1/130. Necrotizing and giant cell granulomatous phlebitis of caecum and ascending colon. A distinctive form of necrotizing and granulomatous phlebitis of a segment of large intestine is described in a previously healthy 36-year-old woman who presented with sudden severe abdominal pain and diarrhoea. At operation the caecum and ascending colon were oedematous and inflamed and right hemicolectomy was performed. Microscopically there was striking involvement of veins in all coats of the bowel ranging from recent fibrinoid necrosis of the whole vessel wall in the case of the caecum, to more chronic giant cell granulomas in parts of the vessel wall with partial or complete occlusion of the lumen in ascending colon. arteries and lymphatics were entirely spared of these changes. The aitiology of this condition has not been elucidated but the histological appearances and site of involvement suggest an immunological reaction to material absorbed from the bowel. No evidence of food or other allergies or of infection has been obtained. The patient remains symptom free after 18 months. This form of phlebitis does not appear to have been previously described. ( info) |
| lower extremity venography is essential to confirm the diagnosis of phlebitis when the clinical situation is not completely typical. 8 patients are presented, 6 of whom had been given prolonged prior anticoagulant therapy for phlebitis and pulmonary embolus. Normal venograms and reassurance led to resolution of symptoms in all cases. ( info) |
| A family with a combined deficiency of factor XII and factor v Leiden is presented. The proposita is a 72-year-old who showed a mild to moderate thrombotic tendency characterized by two episodes of deep venous thrombosis and superficial phlebitis between the age of 50 and 71. She was shown to be carrier of homozygous factor xii deficiency and heterozygous FV Leiden mutation. A sister of the proposita showed the same pattern but remained asymptomatic. Other family members showed either isolated heterozygous factor xii deficiency or combined heterozygous factor xii deficiency and heterozygous FV Leiden mutation but were all asymptomatic. These data lend support to those who maintain that FV Leiden is a mild genetic determinant for thrombosis. The role of FXII deficiency as an additional risk factor remains questionable. ( info) |
4/130. Lymphohistiocytic and granulomatous phlebitis in penile lichen sclerosus. Lichen sclerosus (LS) is a chronic inflammatory disease of unknown etiology that may affect the genital and/or extragenital skin of individuals of either sex at all ages. In boys, the prepuce is the most common site of involvement. The diagnostic criteria of LS include the presence of inflammatory infiltrates mainly composed of T lymphocytes. We report on two cases of LS of the prepuce because of the unusual feature of lymphocytic (CD45RO and CD20 ), histiocytic (CD68 ), and granulomatous phlebitis. This lesion was not present in a group of another 18 cases of childhood penile LS. We have not been able to find any references describing and illustrating inflammatory involvement of the dermal vein walls in LS. Unlike the data reported in the literature, the dermal inflammatory infiltrates of these two cases showed a similar proportion of B and T lymphocytes in addition to frequent CD68 histiocytes. ( info) |
5/130. Isolated granulomatous phlebitis: rare cause of ischemic necrosis of the colon: report of a case. Isolated phlebitis of the gastrointestinal tract is rare and potentially life threatening. We report on a patient who developed peritonitis, requiring emergency laparotomy, total colectomy, and ileostomy because of colon necrosis. The specimen displayed multiple ulcerations and erosions. histology showed a predominantly lymphocytic infiltrate of small-sized and middle-sized veins in the submucosa and subserosa, associated with granulomas and foci of vein wall necrosis. arteries were spared. No local recurrence or systemic vasculitis developed during a follow-up period of two years. Isolated granulomatous phlebitis seems to be self-limited, and its cause is unknown. Surgical resection of the diseased intestine is usually curative. ( info) |
6/130. Idiopathic pylephlebitis and idiopathic sclerosing peritonitis in a man with protein s deficiency. Idiopathic pylephlebitis and primary sclerosing peritonitis are two highly unusual entities. To our knowledge, the association of the two diseases has not been described previously. We report a 42-year-old patient with a protein s deficiency who presented with fever and chills, in whom idiopathic pylephlebitis was diagnosed. A year later, the patient was readmitted because of recurrent vomiting and weight loss. An exploratory laparotomy yielded diagnosis of sclerosing peritonitis, which resolved after surgery. The short time interval between the processes suggests that they were related to each other, and also to the protein s deficiency. ( info) |
7/130. Giant-cell vasculitides. Although many of the vasculitides within the classification of the American College of rheumatology can have a component of granulomatous inflammation with giant cells, two (ie, giant-cell [temporal] arteritis and takayasu arteritis) are characterized by infiltrates that are dominated by granulomatous and/or giant-cell-containing inflammation. Furthermore, granulomatous and/or giant-cell dominant infiltrates can characterize disseminated giant-cell arteritis, granulomatous vasculitis of the central nervous system, localized giant-cell arteritis, mesenteric inflammatory veno-occlusive disease, primary cutaneous phlebitis, and giant-cell phlebitis of mesenteric veins and/or omentum. Like the other systemic vasculitides, there is considerable clinicopathologic overlap between these giant-cell vasculitides. Indeed, they are likely closely related, but how they specifically relate to each other is not clear. Their accurate diagnosis is important; because serious morbidity and even death may occur, if proper treatment is delayed or if excessive immunotherapy is given. ( info) |
8/130. Presumed Eales' disease with neurologic involvement: report of three cases. PURPOSE: To report three cases of presumed Eales' disease with neurologic lesions. methods: case reports, systemic and neurologic evaluation, and magnetic resonance imaging. RESULTS: All three patients were young men who had seizures in the past; two had migrainous headache. magnetic resonance imaging showed putaminal infarct in two cases and edema in the white matter of temporal cortex was noticed in one case. Clinical features in all these patients were suggestive of Eales' disease. CONCLUSION: Ischemic infarction of the brain can be seen in clinically suspected cases of Eales' disease. ( info) |
9/130. Endophlebitis of the leg caused by brucella infection. brucellosis is hyperendemic in saudi arabia where, despite rapid urbanisation, a large segment of the population has a nomadic background and clings to cultural traditions such as the drinking of raw milk. We report here an unusual complication of brucellosis in a microbiology technologist. A 41-year-old male presented with an 8-day history of right ankle pain which, over a 3-day period, extended up to his calf where swelling and tightness developed. The leg symptomatology occurred on a background of fever, seats and rigors. X-ray of the limb was normal but a venogram revealed thrombosis of the deep veins of the right calf. Although his blood culture was negative, he developed high brucella antibody titres. Treatment with anticoagulants combined with a course of doxycycline and rifampin produced a full recovery. ( info) |
10/130. Dextran 40: another cause of drug-induced noncardiogenic pulmonary edema. Drug-induced noncardiogenic pulmonary edema occurred in a previously patient receiving dextran 40. Dextran 40 should be considered another etiologic factor of drug-induced noncardiogenic pulmonary edema when this syndrome occurs in the absence of known precipitating causes such as shock, aspiration, and overwhelming pneumonia. ( info) |