóstico precoz, como la adenitis tuberculosa (AT). El objetivo fue describir las características clínicas, estudios com plementarios y procedimientos realizados a pacientes con diagnóstico confirmado por bacteriología o anatomía patológica de AT. Métodos : Estudio observacional, descriptivo, retros pectivo. Período: 2017-2023. Resultados : Se incluyeron 49 pacientes, con una mediana de edad de 31 años; 59% de sexo femenino, 22% con comorbilidades El 40% presentó adenopatías localizadas, la mayoría cervicales. La serología para HIV era positiva en 3 (6.1%). Al 73% se le ingresaron muestras para bacteriología, con aislamiento de M. tuberculosis en 71%. Al 79% se le realizó punción aspiración con aguja fina (PAAF) ganglionar; en el 48% los resultados de la citología fueron sugestivos de tuberculosis (TB). Al 77% se le realizó biopsia ganglionar, resultando en el 62% adenitis granulomatosa. Desde la primera consulta hasta el diagnóstico transcurrieron una mediana de 40 días. La mayoría de los tratamientos se iniciaron luego del resultado de la biopsia, seguido de cultivos, baciloscopia, PAAF y GeneXpert. Un paciente falleció. Discusión : La AT predominó en el sexo femenino en el grupo estudiado, coincidente con la experiencia local, la edad promedio de presentación fue 30 a 40 años. Puede afectar cualquier cadena ganglionar, aunque predomina la localización cervical, que coincide con los hallazgos de este trabajo. En nuestra serie, la demora diagnóstica desde la primera consulta fue menor a la referida en la bibliografía.

Abstract Introduction : In the clinical medicine's immediate assistance unit, care is focused on outpatients with dis eases that require early diagnosis, such as tuberculous adenitis (TA). The aim was to describe clinical features, complementary studies and procedures performed in patients with a diagnosis confirmed by bacteriology or pathological anatomy of TA. Methods : Observational, descriptive, retrospective. Period: 2017-2023. Results : Fourty nine patients were included, with a median age of 31 years, 59% were female, 22% with comorbidities. 40% had localized lymphadenopathy, most of them cervical. HIV serology was positive in 3 cases (6.1%). Samples for bacteriology were submitted in 73%, with isolation of M. tuberculosis in 71%. Nodal fine needle aspiration (FNA) was performed in 79%, and in 48% the cytology results were suggestive of tuberculosis. Nodal biopsy was performed in 77%, with granulomatous adenitis as result in 62%. The term between admis sion and diagnosis ranged from a median of 40 days. Most treatments were started after the biopsy result, followed by culture, bacilloscopy, FNA, and GeneXpert. One patient died. Discussion : TA predominates in the female sex in the studied group, coinciding with the local experience, the average age of presentation is 30 to 40 years, can affect any lymph node region, although the cervical location predominates, which coincides with the findings of this work. In our series, the diagnostic delay from the first consultation was shorter than reported in the literature.

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INTRODUCTION: In the clinical medicine's immediate assistance unit, care is focused on outpatients with diseases that require early diagnosis, such as tuberculous adenitis (TA). The aim was to describe clinical features, complementary studies and procedures performed in patients with a diagnosis confirmed by bacteriology or pathological anatomy of TA. METHODS: Observational, descriptive, retrospective. PERIOD: 2017-2023. RESULTS: Fourty nine patients were included, with a median age of 31 years, 59% were female, 22% with comorbidities. 40% had localized lymphadenopathy, most of them cervical. HIV serology was positive in 3 cases (6.1%). Samples for bacteriology were submitted in 73%, with isolation of M. tuberculosis in 71%. Nodal fine needle aspiration (FNA) was performed in 79%, and in 48% the cytology results were suggestive of tuberculosis. Nodal biopsy was performed in 77%, with granulomatous adenitis as result in 62%. The term between admission and diagnosis ranged from a median of 40 days. Most treatments were started after the biopsy result, followed by culture, bacilloscopy, FNA, and GeneXpert. One patient died. DISCUSSION: TA predominates in the female sex in the studied group, coinciding with the local experience, the average age of presentation is 30 to 40 years, can affect any lymph node region, although the cervical location predominates, which coincides with the findings of this work. In our series, the diagnostic delay from the first consultation was shorter than reported in the literature.

