Bishakha Deb¹*, Vivek Kharolkar², Vikas Maindad³, Buddheshwar Narayan Hiwale⁴, Pritisha Chaudhary¹, Priyanka Palve⁴ and Shwetambari Thakare²

¹Junior Resident, Department of Pathology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
²Assistant Professor, Department of Pathology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
³Associate Professor, Department of Pathology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
⁴Professor and Head, Department of Pathology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India

*Corresponding Author: Bishakha Deb, Junior Resident, Department of Pathology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India

Received: November 29, 2023; Published: January 30, 2024

Abstract

Background: Introduction: Multi-organ vasculitis is known to be an inflammation affecting vessels of various calibres either in response to an immune mediated event or an infection. It is known to affect virtually all organs including the pulmonary vasculature most commonly, gastrointestinal system, urogenital system and the central nervous system.

Case Description: A 15 – year old male presented with symptoms of nasal swelling which gradually grew to involve the periorbital region along with cervical lymphadenopathy. The physical examination and laboratory investigations were within normal limits. Contrast enhanced computerised tomography revealed features suggestive of an infective etiology favouring osteomyelitis. Corticosteroids were instated to control the inflammation. However the absence of response prompted further investigation. Fine needle aspiration cytology was performed which was suggestive of an inflammatory pathology of the region. This prompted histopathological studies of the lymph node and soft tissue from the mass revealing multiple ill-formed granulomas with multinucleate giant cells and fibrosis and micro abscesses consisting of karyorrhectic debris surrounded by lymphocytes, plasma cells and histiocytes with vasculitis. Ziehl-Neelsen stain for acid-fast bacilli were negative. The final diagnosis was necrotizing granulomatous lymphadenopathy with the differentials of tuberculosis being favoured over Kikuchi’s disease. Pulmonary consult indicated the institution of antituberculosis treatment. By day 19 of admission, the patient became febrile, disoriented and demonstrated aggressive behaviour. Medical and psychiatric evaluation suggested maxillary sinus osteomyelitis, with a suspicion of central nervous system (CNS) tuberculosis. Magnetic resonance imaging (MRI) revealed multifocal non-haemorrhagic infarct secondary to embolic shower, possibly secondary to tuberculosis. On day 23, he succumbed to his illness. A medical post mortem was performed following which the histopathological and microbiological studies lead to the final diagnosis of widespread vasculitis with mycosis involving the cerebrum, lungs and parotid glands.