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![Histological features of intestinal tuberculosis (ITB) and Crohn’s disease (CD) discovered in endoscopic biopsy specimens. ITB commonly features several large, confluent caseating granulomas (a), with central necrosis (b) and giant cells (e). CD features relatively few, small granulomas (c). Large granulomas in CD are rare, and if present, they are poorly organized (d). Basal plasmacytosis can be seen in CD (f). (Images obtained with permission from Ye et al. [20].](publication/349142458/figure/fig1/AS:1080274267975680@1634568864591/Histological-features-of-intestinal-tuberculosis-ITB-and-Crohns-disease-CD.jpg)
Histological features of intestinal tuberculosis (ITB) and Crohn’s disease (CD) discovered in endoscopic biopsy specimens. ITB commonly features several large, confluent caseating granulomas (a), with central necrosis (b) and giant cells (e). CD features relatively few, small granulomas (c). Large granulomas in CD are rare, and if present, they are poorly organized (d). Basal plasmacytosis can be seen in CD (f). (Images obtained with permission from Ye et al. [20].
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A granuloma is defined as a localized inflammatory reaction or a hypersensitive response to a nondegradable product leading to an organized collection of epithelioid histiocytes. Etiologies of granulomatous disorders can be divided into two broad categories: infectious and noninfectious (autoimmune conditions, toxins, etc.) causes. The endless list...
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... Linear or discoid ulcers progress to transmural necrosis, which culminates in intestinal perforation. Intestinal granulomas are rare in patients with typhoid fever but are occasionally found 12 : infiltrates rich in histiocytes mixed with lymphocytes and plasma cells with areas of central non-caseating necrosis should favor suspicion 13 . ...
... Linear or discoid ulcers progress to transmural necrosis, which culminates in intestinal perforation. Intestinal granulomas are rare in patients with typhoid fever but are occasionally found 12 : infiltrates rich in histiocytes mixed with lymphocytes and plasma cells with areas of central non-caseating necrosis should favor suspicion 13 . ...
... Linear or discoid ulcers progress to transmural necrosis, which culminates in intestinal perforation. Intestinal granulomas are rare in patients with typhoid fever but are occasionally found 12 : infiltrates rich in histiocytes mixed with lymphocytes and plasma cells with areas of central non-caseating necrosis should favor suspicion 13 . ...
... Microscopic examination reveals necrotizing granulomas (Koster follicle), which include four pathognomonic elements: uninucleated (epithelioid) and multinucleated histiocytes (Langhans cells), lymphocytes (at the periphery) and eosinophilic, acellular, granular areas of caseous necrosis (central). The granulomas tend to confluence and can have a variable morphology since the only mandatory elements are the epithelioid cells and the peripheral rhyme of lymphocytes 11,12,13 . ...
Extrapulmonary tuberculosis is very rare, representing around 15% of all tuberculosis (TB) cases. Intestinal localization of extrapumonary TB occurs in 1% of the cases and is usually associated with HIV infection. The last portion of the ileum and the ileocecal region are most frequently involved, while perianal localization is extremely rare and has clinical and paraclinical aspects similar to Crohn’s disease, thus leading to difficulties in establishing the diagnosis. We present the case of a 41-year-old patient who came to the proctology department with perianal pain and purulent discharge. He was diagnosed by clinical examination and colonoscopy with multiple simple and complex perianal fistulas complicated with a supralevator abscess. Multiple biopsies were taken and the result was necrotizing granulomatous inflammation. The Ziehl-Neelsen test confirmed the suspicion of perianal TB.
... This inflammation develops in various organs, inside or outside, if there are agglomerations of inflammation-like tumors called granulomas (de Brito and Franco, 1994;Shah et al., 2017). The etiologies of granulomatous disorders can include bacterial, fungal or parasitic infections, as well as autoimmune diseases and certain toxins or irritants (Amarnath et al., 2021). ...
A 4-year-old, neutered male Thai Bangkeaw dog presented with clinical signs of diarrhea, pollakiuria and a mass-like lesion between the bulbus glandis and testicular sac 2 weeks after castration. Ultrasound (U/S) revealed a mass-like lesion from the urethra expanded to the colon. A computerized tomography (CT) scan indicated that the mass had invaded the colon and nearby lymph node. Bacterial culture from the lesion identified infection caused by extended-spectrum beta-lactamases-producing Escherichia coli (ESBL-producing E. coli). Using fine needle aspiration (FNA) of the mass-like lesion, cytology showed irregular, negatively stained hyphal structures. Given the very large size of the lesion, surgical excision could not be performed. A combination of itraconazole, terbinafine and carprofen was prescribed for medical treatment. Additionally, amikacin was given following antimicrobial susceptibility testing. However, there was no improvement after medical treatment. Ultimately, euthanasia was selected. The gross findings revealed an area of swelling primarily located at the caudoventral abdomen due to marked edema and hemorrhage with a focal tract lesion from the focus of the hair skin defect through the urethra. Regionally, the descending colon was markedly thickened. Microscopically, the intestinal wall was obliterated by nodular and coalescing aggregates of granulomas surrounding many indiscernible hyphae with non-parallel walls, non-dichotomous branching and rare septations. Organisms were negatively stained with Periodic Acid Schiff (PAS) but strongly highlighted by Grocott's methenamine silver (GMS) staining. The findings were consistent with intestinal pythiosis. However, macerate tissue culture for fungi and oomycetes was negative.
