Black esophagus is a rare but underdiagnosed disease. It occurs most frequently in severely ill patients and carries a high mortality rate. Cause of death is usually attributed to the comorbid conditions. Treatment is directed at the underlying cause, acid suppression and keeping the patient nil-per-os. Surgery is needed in complicated cases and stenosis is the most feared longterm sequel. In the present article, two cases are described and literature is reviewed

Antonio Carlos Nogueira

Daniel Soares de Sousa Dantas

Edmar Tafner

Francisco Garcia Soriano

Hélio Minamoto

José Pinhata Otoch

João Augusto dos Santos Martines

João Epalanga Júnior Vidro

Lincoln Tavares de Andrade

Luis Masuo Maruta

Simone Peres Pilli

PubMed

Anaplastic large cell lymphoma (ALCL), a well-recognized entity, presents a varied clinical picture and epidemiological characteristics associated with the expression of the anaplastic lymphoma kinase (ALK) protein. When classic symptoms are present (weight loss, fever, and night sweats) and combine with enlarged and easily accessible peripheral lymph nodes, diagnosis is not that difficult. But when the clinical presentation is nonspecific, a tough diagnostic task is required. HIV infection is highly associated with neoplastic disorders—mainly with those of hematological origin. However, ALCL is exceptionally associated with HIV infection, and the few reported cases are ALK–\ud
 ALCL. The authors report two cases of ALK+ ALCL with the unusual clinical presentation: one is associated with the HIV infection and the other presents as a fever of unknown origin (FUO) without peripheral lymphadenopathy. The latter was autopsied and was characterized by nodal and extra nodal involvement. The authors call attention to the plurality of clinical presentation of this group of lymphomas, and the early indication of bone marrow examination in cases of an FUO with elevated hepatic enzymes and lactic dehydrogenase

Campos, Fernando Peixoto Ferraz de

Zerbini, Maria Claudia Nogueira

Simoes, Angelica Braz

Lovisolo, Silvana Maria

Fonseca, Leonardo Gomes da

Laborda, Lorena Silva

Felipe-Silva, Aloisio

Biblioteca Digital da Produção Intelectual da Universidade de São Paulo (BDPI/USP)

Unusual clinical presentation of anaplastic large cell lymphoma

Although infectious diseases are the most prevalent cause of fevers of unknown origin (FUO), this diagnosis remains challenging in some pediatric patients. Imaging exams, such as computed tomography (CT) are frequently required during the diagnostic processes. The presence of multiple hypoattenuating scattered images throughout the liver associated with the history of cohabitation with cats should raise the suspicion of the diagnosis of cat-scratch disease (CSD), although the main etiologic agent of liver abscesses in childhood is Staphylococcus aureus. Differential diagnosis by clinical and \ud
epidemiological data with Bartonella henselae is often advisable. The authors report the case of a boy aged 2 years and 9 months with 16-day history of daily fever accompanied by intermittent abdominal pain. Physical examination was unremarkable. Abdominal ultrasound performed in the initial work up was unrevealing, but an abdominal CT that was performed afterwards disclosed multiple hypoattenuating hepatic images compatible with the diagnosis of micro abscesses. Initial antibiotic regimen included cefotaxime, metronidazole, and oxacillin. Due to the epidemiology of close contact with kittens, diagnosis of CSD was considered and confirmed by serologic tests. Therefore, the initial antibiotics were replaced by clarithromycin orally for 14 days followed by fever defervescence and clinical improvement. The authors call attention \ud
to this uncommon diagnosis in a child presenting with FUO and multiple hepatic images suggestive of micro abscesses

BAPTISTA, Mariana Andrade

LO, Denise Swei

HEIN, Noely

HIROSE, Maki

YOSHIOKA, Cristina Ryoka Miyao

RAGAZZI, Selma Lopes Betta

GILIO, Alfredo Elias

FERRONATO, Angela Espósito

Cat-scratch disease presenting as multiple hepatic lesions: case report and literature review

