A Case of Mexiletine-induced Hypersensitivity Syndrome Presenting as Eosinophilic Pneumonia

An 82-yr-old man was presented with fever and cough accompanied by generalized erythematous rash. He had taken mexiletine for 5 months, as he had been diagnosed with dilated cardiomyopathy and ventricular arrhythmia. Laboratory studies showed peripheral blood eosinophilia and elevated liver transaminase levels. Chest radiographs showed multiple nodular consolidations in both lungs. Biopsies of the lung and skin lesions revealed eosinophilic infiltration. After a thorough review of his medication history, mexiletine was suspected as the etiologic agent. After discontinuing the mexiletine and starting oral prednisolone, the patient improved, and the skin and lung lesions disappeared. Subsequently, mexiletine was confirmed as the causative agent based on a positive patch test. Drug-induced hypersensitivity syndrome is a severe adverse reaction to drugs and results from treatment with anticonvulsants, allopurinol, sulfonamides, and many other drugs. Several cases of mexiletine-induced hypersensitivity syndrome have been reported in older Japanese males with manifestation of fever, rash, peripheral blood eosinophilia, liver dysfunction without other organ involvement. Here, we report a case of mexiletine-induced hypersensitivity syndrome which presented as eosinophilic pneumonia in a Korean male.     

A Case of Eosinophilic Granuloma: Confirmation by Immunohistochemistry

Abstract

Eosinophilic granuloma is a clinical entity that is relatively easy to diagnose. If confirmation beyond routine tinctorial staining is required, a panel of irnmunohistochemical markers is a cheaper and faster alternative to electron microscopy. (The J Histotechnol 11:159, 1988.)     

mRNA COVID-19 Vaccine-Associated Subserosal Eosinophilic Gastroenteritis: A Case Report

The World Health Organization declared coronavirus disease 2019 (COVID-19) a global pandemic in March 2020. Several vaccines have been developed to overcome the COVID-19 pandemic, and messenger RNA vaccines, commonly known as mRNA vaccines, were the first COVID-19 vaccines to be authorized in Korea. With the worldwide increase in vaccinations, reports of adverse reactions are increasing. However, to the best of our knowledge, there have been no reports of eosinophilic gastroenteritis (EGE) following mRNA vaccination. Here, we present the first case of EGE in a patient who received a second dose of the mRNA vaccine, BNT162b2 (Pfizer-BioNTech). A previously healthy 34-year-old woman presented to the emergency department with generalized abdominal pain for the preceding 2 weeks. She had received a second dose of the mRNA COVID-19 vaccine 2 weeks prior. Subserosal EGE was diagnosed, oral prednisolone was administered, and she recovered completely.     

Fasciitis ossificans of the breast

We report a rare case of fasciitis ossificans of the breast. A nodule of the breast was incidentally found in a 77-year-old woman without a history of trauma. The painless lesion was located 3 cm from the nipple in the lower outer quadrant of the left breast. Excisional biopsy was performed, and there has been no evidence of recurrence or metastasis for 2 years. The 1.8 cm diameter nodule was well demarcated from the adjacent tissue and located 2.5 cm beneath the skin. Histologically, the lesion was composed of uniform woven bone trabeculae with rimming of osteoblasts and fibrous stroma. At the periphery, spindle cells actively proliferated in edematous stroma, demonstrating uniform nuclei without increased chromatin, pleomorphism, or evident nucleoli. We counted 2 mitotic figures per 10 high-power fields, but no atypical forms were observed. Spindle cells were immunoreactive for vimentin and alpha-smooth muscle actin, suggesting myofibroblastic differentiation. Fasciitis ossificans is histologically identical to myositis ossificans, but tends to present no zonation phenomenon. We considered this lesion as fasciitis ossificans since it was situated at the superficial layer of the mammary gland. To avoid an unnecessarily aggressive treatment, fasciitis ossificans, a benign bone-forming nodule, needs to be considered in the differential diagnosis of breast hard tumor.     