Introducción: En el consultorio de atención inmediata de clínica se concentra la atención de pacientes ambulatorios con enfermedades que requieren diagnóstico precoz, como la adenitis tuberculosa (AT). El objetivo fue describir las características clínicas, estudios complementarios y procedimientos realizados a pacientes con diagnóstico confirmado por bacteriología o anatomía patológica de AT. Métodos: Estudio observacional, descriptivo, retrospectivo. Período: 2017-2023. Resultados: Se incluyeron 49 pacientes, con una mediana de edad de 31 años; 59% de sexo femenino, 22% con comorbilidades El 40% presentó adenopatías localizadas, la mayoría cervicales. La serología para HIV era positiva en 3 (6.1%). Al 73% se le ingresaron muestras para bacteriología, con aislamiento de M. tuberculosis en 71%. Al 79% se le realizó punción aspiración con aguja fina (PAAF) ganglionar; en el 48% los resultados de la citología fueron sugestivos de tuberculosis (TB). Al 77% se le realizó biopsia ganglionar, resultando en el 62% adenitis granulomatosa. Desde la primera consulta hasta el diagnóstico transcurrieron una mediana de 40 días. La mayoría de los tratamientos se iniciaron luego del resultado de la biopsia, seguido de cultivos, baciloscopia, PAAF y GeneXpert. Un paciente falleció. Discusión: La AT predominó en el sexo femenino en el grupo estudiado, coincidente con la experiencia local, la edad promedio de presentación fue 30 a 40 años. Puede afectar cualquier cadena ganglionar, aunque predomina la localización cervical, que coincide con los hallazgos de este trabajo. En nuestra serie, la demora diagnóstica desde la primera consulta fue menor a la referida en la bibliografía.

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INTRODUCTION: Cat-scratch disease (CSD) is caused by Bartonella henselae and it is under-recognized in adults because it mainly affects children. Clinical course is commonly benign and self-limited; occasionally, there may be systemic involvement. METHODS: Case-series study carried out in a tertiary care hospital in Buenos Aires suburbs. Patients older than 15 years diagnosed with CSD over a 5-year period were included (2016-2021). RESULTS: 30 adult patients were analyzed, with a median age of 20.5 years (IQR 17-29), 73% (n = 22) were male; 96% (n = 27) had history of exposure to cats. The most common clinical presentation of CSD was peripheral lymphadenopathy (90%), the average complication rate was 33% (n = 10), 86.7% (n = 26) received antimicrobial therapy, with a median duration of 5 days (IQR 5-10). Outcome was favorable in 83% (n = 25), 16% (n = 5) were lost to follow-up. DISCUSSION: Clinical features of CSD in adults are poorly described in the worldwide literature. Diagnosis can be challenging because the clinical hallmark is regional lymphadenopathy.

Introducción: La enfermedad por arañazo de gato (EAG) es producida por Bartonella henselae y debido a que afecta principalmente niños, es poco reconocida en adultos. El cuadro evolutivo es generalmente benigno y autolimitado, aunque ocasionalmente puede haber compromiso sistémico. Métodos: Estudio observacional, descriptivo y retrospectivo realizado en un hospital de tercer nivel del conurbano bonaerense. Se incluyeron pacientes mayores de 15 años con diagnóstico de EAG en un período de 5 años (2016-2021). Resultados: Se analizaron 30 pacientes adultos, con una mediana de edad de 20.5 años (17-29), el 73% (n = 22) fueron varones. El 96% (n = 27) presentó contacto estrecho con gatos. La presentación clínica más frecuente fue adenopatías periféricas (90%); el porcentaje de complicaciones fue de 33% (n = 10). La indicación de antibioticoterapia fue de 86.7% (n = 26), con una mediana de duración de 5 días (5-10). La evolución fue favorable en el 83% (n = 25), en el 16% (n = 5) se perdió seguimiento. Discusión: La EAG es poco reconocida en adultos; las características clínicas de este grupo etario se encuentran poco descriptas en la literatura. Es un desafío diagnóstico debido a que su forma de presentación más frecuente es la adenopatía localizada.

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La tuberculosis es una infección bacteriana causada por Mycobacterium tuberculosis que afecta a millones de personas en todo el mundo. Aunque principalmente se manifiesta en los pulmones, también puede afectar otras partes del cuerpo, como la regiónes de la cabeza y el cuello. Aunque es poco común, se han reportado casos de tuberculosis en glándulas parótidas, tonsilas palatinas y seno piriforme. La forma más común de tuberculosis extrapulmonar en esta región es la linfadenopatía superficial, que afecta principalmente los nódulos linfáticos del territorio cervical anterior. Los linfonodos afectados por tuberculosis presentan características específicas en la ecografía, lo que puede ayudar en el diagnóstico. El diagnóstico de tuberculosis extrapulmonar se realiza mediante pruebas como la citología por aspiración con aguja fina (PAAF) o la reacción en cadena de la polimerasa (PCR). Estas pruebas permiten detectar la presencia de Mycobacterium tuberculosis en los tejidos afectados. El tratamiento de la tuberculosis implica el uso de antibióticos antituberculosos durante un periodo prolongado. Es importante seguir el tratamiento completo para asegurar la erradicación de las bacterias y prevenir la recurrencia de la enfermedad. En este artículo, se presenta una revisión sistemática de la literatura de tuberculosis extrapulmonar en la región de la cabeza y cuello y un caso de un paciente sexo masculino de 81 años de edad, que se presentó con un aumento de volumen submandibular izquierdo de 3 semanas de evolución, con hipótesis diagnóstica de submaxilitis idiopática. Presentaba múltiples adenopatías supraclaviculares, mediastínicas e hiliares, y en conjunto a scanner, biopsias, cultivos y test dio resultados positivos para tuberculosis que se manifestó de forma extrapulmonar.

Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis that affects millions of people around the world. Although it manifests primarily in the lungs, it can also affect other parts of the body, such as the head and neck regions. Although rare, cases of tuberculosis in the parotid glands, palatine tonsils, and piriform sinus have been reported. The most common form of extrapulmonary tuberculosis in this region is superficial lymphadenopathy, which mainly affects the nodules of the anterior cervical area. Lymph nodes affected by tuberculosis present specific characteristics on ultrasound, which can help in diagnosis. The diagnosis of extrapulmonary tuberculosis is made through tests such as fine needle aspiration cytology (FNAC) or polymerase chain reaction (PCR), which allow the presence of Mycobacterium tuberculosis in the affected tissues to be detected. Treatment of tuberculosis involves the use of anti-tuberculosis antibiotics for long periods of time. It is important to follow the complete treatment to ensure the eradication of bacteria and prevent recurrence of the disease. In this article, we present a systematic review of the literature on extrapulmonary tuberculosis in the head and neck region and case of an 81-year-old male patient, who presented with a 3-week increase in left submandibular volume with a diagnostic hypothesis of idiopathic submaxilitis. The patient had multiple supraclavicular, mediastinal and hilar lymphadenopathy; following scan, biopsies, and cultures, the patient tested positive for tuberculosis that manifested extrapulmonarily.

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INTRODUCTION: Implant-based breast augmentations and reconstructions are one of the most common surgical procedures performed by plastic surgeons in the United States, which has rapidly increased in popularity since the 2000s. Silicone lymphadenopathy (SL) is a complication of breast implants that involves migration of silicone to nearby soft tissue/lymph nodes. Data on its clinical features and management is scarce. METHODS: SL-related search terms were used to find articles in 3 databases. Of 598 articles, 101 studies met the inclusion criteria. Demographics, clinical presentation, workup, and management data were analyzed. RESULTS: Of 279 cases of SL and 107 with information on initial diagnosis, 35 (33%) were incidental. The most common symptom was painless lymphadenopathy, followed by painful lymphadenopathy. 251 (95%) and 13 (5%) patients had silicone and saline implants, respectively. 149 (68%) patients had implant rupture. Axillary lymphadenopathy was the most affected region (136 cases, 72%), followed by internal mammary (40 cases, 21%), cervical/supraclavicular (36 cases, 19%), and mediastinal (24 cases, 13%) regions. 25% of patients underwent fine-needle aspiration, 12% core needle biopsy, and 59% excisional biopsy. 32% of cases underwent explantation and/or implant exchange. The most common indication for surgery was implant rupture. Histology showed multinucleated giant cells, large histiocytes, and silicone accumulation. CONCLUSIONS: SL is a complication associated with breast implants. The majority of patients are asymptomatic, and most cases are managed conservatively. Minority need a biopsy and surgical interventions due to abnormal imaging, persistent symptoms, and/or implant rupture. Workup and management should be tailored to the patient.

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Resumen Se presenta el caso clínico de una paciente del sexo femenino, de 30 años, con adenopatías supraclaviculares y axilares ipsilaterales, quien fue sometida a biopsia excisional con posterior estudio. El análisis histopatológico de la muestra de tejido resecado reveló una serie de características distintivas asociadas con la enfermedad de Castleman variante hialinovascular. La presentación de este caso no solo proporciona información detallada sobre la evolución clínica de la paciente, sino que también sirve como base para ilustrar los aspectos clave del diagnóstico histopatológico y las implicaciones inmunohistoquímicas en la enfermedad de Castleman. Además de hacer una revisión de tema respecto a esta patología poco común, en la cual los informes de casos son fundamentales para aumentar la comprensión de su variabilidad clínica y su abordaje diagnóstico, ilustrando los desafíos en el diagnóstico diferencial y como deben abordarse los mismos.

Abstract The clinical case of a 30-year-old female patient with supraclavicular and ipsilateral axillary lymphadenopathy who underwent excisional biopsy with subsequent study is presented. Histopathological analysis of the resected tissue sample revealed a series of distinctive features associated with hyalinevascular variant Castleman disease. The presentation of this case not only provides detailed information about the clinical evolution of the patient, but also serves as a basis to illustrate Key aspects of histopathological diagnosis and immunohistochemical implications in Castleman disease. In addition to making a review of the topic regarding this rare pathology in which case reports are essential to increase the understanding of its clinical variability and its diagnostic approach, illustrating the challenges in differential diagnosis and how they should be addressed.

