A singular case of granulomatous lesions of unknown significance.
The acronym used for granulomatous lesion of unknown significance, (GLUS), was first employed in 1990, to describe epithelioid-cell granulomas occasionally observed in biopsies from liver, lymph-nodes and other tissues without any apparent cause than thorough diagnostic examinations. Authors describe a case of a 51-year-old woman who was admitted to hospital because of fever, nodules in the liver and spleen, skin ulcerative lesions on the legs. The patient had a very long medical history; recurrent fever, liver and spleen enlargement have been lasting since 1975. Laboratory data showed erythrocyte sedimentation rate increase (125 mm 1 hour), anemia, (Hb=8.1 g/dL), an increase of alkaline phosphatase activity (328.4 mU/mL NV=80-275) and also an increase of policlonal gamma-globulins; patient's total proteins was 6.8 g/dL while their gamma-globulins were 29.5%; IgG=2 260 mg/dL (NV=751-1 560 mg/dL), IgM=277 mg/dL (NV=46-230 mg/dL), IgA=405 mg/dL (NV=70-400 mg/dL). One culture of the blood and a needle aspiration specimen of liver nodule was positive for Staphylococcus coagulase negative. This case cannot be regarded as GLUS-syndrome because of the long time duration of the disease and other clinical features. The dramatic, even if transient, liver nodules improvement obtained by Linezolid therapy, and the well-being obtained by prolonged monociclin use, make the authors hypothesize that Staphylococcus coagulase negative could be the etiological agent of this granulomatous clinical picture.
Danese
C
C
Department of Clinical Science, Umberto I Hospital Complex, University La Sapienza, Rome, Italy. chiara.danese@uniroma1.it
Cirene
M
M
Colotto
M
M
D000081:Acetamides / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D005260:Female; D006099:Granuloma / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D000069349:Linezolid; D008107:Liver Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D008875:Middle Aged; D023303:Oxazolidinones / Q000627:therapeutic use; D012883:Skin Ulcer / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013158:Splenic Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy
D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D000069349:Linezolid