Tuberculosis-like peritonitis due to an atypical Mycobacterium infection in a Japanese woman

It is not known whether atypical Mycobacterium (AM) causes peritonitis in humans. We described a case of tuberculosis-like peritonitis caused by an AM. Genetic analysis of the biopsy specimens suggested an AM infection. Thus, we concluded that peritonitis in humans can be caused by some AM species as well as by Mycobacterium tuberculosis complex.     

Pulmonary hyalinizing granuloma revealed by a pituitary gland diffusion

INTRODUCTION: Pulmonary hyalinizing granuloma is a rare fibrosing lesion of the lung, characterized by its histological appearance which includes central whorled deposits of lamellar collagen. The extrapulmonary diffusion of the disease is extremely rare, and in our knowledge any case of pituitary diffusion has ever been reported in the literature. EXEGESIS: We reported an unpublished case of a 31-year-old woman presenting with amenorrhea, galactorrhea, diplopia, headache, polyuria and polydipsia. The diagnosis of pulmonary hyalinizing granuloma revealed by an intracranial localization was based on radiologic and pathologic findings. Clinical course was favourable with corticotherapy. CONCLUSION: Our report is particular because cerebral localization was the initial manifestation of primary hyalinizing granuloma and because of the favourable outcome with corticotherapy.     

Pulmonary eosinophilic granuloma in a woman of 72]

We report a case of pulmonary eosinophilic granuloma with the latest onset ever reported in Japan. A 72-year-old woman, a current smoker, developed dyspnea and dry cough in late January 2001. Chest radiography and CT examinations revealed numerous small nodular lesions and multiple cysts in both upper lung fields. A thoracoscopic lung biopsy revealed a granulomatous lesion composed of eosinophils and large histiocytic cells with pale eosinophilic cytoplasms and large cleaved nuclei. These cells gave a positive reaction for S-100 protein. These findings led to a diagnosis of pulmonary eosinophilic granuloma. This disease is generally reported in much younger subjects, and few cases are known in those over 60-years old. No Japanese report of histologically confirmed pulmonary eosinophilic granuloma in an older patient has previously appeared, but it may now be prudent to take this disease into consideration when diagnosing pulmonary disease in older subjects.     

Isolated secretion of testosterone by an adrenocortical tumor in a menopausal woman

A case of adrenal tumor with isolated secretion of testosterone in a menopaused woman is reported. All other androgens (Déhydro-épi-androstérone, Sulfate de Déhydro-épi-androstérone, Delta 4 androstène-dione) were normal as well as other adrenal hormones. This tumor produced a mild hirsutism. A treatment with Cyproterone Acetate, then with Dexamethasone did not produce a significant change. A complete review of literature points out the rarity of this observation, since only twelve similar cases have been previously reported.     

Isolated prolactin deficiency in a woman with puerperal alactogenesis

Idiopathic PRL deficiency was detected in a parturient woman with otherwise normal pituitary function. This PRL disorder first became manifest postpartum when she had no milk production, and oral metoclopramide failed to raise her serum PRL levels. Her second pregnancy occurred spontaneously after 3 yr of attempts to conceive. During the pregnancy, her serum PRL concentration was very low, varying from 4.5-7.8 ng/ml, and the puerperium was again characterized by alactogenesis. During normal menstrual cycles and after iv GnRH, TRH, metoclopramide, and insulin tolerance tests, serum PRL was only rarely detectable by RIA, at very low concentrations. Bioassay results confirmed the PRL deficiency. The results confirm that PRL is necessary for puerperal lactation and suggest that it is needed for normal ovarian function. The present data also suggest that the maternal pituitary is the main source of serum PRL during pregnancy, and the decidua has only a minor contribution in this respect.     

Solitary pulmonary granuloma caused by Mycobacterium avium-intracellulare complex.

OBJECTIVES: To analyse the clinical features and high resolution computed tomography (HRCT) findings of solitary pulmonary granulomas caused by the Mycobacterium avium-intracellulare (MAI) complex. METHODS: We retrospectively analysed a series of 73 consecutive patients with solitary pulmonary granuloma and negative sputum smear and culture results, in whom the diagnosis was established by histological examination of specimens obtained by partial pulmonary resection or lobectomy. We compared the clinical features and HRCT findings of the solitary pulmonary granulomas definitively diagnosed to be caused by the MAI complex with those of granulomas of other causes by univariate and multivariate analyses. RESULTS: In this study series of 24 patients with solitary pulmonary granuloma, the aetiological agent was established as being the MAI complex. According to the results of the multivariate analysis, 'female sex', 'pleural indentation' and 'lobulation' on the HRCT images were significantly associated with solitary pulmonary granuloma caused by the MAI complex. CONCLUSION: This study demonstrated several characteristics of solitary pulmonary granulomas caused by the MAI complex, and suggested that it might be a subtype of pulmonary MAI complex infection without the typical radiographic features of the infection.     

Pulmonary nontuberculous mycobacterial infection caused by Mycobacterium szulgai in a young healthy woman

A 20-year-old woman with no history of pulmonary disease had no symptom and her chest CT scans demonstrated adhesive small multiple nodules in the bronchial lung biopsy specimen showed epithelioid cell granuloma containing Langhans giant cells, therefore she was diagnosed as pulmonary mycobacteriosis caused by M. szulgai. This is the youngest case of this rare condition occurring in a healthy subject without underlying pulmonary diseases.     

