Feroz Alam

Granulomatous dermal lesions pose a diagnostic challenge, since several causes can produce an identical histologic picture and, conversely, a single cause may produce varied histologic pattern. The aim of this study is to analyze the spectrum of various etiologies involved in granulomatous skin diseases and their clinicopathological correlation. Cases of granulomatous lesions reported over last one year on histopathological and cytological examination were reviewed along with special stains. A total of 20 cases of different etiologies were taken for study including infectious and non-infectious underlying causes. Out of the 20 dermal granulomatous lesions studied, 12 cases (60.0%) were bacterial, 1 case (5%) each of fungal and associated with malignancy and 6 cases (30%) due to non-infectious etiology like granuloma annulare and foreign body associated were recorded. Amongst the bacterial granulomatous lesions, predominance of Mycobacterium leprae was seen, 6 cases (40%). The varied presentation of Hansen’s disease in our study included 4 cases (20%) of tuberculoid leprosy and 2 cases (10%) each of lepromatous leprosy and borderline tuberculoid leprosy. Three cases (15%) of cutaneous tuberculosis seen in our study and were typified as lupus vulgaris, 2 cases (10%) and a single case (5%) of tuberculosa verrucosa cutis. One case, (5%) of Klebsiella rhinoscleromatis was also seen. Skin biopsies help in arriving at a conclusive diagnosis, if aided by a proper clinical history and examination and assisted by special stains, culture of organisms, PCR and immunoflourescence.

Tuberculosis of musculoskeletal system is most common manifested as tuberculosis of spinal cord (tubercular spondylitis) followed by joint diseases affecting hip, knee, wrist and elbow in the descending order. Tubercular involvement of small bones of hands and feet is known as tubercular dactylitis. It is a rare from of extrapulmonary tuberculosis, causing spindle shaped expansion of short tubular bones due to granuloma formation thereby named as spina ventosa. We, hereby present a case of nine year old male child who presented with acute painful swelling with pathological fracture of right ring finger later diagnosed as tubercular dactylitis on histopathology.

Pancytopenia is a relatively common hematological disorder manifesting as anemia, leucopenia and thrombocytopenia. Causes of pancytopenia are varied and range from simple drug-induced bone marrow hypoplasia, megaloblastic anemia to fatal bone marrow aplasias and leukemias. Examination of the bone marrow is required in cases for pancytopenia to find out the underlying pathology and hence better patient management. This study was carried out to evaluate hematological and bone marrow findings in patients presenting with pancytopenia. 50 patients in the age group of 6 months- 60 years were included in this prospective study. Detailed history, clinical examination, hematological investigations and bone marrow examination were performed in all the cases. Pancytopenia was more common in second decade of life with slight male preponderance. Fever was the commonest presenting complaint and pallor was the commonest sign. Megaloblastic anemia was the most common cause (58%) of pancytopenia, hypersegmented neutrophils and macro-ovalocyte are very reliable indicators of megaloblastic anemia. Bone- marrow aspiration was diagnostic in majority (80%) of cases, and biopsy is not routinely indicated. Reticulocyte production index is a better indicator of bone-marrow status as compared to reticulocyte count. Nutritional deficiency is the most important cause of megaloblastic anemia, and was the underlying etiology in 58% cases of life-threatening pancytopenia. Findings of automated hematology counter must be correlated with manual peripheral blood smear examination in cases of pancytopenia. Bone- marrow aspiration is highly recommended and reticulocyte production index instead of reticulocyte count must be used to evaluate the actual hematopoietic potential of the bone- marrow.