核素静脉和淋巴显像在下肢浮患者中的应用

目的：探讨核素静脉和淋巴显像在下肢浮肿患者诊治中的价值。方法：对190例下肢浮肿患者和49例正常对照者行^99Tc^m-大颗粒聚合白蛋白（MAA）或（和）^99Tc^m-右旋糖酐（DX）双下肢静脉或（和）淋巴显像，其中35例行肺部多体位静态显像。结果：190例下肢浮肿患者中：下腔静脉栓塞4例（2．1％）；下肢深静脉血栓形成（DVT）146例（76．8％），血栓性静脉炎为20例（10．5％）；浅静脉曲张7例（3．7％），共177例中同时肺部显像异常35例（19．8％），最后确诊肺栓塞29例（16．4％）；13例（6．8％）浮肿患者下肢静脉显像正常或基本正常，双下肢－腹腔淋巴显像均见淋巴回流障碍。正常对照组49例患者下肢静脉和淋巴显像均正常。结论：核素静脉显像对下肢浮肿患者病变的定位和定性诊断有很高的临床实用价值，对肺栓塞的早期诊断有一定价值。对静脉显像正常的浮肿患者，应常规加做下肢－腹腔淋巴显像。     

Eosinophilic meningitis: A case series and review of literature of Angiostrongylus cantonensis and Gnathostoma spinigerum

Eosinophilic meningitis is defined as the presence of >10 eosinophils/μL in cerebrospinal fluid (CSF) or at least 10% eosinophils in the total CSF leukocyte count. Eosinophilic meningitis has been reported in two case series and two case reports in India till date and has not been reported in children below 15 years of age. We present two children with eosinophilic meningitis with peripheral eosinophilia and the proposed etiologic agents based on the clinical setting and their response to antihelminthic agents.     

脑红蛋白在人脑水肿时的表达研究

目的探讨人脑水肿时脑红蛋白(neuroglobin,NGB)的表达变化及其意义。方法人脑组织标本分正常对照组和脑水肿组,分别进行HE及免疫组织化学染色、图像学分析及统计学处理。结果脑水肿组NGB的表达明显高于正常对照组,差异有统计学意义(P<0.05)。结论脑水肿时NGB表达上调,可能有神经保护作用及部分抗脑水肿作用。     

Clinical Characteristics and Factors Influencing the Occurrence of Acute Eosinophilic Pneumonia in Korean Military Personnel

Acute eosinophilic pneumonia (AEP) is an uncommon inflammatory lung disease, and limited data exist concerning the clinical characteristics and factors that influence its occurrence. We retrospectively reviewed the records of AEP patients treated at Korean military hospitals between January 2007 and December 2013. In total, 333 patients were identified; their median age was 22 years, and all were men. All patients presented with acute respiratory symptoms (cough, sputum, dyspnea, or fever) and had elevated levels of inflammatory markers including median values of 13,185/µL for white blood cell count and 9.51 mg/dL for C-reactive protein. All patients showed diffuse ground glass opacity/consolidation, and most had pleural effusion (n = 265; 80%) or interlobular septal thickening (n = 265; 85%) on chest computed tomography. Most patients had normal body mass index (n = 255; 77%), and only 30 (9%) patients had underlying diseases including rhinitis, asthma, or atopic dermatitis. Most patients had recently changed smoking habits (n = 288; 87%) and were Army personnel (n = 297; 89%).The AEP incidence was higher in the Army group compared to the Navy or Air Force group for every year (P = 0.002). Both the number of patients and patients with high illness severity (oxygen requirement, intensive care unit admission, and pneumonia severity score class ≥ III) tended to increase as seasonal temperatures rose. We describe the clinical characteristics of AEP and demonstrate that AEP patients have recently changed smoking habits and work for the Army. There is an increasing tendency in the numbers of patients and those with higher AEP severity with rising seasonal temperatures.     

Eosinophilic angiocentric fibrosis of the upper respiratory tract: a mucosal variant of granuloma faciale? A report of three cases

Three patients with an unusual stenosing lesion affecting the upper respiratory tract are described. The lesion involved the mucosa of the nasal septum and lateral nasal wall in two cases and the mucosa of the sub-glottic region of the larynx in one. The lesion leads to thickening of the sub-mucosal connective tissues by an usual pathological process. It begins as a focal peri-vascular sub-epithelial exudate of eosinophils accompanied by collections of plasma cells and lymphocytes without fibrinoid necrosis. These foci progress to form extensive areas of peri-vascular fibrosis showing a characteristic angiocentric whorling with an 'onion-skin' pattern. This process leads to thickening and matting of the mucosa which becomes adherent to the underlying structures. As fibrosis progresses, the lympho-plasmacytic component regresses but the eosinophils remain. The fibrosis does not resolve and the consequent stenosis requires surgical relief. No other site appears to be affected by this process, but one case was associated with granuloma faciale. The cause is unknown. We have given the term 'eosinophilic angiocentric fibrosis of the upper respiratory tract' to this condition to encompass its cardinal features.     

