To improve the diagnosis of atypical lymphocytes and reduce the misdiagnosis rate,we analyzed the medical records of 2 cases with cell morphology suggestive of atypical lymphocytes.One case was diagnosed with infectious mononucleosis and the other with aggressive NK cell leukemia.The purpose of this paper is to emphasize that the diagnosis of atypical lymphocytes based only on morphological interpretation of cells may be incorrect,which should be combined with clinical symptoms,signs,imaging examination,cell immunophenotype,and disease outcome.
Humans ; Lymphocytosis/diagnosis* ; Infectious Mononucleosis/diagnosis* ; Immunophenotyping ; Diagnosis, Differential ; Diagnostic Errors

PURPOSE: To report a case of Roth spots, panuveitis, and infectious mononucleosis in a healthy adult. CASE SUMMARY: An immunocompetent 30-year-old male visited our clinic complaining of reduced visual acuity and a floating sense in both eyes of 2 days. He had experienced flu-like symptoms including fever, sore throat, myalgia, and malaise for 10 days before visual acuity decreased. His best-corrected visual acuity was 20/25 in both eyes and inflammatory cells were found in both the anterior chambers and the vitreous. Funduscopy revealed multiple retinal hemorrhages and Roth spots in both eyes. We prescribed topical steroid eye drops. A peripheral blood test revealed mild leukocytosis with lymphocytosis (60%) consisted of atypical lymphocyte (7%). Serologic examinations were positive for cytomegalovirus (CMV) immunoglobulin M (IgM) Ab and Epstein-Barr virus IgM Ab. A polymerase chain reaction for blood CMV was positive. The presumptive clinical diagnosis was Roth spots and panuveitis associated with infectious mononucleosis. Three weeks later, no inflammatory cells were apparent in the anterior chamber or vitreous. Best-corrected visual acuity had recovered to 20/20 in both eyes, and the retinal hemorrhage had completely disappeared. CONCLUSIONS: Roth spots and panuveitis can be present in patients with infectious mononucleosis, which should thus be included in the differential diagnosis of Roth spots.
Adult ; Anterior Chamber ; Cytomegalovirus ; Diagnosis ; Diagnosis, Differential ; Fever ; Hematologic Tests ; Herpesvirus 4, Human ; Humans ; Immunoglobulin M ; Infectious Mononucleosis ; Leukocytosis ; Lymphocytes ; Lymphocytosis ; Male ; Myalgia ; Ophthalmic Solutions ; Panuveitis ; Pharyngitis ; Polymerase Chain Reaction ; Retinal Hemorrhage ; Uveitis ; Visual Acuity

PURPOSE: This report describes the results of a survey of the characteristics of pertussis in children from a single institution and compares it to data from the Korea Centers of Disease Control (KCDC). METHODS: We retrospectively evaluated the medical records of 17 and 6 patients diagnosed with pertussis and parapertussis, respectively, at Soonchunhyang University Bucheon Hospital from January 2005 to January 2017. RESULTS: Of the 17 patients with pertussis, 9 were under 1 year of age (52.9%), 3 were aged between 1 and 10 years (17.6%), and 5 were over 10 years of age (29.4%). Seven patients (41.2%) had never received diphtheria-tetanus-acellular pertussis vaccines, of which 5 were infants below 2 months of age and 2 were 10 years old and lived in China. Four patients showed the initial symptoms of cough in China. The sources of infection were the parents (2 cases) and the siblings (8 cases). All patients showed prolonged severe cough and the average duration of cough was 26 days. Severe symptoms, including dyspnea, cyanosis, apnea, and seizures, were observed in the children under 2 months of age. According to the recent 10-year KCDC data, the highest rate of pertussis diagnosis was noted in infants (47.8%), followed by adolescents (18.7%). Six patients with parapertussis also presented with prolonged severe cough without any other severe symptoms. Lymphocytosis was not found, unlike the patients with pertussis. CONCLUSION: The possibility of pertussis and parapertussis should be considered among patients with prolonged severe cough, especially in infants and adolescents.
Adolescent ; Apnea ; Bordetella parapertussis ; Bordetella pertussis ; Child ; China ; Cough ; Cyanosis ; Diagnosis ; Diphtheria-Tetanus-acellular Pertussis Vaccines ; Dyspnea ; Gyeonggi-do ; Humans ; Infant ; Korea ; Lymphocytosis ; Medical Records ; Parents ; Retrospective Studies ; Seizures ; Siblings ; Whooping Cough

No abstract available.
Child, Preschool ; Female ; Flow Cytometry ; Humans ; Hydroa Vacciniforme/*diagnosis/pathology ; Immunophenotyping ; Lymphocytosis/complications ; Lymphoma/*diagnosis ; Receptors, Antigen, T-Cell, gamma-delta/genetics/*metabolism ; STAT3 Transcription Factor/genetics/metabolism ; Sequence Analysis, DNA ; Skin/metabolism ; T-Lymphocytes/*metabolism

