Atopic dermatitis (AD) is a common inflammatory skin disorder mediated by inflammatory cells, such as macrophages and mast cells. Rifampicin is mainly used for the treatment of tuberculosis. Recently, it was reported that rifampicin has anti-inflammatory and immune-suppressive activities. In this study, we investigated the effect of rifampicin on atopic dermatitis in vivo and in vitro. AD was induced by treatment with 2, 4-dinitrochlorobenzene (DNCB) in NC/Nga mice. A subset of mice was then treated with rifampicin by oral administration. The severity score and scratching behavior were alleviated in the rifampicin-treated group. Serum immunoglobulin E (IgE) and interleukin-4 (IL-4) levels were also ameliorated in mice treated with rifampicin. We next examined whether rifampicin has anti-atopic activity via suppression of mast cell activation. Rifampicin suppressed the release of β-hexosaminidase and histamine from human mast cell (HMC)-1 cultures stimulated with compound 48/80. Treatment with rifampicin also inhibited secretion of inflammatory mediators, such tumor necrosis factor-α (TNF-α) and prostaglandin D₂ (PGD₂), in mast cells activated by compound 48/80. The mRNA expression of cyclooxygenase 2 (COX-2) was reduced in the cells treated with rifampicin in a concentration-dependent manner. These results suggest that rifampicin can be used to treat atopic dermatitis.
Administration, Oral ; Animals ; Cyclooxygenase 2 ; Dermatitis, Atopic ; Histamine ; Humans ; Immunoglobulin E ; Immunoglobulins ; In Vitro Techniques* ; Interleukin-4 ; Macrophages ; Mast Cells ; Mice ; Necrosis ; Rifampin* ; RNA, Messenger ; Skin ; Tuberculosis

Atopic dermatitis (AD) is a common inflammatory skin disorder mediated by inflammatory cells, such as macrophages and mast cells. Rifampicin is mainly used for the treatment of tuberculosis. Recently, it was reported that rifampicin has anti-inflammatory and immune-suppressive activities. In this study, we investigated the effect of rifampicin on atopic dermatitis in vivo and in vitro. AD was induced by treatment with 2, 4-dinitrochlorobenzene (DNCB) in NC/Nga mice. A subset of mice was then treated with rifampicin by oral administration. The severity score and scratching behavior were alleviated in the rifampicin-treated group. Serum immunoglobulin E (IgE) and interleukin-4 (IL-4) levels were also ameliorated in mice treated with rifampicin. We next examined whether rifampicin has anti-atopic activity via suppression of mast cell activation. Rifampicin suppressed the release of β-hexosaminidase and histamine from human mast cell (HMC)-1 cultures stimulated with compound 48/80. Treatment with rifampicin also inhibited secretion of inflammatory mediators, such tumor necrosis factor-α (TNF-α) and prostaglandin D₂ (PGD₂), in mast cells activated by compound 48/80. The mRNA expression of cyclooxygenase 2 (COX-2) was reduced in the cells treated with rifampicin in a concentration-dependent manner. These results suggest that rifampicin can be used to treat atopic dermatitis.
Administration, Oral ; Animals ; Cyclooxygenase 2 ; Dermatitis, Atopic ; Histamine ; Humans ; Immunoglobulin E ; Immunoglobulins ; In Vitro Techniques* ; Interleukin-4 ; Macrophages ; Mast Cells ; Mice ; Necrosis ; Rifampin* ; RNA, Messenger ; Skin ; Tuberculosis

