Childhood eosinophilic fasciitis presenting as inflammatory polyarthritis and associated with selective IgA deficiency.

A 13 year old school boy presented with seronegative inflammatory polyarthritis after a flu-like illness. Four months later clinical features of eosinophilic fasciitis became apparent. After histological diagnosis treatment was started with prednisone 40 mg daily, with a good response. Routine investigations showed persistent selective IgA deficiency.     

Pulmonary anisakiasis presenting as eosinophilic pleural effusion

A 63-year-old man developed a pleural effusion with marked eosinophilia, which was more prominent in the pleural fluid than in the peripheral blood. The pleural effusion spontaneously disappeared 7 days after admission. A multiple dot enzyme-linked immunosorbent assay for anisakiasis was strongly positive for both the serum and pleural fluid. The serum IgG titre for Anisakis simplex gradually decreased over 7 months. It is suspected that Anisakis larvae can penetrate the alimentary canal, and then migrate into the pleural cavity through the diaphragm. Screening with a serological test is useful in the diagnosis of this condition; human pulmonary anisakiasis.     

Melioidotic necrotizing fasciitis presenting as a supraclavicular mass

Melioidosis is an infection caused by Burkholderia pseudomallei that usually involves the respiratory tract. It may manifest as pneumonia, septicemia, or localized infection. We present here a case of melioidosis initially manifesting as a mass over the supraclavicular area and subsequently progressing to necrotizing fasciitis. With appropriate antimicrobial treatment and adequate surgical debridement, localized melioidosis can be treated successfully. Melioidosis should be considered in the differential diagnosis of neck masses, especially in patients who have traveled to or stayed in an endemic area.     

Epiglottitis presenting as acute pulmonary edema

Presented is the case of a 2 1/2-year-old with acute pulmonary edema associated with epiglottitis prior to intubation. The patient complained only of odynophagia and had one brief episode of apnea and flaccid posturing. Chest radiograph demonstrated pulmonary edema. A soft tissue radiograph of the neck confirmed the diagnosis of epiglottitis. The patient was managed successfully with prompt intubation, PEEP, and antibiotics. Pulmonary edema associated with epiglottitis may be more common than previously recognized. It may occur prior to or after intubation. When pulmonary edema is clinically evident, PEEP should be administered early.     

Pheochromocytoma presenting as life-threatening pulmonary edema

Acute cardiogenic pulmonary edema as the first presentation of phenochromocytoma is uncommon and usually rapidly fatal. A 39-yr-old man presented in acute cardiogenic shock with global ventricular dysfunction that required high-dose iv inotrope support and an intraaortic balloon pump assist device. Abdominal imaging to exclude aortic dissection revealed a 6-cm right adrenal mass. Significant myocardial infarction (electrocardiographic changes and elevated cardiac enzymes) contributied to the cardiac decompensation. After with drawal of inotrope support, 24-h urinary catecholamine levels revealed 2155 nmol/d (<125) of adrenaline and 7437 nmol/d (<560) of norad-renaline, confirming a pheochromocytoma. The tumor was successfully removed at laparotomy; however, the patient's course was complicated by a thromboembolic cerebrovascular accident with paraplegia. He recovered cardiac function almost completely within 3 wk of medical therapy alone. Although uncommon, this case highlights the need to consider pheochromocytoma early in the management of unexplained cardiogenic shock.     

Hydatid cyst presenting as an eosinophilic pleural effusion

A 61-year-old woman presented with an eosinophilic pleural effusion, secondary to transdiaphragmatic intrapleural spread of an hepatic hydatid cyst. Right posterolateral thoracotomy and frenotomy revealed a loculated pleural effusion associated with a 10 x 8 cm hydatid cyst in the posterior segment of the liver. Hydatid disease should be included in the differential diagnosis of eosinophilic pleural effusions in endemic regions.     

Gastroenteritis eosinophilic presenting as colitis with acute abdomen

Eosinophilic gastroenteritis is rare. Fewer than 30 cases have been published in the Spanish literature, although Kaijser first described this entity in 1937. Its etiology is still unknown and it has frequently been reported to involve the stomach and small bowel, with characteristic eosinophilic infiltration of the bowel wall. The colon has rarely been reported as a site of this condition, which manifests as acute abdominal pain due to intestinal obstruction. We report the case of a 38-year-old woman who presented eosinophilic gastroenteritis. Onset was acute colitis causing acute abdomen. The patient received conservative treatment and responded well to steroids. To our knowledge, such a case has not previously been reported.     

Toxocara canis infection presenting as eosinophilic ascites and gastroenteritis

Summary Eosinophilic ascites is rarely observed in clinical practice. It may be associated with the serosal type of eosinophilic gastroenteritis, abdominal lymphoma, hypereosinophilic syndrome, or peritoneal dialysis but is uncommonly related to parasitic infections. We report a case of a previously healthy young patient who developed diarrhea and exudative eosinophilic ascites. The final diagnosis was consistent with a parasitic infection due toToxocara canis, while the clinical and radiological findings suggested an eosinophilic gastroenteritis. The diagnostic approach, especially parasitic serological data, which must be carefully interpreted, are discussed; in addition, the possible pathophysiological mechanisms involved in the production of ascites are evoked.     