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La mononucleosis infecciosa es una enfermedad infectocontagiosa causada por el virus de Epstein-Barr, que afecta principalmente a personas jóvenes, se caracteriza por presencia de fiebre, faringitis y linfadenopatía, generalmente autolimitada, de 1-2 semanas de evolución. Se presenta el caso de un paciente masculino de 22 años con historia de 1 mes de evolución de fiebre y cefalea al que posteriormente se añade odinofagia, adenopatía cervical posterior y exantema generalizado. En analítica laboratorial se constata leucocitosis con neutrofilia. Entre sus estudios complementarios retorna IgM para virus de Epstein-Barr positivo.

Infectious mononucleosis is an infectious disease caused by the Epstein-Barr virus, which mainly affects young people. It is characterized by the presence of fever, pharyngitis and lymphadenopathy, generally self-limited, lasting 1-2 weeks. The case of a 22-year-old male patient with a 1-month history of fever and headache is presented to which odynophagia, posterior cervical lymphadenopathy, and generalized rash are later added. Laboratory analysis revealed leukocytosis with neutrophilia. Among his complementary studies, IgM for Epstein-Barr virus was positive.

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La infección por Bartonella henselae (BH) adopta diversas formas de presentación clínica en pediatría. Según la bibliografía la forma de presentación más frecuente en pacientes inmunocompetentes es la linfadenopatía única asociada a fiebre. En el 85 % de los casos se compromete un solo ganglio siendo los axilares y los epitrocleares los más frecuentemente involucrados. Existen otras formas de presentación menos frecuentes que debemos tener en consideración, para poder realizar un diagnóstico precoz e indicar un tratamiento adecuado si así lo requiere. El diagnóstico requiere de la sospecha clínica del equipo de salud tratante, junto al antecedente epidemiológico, los hallazgos clínicos del examen físico y la realización de serologías que incluyan el dosaje de inmunoglobulina M y G. Los objetivos del presente trabajo fueron reconocer las manifestaciones clínicas típicas y atípicas de la EAG por Bartonella henselae, describir la epidemiología, características clínicas y evolución de esta enfermedad que se presentaron en nuestro hospital. Se estudiaron un total de 187 pacientes. La media de edad fue de 7.6 años (rango 1-14); siendo 53.5% de género masculino. Las formas de presentación más frecuentes en nuestro trabajo fueron la adenitis y la fiebre. La mayoría recibió diversos esquemas de tratamiento antibiótico, secundario al retraso en el diagnóstico. La tasa de hospitalización fue muy baja, remitió con tratamiento ambulatorio con antibióticos o sin ellos (AU)

Bartonella henselae infection has different clinical presentations in pediatrics. According to the literature, the most common form of presentation in immunocompetent patients is single lymphadenopathy associated with fever. In 85 % of the cases a single lymph node is involved, with the axillary and epitrochlear nodes being the most commonly involved. There are other, less frequent, forms of presentation that should be taken into consideration in order to make an early diagnosis and indicate appropriate treatment if required. Diagnosis relies on clinical suspicion by the treating healthcare team, together with the epidemiological history, clinical findings on physical examination, and serology including immunoglobulin M and G dosage. The objectives of this study were to identify both the typical and atypical clinical manifestations of Bartonella henselae cat scratch disease, to describe the epidemiology, clinical characteristics, and outcomes of cases presenting at our hospital. A total of 187 patients were studied. The mean age was 7.6 years (range 1-14); 53.5% were male. The most frequent forms of presentation in our study were adenitis and fever. Most of them received different antibiotic treatment regimens due to delayed diagnosis. The hospitalization rate was very low and the disease typically resolved with outpatient treatment, with or without antibiotics (AU)

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Introduction Tuberculosis is a disease of diversified presentation. It affects almost all organs in the body, and otorhinolaryngological, head and neck involvement is not an exception. Objective To increase awareness about the different clinical presentations of otorhinolaryngological, head and neck tuberculosis, the techniques employed to diagnose it, and to assess the response to the treatment. Methods We conducted a prospective study of 114 patients who presented primarily with otorhinolaryngological, head and neck tuberculosis. Routine blood investigations, chest radiographs, the tuberculin test, and sputum examination for the presence of acid-fast bacilli were performed in all cases. Site-specific investigations were performed in relevant cases only. The patients were treated according to the antitubercular treatment (ATT) regimen recommended by the Indian Ministry of Health and Family Welfare's National Tuberculosis Elimination Program (NTEP), and they were followed up clinically two and six months after starting the ATT. Results Tubercular cervical lymphadenopathy was the most common clinical presentation (85.96%), followed by deep neck abscess (5.27%). Fine-needle aspiration cytology proved to be a reliable tool for the diagnosis of tubercular lymphadenopathy. Improvement at the end of 2 and 6 months of the ATT was observed in 90.35% and 96.50% of the cases respectively. Conclusion The diagnosis of otorhinolaryngological, head and neck tuberculosis requires a high index of clinical suspicion, and the ATT proved to be very effective in reducing the severity of the disease.