Sphingomonas paucimobilis is an aerobic Gram-negative bacillus that, although rare in humans, most commonly infects immunocompromised and hospitalized patients. Among the 59 pediatric cases of S. paucimobilis infection reported in the literature, the most common diagnosis involves isolated bacteremia. These cases are related to sporadic or epidemic infections. Death related to this infection occurred in only one case. The authors report a case of an 11-year-old boy with the diagnosis of Sphingomonas paucimobilis otomastoiditis and a thorough review of the literature on this infection in \ud
pediatrics. The patient presented a 20-day history of fever, otalgia, otorrhea, and progressive retroauricular swelling with protrusion of the left ear; despite 15 days of amoxicillin regimen. His past medical history included chronic bilateral otitis \ud
media, but no cause of immunosuppression was found. A brain computed tomography scan showed left otomastoiditis associated with a large circumscribed fluid collection with deep involvement of the soft tissues of the temporal region, including the subperiosteal space. Blood tests showed neutrophilia and elevated C-reactive protein. Surgical manipulation of the cited collection drained a large amount of a fetid purulent secretion. Ceftazidime and clindamycin were empirically initiated. The outcome was favorable, with fever defervescence and resolution of the scalp deformation. Culture of the drained secretion was positive for S. paucimobilis. Ciprofloxacin was scheduled for a further 10 days after discharge. The follow-up showed complete recovery. As far as we know, this is the first case of S. paucimobilis otomastoiditis, complicated with subperiosteal abscess in an immunocompetent child. The authors call attention to the increasing number of reports on S. paucimobilis infection over the years, and therefore to the importance of this pathogen, which was previously underestimated

BENEVIDES, Gabriel Nuncio

CARDOSO, Débora Morais

SANTOS, Sílvia Regina dos

Otomastoiditis caused by Sphingomonas paucimobilis: case report and literature review

Septic pelvic thrombophlebitis (SPT) is a rare and severe entity, which may occur after abortion, delivery, gynecological diseases, or surgeries. Diagnosis is challenging when no risk factor is clearly present, since clinically, symptoms are nonspecific. Nowadays, with the aid of imaging methods, diagnosis has become more achievable, but the treatment still bears some uncertainties. The authors present a fatal case of SPT in a young woman who sought medical care already presenting signs of septic shock, referring fever and non-characteristic abdominal pain. The patient evolved rapidly to multiple organ failure and respiratory distress, which was also due to septic pulmonary embolism. The autopsy confirmed the computed tomographic findings of a right ovarian vein septic thrombophlebitis and multiple septic pulmonary embolization foci. The patient did not present any of the recognized risk factors; neither did she present signs of pelvic\ud
inflammatory disease on admission or at autopsy. However, an intrauterine device was present. The authors call attention to this entity in the differential diagnosis of a woman with fever and abdominal pain, as well as for an empiric broadspectrum\ud
antibiotic regimen in these cases

Roepke, Roberta Muriel Longo

Santos, Eduardo Henrique Sena

Septic pelvic thrombophlebitis of unknown origin: an ever threatening entity

Sickle cell anemia (SCA) is a hemoglobin disorder that occurs more commonly among Afro-descendants. The authors report the case of a 28-year-old Afro-descendent male patient with the diagnosis of homozygotic sickle cell disease (SCD) referred for evaluation of mandibular lesions. The patient’s main complaints included pain and bilateral teeth mobility. An intraoral examination revealed gingiva recession affecting the lower molars with extensive root exposure. A panoramic x-ray showed two radiolucent symmetrical periapical lesions evolving both the first and the second lower molars, bilaterally. The diagnostic hypotheses comprised odontogenic infection, among others. Besides antimicrobial therapy, the two molars of both sides were extracted and bone was collected for histopathological and microbiological analyses. Osteomyelitis was diagnosed, and Streptococcus viridans was recovered from the culture media. Mandibular osteomyelitis should be considered as a diagnosis in patients with SCD. The present case offers an alert to clinicians about the importance of knowing jaw lesions related to SCA

