Search

Leiomyomas of the paratesticular region are a rare entity. A subtype of leiomyomas called bizarre nuclei leiomyoma is even rarer and histologically present some interesting features that are important to recognise to make the differential diagnosis with its malignant counterpart-leiomyosarcoma. We present a case of a man in his 60s, who presented with a painless mass on the right testicle. The clinical diagnosis was of an epidermoid cyst. The mass was excised and a diagnosis of leiomyoma of bizarre nuclei was made., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Staphylococcus aureus is a troublesome pathogen, responsible for a broad range of clinical manifestations, ranging from benign skin infections to life-threatening conditions such as endocarditis and osteomyelitis. The kidney can be affected through a rapidly progressive glomerulonephritis mediated by an inflammatory reaction against a superantigen deposited in the glomerulus during the infection's course. This glomerulopathy has a poor prognosis, often leading to chronically impaired kidney function, eventually progressing to end-stage renal disease. Treatment rests on antibiotherapy. Despite the inflammatory role in this disease's pathophysiology, most authors discourage a simultaneous immunosuppressive approach given the concomitant infection. However, there are some reports of success after administration of systemic corticosteroids in these patients. We present a 66-year-old man with a staphylococcus-induced glomerulonephritis brought on by a vascular graft infection, with rapidly deteriorating kidney function despite extraction of the infected graft and 3 weeks of antibiotherapy with achievement of infection control. Kidney function improved after the introduction of corticosteroids. This case highlights the potential role of corticosteroids in selected cases of staphylococcus-induced glomerulonephritis, particularly those in which the infection is under control., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Granulomatous interstitial nephritis (GIN) is a rare entity identified in <1% of native kidney biopsies. The most frequent aetiology is drug-related, followed by systemic granulomatous conditions. Among drugs implicated in GIN, antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequent. We report the case of a 45-year-old white man referred to a nephrology consult due to chronic kidney disease. He had a history of arterial hypertension with 10 years of evolution, hyperuricaemia, medicated with allopurinol and NSAID abuse for at least 20 years. Urine sediment was blunt, without proteinuria. Renal ultrasound was normal. A kidney biopsy revealed well-defined epithelioid granulomas with glomerular wrinkling and collapse. Infectious and systemic conditions were excluded, favouring the hypothesis of drug-induced GIN, probably related to NSAIDs. Kidney biopsy remains the gold standard for the diagnosis of GIN. Facing a patient with renal failure without significant proteinuria or active sediment, one should look for causes of tubulointerstitial injury., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Parvovirus infection is usually asymptomatic especially in immunocompetent adults. When symptomatic it can range from mild to life threatening depending on the patient's age and comorbidities. We report a case of a 40-year-old male patient with parvovirus infection who presented a purpuric rash in distal extremities, acute kidney injury, type II mixed cryoglobulinaemia and hypocomplementaemia. His renal biopsy showed a mesangioproliferative glomerulonephritis with positive immunoreactivity to C3, IgM and C1q. Parvovirus B19 was detected in the biopsy tissue by PCR. He was treated with prednisolone with total remission after 1 month. We discuss the diagnosis of kidney lesion due to parvovirus in an immunocompetent person, which is a very rare condition and its association with the cryoglobulinaemia diagnosis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Extragonadal germ cell tumours (EGGCTs) originated in prostate are extremely rare, with <20 cases described in the literature. We report a case of a patient with a primary prostatic mixed EGGCT. A 47-year-old man presenting severe low urinary tract symptoms and signs of prostatic enlargement, with no malignancy suspicion, underwent transurethral resection of the prostate. The histopathological evaluation suggested the diagnosis of a retroperitoneal sarcoma. The patient underwent neoadjuvant chemotherapy and then was submitted to radical cystoprostatectomy. Histology revealed a mixed EGGCT of the prostate with yolk sac tumour and seminoma components. No testicular abnormalities were identified on the postoperative scrotal ultrasound. The patient went through four cycles of chemotherapy with bleomycin, etoposide and cisplatin. After 12 months of follow-up, the patient is alive and free of recurrence., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Birt-Hogg-Dubé (BHD) is a rare syndrome of inherited renal cell carcinomas, characterised by cutaneous lesions and pulmonary cysts and pneumothorax in a vast majority of the patients. Awareness of this syndrome is important in order to refer patients for genetic counselling and personalised follow-up as soon as possible. We describe a case of a 30-year-old female referred to our institution due to incidental discovery of solid bilateral renal masses. Renal biopsies were consistent with chromophobe tumour, and bilateral nephrectomy was performed. Gross examination revealed deformed kidneys with 28 brown and solid lesions, size variable between 0.1 and 6 cm, histologically corresponding to renal cell carcinomas, chromophobe type. Genetic test was required that showed a c.573delGAinsT frameshift mutation in heterozigosity at the folliculin gene, consistent with BHD diagnosis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Bronchial schwannomas are very rare pulmonary lesions, but its awareness is important to reach correct diagnosis and decide proper intervention. Clinical and radiological characteristics are mainly unspecific and pathological examination usually provides the definite diagnosis. In small lesions, endoscopic approach may be sufficient, but in large lesions associated with organising pneumonia surgical intervention may be required. Prognosis is typically favourable. We describe a case of a woman, aged 66 years, with productive cough and sporadic haemoptysis, dyspnoea, anorexia, excessive sweating and weight loss with 2 months evolution. CT scan showed a soft tissue dense lesion on the left hilum with 3.75 cm with 18-Fludeoxyglucose uptake. Left upper lobectomy was performed. Gross examination revealed a polypoid mass without necrosis, histologically showing cellular dense (Antoni A) and less dense (Antoni B) areas with Verocay bodies, slightly pleomorphic spindle cells, without mitotic activity and positive for S100 protein on immunohistochemistry., Competing Interests: Conflicts of Interest: None declared., (2016 BMJ Publishing Group Ltd.)

