Splenic abscesses are uncommon in systemic lupus erythematosus (SLE) and are typically infectious. Aseptic abscesses—sterile purulent collections resulting from immune dysregulation—are exceedingly rare and diagnostically challenging. We report a 25-year-old woman with no prior renal disease who presented with fever, left hypochondrial pain, and edema. Computed tomography imaging revealed a large splenic abscess measuring 12 × 13 × 10 cm. Ultrasound-guided drainage yielded 800 mL of purulent fluid, but bacterial, fungal, and mycobacterial cultures remained negative. Serology indicated active lupus (anti-dsDNA >800 IU/mL, hypocomplementemia), and renal biopsy showed Class IV diffuse lupus nephritis (ISN/RPS 2022). The patient improved with high-dose methylprednisolone followed by cyclophosphamide, and was transitioned to mycophenolate mofetil for maintenance. At 6-month follow-up, she remained asymptomatic with biochemical remission. Aseptic splenic abscess should be suspected in SLE patients with negative cultures and high disease activity, as prompt drainage and immunosuppression can lead to favorable outcomes.
Eosinophilic granuloma with solitary involvement of a lymph node is very rare. It occurs mainly in children. We present a rare case report of an adult male with primary eosinophilic granuloma of a lymph node, which had regressed following fine-needle aspiration cytology (FNAC) and again to reappeared after 1 month. Eosinophilic granuloma is most likely to be a reactive process directed against one or more yet unidentified agents. Isolated lymph node involvement in Langerhans cell histiocytosis still remains an enigmatic entity, as its pathogenesis is not fully unraveled. Careful morphological examination and immunohistochemistry studies will help to arrive at the correct diagnosis of this rare entity. This case is presented due to its rarity, uncommon age group of presentation, and histology with completely effaced lymph node architecture and regression episode following FNAC.
Suspecting combined immunodeficiency disorders (CID) in children with acute infections is the first step in diagnosing this group of disorders. Lymphopenia is one screening investigation for these disorders but it lacks specificity as it is often observed in acute infections. We observed in our study that persistent lymphopenia for age by 2 weeks after illness onset enhances its specificity. Subjecting these children with persistent lymphopenia by 2 weeks to other expensive diagnostic investigations can be a strategy to diagnose CID in resource-limited settings.
Introduction Phaeohyphomycosis usually presents as superficial or subcutaneous infections. However, in immunocompromised patients with disseminated disease, there is a high probability of cerebral invasion; hence, it must be detected before the fungi reach this stage. Case Report Here, we report a case of phaeohyphomycosis that presented with subluxation of teeth, 2 years post-COVID, and was found to have blackish discoloration of the alveolar bone with features of necrosis. Histopathological examination of biopsy samples was positive for phaeohyphomycosis, with positive Periodic acid-Schiff (PAS) and Fontana–Masson staining. Following diagnosis, surgical debridement of the polypoidal tissue and necrotic bone was done along with left uncinectomy. The patient was started on IV amphotericin B and oral voriconazole. The patient had complete resolution of symptoms 3 months after initiation of treatment. Conclusion Phaeohyphomycosis has been reported to have high mortality and morbidity. Hence, timely diagnosis and initiating appropriate antifungal therapy as soon as possible are important to reduce the fatal consequences of phaeohyphomycosis infection.