Juliane Pirágine Araújo

Ana Maria Hoyos Cadavid

Celso Augusto Lemos

Marilia Trierveiler

Fabio Abreu Alves

Directory of Open Access Journals

Autopsy and Case Reports. ISSN 2236-1960. Copyright © 2014. This is an Open Access article distributed of terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided article is properly cited.a Stomatology Department - School of Dentistry - Universidade de São Paulo, São Paulo/SP – Brazil.b Oral Pathology Department - School of Dentistry - Universidade de São Paulo, São Paulo/SP – Brazil.c Stomatology Department - AC Camargo Cancer Center, São Paulo/SP – Brazil.Bilateral mandibular osteomyelitis mimicking periapical cysts in a patient with sickle cell anemiaJuliane Pirágine Araújoa, Ana Maria Hoyos Cadavida, Celso Augusto Lemosa, Marilia Trierveilerb, Fabio Abreu Alvesa,cAraújo JP, Cadavid AMH, Lemos CA, Trierveiler M, Alves FA. Bilateral mandibular osteomyelitis mimicking periapical cysts in a patient with sickle cell anemia. Autopsy Case Rep [Internet]. 2015;5(3):55-60. http://dx.doi.org/10.4322/acr.2015.013ABSTRACTSickle cell anemia (SCA) is a hemoglobin disorder that occurs more commonly among Afro-descendants. The authors report the case of a 28-year-old Afro-descendent male patient with the diagnosis of homozygotic sickle cell disease (SCD) referred for evaluation of mandibular lesions. The patient’s main complaints included pain and bilateral teeth mobility. An intraoral examination revealed gingiva recession affecting the lower molars with extensive root exposure. A panoramic x-ray showed two radiolucent symmetrical periapical lesions evolving both the first and the second lower molars, bilaterally. The diagnostic hypotheses comprised odontogenic infection, among others. Besides antimicrobial therapy, the two molars of both sides were extracted and bone was collected for histopathological and microbiological analyses. Osteomyelitis was diagnosed, and Streptococcus viridans was recovered from the culture media. Mandibular osteomyelitis should be considered as a diagnosis in patients with SCD. The present case offers an alert to clinicians about the importance of knowing jaw lesions related to SCA. Keywords Osteomyelitis; Anemia, Sickle Cell; Mandible.INTRODUCTIONSickle cell anemia (SCA) is a common genetic condition characterized by the presence of abnormal hemoglobin, designated hemoglobin S (HbS), and is particularly common among people whose ancestors come from sub-Saharan Africa, India, Saudi Arabia, and Mediterranean countries. The red blood cells become sickle-shaped, blocking capillaries. Consequently, a low level of oxygen reaches the tissues and the patients will present recurrent painful crises, bone or joint necrosis, and renal failure. Blood transfusion and iron-chelation therapy may be necessary in severe cases.1Osteomyelitis, due to altered blood supply associated with sickle cell disease (SCD), is more commonly observed in long bones. In the jaw bones, the posterior region of the mandible is the area most frequently affected, and oral microorganisms may reach this area via periodontal ligaments or by hematogenous spread.2-4 In addition, vaso-occlusive Article / Clinical Case Report Artigo / Relato de Caso ClínicoAutopsy and Case Reports 2015;5(3):55-60Bilateral mandibular osteomyelitis mimicking periapical cysts in a patient with sickle cell anemia56radiopaque lesions can be observed in the mandible and can represent mandibular infarcts whose onset coincides with severe facial pain in sickling crises. As the initial radiographic appearance of infarction may be identical to that seen in osteomyelitis, clinical and laboratory features can help to distinguish infarction and osteomyelitis, which involve different therapeutic aproaches.5-7The aim of this report is to describe a case of bilateral mandibular osteomyelitis related to SCD, which could be misdiagnosed as periapical cyst.CASE REPORTA 28-year-old Afro-descendent male was referred to our institution for evaluation of painful mandibular lesions. His medical history included homozygotic SCA diagnosis and some previous hospitalizations due to chest and femoral pain. (His most recent hospitalization occurred 1-month prior, when antibiotics and a blood transfusion were prescribed.) Intraoral examination showed extensive root exposure affecting the lingual side of the right and the left lower molars, localized gingival purulent drainage, mobility, and caries in those teeth (Figure 1A-1D). The panoramic radiography showed two radiolucent symmetrical periapical lesions evolving both the first and the second lower molars, bilaterally (Figure 2).The main differential diagnoses were odontogenic infection, periapical cyst and keratocystic odontogenic tumor related to nevoid basal cell carcinoma syndrome (KOCT-NBCCS). Some hematological exams were requested, and the results were: 3.09 million/mm3 red cells, 8.9 g/dL of hemoglobin, red cell