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Cervical lymphadenopathy and acute urinary tract infection
LETTERS TO THE EDITOR
ULTRASOUND
ately tender, moveable, asymmetrical, and ranged from pea-to-marble size. A catheterized urine specimen, on admission, showed coarse granular casts, 12 to 14 white blood cells with clumping per high-power field. Urine, blood, and tuberculosis cultures showed no growth. A glucose tolerance test was consistent with diabetes mellitus. Febrile agglutinins and serology were nonreactive, and a complete blood count was normal. A chest x-ray film, intravenous pyelogram and liver scan results were normal. The patient was treated with cephalexin monohydrate. At the end of one week she was asymptomatic, urinalysis was normal, and the cervical lymph nodes were no longer palpable. One month later the patient was readmitted to the hospital because of urinary frequency, dysuria, and her temperature was 104” F. Physical examination was significant only for bilateral cervical lymphadenopathy similar to that noted on the previous admission. The urinalysis obtained by catheterization showed 15 to 25 white blood cells per high-power field, and urine culture produced no growth. Cystourethroscopy and urethral calibration revealed a moderately severe stricture of the urinary meatus accompanied by a 3-plus trabeculation of the urinary bladder. Results of rectoabdominal examination under anesthesia were normal. An internal urethrotomy was performed. The patient was initially treated with trimethoprim and sulfamethoxazol to which an allergic reaction occurred and subsequently was treated with nalidixic acid. Her symptoms improved promptly, and the cervical nodes again disappeared in a period of three days. Regional lymph node enlargement may be a result of either local or acute generalized infection. In the absence of any local disease, it would appear to be a valid deduction of cause and effect that this patient’s acute urinary tract infections resulted in cervical lymphadenopathy.
DIAGNOSIS
To the Editor: Permit me to respond to the letter of Dr. Thomas L. Lawson and Dr. Bruce L. McClennan on “Ultrasound in Renal Lesions” published in the October issue (vol. 6, page 532) of UROLOGY. It refers, in part, to my failure to reproduce an ultrasonogram in the case profile of a renal tumor venogram. Because the purpose of this abbreviated presentation was to present the seldom seen percutaneous renal tumor venogram, other studies were purposely omitted. Dr. Lawson and Dr. McClennan may be correct when they state, “An erroneous ultrasound diagnosis is invariably due to poor technique or misinterpretation of the ultrasonograms rather than a defect in the basic diagnostic modality.” I, personally, have some reservations about the arrival of this diagnostic millenium, but look forward to improvements, refinements, and advancements in the techniques of ultrasonography, as well as the arrival of infallible ultrasonographers. Arthur N. Tessler,
M.D. University Hospital 566 First Avenue New York, New York 10016
CERVICAL LYMPHADENOPATHY AND ACUTE URINARY TRACT INFECTION To the Editor: The association of cervical lymphadenopathy with acute urinary tract infection is an unusual and, to our knowledge, a hitherto unreported phenomenon. A fifty-eight-year-old white female with controlled hypothyroidism entered the hospital for treatment of an acute urinary tract infection. She had been treated for an acute urinary tract infection one year prior to admission. There was a one-week history of chills, fever to 102” F., severe backache, dysuria, urinary frequency, and nuchal tenderness. Physical examination was positive for bilateral cervical posterior triangle adenopathy. The nodes were discrete, moder-
UROLOGY
I
DECEMBER
1975 / VOLUME
VI, NUMBER
Richard L. Golden, 554 Larkfield East Northport, New York Nathan A. Newman, 181 Main Huntington, New York
6
M.D. Road 11731 M.D. Street 11743
789
ULTRASOUND
ately tender, moveable, asymmetrical, and ranged from pea-to-marble size. A catheterized urine specimen, on admission, showed coarse granular casts, 12 to 14 white blood cells with clumping per high-power field. Urine, blood, and tuberculosis cultures showed no growth. A glucose tolerance test was consistent with diabetes mellitus. Febrile agglutinins and serology were nonreactive, and a complete blood count was normal. A chest x-ray film, intravenous pyelogram and liver scan results were normal. The patient was treated with cephalexin monohydrate. At the end of one week she was asymptomatic, urinalysis was normal, and the cervical lymph nodes were no longer palpable. One month later the patient was readmitted to the hospital because of urinary frequency, dysuria, and her temperature was 104” F. Physical examination was significant only for bilateral cervical lymphadenopathy similar to that noted on the previous admission. The urinalysis obtained by catheterization showed 15 to 25 white blood cells per high-power field, and urine culture produced no growth. Cystourethroscopy and urethral calibration revealed a moderately severe stricture of the urinary meatus accompanied by a 3-plus trabeculation of the urinary bladder. Results of rectoabdominal examination under anesthesia were normal. An internal urethrotomy was performed. The patient was initially treated with trimethoprim and sulfamethoxazol to which an allergic reaction occurred and subsequently was treated with nalidixic acid. Her symptoms improved promptly, and the cervical nodes again disappeared in a period of three days. Regional lymph node enlargement may be a result of either local or acute generalized infection. In the absence of any local disease, it would appear to be a valid deduction of cause and effect that this patient’s acute urinary tract infections resulted in cervical lymphadenopathy.
DIAGNOSIS
To the Editor: Permit me to respond to the letter of Dr. Thomas L. Lawson and Dr. Bruce L. McClennan on “Ultrasound in Renal Lesions” published in the October issue (vol. 6, page 532) of UROLOGY. It refers, in part, to my failure to reproduce an ultrasonogram in the case profile of a renal tumor venogram. Because the purpose of this abbreviated presentation was to present the seldom seen percutaneous renal tumor venogram, other studies were purposely omitted. Dr. Lawson and Dr. McClennan may be correct when they state, “An erroneous ultrasound diagnosis is invariably due to poor technique or misinterpretation of the ultrasonograms rather than a defect in the basic diagnostic modality.” I, personally, have some reservations about the arrival of this diagnostic millenium, but look forward to improvements, refinements, and advancements in the techniques of ultrasonography, as well as the arrival of infallible ultrasonographers. Arthur N. Tessler,
M.D. University Hospital 566 First Avenue New York, New York 10016
CERVICAL LYMPHADENOPATHY AND ACUTE URINARY TRACT INFECTION To the Editor: The association of cervical lymphadenopathy with acute urinary tract infection is an unusual and, to our knowledge, a hitherto unreported phenomenon. A fifty-eight-year-old white female with controlled hypothyroidism entered the hospital for treatment of an acute urinary tract infection. She had been treated for an acute urinary tract infection one year prior to admission. There was a one-week history of chills, fever to 102” F., severe backache, dysuria, urinary frequency, and nuchal tenderness. Physical examination was positive for bilateral cervical posterior triangle adenopathy. The nodes were discrete, moder-
UROLOGY
I
DECEMBER
1975 / VOLUME
VI, NUMBER
Richard L. Golden, 554 Larkfield East Northport, New York Nathan A. Newman, 181 Main Huntington, New York
6
M.D. Road 11731 M.D. Street 11743
789