地奥司明片治疗痔疮术后创缘水肿的临床疗效

目的 探讨痔疮术后创缘水肿患者给予地奥司明片治疗的临床效果。方法 选取2017年10月~2018年10月我院收治的80例行痔疮术后创缘水肿患者,随机分为对照组和观察组,每组40例。对照组患者给予常规抗感染与换药治疗,观察组则给予地奥司明片治疗,对比两组患者临床疗效、治疗前后创缘水肿积分、创缘水肿消失时间及患者生存质量。结果 观察组治疗总有效率高于对照组（95.00% vs 77.50%）,差异有统计学意义（P＜0.05）。经治疗后,两组患者创缘水肿积分均有降低,且观察组在治疗后1 d、1周、2周创缘水肿积分均低于对照组,差异有统计学意义（P＜0.05）。观察组创缘水肿消失时间短于对照组[（5.94±1.31）d vs （8.23±1.62）d],WHOQOL-100评分高于对照组[（78.61±5.18）分 vs （63.58±4.62）分],差异有统计学意义（P＜0.05）。结论 对痔疮术后创缘水肿患者给予地奥司明片治疗,其临床效果理想,能减少创面愈合时间,提高患者生存质量。     

Giant Ovarian Tumor Presenting as an Incarcerated Umbilical Hernia: A Case Report

We report a rare case of a giant ovarian tumor presenting as an incarcerated umbilical hernia. A 61-yr-old woman was admitted to the hospital with severe abdominal pain, an umbilical mass, nausea and vomiting. On examination, a large, irreducible umbilical hernia was found. The woman underwent an urgent operation for a possible strangulated hernia. A large, multilocular tumor was found. The tumor was excised, and a total abdominal hysterectomy and bilateral salphingo-oophorectomy were performed. The woman was discharged 6 days after her admission. This is the first report of incarcerated umbilical hernia containing a giant ovarian tumor within the sac.     

A Case of Pathologically Confirmed Corticobasal Degeneration Initially Presenting as Progressive Supranuclear Palsy Syndrome

Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) overlap clinically with parkinsonism or extrapyramidal signs and pathologically with tauopathy. Asymmetric parkinsonism and cortical dysfunctions are classical features of CBD. However, symmetric parkinsonism, frequent falls, and supranuclear gaze palsy are key features of PSP. Despite biochemically classified as 4R tauopathies, tufted astrocytes of PSP and astrocytic plaque of CBD show pathologically important differences. Herein, we report a 68-year-old man with pathologically confirmed CBD. He was clinically suspected to have PSP because of progressive gait disturbances, frequent falls, and vertical saccade limitation. Neurological examination performed at age 71 revealed symmetrical bradykinesia, axial rigidity, and postural instability with worsening of early existing symptoms. Magnetic resonance imaging of the brain taken at age 70 detected midbrain and left frontotemporal atrophy and right middle cerebral artery infarction. Left frontotemporoparietal hypometabolism and asymmetrically decreased fluoro-propyl-carbomethoxy-iodophenyl-tropane uptake in the basal ganglia were observed. The autopsy was performed at the time of his death (at age 72), which revealed severe pallor of the substantia nigra and mildly hypopigmented locus ceruleus. AT8 immunohistochemistry and Gallyas staining revealed tau-positive neuronal and glial inclusions, astrocytic plaques, ballooned neurons, and numerous threads in both gray and white matter. No abnormal inclusions were revealed by beta-amyloid, α-synuclein and TDP-43 immunohistochemistry. In our case, cerebral infarction, periventricular and deep white matter ischemic changes, and midbrain atrophy were likely to produce PSP–CBD overlapping symptoms. However, our patient was finally confirmed to have CBD based on pathological findings such as astrocytic plaques.