distribution width 22%, anisocytosis (+++), 14,400 /mm3 leukocytes, 320,000 /mm3 platelets, the presence of sickle erythrocytes, 1:30 min bleeding time, and prothrombin time was normal. The clinical management consisted of an antimicrobial prescription followed by extraction of the first and the second lower molars (on both sides of the mandible). During the procedure, a sequestrum of alveolar bone was removed. In addition, tissue fragments for histopathology and microorganism culture were sampled. The histopathological findings consisted of granulation tissue with lymphoplasmacytic inflammatory infiltrate and areas with bacterial colonies and microabscesses. A large fragment of necrotic bone was also observed (Figure 3A and 3B).Figure 1. A and C – Right molars presenting caries and lingual root exposure; B and D – Left molars with extensive lingual root exposure.Autopsy and Case Reports 2015;5(3):55-60Araújo JP, Cadavid AMH, Lemos CA, Trierveiler M, Alves FA57The culture of the lesion showed the growth of Streptococcus viridans, which was sensitive to penicillin, clindamycin, erythromycin, and vancomycin. Anaerobic bacteria were not recovered in the culture media. The patient was followed-up for 3 months and has been asymptomatic ever since (Figure 4A-4C).DISCUSSIONSCA is characterized by the synthesis of an abnormal hemoglobin molecule (HbS), which is a result of point mutation in the hemoglobin gene. There is the substitution of the valine for glutamic acid as the sixth amino acid of the beta chain, which results in abnormal reactions between molecules of HbS when oxygen tension is lowered. The polymerization of deoxygenated HbS is the primary event in the molecular pathogenesis of SCD, resulting in a distortion of the shape of the erythrocyte and a marked decrease in its ability to deform.8 Thus, the red blood cell lifespan is decreased from 120 days to 10-12 days, resulting in hemolytic anemia.2,9 The increased susceptibility of SCD patients to infections, including osteomyelitis, has long been recognized by several mechanisms, including hyposplenism and the presence of infarcted or necrotic bone.3 A sickle cell crisis may be spontaneously triggered, but patients may describe specific events preceding the pain crisis, such as cold temperature, emotional stress, anxiety, or other painful states, such as tooth pain.2Aseptic necrosis has been more frequently observed in long bones than in the mandible. Interestingly, Salmonella sp is more related to the former, and Streptococcus sp and Staphylococcus aureus to the latter.3,8 Olaitan et al.10 evaluated 16 patients with mandibular osteomyelitis associated with SCA: 13 were men (81%) and the majority of them were in the third decade of life (mean age = 23 years). All lesions were located in the mandible (angle and ascending ramus). Mixed flora and S. aureus infection was the predominant agents and no Salmonella sp was isolated in that study.Increased radiolucency of bone is more commonly observed in the area between the apices of the lower teeth. In addition, suppurative osteomyelitis usually presents as indistinct radiolucency and painful osseous resorption.8 In the present case, two symmetrical and well-defined radiolucent lesions were observed in the body of the mandible (the lesions involved the roots of the first and second molars, bilaterally). Such Figure 2. Panoramic x-ray showing two symmetrical radiolucent lesions involving the roots of the lower molars.Figure 3. A – Intense lymphoplasmacytic inflammatory infiltrate (HE, 400X); B – Necrotic bone presenting bacterial colonies (HE, 100X).Autopsy and Case Reports 2015;5(3):55-60Bilateral mandibular osteomyelitis mimicking periapical cysts in a patient with sickle cell anemia58lesions had radiographic features similar to that of periapical cysts. Extensive caries and restorations also contributed to cyst diagnosis. Furthermore, keratocystic odontogenic tumors related to nevoid basal cell carcinoma syndrome can be a differential diagnosis mainly because the lesions were synchronic. However, a thin sclerotic halo, which is commonly observed in cystic lesions, was not present in our case. Another interesting radiographic feature is a small radiopaque area around the apices of the left first lower molar suggesting bone sequestrum, which was confirmed during surgery.Although we did not perform the dental pulp sensibility test, the extensive caries of the right first and second molars and the advanced periodontal diseases in the left molars likely caused the pulp necrosis of those teeth (Figure 1A-1D). In our opinion, this information was not essential in the present case, since these patients usually present asymptomatic pulpal necrosis and increased incidence of dental caries, mandibular osteomyelitis, mandibular nerve anesthesia, and the aforementioned radiographic findings.3,4 In addition, Guzeldemir et al.11 reported that plaque and gingival indices