Renal involvement in Waldenström's macroglobulinaemia (WM) is very unusual when compared to multiple myeloma. We report a case of a patient who developed anuric acute kidney injury secondary to cast nephropathy, dependent on high-flux haemodialysis. Complementary study revealed the presence of blood IgM monoclonal gammopathy and a massive bone marrow lymphoplasmacytic infiltration. There were no osteolytic lesions and no clinical signs/symptoms of hyperviscosity syndrome. The diagnosis of WM was established and a dexamethasone plus cyclophosphamide regime was started, in addition to plasmapheresis. The patient partially recovered renal function allowing haemodialysis and plasmapheresis withdrawal. He remained asymptomatic with a good response to chemotherapy and 12 months after his renal function remained stable. This is a rare clinical case in which WM presented as an IgM cast nephropathy, which in turn is an extremely rare renal presentation of this equally rare haematological disorder., (2015 BMJ Publishing Group Ltd.)

Objectives: To obtain national estimates of the annual cumulative incidence and incidence density of severe non-fatal injuries using compensation benefits data from the Brazilian National Social Security Institute (INSS), and to describe their sociodemographic distribution among workers aged under 25 years., Methods: Data are records of health-related compensation benefits from the Ministry of Social Insurance's information system of compensation benefits of the INSS recorded in 2006. Injuries were cases classified under chapter XIX, ICD-10. The assessment of their relation with work was made by INSS's occupational physician experts. The study population comprised young workers aged 16-24 years., Results: 59,381 workers received compensation benefits for injuries in the study year. Among them 14,491 (24.4%) were work related, 12,501 (86.3%) were male and 1990 were female workers (13.7%). The annual cumulative incidence rate of work-related injuries (ACI-WI) was 2.9×1000 workers, higher among men (4.2×1000) than women (1.0×1000). The incidence density rate (IDR-WI) was 0.7/1000 full-time equivalent (FTE), higher for men (0.97/1000 FTE) than women (0.24/1000 FTE). Both morbidity measures were higher in the younger group (16-19 years), and inversely related to wage, especially for women in the younger group. Logging, extraction, food/beverage and construction industries had higher ACI-WI and IDR-WI for adolescents and young adult workers of both sex groups., Conclusions: These findings suggest that the Brazilian labour laws limiting young adult workers in hazardous settings need to be expanded, adding occupations in other extractive industries and certain types of work in the food/beverage manufacturing industries. Social inequalities associated with sex need to be examined further with more detailed data.