RESUMO
We present a patient with actinomycosis of the parotid, as confirmed by histology, and discuss the challenges involved when clinical and radiological findings are highly indicative of metastatic malignancy. Early treatment with antibiotics is indicated infungating or infected masses and exclusion of malignancy by histology is often needed.
Assuntos
Actinomicose Cervicofacial/diagnóstico , Neoplasias de Cabeça e Pescoço/patologia , Doenças Parotídeas/diagnóstico , Glândula Parótida/microbiologia , Idoso , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Metástase Linfática , Masculino , Doenças Parotídeas/microbiologiaAssuntos
Adulto , Feminino , Humanos , Nocardiose/diagnóstico , Nocardia asteroides/isolamento & purificação , Doenças Parotídeas/microbiologia , Anti-Infecciosos/uso terapêutico , Drenagem , Nocardiose/terapia , Doenças Parotídeas/diagnóstico , Doenças Parotídeas/terapia , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoAssuntos
Nocardiose/diagnóstico , Nocardia asteroides/isolamento & purificação , Doenças Parotídeas/microbiologia , Adulto , Anti-Infecciosos/uso terapêutico , Drenagem , Feminino , Humanos , Nocardiose/terapia , Doenças Parotídeas/diagnóstico , Doenças Parotídeas/terapia , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
BACKGROUND: Tuberculosis is one of the leading infectious diseases in the world, with more than 2 million new cases annually. It is one of the main causes of death of human immunodeficiency virus (HIV)-positive patients, involving multiple organs and particularly the lungs. Nevertheless there are few consistent studies about tuberculosis involving the parotid of HIV patients. The objective of this work was to describe the histological and immunohistochemical characteristics of 10 cases of mycobacteriosis involving the parotid of autopsied patients with advanced acquired immunodeficiency syndrome (AIDS), including identification of the Mycobacterium species. METHODS: Detection of 'M. tuberculosis complex' was performed by polymerase chain reaction (PCR) and ligase chain reaction (LCR) and Mycobacterium avium by PCR. RESULTS: All cases showed involvement of intraparotid lymph nodes, but the glandular parenchyma was affected in only three cases. Most of the cases (80%) presented a chronic non-caseating granulomatous inflammation, and in two cases predominated foamy macrophages, full of bacteria, and no granuloma formation. In areas of mycobacteriosis, macrophages predominated followed by TCD8, B and TCD4 lymphocytes. All cases were infected by Mycobacterium genus and 'M. tuberculosis complex' was detected in five cases by LCR and in eight by PCR, while M. avium was positive in one case only, which was also positive for M. tuberculosis. CONCLUSIONS: Parotid mycobacteriosis in advanced AIDS is characterized by intraparotid lymph node non-caseating inflammatory granulomatous lesion, caused mainly by M. tuberculosis.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Doenças Parotídeas/microbiologia , Tuberculose/microbiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium avium/genética , Mycobacterium avium/isolamento & purificação , Mycobacterium tuberculosis/genética , Doenças Parotídeas/patologiaRESUMO
OBJECTIVE: This study describes the involvement and the histological alterations found in the parotid glands of 100 patients who died with AIDS. MATERIALS AND METHODS: Sex, age, CD4 cell count and clinical history were obtained from the files of 100 patients who died with AIDS. Histological analysis of the parotid glands was performed using H&E, Gomori-Grocott, Ziehl-Neelsen and Mucicarmine. Histological findings were grouped in reactive, infectious, cystic, neoplastic and concomitant lesions. RESULTS: None of the patients presented complaints or symptoms related to salivary gland alterations prior to death. The mean age of the patients and CD4 cell count were 36.4 years and 76.07 cells microliter-1, respectively. Histological alterations of the parotid glands were found in 51% of the patients. The most common alteration was non-specific chronic sialadenitis (29 cases), followed by infectious conditions (22 cases). Mycobacteriosis was the most common infectious disease (10 cases), followed by cytomegalovirus (nine cases), cryptococcosis (three cases) and histoplasmosis (two cases). Lymphoepithelial cysts occurred in six cases, Warthin's tumor and non-Hodgkin Lymphoma in one case each. CONCLUSIONS: These results indicate that infection and other lesions in the parotid glands are more frequent than hitherto described in the specialized literature in AIDS patients. Clinicians should consider parotid gland involvement, when evaluating disease extension in advanced AIDS patients.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/patologia , Síndrome da Imunodeficiência Adquirida/complicações , Doenças Parotídeas/complicações , Glândula Parótida/patologia , Adulto , Criptococose/complicações , Infecções por Citomegalovirus/complicações , Feminino , Histoplasmose/complicações , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium/complicações , Doenças Parotídeas/microbiologia , Doenças Parotídeas/patologia , Doenças Parotídeas/virologia , Neoplasias Parotídeas/complicações , Parotidite/complicaçõesRESUMO
We report the unusual simultaneous occurrence of lymphoepithelial cysts, cytomegalovirus (CMV) and mycobacterial infections in the intraparotid lymph nodes of a 52-year-old AIDS patient who died of disseminated mycobacteriosis. Although cytomegalovirosis is a common finding in the salivary glands of HIV patients, the association of CMV inclusions with lymphoepithelial cyst (LC) has not been previously reported. Parotid mycobacterial infection is an uncommon finding, despite its usual disseminated presentation in HIV patients. These data emphasize that in immunosuppressed patients, simultaneous diseases of the parotid gland may occur and should be considered for diagnosis and treatment.