were significantly higher in patients with SCD than in healthy individuals.The treatment of odontogenic infect ions usually includes the removal of the causative tooth, fol lowed by drainage and antibiotictherapy.12 Antibiotic prophylaxis for oral surgical procedures is recommended, not only because of the patient’s increased risk for infection, but also because infection can potentially induce hemolytic crisis. Penic i l l in V, amoxic i l l in,  and cl indamycin are Figure 4. A-C – Clinical and radiographic control 3 months after the surgeries.Autopsy and Case Reports 2015;5(3):55-60Araújo JP, Cadavid AMH, Lemos CA, Trierveiler M, Alves FA59acceptable preoperative oral antibiotics and should be administered approximately 1 hour before the procedure.2 Treatment of SCA osteomyelitis in most of the reported mandibular cases included sequestrectomy and debridement of the infected areas,  a long with the appropr iate ant ib iot ic prescription. However, antibiotics alone remain the mainstay of bone infection treatment in SCA. Surgery should be limited to diagnosis and therapeutic drainage of an obvious periosteal abscess or a sequestrectomy.6 The treatment of our case included exodontia of the lower first and second molars, administration of amoxicillin 500 mg three times daily for 2 weeks, curettage of the lesion, and wound closure. The patient had a good postoperative period without pain or bleeding. The wound showed a mild healing delay on the left side compared with the right side.CONCLUSIONThis case illustrates that patients with SCA can present oral abnormalities with challenging diagnosis and management. Furthermore, the osteomyelitis is an important differential diagnosis of radiolucent jaw lesions.ACKNOWLEDGEMENTSThe authors are grateful to the Brazilian Federal Agency for the Support and Evaluation of Graduate Education—CAPES—and the National Council for Scientific and Technological Development—CNPq—for their financial support.REFERENCES1. World Health Organization (WHO). Sickle cell anaemia, in Report by the Secretariat in Provisional Agenda Item 11.4. A59/9. Geneva: WHO; 2006.2. Stanley AC, Christian JM. Sickle cell disease and perioperative considerations: review and retrospective report. J Oral Maxillofac Surg. 2013;71(6):1027-33. http://dx.doi.org/10.1016/j.joms.2012.12.004. PMid:23434171.3. Almeida A, Roberts I. Bone involvement in sickle cell disease. Br J Haematol. 2005;129(4):482-90. http://dx.doi.org/10.1111/j.1365-2141.2005.05476.x. PMid:15877730.4. Kelleher M, Bishop K, Briggs P. Oral complications associated with sickle cell anemia: a review and case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;82(2):225-8. http://dx.doi.org/10.1016/S1079-2104(96)80261-7. PMid:8863314.5. Sanger RG, Greer RO Jr, Averbach RE. Differential diagnosis of some simple osseous lesions associated with sickle-cell anemia. Oral Surg Oral Med Oral Pathol. 1977;43(4):538-45. http://dx.doi.org/10.1016/0030-4220(77)90106-2. PMid:265481.6. Lawrenz DR. Sickle cell disease: a review and update of current therapy. J Oral Maxillofac Surg. 1999;57(2):171-8. http://dx.doi.org/10.1016/S0278-2391(99)90234-3.7. Kavadia-Tsatala S, Kolokytha O, Kaklamanos EG, Antoniades K, Chasapopoulou E. Mandibular lesions of vasoocclusive origin in sickle cell hemoglobinopathy. Odontology.  2004;92(1) :68-72.  http:/ /dx.doi.org/10.1007/s10266-004-0036-3. PMid:15490308.8. Sansevere JJ, Milles M. Management of the oral and maxillofacial surgery patient with sickle cell disease and related hemoglobinopathies. J Oral Maxillofac Surg. 1993;51(8):912-6. http://dx.doi.org/10.1016/S0278-2391(10)80114-4. PMid:8336229.9. Shroyer JV 3rd, Lew D, Abreo F, Unhold GP. Osteomyelitis of the mandible as a result of sickle cell disease: report and literature review. Oral Surg Oral Med Oral Pathol. 1991;72(1):25-8. http://dx.doi.org/10.1016/0030-4220(91)90184-E. PMid:1891241.10. Olaitan AA, Amuda JT, Adekeye EO. Osteomyelitis of the mandible in sickle cell disease. Br J Oral Maxillofac Surg. 1997;35(3):190-2. http://dx.doi.org/10.1016/S0266-4356(97)90562-3. PMid:9212297.11. Guzeldemir E, Toygar HU, Boga C, Cilasun U. Dental and periodontal health status of subjects with sickle cell disease. J Dent Sci. 2011;6(4):227-34. http://dx.doi.org/10.1016/j.jds.2011.09.008.12. Farmahan S, Tuopar D, Ameerally PJ. The clinical relevance of microbiology specimens in head and neck space infections of odontogenic origin. Br J Oral Maxillofac Surg. 2014;52(7):629-31. http://dx.doi.org/10.1016/j.bjoms.2014.02.027. PMid:24906248.Autopsy and Case Reports 2015;5(3):55-60Bilateral mandibular osteomyelitis mimicking periapical cysts in a patient with sickle cell anemia60Conflict of interest: NoneSubmitted on: March 7, 2015 Accepted on: June 20, 2015Correspondence Fabio Abreu Alves Rua Prof Antonio Prudente, 211 – Liberdade  CEP: 01509-900 – São Paulo/SP – Brazil Phone: +55 (11) 2189-5129 E-mail: falves@accamargo.org.br