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Introducción: La biopsia ganglionar retroperitoneal es un procedimiento frecuentemente requerido en el estudio de neoplasias; resulta deseable optimizar su rendimiento con baja morbilidad. Este artículo describe la utilidad y complicaciones de biopsias ganglionares retroperitoneales por laparoscopia en una institución oncológica de Latinoamérica. Material y Métodos: Cohorte retrospectiva de pacientes con biopsia ganglionar retroperitoneal o mesentérica laparoscópica entre 2011 y 2021 en el Instituto Nacional de Cancerología, en Bogotá, Colombia. Se recogieron datos demográficos, quirúrgicos, complicaciones y mortalidad a 30 días, resultados histopatológicos y su rol en la clínica. Resultados: Se incluyeron 41 pacientes; 73% con diagnóstico de malignidad, principalmente linfoma. La indicación fue mayormente sospecha de recaída, seguida por sospecha de enfermedad hematológica de novo. Siempre se obtuvo tejido adecuado y suficiente para diagnóstico histológico. Requirieron conversión a laparotomía cinco pacientes (12%). No hubo complicaciones Clavien-Dindo III /IV ni mortalidad a 30 días. Se presentó morbilidad grado I o II en 3 casos (7%) y un incidente intraoperatorio grado III. Conclusión: La naturaleza invasiva y el carácter diagnóstico de la biopsia retroperitoneal laparoscópica, constituyen un desafío frecuente en la práctica del cirujano general. La planeación estratégica e individualizada y la técnica quirúrgica depurada son las claves para lograr el máximo rendimiento, con baja morbimortalidad.

Introduction: Retroperitoneal lymph node biopsy is a frequently required procedure in the study of neoplasms; it is desirable to optimize its performance with low morbidity. This paper describes the usefulness and complications of retroperitoneal lymph node biopsies by laparoscopy in a cancer institution in Latin America. Material and Methods: Retrospective cohort of patients with laparoscopic retroperitoneal or mesenteric lymph node biopsy between 2011 and 2021 at the National Cancer Institute, in Bogotá, Colombia. Demographic and surgical data, complications and 30-day mortality, histopathological results and their clinical role were collected. Results: 41 patients were included; 73% diagnosed with malignancy, mainly lymphoma. The indication was mostly suspected relapse, followed by suspected de novo hematologic disease. Adequate and sufficient tissue was always obtained for histological diagnosis. Five patients (12%) required conversion to laparotomy. There were no Clavien-Dindo III/IV complications or 30-day mortality. Grade I or II morbidity occurred in 3 cases (7%) and a grade III intraoperative incident. Conclusion: The invasive nature and diagnostic character of laparoscopic retroperitoneal biopsy constitute a frequent challenge in the practice of the general surgeon. Strategic and individualized planning and a refined surgical technique are the keys to achieving maximum performance, with low morbidity and mortality.

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BACKGROUND: The differential diagnosis of lymphadenopathies in children including benign and malignant conditions is often difficult to identify by ultrasound (US). The lymphadenopathies in children are frequent and mostly benign, therefore it is essential to decide what patients should undergo further studies. OBJECTIVE: To describe the potential usefulness of a new suspicious ultrasound sign on pediatric lymphadenopathies that can orient the diagnosis of malignancy. MATERIALS AND METHODS: We retrospectively reviewed all pediatric cases with lymphadenopathy suspicious of lymphoma or lymphoproliferative syndrome on soft tissue ultrasound from 2014 to 2021. Two expert ultrasound radiologists reviewed ultrasound images of these patients, associating the internal structure of infiltrated adenopathy with the internal structure of the truffles. RESULTS: On ultrasound, twelve cases presented enlarged lymphadenopathy with loss of internal structure, without hilum; mostly hypoechoic parenchyma, with some fine echogenic serpiginous linear surrounding hypoechoic pseudo nodular images, resembling the inner structure of black truffles. This US pattern looked suspicious and histological study was recommended. In 9 cases a lymphomatous infiltrated adenopathy was confirmed on biopsy. CONCLUSION: The truffle sign is a new potential suspicious ultrasound sign, that can suggest malignant lymphadenopathy in children. This ultrasound pattern can have some probable usefulness to the radiologist in order to recommend further studies, including histological study, that need to be validated by a larger sample. It is important to recognize easily and early the lymphomatous compromise in a lymph node.

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ABSTRACT Sarcoidosis is a generalized systemic chronic inflammation that rarely involves the orbit. As a chronic inflammation, sarcoidosis typically manifests with an insidious onset and slowly progressive course. We report a case of acute-onset proptosis resulting from a rapidly growing diffuse orbital mass that simulated malignant growth, which was biopsy proven to be the first manifestation of systemic sarcoidosis. The patient demonstrated complete resolution of proptosis and systemic involvement with long-term corticosteroid treatment.