Congenital oesophageal stenosis: an atypical presentation in a young woman

Congenital oesophageal stenosis is a very rare disease that commonly occurs in infancy with male predominance. This report describes a highly unusual case of congenital oesophageal stenosis extended throughout the length of the oesophagus, without webs or tracheobronchial remnants in the oesophageal wall, with normal oesophageal motility and normal endosonography in an adult female.     

Disseminated Mycobacterium intracellulare infection in an HIV-negative, nonimmunosuppressed patient with multiple endobronchial polyps

Endobronchial lesions caused by nontuberculous mycobacterial disease are extremely rare, but we recently encountered a case of disseminated disease due to Mycobacterium intracellulare presenting as multiple endobronchial polypoid lesions in an HIV-negative host. The patient was a 45-year-old Japanese female with fever, loss of body weight and cervical lymphadenopathy. Chest X-rays demonstrated a left hilar mass, and bronchoscopy revealed multiple polypoid lesions in the left main bronchus and bronchus of the left upper lobe. The infection later progressed, involving generalized lymphadenopathy, liver splenic and cutaneous abscesses, pulmonary infiltration, pleural effusion, and costal fracture. Finally, in two separate cutaneous abscesses M. intracellulare was identified by a DNA probe method. Antimycobacterial drugs were given, and the endobronchial lesions along with other symptoms and signs greatly improved.     

Mycobacterium avium-intracellulare pulmonary infection complicated by cutaneous leukocytoclastic vasculitis in a woman with anorexia nervosa

A 53-year-old Caucasian woman with a history of anorexia nervosa developed a bilateral lower extremity rash comprised of palpable red to violaceous, sub-centimeter papular lesions that increased in quantity rapidly. She also noted a 2-month history of non-productive cough. Imaging modalities revealed a thin-walled cavitary lesion in the right lung apex and scattered nodular opacities. Acid fast bacilli (AFB) were found in sputum and subsequently identified by culture as Mycobacterium avium-intracellulare (MAI). Punch biopsies of her skin lesions yielded a histological diagnosis of small-to-medium vessel vasculitis. Stains and cultures for organisms were negative. Her skin lesions resolved quickly after the initiation of antimicrobial therapy for MAI. Hypersensitivity vasculitis associated with an atypical mycobacterial infection is unusual. The postulated underlying mechanism is the deposit of immune complexes and not the bacillus itself. While cutaneous leukocytoclastic vasculitis (CLV) due to MAI is certainly a rare entity, it should be entertained in patients with vasculitic skin lesions and a concomitant pulmonary disease.     

Mycobacterium bovis peritonitis mimicking ovarian cancer in a young woman.

We describe a 27-year-old woman with peritonitis due to Mycobacterium bovis that initially appeared to be ovarian cancer. Clinicians should include this disease in the differential diagnosis of ovarian cancer and should consider laparoscopic diagnosis in the appropriate epidemiologic setting.     

Mycobacterium avium complex-associated cholecystitis in an HIV-infected woman

Mycobacterium avium complex (MAC) is commonly associated with fever, fatigue, nausea, diarrhea, and cytopenias related to invasion of the intestine and bone marrow. Infection and clinical disease has been reported in other organs as well. We report the first case of cholecystitis associated with MAC infection of the gallbladder.     

Spontaneous regression of anterior pituitary deficits in a woman harboring a persistent hypothalamic mass

Sellar or parasellar lesions can cause anterior pituitary dysfunction either by direct damage to the anterior pituitary gland or by compression of the pituitary stalk and mediobasal hypothalamus which contain the hypophysiotropic hormones. Without treatment, the pituitary deficits in such cases are not likely to improve. We describe a case in which deficits in anterior pituitary hormones spontaneously remitted in a woman who had a persistent hypothalamic lesion that was not amenable to surgery or radiotherapy. The factors that may predict spontaneous recovery of anterior pituitary function in such cases are discussed.     

Extensive mediastinal lymphadenopathy in an adult immunocompetent woman caused by Mycobacterium avium complex

We report a case of extensive mediastinal lymphadenopathy in a 29-year-old immunocompetent woman, which was thought to be caused by Mycobacterium tuberculosis (MTB). Chest radiographs showed deterioration while the patient was receiving antituberculous medication for 8 months. After isolation of Mycobacterium avium complex (MAC) from a lymph node aspiration biopsy and switch to a MAC-specific therapeutic regimen, the lesion almost completely disappeared within 1 year. To our knowledge, this is the first report of an extensive mediastinal lymphadenopathy caused by MAC in an immunocompetent adult.     

Subacute thyroiditis in woman presenting with thyrotropin-secreting pituitary adenoma

Thyrotropin secreting tumors constitute 0,9 to 2,8% of all pituitary tumors. Thus, it is very rare tumor of this endocrine gland. Standards of the diagnosis of TSH-omas are based on me lack of inhibition of TSH levels in the presence of increased free thyroid hormones and abnormal, neoplastic intrasellar or parasellar mass. The additional criterion is lack of response of TSH after TRH stimulation. The proper treatment is surgical excision (selective adenomectomy) by the transsphenoidal route. In this paper we report the case presenting TSH-oma and consecutive subacute thyroiditis.