Autopsy and Case Reports

Bilateral mandibular osteomyelitis mimicking periapical cysts in a patient with sickle cell anemia

Septic pelvic thrombophlebitis (SPT) is a rare and severe entity, which may occur after abortion, delivery, gynecological diseases, or surgeries. Diagnosis is challenging when no risk factor is clearly present, since clinically, symptoms are non-specific. Nowadays, with the aid of imaging methods, diagnosis has become more achievable, but the treatment still bears some uncertainties. The authors present a fatal case of SPT in a young woman who sought medical care already presenting signs of septic shock, referring fever and non-characteristic abdominal pain. The patient evolved rapidly to multiple organ failure and respiratory distress, which was also due to septic pulmonary embolism. The autopsy confirmed the computed tomographic findings of a right ovarian vein septic thrombophlebitis and multiple septic pulmonary embolization foci. The patient did not present any of the recognized risk factors; neither did she present signs of pelvic inflammatory disease on admission or at autopsy. However, an intrauterine device was present. The authors call attention to this entity in the differential diagnosis of a woman with fever and abdominal pain, as well as for an empiric broad-spectrum antibiotic regimen in these cases

Roberta Muriel Longo Roepke

Fernando Peixoto Ferraz de Campos

Silvana Maria Lovisolo

Eduardo Henrique Sena Santos

Sialolithiasis is a disease that affects the salivary glands. It is characterized by the presence of calcified structures within the duct system or within the glandular parenchyma. Those calculi, or sialoliths, can obstruct normal salivary flow, potentially leading to infectious sialadenitis, with pain, local swelling, and purulent discharge. Treatment typically consists of the surgical removal
of the calculus, often in conjunction with sialoadenectomy. The authors report an atypical case of bilateral submandibular gland sialolithiasis treated conservatively, using intra-oral access to remove the calculi