RESUMO A sarcoidose é uma inflamação sistêmica generalizada que raramente envolve a órbita. Sendo uma inflamação crônica, a sarcoidose geralmente se manifesta com um início insidioso e uma evolução lentamente progressiva. Neste artigo, é relatado um caso de proptose de início agudo, resultante de uma massa orbitária difusa de rápido crescimento, simulando um crescimento maligno, mas cuja biópsia comprovou ser a primeira manifestação de uma sarcoidose sistêmica. O paciente apresentou resolução completa da proptose e do envolvimento sistêmico com tratamento de longo prazo com corticosteroides.

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Introducción. Bartonella henselae es el agente etiológico de la enfermedad por arañazo de gato. Afecta a niños y a adultos jóvenes. El espectro clínico es amplio; la forma de presentación más frecuente es la linfadenopatía única. El objetivo de este estudio fue analizar epidemiología, características clínicas y evolución de esta enfermedad en un hospital de alta complejidad de Argentina. Población y métodos. Estudio retrospectivo, descriptivo y observacional realizado en un hospital pediátrico de tercer nivel, desde el 01 de enero de 2019 hasta el 30 de junio de 2021. Se incluyeron niños de 0 a 16 años con clínica compatible y serología positiva. Resultados. Se incluyeron 150 niños, con una media de edad de 7,9 años ± 3,68. El 68,7 % refirió tener contacto con gatos. El motivo de consulta más frecuente fueron las adenopatías únicas (84,7 %) localizadas en cabeza y cuello. El síndrome febril sin foco motivó la consulta en el 15,5 % de los casos, con ecografía abdominal patológica en el 85,7 %. Presentó IgM e IgG positivas el 88 %. Con el resultado de la serología positiva, el 44 % recibió tratamiento antibiótico. Las adenopatías prolongadas fueron la principal causa de su instauración; el más utilizado fue la azitromicina (42,4 %). El 14 % (n = 21) requirió internación. Conclusiones. El diagnóstico implica sospecha clínica, nexo epidemiológico y exámenes complementarios. Su forma típica son las adenomegalias únicas localizadas en cabeza y cuello. Debido a la alta frecuencia de compromiso hepatoesplénico, la realización de ecografía abdominal estaría indicada en niños con fiebre.

Introduction. Bartonella henselae is the etiologic agent in cat-scratch disease. It affects children and young adults. The clinical spectrum is wide; the most common clinical presentation is a solitary lymphadenopathy. The objective of this study was to analyze the epidemiology, clinical features, and course of this disease in a tertiary care hospital in Argentina. Population and methods. Retrospective, descriptive, and observational study conducted at a tertiary care pediatric hospital from January 1st, 2019 to June 30 th, 2021. Children aged 0 to 16 years with compatible clinical signs and symptoms and positive serology were included. Results. A total of 150 patients were included; their mean age was 7.9 years ± 3.68. Of them, 68.7% reported having contact with cats. The most common reason for consultation was the presence of solitary lymphadenopathies (84.7%) in the head and neck. Febrile syndrome without source was the reason for consultation in 15.5% of cases, with a pathological abdominal ultrasound scan in 85.7%. IgM and IgG were positive in 88%. With the result of a positive serology test, 44% received antibiotic treatment. Protracted lymphadenopathy was the main reason for antibiotic treatment; the agent most commonly used was azithromycin (42.4%). Fourteen percent (n = 21) required hospitalization. Conclusions. Diagnosis is based on clinical suspicion, epidemiological history, and complementary testing. Its typical presentation is a solitary enlarged lymph node in the head and neck. Due to the high frequency of hepatosplenic involvement, an abdominal ultrasound scan would be indicated in children with fever.

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Introduction. Bartonella henselae is the etiologic agent in cat-scratch disease. It affects children and young adults. The clinical spectrum is wide; the most common clinical presentation is a solitary lymphadenopathy. The objective of this study was to analyze the epidemiology, clinical features, and course of this disease in a tertiary care hospital in Argentina. Population and methods. Retrospective, descriptive, and observational study conducted at a tertiary care pediatric hospital from January 1st , 2019 to June 30th, 2021. Children aged 0 to 16 years with compatible clinical signs and symptoms and positive serology were included. Results. A total of 150 patients were included; their mean age was 7.9 years ± 3.68. Of them, 68.7% reported having contact with cats. The most common reason for consultation was the presence of solitary lymphadenopathies (84.7%) in the head and neck. Febrile syndrome without source was the reason for consultation in 15.5% of cases, with a pathological abdominal ultrasound scan in 85.7%. IgM and IgG were positive in 88%. With the result of a positive serology test, 44% received antibiotic treatment. Protracted lymphadenopathy was the main reason for antibiotic treatment; the agent most commonly used was azithromycin (42.4%). Fourteen percent (n = 21) required hospitalization. Conclusions. Diagnosis is based on clinical suspicion, epidemiological history, and complementary testing. Its typical presentation is a solitary enlarged lymph node in the head and neck. Due to the high frequency of hepatosplenic involvement, an abdominal ultrasound scan would be indicated in children with fever.

