Granulomas

There are hundreds of topical steroid preparations that are available for the treatment of skin diseases. In addition to their aforementioned antiinflammatory effects, topical steroids also exert their effects by vasoconstriction of the capillaries in the superficial dermis and by reduction of cellular mitosis and cell proliferation especially in the basal cell layer of the skin. In addition to the aforementioned systemic side effects, topical steroids can have adverse local effects. Chronic treatment with topical corticosteroids may increase the risk of bacterial and fungal infections. A combination steroid and antibacterial agent can be used to combat this problem. Additional local side effects that can be caused by extended use of topical steroids are epidermal atrophy, acne, glaucoma and cataracts (thus the weakest concentrations should be used in and around the eyes), pigmentation problems, hypertrichosis, allergic contact dermatitis, perioral dermatitis, and granuloma gluteale infantum (251). 

Chelated complexes such as sodium zirconium lactate [15529-67-6] or ammonium zirconium carbonate [22829-17-0] and acidic forms such as zirconium hydroxy oxide chloride [18428-88-1] have been used in preparations in deodorants or for treatment for poison oak and poison ivy dermatitis. In such occasions, when the skin had been cut or abraded, a few users developed granulomas which have been identified as a delayed hypersensitivity to zirconium (99). These may take several weeks to develop, and commonly persist for 6 months to over a year. 

Testes from the males examined 43 days after the 8-D treatment appeared normal. However, the epididymis was involved in an inflammatory process with sperm granulomas formation. The granulomatous epididymal lesion resembled the lesion seen in auto-immune reaction following bacterial infections or tissue response to foreign bodies (16, 17,... 

In male rats 2,3,7,8-tetrachlorodibenzo-p-dioxin induced hyperplastic changes and sperm granulomas in the epididymis, but no apparent lethal mutations were noted during post-meiotic phases of spermatogenesis. 

Roge, J., Fabre, M., Levillain, P. and Dubois, P. (1991). Unusual particles and crystals in Crohn s disease granulomas. Lancet 337, 502-503. 

Colonoscopy patchy "cobblestone" inflammation in the terminal ileum and ascending colon with evidence of recent bleeding, (-) polyps or strictures, biopsy taken Path Evidence of disease extension to muscularis with non-caseating granulomas... 

T lymphocytes become activated over the course of 3 to 4 weeks, producing interferon-y (IFN-y) and other cytokines. These stimulate microbicidal macrophages to surround the tuberculous foci and form granulomas to prevent further extension.15 At this point, the infection is largely under control, and bacillary replication falls off dramatically. Any remaining mycobacteria are believed to reside primarily within granulomas or within macrophages that have avoided detection and lysis. Over 1 to... 

About 10% of infected patients develop reactivation TB, with half occurring in the first 2 years after infection.2 6 12 Upper lobe pulmonary disease is the most common (85% of cases).2 Caseating granulomas result from the vigorous immune response, and liquefaction leads to local spread. Eventually, a pulmonary cavity results, and this provides a portal to the outside that allows for person-to-person spread. Bacterial counts in the cavities can be as high 1011 per liter of cavitary fluid (108 per milliliter).2,15 Prior to the chemotherapy era, pulmonary TB usually was associated with hypoxia, respiratory acidosis, and eventually death. 

Caseating granulomas, regardless of location, can undergo liquefaction, spread tubercle bacilli and cause symptoms.2,6 Because of muted or altered symptoms, the diagnosis of TB is difficult and often delayed in immunocompromised hosts.2,3,6 HIV-infected patients may present with only extrapulmonary TB, which is very uncommon in HIV-negative persons. A widely disseminated form of the disease called miliary TB can occur, particularly in children and immunocompromised hosts, and it can be rapidly fatal.17 Immediate treatment is required. 

Caseating granulomas A mass or nodule of chronically inflamed tissue with granulations, usually associated with an infective process. 

Granuloma A small nodular delimited aggregation of mononuclear inflammatory cells, or such a collection of modified macrophages usually surrounded by a rim of lymphocytes. Generally denotes a chronic, cell-mediated immune response. 

Sarcoidosis An inflammatory disease characterized by granulomas (masses of chronically inflamed tissues with granulations) that can produce many different symptoms. 

Hogaboam CM, Bone-Larson CL, Lipinski S, et al. Differential monocyte chemoattractant protein-1 and chemokine receptor 2 expression by murine lung fibroblasts derived from Thl- and Th2-type pulmonary granuloma models. J Immunol 1999 163(4) 2193-2201. 

These results show that the covalently crosslinked Adjuvax formulations were superior to the physically entrapped Adjuvax formulations. In addition, the Adjuvax crosslinked formulations were as effective in stimulating antibody titers as Freund s Adjuvant. Furthermore, animals immunized with Adjuvax did not experience local inflammatory reactions or granuloma formation which was observed with all CFA/IFA immunized animals. 

The question of particulate matter is also of great importance. Although the total effect of particulate inclusion in the anterior chamber is not completely known, some possible results have been postulated [82]. Certain amounts of iritis and uveitis might be expected, as well as the production of granulomas similar to the type reported for pulmonary tissue that... 

In vivo, SWNTs individually dispersed by Pluronic F108NF were demonstrated to be nontoxic after intratracheal administration to mice, whereas aggregated SWNTs caused granuloma-like structures with mild fibrosis in the lungs of the treated animals [39]. 

Controversial results were reported by Warheit et al. in two studies [57, 65] in which rats were exposed to raw SWNTs. Cell proliferation and cytotoxicity indices indicated that exposure to SWNTs produced only transient inflammation. Histological examination of exposed animals, however, identified the development of granulomas, which were non-dose dependent, nonuniform in distribution and not progressive after 1 month. The presence of granulomas was considered inconsistent with the lack of severe lung inflammation. These two reports highlighted the need for more research on the potential pulmonary toxicity of CNTs, shifting the scientific focus towards this aim. 

Chensue, S.W., Warmington, K.S., Ruth, J.H., Sanghi, P.S., Lincoln, P. and Kunkel, S.L. (1996) Role of monocyte chemoattractant protein-1 (MCP-1) in Thl (mycobacterial) and Th2 (schistosomal) antigen-induced granuloma formation. Journal of Immunology 157, 4602-4608. 

Subramanian, G., Kazura, J.W., Pearlman, E., Jia, X., Malhorta, I. and King, C.L. (1997) B7-2 requirement for helminth induced granuloma formation and CD4 type 2 T helper cell cytokine expression. Journal of Immunology 158, 5914-5920. 

---