Ricardo Martins

Carlos Augusto Ferreira Alves

Edson Martins de Oliveira Junior

Fernando Melhem Elias

Antônio Carlos de Campos

Intra-oral surgical access for the treatment of bilateral submandibular sialolithiasis: case report

Ureteric neoplasms are rare tumors. The annual incidence (during the period 1995-2005) was 0,95-1,15/100.000 person-year. They are almost always urothelial tumors, especially papillary transitional cell carcinoma, as in the image above, and are less common than tumors of the renal pelvis and 10 times less common than urinary bladder tumors. In a large series of 1249 cases of urothelial neoplasms of the upper urinary tract (pelvis and ureter) (upper urinary tract tumors; UUTT) 34% of the cases involved the ureter, and in 8% the neoplasia was found in both sites concomitantly. Concomitance with bladder tumors is also observed, either synchronously or methachronously. When metachronous; bladder tumors precede UUTT in 10,2% of cases, and when synchronous in 49%

Stephen A. Geller

Ureteric carcinoma

Primary lung lymphoma is a rare entity accounting for approximately 0.3% of
all primary neoplasia of the lung and includes diffuse large B-cell lymphoma
(DLBL) and lymphomatoid granulomatosis (LYG). Considering that clinical
features may be similar, whereas epidemiology, morphology, and radiological
features are different, the authors report a case of a middle-aged man
who presented multiple pulmonary nodules in the lower lobes and groundglass
opacities scattered bilaterally on computed tomography. Clinically, he
presented a consumptive syndrome with respiratory failure and pleurisy,
which progressed until death. The autopsy findings were consistent with
lymphomatoid granulomatosis (LYG) grade 3/ diffuse large B-cell lymphoma
(DLBL). The authors call attention to the difficulty of establishing an accurate
diagnosis, mainly when the demonstration of EBV-infected atypical B-cells
fails

Silva, Aloísio Souza Felipe da

Martines, João Augusto dos Santos

RCAAP - Repositório Científico de Acesso Aberto de Portugal

Primary diffuse large B-cell lymphoma or lymphomatoid granulomatosis grade 3: 
a still-puzzling diagnosis in autopsy

Although the Pseudomonas aeruginosa infection is well known and frequently found in hospitals and nursing care facilities, many cases are also reported outside these boundaries. In general, this pathogen infects debilitated patients either by\ud
comorbidities or by any form of immunodeficiency. In cases of respiratory infection, tobacco abuse seems to play an important role as a risk factor. In previously healthy patients, community-acquired pneumonia (CAP) with P. aeruginosa as the etiological agent is extremely rare, and unlike the cases involving immunocompromised or hospitalized patients, the outcome is severe, and is fatal in up to 61.1% of cases. Aerosolized contaminated water or solutions are closely linked to the development of respiratory tract infection. In this setting, metalworking fluids used in factories may be implicated in CAP involving previously healthy people. The authors report the case of a middle-aged man who worked in a metalworking factory and presented a right upper lobar pneumonia with a rapid fatal outcome. P. aeruginosa was cultured from blood and\ud
tracheal aspirates. The autopsy findings confirmed a hemorrhagic necrotizing pneumonia with bacteria-invading vasculitis and thrombosis. A culture of the metalworking fluid of the factory was also positive for P. aeruginosa. The pulsed-field gel electrophoresis showed that both strains (blood culture and metalworking fluid) were genetically indistinguishable. The authors highlight the occupational risk for the development of this P. aeruginosa-infection in healthy people

Lopes, Ana Claudia Frota Machado de Melo

Passadore, Lilian Ferri

Guida, Stella Maria

Balabakis, Angelica Jean

Universidade de São Paulo

Community-acquired Pseudomonas aeruginosa-pneumonia in a previously healthy man occupationally exposed to metalworking fluids

https://www.revistas.usp.br/autopsy/article/download/98451/97153