BACKGROUND AND OBJECTIVES: The parotid abscess is a rare disease. It occurs mainly in patients with poor oral hygiene, dehydration, and immune compromised. This study aims to analyze clinical presentations of the parotid abscess treated with ultrasonography and fluoroscopy guided percutaneous drainage. SUBJECTS AND METHOD: A retrospective review of medical records were carried out for nine patients with parotid abscess treated with percutaneous drainage during the period from March 2007 to May 2013. RESULTS: Of the nine patients identified with parotid abscess, there were seven males and two females who were in the age range of 41 to 85 years (mean age of 61.8). The mean level of the serum amylase was 167.4 IU/L (ranging from 52 to 343). Of the nine patients, two were found with intra-parotid cystic tumor, one was infected with the Tuberculosis, and six were found with an unidentifed parenchymal infection. All except one patient were improved after percutaneous drainage. One patient, who suffered underlying diabetes, chronic renal failure and liver cirrhosis, died due to sepsis that rapidly progressed from parotid abscess despite percutaneous drainage. The mean period of hospitalization was 16.1 days. Bacteria isolations resulted in identification for 4 patients (44.4%). CONCLUSION: Parotid abscess could be successfully treated with ultrasonography and fluoroscopy guided percutaneous drainage unless it involved multiple regions or progressing rapidly.
Abscess* ; Amylases ; Bacteria ; Catheters ; Dehydration ; Drainage* ; Female ; Fluoroscopy ; Hospitalization ; Humans ; Kidney Failure, Chronic ; Liver Cirrhosis ; Male ; Medical Records ; Methods ; Oral Hygiene ; Parotid Gland ; Rare Diseases ; Retrospective Studies ; Sepsis ; Tuberculosis ; Ultrasonography

Rifampin is commonly used as a first-line anti-tuberculosis drug, but it can induce a serum sickness-like reaction or anaphylaxis. However, it is possible for 1 drug antigen to induce 2 or more simultaneous immunologic reactions. Here, we report a case of a serum-sickness-like reaction and anaphylaxis induced concurrently by rifampin. A 25-year-old male presented with high fever and a maculopapular rash with vesicles on the hands, which developed 2 weeks following regular administration of anti-tuberculosis drugs for tuberculous meningitis, including rifampin. Elevated liver enzymes, peripheral neuropathy, and decreased serum C3 and C4 levels were found. Interestingly, these symptoms were accompanied by severe hypotension. A serum-sickness-like reaction was considered after excluding other potential causes for the fever. A drug provocation test showed that the fever developed after oral administration of rifampin, suggesting that rifampin was the cause of the allergic reaction. However, hypotension, epigastric discomfort, and diarrhea also accompanied these symptoms, indicating that IgE-mediated type I hypersensitivity could be part of the serum sickness-like reaction. An intradermal skin test clearly showed an immediate positive reaction to rifampin. This case was diagnosed as concurrent serum-sickness-like reaction and anaphylaxis induced by rifampin. One drug may therefore induce combined allergic reactions via 2 or more simultaneous hypersensitivity responses.
Administration, Oral ; Adult ; Anaphylaxis* ; Diarrhea ; Exanthema ; Fever ; Hand ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate ; Hypotension ; Liver ; Male ; Peripheral Nervous System Diseases ; Rifampin* ; Skin Tests ; Tuberculosis, Meningeal

OBJECTIVETo study the clinicopathologic features, histologic diagnosis and differential diagnosis of primary mucosal tuberculosis (TB) in the head and neck region.

METHODSForty-seven cases of primary mucosal TB of the head and neck region were studied by hematoxylin-eosin and Ziehl-Neelsen stains. The clinical and pathologic features were analyzed with review of the literature.

RESULTSThe patients included 26 male and 21 female, with mean age 47.1 years (range 14-84 years). There were three sinonasal TB, 19 nasopharyngeal TB, two oropharyngeal TB, 18 laryngeal TB, four middle ear TB, one salivary gland TB and one laryngeal TB complicating laryngeal cancer. The initial symptoms were nasal obstruction, mucopurulent rhinorrhea, epistaxis, snoring, hoarseness, dysphagia, odynophagia, serous otitis, hearing loss, tinnitus, and otalgia. Physical examination result was variable, from an apparently normal mucosa, to an evident mass, or a mucosa with an adenotic or swollen appearance, ulcers, leukoplakic areas, and various combinations thereof. CT and MRI findings included diffuse thickening, a soft-tissue mass, calcification within the mass and bone destruction resembling malignancy. Histologic examination showed granulomas with a central necrotic focus surrounded by epithelioid histiocytes and multinucleated Langhan's giant cells. Acid-fast bacilli were difficult to demonstrate but found in 13/45 cases. Follow-up data were available in 42 patients.