Introducción. Bartonella henselae es el agente etiológico de la enfermedad por arañazo de gato. Afecta a niños y a adultos jóvenes. El espectro clínico es amplio; la forma de presentación más frecuente es la linfadenopatía única. El objetivo de este estudio fue analizar epidemiología, características clínicas y evolución de esta enfermedad en un hospital de alta complejidad de Argentina. Población y métodos. Estudio retrospectivo, descriptivo y observacional realizado en un hospital pediátrico de tercer nivel, desde el 01 de enero de 2019 hasta el 30 de junio de 2021. Se incluyeron niños de 0 a 16 años con clínica compatible y serología positiva. Resultados. Se incluyeron 150 niños, con una media de edad de 7,9 años ± 3,68. El 68,7 % refirió tener contacto con gatos. El motivo de consulta más frecuente fueron las adenopatías únicas (84,7 %) localizadas en cabeza y cuello. El síndrome febril sin foco motivó la consulta en el 15,5 % de los casos, con ecografía abdominal patológica en el 85,7 %. Presentó IgM e IgG positivas el 88 %. Con el resultado de la serología positiva, el 44 % recibió tratamiento antibiótico. Las adenopatías prolongadas fueron la principal causa de su instauración; el más utilizado fue la azitromicina (42,4 %). El 14 % (n = 21) requirió internación. Conclusiones. El diagnóstico implica sospecha clínica, nexo epidemiológico y exámenes complementarios. Su forma típica son las adenomegalias únicas localizadas en cabeza y cuello. Debido a la alta frecuencia de compromiso hepatoesplénico, la realización de ecografía abdominal estaría indicada en niños con fiebre.

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Rituximab is indicated in some patients with refractory systemic lupus erythematosus (SLE). Occasionally, this medication is required in chronic form to maintain control of the disease. We described two patients who developed lymphoid follicular hyperplasia (LFH) after multiple cycles of rituximab and evaluated the expression of B cell activating factor belonging to the tumor necrosis factor (TNF) family (BAFF) and its receptors [BAFF-receptor (BAFF-R) and B cell maturation antigen (BCMA)], as possible factors related to lymphoid node enlargement. Two patients with SLE completed six and nine cycles of rituximab (1 g every 2 weeks) indicated each 9 months, achieving remission for 5 and 7 years, respectively, when developed prominent lymphadenopathies. Biopsies showed LFH. Haematological neoplasms were ruled out. Immunohistochemistry showed BAFF overexpression in the follicles, and moderate expression of BAFF-R confined to the mantle zone and BCMA to the germinal centre. Belimumab B cell activating factor belonging to the TNF family (anti-BAFF therapy) was started with positive effects on the clinical condition. LFH can develop in patients with SLE who received multiple cycles of rituximab. BAFF overexpression and moderate expression of BAFF-R and BCMA in lymph nodes were seen. These findings added to the improvement with the change to belimumab could suggest that LFH after cluster of differentiation (CD20) depletion therapy may be associated with a compensatory overexpression of BAFF and its receptors.

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OBJECTIVE: The objective of this study was to investigate the differences in the clinical characteristics of Kawasaki disease between older and younger children. STUDY DESIGN: This retrospective study examined 405 children with Kawasaki disease admitted to Showa University Northern Yokohama Hospital between 2015 and 2019. RESULTS: Eligible patients were classified into the older (≥3.0 years of age, n = 169) and younger (<3.0 years of age, n = 236) groups. Skin rash was found in significantly fewer cases (112 [66.3%] vs 229 [97.0%], P < .001 in the younger group). Cervical lymphadenopathy was more common in older children (153 [90.5%] vs 165 [69.9%], P < .001) and in incomplete Kawasaki disease (3 or 4 findings) (34 [20.1%] vs 25 [10.6%], P = .0078). The diagnosis was more delayed in older children (median: 5.0 days vs 4.0 days, P = .003) than the younger group. Additionally, fever nonresponsive to a single intravenous immunoglobulin was more common, and the duration of fever was significantly longer in the older group (48 [28.4%] vs 47 [19.9%], P = .0479). CONCLUSIONS: Kawasaki disease should be suspected in children aged >3.0 years with cervical lymphadenopathy and fever, despite the absence of skin rash. Additionally, incomplete Kawasaki disease, fever unresolved by a single intravenous immunoglobulin infusion, and the tendency to delay treatment initiation are more common in children aged >3.0 years.