Tropical pulmonary eosinophilia presenting as eosinophilic pleural effusion.

A case of tropical pulmonary eosinophilia presenting as an eosinophilic pleural effusion is reported. The condition resolved by treatment with diethylcarbamazine. The patient has been well during the two year follow-up period.     

Colitis and pericarditis in a patient with eosinophilic fasciitis. A contribution to the multisystem nature of eosinophilic fasciitis

A case of eosinophilic fasciitis (EF), associated with monoclonal gammopathy, thyroglobulin antibodies, pericarditis and colitis, is described. The occurrence of EF in the framework of a multisystem disease is the outstanding feature, contrasting with the absence of visceral involvement or solitary organ involvement in the large majority of cases. The unusual histologic features of the colitis and beneficial effect of cimetidine on EF are discussed.     

Rheumatoid iliopsoas bursitis presenting as unilateral leg edema

A 66-year-old woman with rheumatoid arthritis presented with unilateral leg edema attributable to an enlarged iliopsoas bursa with presumed impedance of lymphatic drainage. The adjacent hip joint was not severely involved by arthritis. Ultrasonography and computed tomography were used to delineate the bursal mass and demonstrate communication with the joint space.     

Perforating oesophageal carcinoma presenting as necrotizing fasciitis of the neck.

A patient with a history of schizophrenia was admitted to our hospital in an already severe stage of necrotizing fasciitis of the neck, complicated with mediastinitis and gangrene. Later on, he also developed a vena cava superior syndrome and sepsis. In the few cases and small series described in the literature, necrotizing fasciitis of the neck is usually associated with surgery or trauma. Less frequently, an orodental or pharyngeal infection, often innocuous, is the underlying cause. None of these causes could be identified in our patient. Initially, on computer-assisted tomography (CT) scan, a tracheal rupture was suspected, but this diagnosis could not be confirmed on bronchoscopic examination. On gastroscopy, a stenotic oesophageal segment was discovered. Biopsy of this segment showed a poorly differentiated squamous cell carcinoma. The patient died in sepsis. Autopsy confirmed the presence of a large proximal oesophageal tumour with perforation. As far as we know, no case of a necrotizing fasciitis of the neck caused by perforation of a formerly unknown oesophageal carcinoma has been reported. Even mediastinitis, with or without gangrene, is rarely associated with oesophageal cancer, and in the few cases reported it is always due to fistulization after surgery.     

Pulmonary eosinophilic granuloma presenting as a solitary pulmonary nodule]

A symptomless 60 year old man with a heavy smoking history presented with a nodule in the right lung, which was found by an annual chest X-ray. Chest CT showed a 1 cm speculated nodule in the right S8. Bronchoscopic transbronchial biopsy to the nodule yielded no definite diagnosis. Since the nodule was highly suggestive of lung cancer, wedge resection was performed by video-assisted thoracoscopic surgery. Pathological findings of the specimen showed that the nodule consisted of a mixed population of histiocytoid cells with eosinophils. The nuclei and cytoplasms of the histiocytoid cells were stained positively for S-100 protein. Pulmonary eosinophilic granuloma (PEG) was diagnosed. Common radiographic findings of PEG should present with a mixture of multiple nodular shadows and cystic lesions. PEG presenting as a solitary nodule is rare.     

A case report about eosinophilic enteritis presenting as abdominal pain

Rationale:Eosinophilic enteritis (EE) is an immune-mediated antigen-driven disease that may lead to clinical symptoms and organ dysfunction and characterized by the presence of extensive eosinophilic infiltrates on histopathological examination of the intestinal mucosa.Patient concerns:A 29-year-old man presented with a half-month duration of paroxysmal upper abdominal pain that gradually evolved into continuous pain accompanied by the urge to defecate.Diagnoses:Pathological findings of enteroscopy showed acute and chronic inflammation accompanied by eosinophilic infiltration (>20/ high-power field).Interventions:The patient was initially treated with IV infusion of dexamethasone 10 mg per day for 3 days, which was reduced to 7.5 mg per day for 2 days once pain relief was achieved. Upon discharged from our hospital, the patient was prescribed with oral prednisolone 30 mg per day, which was reduced by 5 mg per week for 6 weeks until discontinuation.Outcomes:The patient was relieved from the pain after receiving dexamethasone for 5 days, and he was maintained on oral prednisolone 30 mg per day upon discharge from the hospital. On the day of discharge, the eosinophil count and derived ratios were normal.Lessons:In patients with EE, the dynamic changes of the eosinophil count should be monitored. Clinicians must be aware that not all patients with EE have a history of allergies. In the management and treatment of the disease, multisite biopsies should be carried out if EE is suspected, and EE is responsive to steroid therapy.