CONCLUSIONSPrimary TB arising in the head and neck mucosa is rare. It may mimic or co-exist with other conditions. The characteristic histopathology is a granuloma with central caseous necrosis and Langhans'giant cells. Identification of acid-fast bacilli and bacteriologic culture confirm the diagnosis of mycobacterial disease.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antitubercular Agents ; therapeutic use ; Carcinoma, Squamous Cell ; complications ; microbiology ; surgery ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Laryngeal Neoplasms ; complications ; microbiology ; surgery ; Male ; Middle Aged ; Otorhinolaryngologic Diseases ; diagnostic imaging ; drug therapy ; microbiology ; pathology ; Tomography, X-Ray Computed ; Tuberculin Test ; Tuberculosis ; diagnostic imaging ; drug therapy ; pathology ; Tuberculosis, Laryngeal ; complications ; surgery ; Tuberculosis, Oral ; drug therapy ; pathology ; Young Adult

Breast tuberculosis is a rare form of tuberculosis (TB). In healthy individuals in developed countries, the incidence is <0.1% of breast lesions examined histologically. The significance of breast TB is due to its rare occurrence and mistaken identity with breast cancer or pyogenic breast abscess. We report the case of an 18-year-old healthy woman diagnosed with breast TB that mimicked breast abscess. She was admitted for multiple erythema nodosum (EN) of the lower extremities of 6 weeks duration. She also noticed a painful oral ulcer and a palpable nodule with fistula on the right breast for 8 weeks. Our patient had the characteristic radiological and histopathological features of breast TB. Breast abscess and EN improved after antitubercular medication, including isoniazid, rifampin, ethambutol and pyrazinamide.
Abscess ; Adolescent ; Breast ; Breast Neoplasms ; Developed Countries ; Erythema Nodosum ; Ethambutol ; Female ; Fistula ; Humans ; Incidence ; Isoniazid ; Lower Extremity ; Oral Ulcer ; Pyrazinamide ; Rifampin ; Tuberculosis

Although tuberculosis is a chronic infectious disease that can occur in any section of the body, oral tuberculosis is rare. Here, we report a case of oral tuberculosis in which the patient sought treatment for a painful oral lesion. A histopathologic examination revealed the characteristics of tuberculosis and pulmonary lesions were detected on subsequent examination. The patient was treated with antituberculosis therapy, and his symptoms improved. This case emphasizes the importance of including oral tuberculosis as part of the differential diagnosis for mucosal lesions.
Communicable Diseases ; Diagnosis, Differential ; Humans ; Mouth ; Tuberculosis ; Tuberculosis, Oral

PURPOSE: Idiopathic granulomatous mastitis (GM) is an uncommon breast disease that mimics carcinoma in terms of the clinical and radiological findings. Its unknown etiology makes the management difficult. Although surgical excision with or without steroid therapy has been the mainstay of the treatment, the efficacy of this treatment has been inconsistent. This study was performed to evaluate the diagnostic methods and the treatment outcomes. METHODS: This retrospective study included 31 patients with the diagnosis of GM and 4 patients had bilateral disease. They were found from the database of the pathology laboratory at Cheil General Hospital between January 1999 and December 2004. We reviewed the clinical, radiological, and pathological information, and we finally evaluated the treatment outcomes according to the surgical and medical treatments. RESULTS: The mean age at diagnosis was 34.2 years (range: 27~57). All the patients were parous except one, and 82% of patients were within 5 years from their last delivery. Four patients had bilateral involvement. Only three patients used oral contraceptives and 54% of patients had a history of breast feeding. Most patients (91%) presented with mass and the remainder (9%) presented with fistula. The confirmative diagnosis was made by FNAB (fine needle aspiration biopsy), debridement, CNB (core needle biopsy) or excision. Surgical excision or debridement was successful in 13 cases (39.4%) of 33 cases. Anti-tuberculosis medications were successful in 85% (11/13). Steroid treatment was successful in only two patients (29%). CONCLUSION: Surgical excision provided not only the definite diagnosis, but also treatment of GM for the cases in which a clear surgical margin was obtained. Anti-tuberculosis medication can be considered if fistula or abscess is intractable after excision, even with failure to identify tuberculosis.
Abscess ; Breast Diseases ; Breast Feeding ; Contraceptives, Oral ; Debridement ; Diagnosis* ; Fistula ; Granulomatous Mastitis* ; Hospitals, General ; Humans ; Needles ; Pathology ; Retrospective Studies ; Treatment Outcome* ; Tuberculosis

