Soft spots
Introduction
Introduction to softening spots Softening plaque, also known as soft plaque, is a rare histologically unique inflammatory reactive lesion that is usually caused by intestinal bacteria and can invade many organ mucosa, such as the prostate, ureter and pelvic mucosa, bone, lung, testis , gastrointestinal tract, skin and kidneys. basic knowledge The proportion of illness: 0.004% Susceptible people: no special people Mode of infection: non-infectious Complications: renal failure
Cause
Softening spot cause
Bacterial infection (30%):
Often caused by intestinal bacteria, invading multiple organs, but the most common is urinary system involvement.
Pathophysiology
The pathogenesis of this disease is unclear, but half of the cases are related to immunodeficiency and autoimmune diseases including hypergammaglobulinemia, immunosuppressive therapy, malignant tumors, chronic serious diseases, rheumatoid arthritis and AIDS. The view is that this lesion is a macrophage dysfunction that blocks the degradation of phagocytic bacteria by lysosomes, resulting in excessive cytoplasmic undigested bacterial debris, which is presumed to be a defect in microtubules that causes lysosomes to The movement of phagocytic cytosol is affected and the release of lysosomal enzymes in macrophages is reduced. MG bodies may be formed by the deposition of calcium phosphate and other minerals on these excess lysosomal enzymes.
Prevention
Softening spot prevention
It is extremely important to prevent and remove the predisposing factors of this disease. It is effective to give symptomatic treatment to the primary disease which is easy to cause this disease, especially to prevent and treat urinary tract infection. Because infection is a factor in the formation of this disease, these bacteria can decompose urea into ammonia. In order to make the urine become alkaline, it produces softening spots, so timely treatment of urinary tract infection can prevent the disease from occurring.
Complication
Softening plaque Complications, renal failure
Renal softening plaque often associated with liver and duodenal softening plaque, and its serious complication is post-renal renal failure.
Symptom
Symptoms of softening spots Common symptoms Low fever Liver enlargement Upper gastrointestinal bleeding Granuloma Drowsiness convulsion Renal failure Kidney rupture Acute renal failure
1.Honjo et al reported that a male infant with only 4 weeks of age had renal softening plaque, which was characterized by hypothermia, convulsions, lethargy, severe anemia, hepatomegaly, renal enlargement and renal dysfunction, and blood and urine culture of the large intestine. Positive for Bacillus.
2. Adult patients often have rib abdominal pain and active renal infections. Both kidneys can be damaged at the same time. Sometimes the clinical manifestations resemble acute renal failure. Occasionally, renal softening spots can cause kidney rupture. Mitchell et al reported 1 case. The patient presented with long-term unexplained fever, urinary tract collateral softening plaque caused by excretory disorder and post-renal renal failure, and renal transplant patients developed renal dysfunction.
3. Softening plaque can invade multiple organs and multiple organs, such as renal softening plaque with double lung damage, Escherichia coli endophthalmitis, etc. Domestic Chen reported that a 53-year-old female patient had recurrent renal pelvis on the basis of diabetes. Nephritis, followed by kidney lumps, upper gastrointestinal bleeding, pathological examination after surgery confirmed as soft spots.
4. There are underlying diseases that reduce systemic immune function, especially in patients with long-term use of immunosuppressive drugs. When urinary tract infection or urinary system occupying lesions occur, the possibility of this disease should be highly suspected.
5. The softening plaque of the kidney is the same as that of the yellow granulomatous pyelonephritis. In the case of chronic infection with obstruction, except for the softening plaque, there are MG small in vitro, and the gross histological features are almost the same, but the MG small body is generally difficult. It is necessary to distinguish between tissue sections for immunohistochemistry and electron microscopy. In the early stage of renal softening plaque, there is a lack of typical MG corpuscles. At this time, ultrastructural examination is helpful for tissue-cell relationship caused by other diseases. Identification of qualitative renal damage.
6. Radionuclide scintigraphy was performed in patients with renal softening plaque. If the Tc-99m glucoheptonate imaging showed a significant increase in Ga-67 activity in the corresponding focal cortical defect, the In-111 white blood cell kidney scan was not significant. When abnormal, it can contribute to the diagnosis of this disease.
Examine
Softening spot check
1. Urine test: Escherichia coli is the most common microorganism cultivated in urine.
2. Blood test: severe anemia can be seen.
3. Histopathological examination: Most of the softened plaques are confined to the mucosa, and the appearance is soft, yellow, slightly uplifted, and often fused into plaques of 3 to 4 cm. The plaques under the microscope are closely assembled by macrophages, occasionally. Also, lymphocytes, macrophages are rich, foamy, PAS-positive cytoplasm, in addition, MG bodies in macrophages and interstitial tissues (ie, coagulated layers of inorganic substances), MG The diameter of the small body is 4-10 mm. The PAS stain is strongly positive and contains calcium salt. Under the electron microscope, it shows a typical crystal structure. The center is a high-density core with an aperture in the middle, surrounded by flaky circles and macrophages. There are bacteria and phagolysosomes in the cells.
4. CT and magnetic resonance imaging (MRI) examination: CT and magnetic resonance imaging (MRI) showed that the softening plaque showed a strong high density (105HU) shadow when non-enhanced CT examination; T1-MRI, T2-MRI showed low density Signal, there is a mild uniform enhancement effect after intravenous administration of sputum. The above characteristics are different from common tumors and inflammatory lesions in the rectum. In the latter two cases, MRI shows typical isometric imaging, but the intensity is different after injection. Whether this observation is applicable to kidney examination remains to be studied.
5. Nuclide examination: Cox et al. performed a radionuclide scintigraphy on patients with renal softening plaque, and found that the activity of Ga-67 in the corresponding site of focal cortical defect of Tc-99m glucoheptonate was significantly increased, while In- 111 white blood cell kidney scan showed no significant abnormalities.
Diagnosis
Soft spot diagnosis and identification
Diagnosis :
There are underlying diseases that reduce systemic immune function, especially in patients with long-term use of immunosuppressive drugs. When urinary tract infection or urinary system occupying lesions occur, the possibility of this disease should be highly suspected.
The softening plaque of the kidney is the same as that of the yellow granulomatous pyelonephritis. In the case of chronic infection with obstruction, except for the softening plaque, the MG is small in vitro, and the gross histological features are almost the same. However, MG bodies are generally difficult to distinguish, and tissue sections for immunohistochemistry and electron microscopy are necessary. In the early stage of renal softening plaque, the performance of typical MG bodies is lacking. At this time, ultrastructural examination is helpful to identify the interstitial renal damage caused by other diseases. Radionuclide scintigraphy was performed in patients with renal softening plaque. If the Tc-99m glucoheptonate imaging showed a significant increase in Ga-67 activity in the corresponding focal cortical defect, the In-111 white blood cell kidney scan was not significant. When abnormal, it can contribute to the diagnosis of this disease.
Differential diagnosis
Identification with other chronic urinary tract infections, such as yellow granuloma, chronic pyelonephritis, urethral obstruction, stones, etc.