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Resumen ANTECEDENTES: Durante el embarazo es más común el linfoma de Hodking que el no Hodking; afecta, en promedio, a mujeres de 30 años (18-44 años) y más. Suele diagnosticarse alrededor de las 28 semanas de embarazo y está documentado que puede llegarse al término. Los esquemas de tratamiento pueden iniciarse en el posparto inmediato o, incluso, antes. La incidencia mundial del linfoma no Hodking es de 0.8 por cada 100,000 mujeres; se desconoce la supervivencia durante el embarazo. CASO CLINICO: Paciente de 34 años, con antecedentes obstétricos de tres embarazos, una cesárea y un aborto y el embarazo actual en curso de las 29 semanas, referida de la ciudad de Colima debido a un reporte de BI-RADS 3 en el ultrasonido de mama y un nódulo mamario palpable, con evidencia de múltiples tumoraciones en la zona hepática, esplénica y peripancreática. La biopsia tomada de las zonas de la lesión reportó: linfoma de células B de alto grado de malignidad, con morfología blastoide y expresión de C-MYC y BCL2. Además, la paciente se encontró con: anemia, dolor abdominal, múltiples nódulos hepáticos y adenopatías abdominales. Se decidió la interrupción del embrazo a las 30 semanas, con la obtención de un recién nacido, sin complicaciones. Enseguida se inició el tratamiento con rituximab-etopósido-prednisolona-vincristina-ciclofosfamida-doxorrubicina (R-EPOCH) con adecuada adaptación por la paciente. CONCLUSION: Puesto que la información bibliográfica de linfoma y embarazo es escasa el caso aquí reportado es relevante por su aporte. La atención multidisciplinaria favorecerá siempre el pronóstico de las pacientes.

Abstract BACKGROUND: Hodking's lymphoma is more common during pregnancy than non-Hodking's lymphoma; it affects, on average, women aged 30 years (18-44 years) and older. It is usually diagnosed around 28 weeks of pregnancy and is documented to be carried to term. Treatment regimens can be initiated in the immediate postpartum period or even earlier. The worldwide incidence of non-Hodking's lymphoma is 0.8 per 100,000 women; survival during pregnancy is unknown. CLINICAL CASE: 34-year-old patient, with obstetric history of three pregnancies, one cesarean section and one abortion and the current pregnancy in progress at 29 weeks, referred from the city of Colima due to a report of BI-RADS 3 on breast ultrasound and a palpable breast nodule, with evidence of multiple tumors in the hepatic, splenic and peripancreatic area. Biopsy taken from the lesion areas reported: high grade malignant B-cell lymphoma, with blastoid morphology and expression of C-MYC and BCL2. In addition, the patient was found to have: anemia, abdominal pain, multiple hepatic nodules and abdominal adenopathies. It was decided to terminate the pregnancy at 30 weeks, with the delivery of an uncomplicated newborn. Rituximab-Etoposide, Prednisone, Vincristine, Cyclophosphamide, and Doxorubicin (R-EPOCH) therapy was started immediately with adequate adaptation by the patient. CONCLUSION: Since bibliographic information on lymphoma and pregnancy is scarce, the case reported here is relevant for its contribution. Multidisciplinary care will always favor the prognosis of patients.

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Abstract Introduction Tuberculosis is a disease of diversified presentation. It affects almost all organs in the body, and otorhinolaryngological, head and neck involvement is not an exception. Objective To increase awareness about the different clinical presentations of otorhinolaryngological, head and neck tuberculosis, the techniques employed to diagnose it, and to assess the response to the treatment. Methods We conducted a prospective study of 114 patients who presented primarily with otorhinolaryngological, head and neck tuberculosis. Routine blood investigations, chest radiographs, the tuberculin test, and sputum examination for the presence of acid-fast bacilli were performed in all cases. Site-specific investigations were performed in relevant cases only. The patients were treated according to the antitubercular treatment (ATT) regimen recommended by the Indian Ministry of Health and Family Welfare's National Tuberculosis Elimination Program (NTEP), and they were followed up clinically two and six months after starting the ATT. Results Tubercular cervical lymphadenopathy was the most common clinical presentation (85.96%), followed by deep neck abscess (5.27%). Fine-needle aspiration cytology proved to be a reliable tool for the diagnosis of tubercular lymphadenopathy. Improvement at the end of 2 and 6 months of the ATT was observed in 90.35% and 96.50% of the cases respectively. Conclusion The diagnosis of otorhinolaryngological, head and neck tuberculosis requires a high index of clinical suspicion, and the ATT proved to be very effective in reducing the severity of the disease.

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COVID-19 has brought a number of diseases secondary to viral infection, and there have been several reports on clinical manifestations related to vaccination. One of the effects reported in the literature, either related to the disease or to the vaccines, is the occurrence of cervical lymphadenopathy, which can result in a misleading differential diagnosis of malignant neoplasms. It is important that the specialist be aware of this differential diagnosis for an accurate management of cases.