PURPOSE: Granulomatous mastitis is a rare benign inflammatory breast disease of an unknown etiology. Clinically and radiologically, it can mimic a breast carcinoma. Therefore, surgeons, pathologists, radiologists need to be aware of this condition in order to avoid unnecessary mastectomies. This study examined the modalities that are important for diagnosing and treating of the granulomatous mastitis. METHODS: The data regarding 14 patients with histologically confirmed granulomatous mastitis and treated at our hospital were analyzed. Age, associated disease, parity, past history of breast feeding and oral contraceptives, radiology findings were retrospectively evaluated. RESULTS: Among the 14 patients, the mean age was 41 years with 5 being in their thirties. Breast pain was the most common presentation. Of the 14 patients, 11 patients had breast-fed and none had previously used oral contraceptives. No patient suffered from pulmonary tuberculosis. Preoperative mammography and ultrasonography was not helpful in identifying granulomatous mastitis. After ultrasonography, 7 patients were found to have mastitis with an abscess and a benign or malignant tumor was found in 3 patients. Two of the 14 patients were diagnosed using pre-operative fine-needle aspiration, which that showed an epithelial histiocyte or multinucleated giant cell. Three cases completely recovered after an excision. In 11 cases, incision and drainage were performed but there was a recurrence in 4 of these, which needed to be treated more than twice by an incision and drainage and steroid. The average treatment period was 5 months and a recurrence was encountered in 4 patients within a 30-month follow-up period. CONCLUSION: Granulomatous mastitis is rare, but it is important to make a histological diagnosis at the early stages. It is believed that a complete excision of the lesion will help prevent a recurrence, and patients with a frequent recurrence can be treated with steroid after stopping unnecessary antibiotic treatment.
Abscess ; Biopsy, Fine-Needle ; Breast Diseases ; Breast Feeding ; Breast Neoplasms ; Contraceptives, Oral ; Diagnosis ; Drainage ; Female ; Follow-Up Studies ; Giant Cells ; Granulomatous Mastitis* ; Histiocytes ; Humans ; Mammography ; Mastectomy ; Mastitis ; Mastodynia ; Parity ; Recurrence ; Retrospective Studies ; Tuberculosis, Pulmonary ; Ultrasonography

OBJECTIVETo investigate the effects of oral administration of type II collagen (CII) on adjuvant arthritis (AA) in rats and its mechanisms, and to compare the effects of CII with those of the Chinese traditional medicine Tripterygium Polyglycoside administered similarly.

METHODSArthritis was induced in rats by immunization using Freund's complete adjuvant (FCA). After feeding rats either soluble CII or Tripterygium Polyglycoside, changes in degree of articular swelling and articular histological findings were observed in AA rats. Some correlative immunological indexes were measured, including delayed type hypersensitivity (DTH) reaction, anti-collagen and anti-Mycobacterium tuberculosis (MT) antibody in serum, and levels of IFN-gamma and TNF-alpha in articular steep in rats.

RESULTSOral administration of CII was able to alleviate both distinctly articular and general symptoms in AA rats, suppress synovium hyperplasia and inflammatory cells infiltration in arthrosis capsule. The effects brought about by CII were stronger than those by Tripterygium Polyglycoside. Oral administration of CII inhibited antigen-specific immune response, such as DTH and antibody reaction to CII. In addition, the expression of IFN-gamma and TNF-alpha in joints were locally downregulated.

CONCLUSIONSThe therapeutic effect of oral administration of CII is obvious on adjuvant arthritis in rats. Its remedial mechanisms are likely related to the downregulation of both IFN-gamma and TNF-alpha, and the suppression of cell immunity.

Administration, Oral ; Animals ; Antibodies ; blood ; Arthritis, Experimental ; drug therapy ; immunology ; Collagen Type II ; therapeutic use ; Hypersensitivity, Delayed ; prevention & control ; Immune Tolerance ; Interferon-gamma ; biosynthesis ; Male ; Mycobacterium tuberculosis ; immunology ; Phytotherapy ; Rats ; Rats, Sprague-Dawley ; Synovial Membrane ; pathology ; Tripterygium ; Tumor Necrosis Factor-alpha ; biosynthesis