trimethoprim--sulfamethoxazole-drug-combination and Granuloma

The granulomatous vasculitides frequently involve the lung. These syndromes include Wegener's granulomatosis, allergic angiitis and granulomatosis, and the polyangiitis overlap syndrome. Although not a true systemic vasculitis, necrotizing sarcoid granulomatosis also represents a type of pulmonary vasculitis. It is clear that many infectious agents can cause a picture in the lung that can be confused with granulomatous vasculitis and that an infectious process must be ruled out before a diagnosis of pulmonary vasculitis can be established. Pulmonary vasculitis can be associated with the hypersensitivity vasculitides, and pulmonary hemorrhage can be secondary to pulmonary capillaritis. Therapy of the hypersensitivity vasculitides consists of removing the offending antigen and instituting a limited course of corticosteroids. If the vasculitis is secondary to an underlying disease, such as lymphoma, therapy should be directed at the primary disease. Combination therapy with cyclophosphamide and corticosteroids is effective in the systemic vasculitides and the 5-yr survival rate is approximately 90%.

Topics: Adrenal Cortex Hormones; Azathioprine; Behcet Syndrome; Chlorambucil; Connective Tissue Diseases; Cyclophosphamide; Cyclosporins; Drug Combinations; Granuloma; Granulomatosis with Polyangiitis; Hemorrhage; Humans; Lung Diseases; Lymphomatoid Granulomatosis; Respiratory Tract Infections; Sulfamethoxazole; Syndrome; Takayasu Arteritis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis; Vasculitis, Leukocytoclastic, Cutaneous

Topics: Adult; Anti-Bacterial Agents; Female; Granuloma; Humans; Mesotherapy; Nocardia; Nocardia Infections; Suppuration; Trimethoprim, Sulfamethoxazole Drug Combination

Rituximab, an anti-CD20 antibody that targets B cells, is a promising agent against steroid-dependent and steroid-resistant nephrotic syndrome in children.. We report a 3-year-old boy who presented with atypical Pneumocystis jiroveci pneumonia (PCP) following administration of rituximab for refractory nephrotic syndrome. He had received cyclosporine and daily prednisolone for over 1 year. Following rituximab therapy, a hazy shadow was observed on his chest X-ray. Chest-computed tomography revealed multiple nodular lesions in bilateral lungs, although his clinical symptoms were subtle. PCR analysis demonstrated the presence of Pneumocystis DNA in his bronchoalveolar lavage. Lung wedge resection of the nodular lesion exhibited granulomas containing a few cysts of P. jiroveci that primarily consisted of T cells and histiocytes and lacked B cells. A deficiency of B cells following rituximab treatment suggests a dramatic effect on the immune response and, therefore, could result in granulomatous PCP. Nodular granulomatous lesions of PCP comprise an emerging concept previously reported in adults with hematological disease, bone marrow transplant, or treatment with rituximab. We report the first pediatric case of nodular PCP. Granulomatous PCP can be life-threatening. Moreover, bronchoalveolar lavage often fails to demonstrate the presence of P. jiroveci DNA. Wedge biopsy is warranted for definitive diagnosis. Our patient fully recovered with sulfamethoxazole/trimethoprim treatment because of early detection.. The indication of rituximab for refractory nephrotic syndrome has increased recently. Therefore, recognition of the risk of atypical PCP is important. Our findings suggest that PCP prophylaxis should be considered following rituximab therapy.

Topics: Anti-Infective Agents; Antibodies, Monoclonal, Murine-Derived; Child, Preschool; Granuloma; Humans; Immunocompromised Host; Immunosuppressive Agents; Male; Nephrotic Syndrome; Pneumocystis carinii; Pneumonia, Pneumocystis; Rituximab; Trimethoprim, Sulfamethoxazole Drug Combination

We describe the case of a 14-year-old girl with Down syndrome and a large cutaneous plaque localized to the right neck and shoulder that had enlarged over five years after a minor traumatic injury. The plaque was characterized by numerous inflammatory nodules and fistulae that secreted purulent discharge. Nocardia grains were identified and Nocardia brasiliensis was identified by culture. Histopathology examination showed a chronic inflammatory infiltrate with granuloma development. The treatment scheme was with Diaminodiphenylsulfone 50/mg/d and Trimethoprim-Sulfamethoxazole 800/160 mg BID. Therapy was continued over 1(1/2) years, with a tapering dose. After 2(1/2) years of continuous treatment, clinical and microbiological healing was achieved.