Aged ; B-Lymphocytes ; pathology ; Granulomatosis with Polyangiitis ; diagnosis ; Humans ; Lymphocytosis ; diagnosis ; Male

BACKGROUND: Cellular analysis of bronchoalveolar lavage fluid (BALF) is a useful diagnostic tool for interstitial lung diseases (ILDs). The lymphocytes in BALF consist of CD3+CD4+ T cells (T4), CD3+CD8+ T cells (T8), and a few B cells. However, sometimes, an increased number of CD3+CD4-CD8- T cells (double-negative T cells, DNTs) are noted in BALF. It is known that DNTs in the blood are associated with immunoregulation and autoimmune diseases. However, there are only few studies on DNTs in BALF. We evaluated the DNTs in BALF in patients with pulmonary diseases. METHODS: Immunophenotyping results of the BALF obtained from 122 pulmonary disease patients over an 8-yr period were reviewed. T-lymphocyte subsets (T4, T8, and DNT) and inflammatory markers were analyzed for each group of clinical diagnosis. T-lymphocyte percentage of more than 15% of the total cells was defined as BALF lymphocytosis, and DNT percentage of more than 5% of T lymphocytes was defined as high DNT. RESULTS: The most frequent diseases found in the patients were pneumonia (31.6%), autoimmune-related ILDs (18.0%), hypersensitivity pneumonitis (10.7%), and organizing pneumonia (10.7%). However, the occurrence of autoimmune-related ILDs was significantly high (40%) in patients with lymphocytosis and high DNT (P=0.002). All lung cancer patients showed lymphocytosis with high DNT. In addition, CD3-signal intensities of DNTs were significantly higher than those of other T-lymphocyte subtypes (P=0.003). CONCLUSION: The number of DNTs in BALF was increased in patients with autoimmune-related ILDs and lung cancer. High DNTs in BALF are useful as supportive diagnostic tools for autoimmune-related ILDs.
Alveolitis, Extrinsic Allergic ; Autoimmune Diseases ; B-Lymphocytes ; Bronchoalveolar Lavage Fluid* ; Diagnosis* ; Humans ; Immunophenotyping ; Lung Diseases* ; Lung Diseases, Interstitial ; Lung Neoplasms ; Lymphocytes ; Lymphocytosis ; Pneumonia ; T-Lymphocyte Subsets ; T-Lymphocytes*

Drug-induced hypersensitivity pneumonitis results from interactions between pharmacologic agents and the human immune system. We describe a 54-year-old man with hypersensitivity pneumonitis caused by cephalosporins with identical R1 side chains. The patient, who complained of cough with sputum, was prescribed ceftriaxone and clarithromycin at a local clinic. The following day, he complained of dyspnea, and chest X-ray revealed worsening of inflammation. Upon admission to our hospital, antibiotics were changed to cefepime with levofloxacin, but his pneumonia appeared to progress. Changing antibiotics to meropenem with ciprofloxacin improved his symptoms and radiologic findings. Antibiotics were de-escalated to ceftazidime with levofloxacin, and his condition improved. During later treatment, he was mistakenly prescribed cefotaxime, which led to nausea, vomiting, dyspnea and fever, and indications of pneumonitis on chest X-ray. We performed bronchoalveolar lavage, and the findings included lymphocytosis (23%), eosinophilia (17%), and a low cluster of differentiation (CD) 4 to CD8 ratio (0.1), informing a diagnosis of drug-induced pneumonitis. After a medication change, his symptoms improved and he was discharged. One year later, he was hospitalized for acute respiratory distress syndrome following treatment with ceftriaxone and aminoglycosides for an upper respiratory tract infection. After steroid therapy, he recovered completely. In this patient, hypersensitivity reaction in the lungs was caused by ceftriaxone, cefotaxime, and cefepime, but not by ceftazidime, indicating that the patient's hypersensitivity pneumonitis was to the common R1 side chain of the cephalosporins.
Alveolitis, Extrinsic Allergic* ; Aminoglycosides ; Anti-Bacterial Agents ; Bronchoalveolar Lavage ; Cefotaxime ; Ceftazidime ; Ceftriaxone ; Cephalosporins* ; Ciprofloxacin ; Clarithromycin ; Cough ; Diagnosis ; Drug-Related Side Effects and Adverse Reactions ; Dyspnea ; Eosinophilia ; Fever ; Humans ; Hypersensitivity ; Immune System ; Inflammation ; Levofloxacin ; Lung ; Lymphocytosis ; Middle Aged ; Nausea ; Pneumonia ; Respiratory Distress Syndrome, Adult ; Respiratory Tract Infections ; Sputum ; Thorax ; Vomiting

OBJECTIVETo investigate the clinicopathologic features of adult-onset autoimmune enteropathy (AIE).

METHODSA case of adult-onset AIE was described along with a literature review.

RESULTSA 41-year-old male patient was admitted for intractable diarrhea for more than three months despite of any dietary restriction or anti-inflammatory therapy. Fat globule was observed by stool examination and Sudan III staining of the stool was positive. Enteroclysis showed weak movement and few plica of small intestine, while colonoscopy appeared normal. Small bowel biopsies revealed villus atrophy and increased crypt apoptotic bodies and lymphocytic infiltration in deep crypt. Although without significant surface intro-epithelial lymphocytosis, there were a large number of monocytes, lymphocytes, plasmacytes and neutrophilic granulocytes infiltrating in the lamina propria. Morphologically, the colonic mucous was similar to the small intestine although cryptitis and crypt abscess were significant in the former. Serum IgG anti-goblet cell antibody was demonstrated by indirect immunofluorescence. Other causes of diarrhea were excluded on the base of medical history, histopathology and other accessory examinations before the diagnosis of AIE was made. The patient had a complete remission after steroid treatment without recurrence for eight months during the follow-up even after steroid withdrawal for five months.

CONCLUSIONSAIE is exceedingly rare and timely diagnosis is important for successful therapy. Histological differential diagnoses should include ulcerative colitis, celiac disease, lymphocytic colitis, etc. The final diagnosis should be based on histological examination combined with the patient history, clinical manifestation, endoscopy finding and serological testing.

Atrophy ; Biopsy ; Celiac Disease ; pathology ; Colon ; pathology ; Colonoscopy ; Diagnosis, Differential ; Diarrhea ; etiology ; Humans ; Intestinal Mucosa ; pathology ; Intestine, Small ; pathology ; Lymphocytes ; Lymphocytosis ; pathology ; Polyendocrinopathies, Autoimmune ; pathology

An Australian cattle dog (case 1: 6-year-old castrated male) and a Shih-Tzu dog (case 2: 8-year-old castrated male) were referred to the Gyeongsang Animal Medical Center due to anorexia and depression. Physical examinations, complete blood counts, serum chemical analysis, radiography, ultrasonography, and bone marrow biopsy were performed. Upon physical examinations of cases 1 and 2, enlargement of superficial lymph nodes was not identified. Hematologic findings in these dogs included leukocytosis with severe lymphocytosis, anemia, and thrombocytopenia. Upon radiography, both dogs showed splenomegaly. Upon examination of a peripheral blood smear in case 1, immature lymphoid cells, featuring decreased nuclear chromatin condensation and nuclear pleomorphism, were present. Biopsy samples of the bone marrow in case 1 revealed hypercellularity as well as a large number of immature lymphoblastic cells similar in shape to cells in the peripheral blood. The characteristic morphological features of peripheral blood and bone marrow samples in case 2 were small lymphocytes. Thus, the dogs were tentatively diagnosed with acute lymphoblastic leukemia (ALL) and chronic lymphocytic leukemia (CLL), respectively. After diagnosis, the CLL patient was administered chlorambucil and prednisolone therapy. Due to its similarity to human leukemia, the canine leukemia model provides a valuable model for research into human leukemia.
Anemia ; Animals ; Anorexia ; Biopsy ; Blood Cell Count ; Bone Marrow ; Cattle ; Child ; Chlorambucil ; Chromatin ; Depression ; Diagnosis ; Dogs* ; Humans ; Leukemia ; Leukemia, Lymphocytic, Chronic, B-Cell* ; Leukocytosis ; Lymph Nodes ; Lymphocytes ; Lymphocytosis ; Lymphoma ; Physical Examination ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Prednisolone ; Radiography ; Splenomegaly ; Thrombocytopenia ; Ultrasonography

Hypersensitivity to mosquito bites (HMB) is a rare disease characterized by intense skin reactions such as bulla and necrotic ulcerations at bite sites, accompanied by general symptoms such as high-grade fever and malaise occurred after mosquito bites. It has been suggested that HMB is associated with chronic Epstein-Barr virus (EBV) infection and natural killer (NK) cell leukemia/lymphoma. We describe here a Korean child who presented with 3-yr history of HMB without natural killer cell lymphocytosis. He has been ill for 6 yr with HMB. Close observation and examination for the development of lymphoproliferative status or hematologic malignant disorders is needed.
Child ; Epstein-Barr Virus Infections/complications ; Humans ; Hypersensitivity/*diagnosis/etiology ; Insect Bites and Stings/*diagnosis/pathology ; Killer Cells, Natural/immunology ; Lymphocytosis/complications/pathology ; Male ; Republic of Korea ; Skin/pathology