Sonu Nigam

Sporadic Burkitt’s lymphoma masquerading as an intussuscepted Meckel’s diverticulum in a 9-year-old child

We report the case of a 9-year-old boy who presented with abdominal pain and was found to have an intussusception with a sporadic Burkitt’s lymphoma (BL) lead point. Our case was unusual in that the patient did not present with the typical clinical features of BL, nor was he in a high-risk demographic for this uncommon disease.

23. Case study: Visceral leishmaniasis - A rare cause of hepatosplenomegaly in australia

Background Although still endemic in Africa, South America, Southern Europe and South Asia, leishmaniasis is seldom seen in Australia, and as a result clinicians often have a low index of suspicion for this disease. Case A 48-year-old male presented with fevers, shortness of breath, weight loss, anaemia and lymphadenopathy. He had no significant past medical history, and denied any recent overseas travel. On admission he was noted to be mildly tachypnoiec and febrile, and his blood tests showed pancytopenia and mild kidney injury. He initially had an excisional inguinal lymph node biopsy which showed reactive changes only. Imaging demonstrated massive hepatosplenomegaly, and PET scan showed abnormal uptake in the spleen. Bone marrow aspirate and trephine were unhelpful, showing reactive changes only. He proceeded to splenectomy, where histopathology demonstrated numerous amastigotes, and the diagnosis of visceral leishmaniasis (presumed to be leishmaniasis chagasi/infantum, which will be subsequently confirmed with PCR± serology). Treatment was commenced with liposomal amphotericin B, and the patient was shortly thereafter discharged from hospital for further outpatient treatment. Discussion This case illustrates the need to always consider visceral leishmaniasis in the differential diagnoses of unexplained hepatosplenomegaly, even in parts of the world where the disease is not endemic, and without relevant travel history to endemic areas. Although this is always likely to be a difficult diagnosis, a higher index of suspicion may have prompted more expeditious investigation and treatment. This is an important consideration given the high morbidity/mortality of untreated or misdiagnosed cases of visceral leishmaniasis.

Isolated necrotising arteritis of the appendix in a 17-year-old male

Here we repo rt a case of necrotising arteritis of the appendix in a 17-year-old male presenting with right lower quadrant pain. The appendix was macroscopically normal. Histological examination showed fibrous obliteration of the tip with necrotising vasculitis involving small to medium-sized arteries comprised of fibrinoid necrosis and neutrophilic infiltrate, karyorrhexis and cuffing by histiocytes and lymphocytes. No acute appendicitis was found. Isolated necrotising vasculitis of the appendix is an uncommon finding of long debated relatedness to systemic vasculitic disorders. Our patient showed no clinical signs of vasculitis and tested negative for pANCA, cANCA, ANA and ENA. A risk of systemic vasculitis approaching 30% has been reported in some studies, 1 however these are limited by study size. Polyarteritis nodosa is the most commonly associated systemic vasculitic disease. Careful histological examination is required to identify vasculitis. Given the rarity of the condition, we suggest routine follow-up of all patients by clinical and serological screening for systemic vasculitis. The question of duration of screening in a young patient with no significant family history is difficult to answer.

29. Morphological spectrum of renal involvement in plasma cell dyscrasias

Different morphologic patterns of kidney damage are seen in patients with plasma cell dyscrasias. This is a retrospective review of 6 cases of renal involvement in plasma cell dyscrasias, out of 71 renal biopsies reported in the Gold Coast Hospital from July 2011 to April 2012. The primary diagnoses included multiple myeloma (5) and MGUS (1). There were 4 males and 2 females. The age range was 54–91 years, mean age being 71 years. The renal biopsies showed amyloidosis, monoclonal immunoglobulin deposition disease, myeloma cast nephropathy, immunotactoid glomerulopa-thy, proximal tubulopathy with acquired Fanconi syndrome and kappa light chain related proximal tubulopathy with acute tubular injury. Their clinical and pathological features including light microscopy, immunofluorescence and electron microscopy with a review of the literature is discussed.