... As these organisms gain foot hold on the tissue via their hyphae (hold), so they are difficult to dislodge. Similarly, other fungi like Coccidioides immitis and Histoplasma capsulatum may lead to pulmonary disease resembling that of Mycobacterium tuberculosis with granulomatous inflammation [24]. Surprisingly, fungi do not have a propensity for vascular invasion, and Pneumocystis pneumonia is not typically accompanied by vascular changes but common in immunocompromised individuals [25]. ...
In the current pandemic, COVID-19 patients with predisposing factors are at an increased risk of mucormycosis, an uncommon angioinvasive infection that is caused by fungi with Mucor genus which is mainly found in plants and soil. Mucormycosis development in COVID-19 patient is related to various factors, such as diabetes, immunocompromise and neutropenia. Excessive use of glucocorticoids for the treatment of critically ill COVID-19
patients also leads to opportunistic infections, such as pulmonary aspergillosis. COVID-19 patients with mucormycosis have a very high mortality rate. This review describes the pathogenesis and various treatment approaches for mucormycosis in COVID-19 patients, including medicinal plants, conventional therapies, adjunct
and combination therapies.
... This infection is also more prevalent in those with acquired immunodeficiency disease [2]. Extrapulmonary TB, in particular, is more common in females, HIV-positive patients, and in non-Hispanic blacks [3,4]. When a disease is this encompassing, it becomes critical for physicians to be familiar with even the least common manifestations of it. ...
Tuberculosis is a chronic, infectious disease that predominantly affects the respiratory system. Of the least common extrapulmonary forms of the disease is cutaneous tuberculosis. We present an unusual case, which is of cutaneous tuberculosis in the finger, manifesting as an ulcerating, erythematous lesion. This had later spread to the adjacent soft tissue and bones, causing osteomyelitis of the phalanges. It is important that physicians maintain a high index of suspicion when faced with atypical skin lesions to avoid the sequelae of the local and disseminated spread of a tuberculosis infection.
Drug‐induced mucosal injury (DIMI) in the gastrointestinal tract is important to recognise, partly because cessation of the culprit agent alone may result in resolution of symptoms. An ever‐growing list of medications, including newer immunotherapeutic agents and targeted therapies, can cause gastrointestinal inflammation of varying severity. However, the diagnosis of DIMI is challenging, as a single drug can induce a variety of histopathological patterns of injury including acute colitis, chronic colitis, microscopic colitis, apoptotic colopathy, and ischaemic‐type colitis. An additional consideration is the potential clinical, endoscopic and histological overlap of DIMI with gastrointestinal mucosal injury secondary to other entities such as inflammatory bowel disease (IBD). We discuss DIMI of the gastrointestinal tract with an emphasis on histological patterns that mimic IBD, histological features which may distinguish the two entities, and the diagnostic role and limitations of the pathologist.
Crohn's disease is a chronic inflammatory disease that can affect any portion of the gastrointestinal tract. Associated symptoms can vary based on the severity of disease, extent of involvement, presence of extraintestinal manifestations, and development of complications. Diagnosis is based on a constellation of findings. Many diseases can mimic Crohn's disease and lead to diagnostic conundrums. These include entities associated with the gastrointestinal luminal tract, vascular disease, autoimmune processes, various infections, malignancies and complications, drug- or treatment-induced conditions, and genetic diseases. Careful consideration of possible causes is necessary to establish the correct diagnosis.
There is a wide spectrum of hereditary and acquired immunodeficiency disorders that are characterized by specific abnormalities involving a plethora of humoral, cellular, and phagocytic immunologic pathways. These include distinctive primary immunodeficiency syndromes due to characteristic genetic defects and secondary immunodeficiency syndromes, such as AIDS from HIV infection and therapy-related immunosuppression in patients with cancers or a solid organ or stem cell transplant. The gut mucosa and gut-associated lymphoid tissue (the largest lymphoid organ in the body), along with diverse commensal microbiota, play complex and critical roles in development and modulation of the immune system. Thus, myriad gastrointestinal (GI) symptoms are common in immunocompromised patients and may be due to inflammatory conditions (graft versus host disease, neutropenic enterocolitis, or HIV-related proctocolitis), opportunistic infections (viral, bacterial, fungal, or protozoal), or malignancies (Kaposi sarcoma, lymphoma, posttransplant lymphoproliferative disorder, or anal cancer). GI tract involvement in immunodeficient patients contributes to significant morbidity and mortality. Along with endoscopy and histopathologic evaluation, imaging plays an integral role in detection, localization, characterization, and distinction of GI tract manifestations of various immunodeficiency syndromes and their complications. Select disorders demonstrate characteristic findings at fluoroscopy, CT, US, and MRI that permit timely and accurate diagnosis. While neutropenic enterocolitis affects the terminal ileum and right colon and occurs in patients receiving chemotherapy for hematologic malignancies, Kaposi sarcoma commonly manifests as bull's-eye lesions in the stomach and duodenum. Imaging is invaluable in treatment follow-up and long-term surveillance as well. Online supplemental material is available for this article. ©RSNA, 2022.