Topics: Adolescent; Dapsone; Diagnostic Errors; Down Syndrome; Edible Grain; Female; Granuloma; Humans; Mycetoma; Neck; Nocardia; Nocardia Infections; Plant Shoots; Shoulder Injuries; Skin Ulcer; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Cutaneous; Wound Infection

Topics: Actinomycetales Infections; Adult; Anti-Infective Agents; Bacterial Infections; Brain Diseases; Female; Granuloma; Humans; Radiography; Scalp; Trimethoprim, Sulfamethoxazole Drug Combination

A review was undertaken of the clinical features and results of diagnostic tests in non-HIV infected patients who developed granulomatous Pneumocystis carinii pneumonia (PCP).. A retrospective review was performed of the charts and radiographs of patients with a granulomatous reaction to P carinii identified from computerised pathology records at Memorial Sloan Kettering Cancer Center, a university affiliated tertiary care hospital.. Three cases were identified; the incidence of granulomatous PCP was 3%. All patients had risk factors for PCP and had received high dose corticosteroids which had been stopped. Two patients had received chemotherapy. Presentation was insidious with only mild symptoms; only one patient had fever. Chest radiographs showed a reticulonodular pattern. Bronchoscopy was negative for PCP in all cases and open lung biopsy was necessary.. A granulomatous pathological reaction to PCP occurs rarely in patients with malignancy. In these cases the clinical presentation may be atypical and bronchoscopy can be non-diagnostic.

Topics: Adolescent; Adult; Anti-Infective Agents; Bronchoalveolar Lavage Fluid; Female; Glioblastoma; Granuloma; Hodgkin Disease; Humans; Male; Middle Aged; Pneumocystis Infections; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Although there have been reports of Brucella granuloma or abscess in the literature, they were all localized extradurally except one, and most patients underwent surgery.. A 40-year-old female presented with urinary and fecal incontinence and a two-month history of progressive weakness of the right leg and numbness of the left leg. Four months previously, she had been diagnosed with systemic brucellosis with a period of radiculomeningoencephalitis; she was treated successfully with rifampicin, doxycycline, trimethoprim/sulfamethoxazole (TMP/SMZ), and streptomycin, and was discharged symptom-free on rifampicin and doxycycline. Neurological examination revealed spastic paraparesis, globally hyperactive deep tendon reflexes (DTRs) and sensory level at T6. Magnetic resonance imaging (MRI) of the spinal cord revealed a 10 x 30 mm intradural-intramedullary mass lesion at the T5 level with surrounding edema that enhanced with contrast. The cerebrospinal fluid (CSF) was xanthochromic with lymphocytic pleocytosis and elevated levels of albumin, immunoglobulins, and antibody titers for Brucella. The medications were modified to rifampicin 1200 mg, doxycycline 400 mg, and TMP/SMZ 480/2400 mg daily, and methylprednisolone 100 mg in decremental doses (for 6 weeks). After 2 months, the patient was almost symptom-free and her medication doses were decreased. After 5 months, the mass lesion resolved almost completely. The treatment was discontinued after 2 years.. The case is presented because of its uniqueness. In cases of Brucella granuloma, the authors recommend a trial of medical treatment with adequate dosages for a reasonable length of time before considering surgical intervention.

Topics: Adult; Brucellosis; Dose-Response Relationship, Drug; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Granuloma; Humans; Magnetic Resonance Imaging; Methylprednisolone; Neurologic Examination; Rifampin; Spinal Cord; Spinal Cord Diseases; Thoracic Vertebrae; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

A case of Pneumocystis carinii pneumonia and the acquired immunodeficiency syndrome presented radiographically with upper lobe cavitation and association pleural thickening, mimicking granulomatous lung disease. The patient was diagnosed in our institution with transbronchial biopsies which showed P carinii organisms and foamy eosinophilic debris in the alveolar spaces. Clinical and radiographic resolution occurred with trimethoprim sulfamethoxazole therapy. This particular radiographic pattern has not been previously reported in the literature.

Topics: Acquired Immunodeficiency Syndrome; Adult; Diagnosis, Differential; Granuloma; Humans; Lung Diseases; Male; Pneumonia, Pneumocystis; Radiography; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Pulmonary

Topics: Adult; Animals; Antitubercular Agents; Drug Combinations; Female; Fingers; Fishes; Forearm; Granuloma; Humans; Male; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Skin Diseases, Infectious; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination