A 36-year-old woman presented with erythematous confluent macules on her whole body with fever and chills associated with jaundice after 8 months of dapsone therapy. Her symptoms had developed progressively, and a physical examination revealed bilateral cervical lymphadenopathy and splenomegaly. Excisional biopsy of a cervical lymph node showed effacement of the normal architecture with atypical lymphoid hyperplasia and proliferation of high endothelial venules compatible with angioimmunoblastic T-cell lymphoma. However, it was assumed that the cervical lymphadenopathy was a clinical manifestation of a systemic hypersensitivity reaction because her clinical course was reminiscent of dapsone-induced hypersensitivity syndrome. A liver biopsy revealed drug-induced hepatitis with no evidence of lymphomatous involvement. Intravenous glucocorticoid was immediately initiated and her symptoms and clinical disease dramatically improved. The authors present an unusual case of cervical lymphadenopathy mimicking angioimmunoblastic T-cell lymphoma as an adverse reaction to dapsone.
Biopsy ; Chills ; Dapsone ; Drug-Induced Liver Injury ; Female ; Fever ; Humans ; Hyperplasia ; Hypersensitivity ; Jaundice ; Liver ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma, T-Cell ; Physical Examination ; Pseudolymphoma ; Splenomegaly ; T-Lymphocytes ; Venules

Mucosa-associated lymphoid tissue (MALT) lymphoma is a typical primary gastrointestinal lymphoma, particularly in the stomach. Although primary rectal lymphoma is rare, it may present as a subepithelial tumor. Several techniques have been proposed for a tissue diagnosis in subepithelial tumor, including endoscopic ultrasonography (EUS)-guided fine needle aspiration (EUS-FNA), EUS-guided trucut biopsy (EUS-TCB), and tacked biopsy. However the diagnostic efficacy of these techniques appears to be limited. The unroofing technique involves removal of the overlying mucosa, thereby exposing the subepithelial lesion. It was originally reported as a method for endoscopic treatment of colorectal lymphangioma. In this case, a subepithelial tumor of the rectum was diagnosed using the endoscopic unroofing technique. This is a useful modality for the diagnosis of subepithelial tumor, because it provides histologic results in a safe and rapid manner.
Adult ; Antigens, CD20/metabolism ; Colonoscopy ; Humans ; Immunohistochemistry ; Intestinal Mucosa/surgery ; Lymphoma, B-Cell, Marginal Zone/*diagnosis/pathology/ultrasonography ; Male ; Rectal Neoplasms/*diagnosis/pathology/ultrasonography ; Tomography Scanners, X-Ray Computed

PURPOSE: Paraquat (1,1'-dimethy-4,4'-bipyridinium dichloride, PQ) is an effective and widely used herbicide, which was introduced commercially in 1962. It is reduced by an electron donor, such as NADPH, and then transfers the electron to molecular oxygen. As a result, the reactive oxygen species (ROS) produced are related to its cellular toxicity. Resveratrol (trans-3,4',5-trihydroxystilbene), a naturally occurring hydroxystilbene, is considered an essential antioxidative constituent of red wine, possessing chemopreventive properties. However, the influence of resveratrol on PQ-induced oxidative cell damage has not fully been investigated. METHODS: This experiment was conducted in vitro using cultured lung cells from SD rats. The MTT and LDH methods were used for assessment of cytotoxicity. The 2',7'-dichlorofluorescein diacetate (DCF-DA) assay was used for measurement of intracellular ROS levels. The 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay was used for measurement of pro-oxidant capacity of resveratrol. The Thiobarbituric acid reactive substances (TBARS) assay, which reflects lipid peroxidation, was used for estimation of oxidative stress. RESULTS: According to results of the MTT and LDH assays, incubation of cultured lung cells with resveratrol did not protect lung cells from PQ-induced cytotoxicity, and no decrease in ROS production was observed, according to results of the DCF-DA assay. On the other hand, incubation of lung cells with non-lethal resveratrol resulted in aggravation of PQ-induced oxidative stress. CONCLUSION: Results of this study showed that incubation of cells with resveratol did not result in reduction of PQ toxicity, but lead to elevation of PQ-induced oxidative stress in cultured lung cells.
Animals ; Biphenyl Compounds ; Electrons ; Fluoresceins ; Hand ; Humans ; Lipid Peroxidation ; Lung ; NADP ; Oxidative Stress ; Oxygen ; Paraquat ; Picrates ; Rats ; Reactive Oxygen Species ; Stilbenes ; Thiobarbiturates ; Thiobarbituric Acid Reactive Substances ; Tissue Donors ; Wine

Methotrexate (MTX) has been established as a standard disease-modifying anti-rheumatic drug. If adequate disease control is achieved for a reasonable period of time, tapering the MTX dosage is recommended because the chronic use of MTX can result in opportunistic infection. We present here a case of a woman with rheumatoid arthritis taking MTX, and the woman developed actively caseating endobronchial Mycobacterium intracellulare disease with pulmonary infiltrations. After discontinuing the MTX, the patient was able to tolerate 18 months of antimycobacterial treatment without flare ups of rheumatoid arthritis, and she completely recovered from nontuberculous mycobacterial respiratory disease.
Arthritis, Rheumatoid ; Bronchial Diseases ; Female ; Humans ; Lung Diseases ; Methotrexate ; Mycobacterium ; Mycobacterium avium Complex ; Nontuberculous Mycobacteria ; Opportunistic Infections ; Tuberculosis, Pulmonary