Identification of Rickettsiae in Cutaneous i Biopsy Specimens From Dogs With Experimental Rocky Mountain Spotted Fever

Direct immunofluorescence reaction for Rickettsia rickettsii was performed on formalin-fixed, paraffin-embedded cutaneous biopsy specimens collected from dogs with experimental Rocky Mountain spotted fever (RMSF). A technique of trypsin digestion of deparaffinized, rehydrated sections was successful in demonstrating discrete, immunofluorescent organisms in endothelia and adjacent vessel walls in the dermis. R rickettsii was identified only in grossly evident dermal lesions (macular rash or oral vesicles) and was not apparent in randomly collected biopsy specimens from clinically normal inguinal skin. These results suggest that clinical application of this technique for diagnosis of RMSF may be limited in dogs without cutaneous lesions. (Journal of Veterinary Internal Medicine 1989; 3:8–11)     

Rocky Mountain spotted fever in dogs and its differentiation from canine ehrlichiosis

Rocky Mountain spotted fever (RMSF) or ehrlichiosis was diagnosed in dogs on the basis of specific immunofluorescent testing for each disease. Comparisons between clinical and laboratory findings were made between the 2 diseases. The incidence of RMSF tended to be more seasonal and it affected younger dogs. Purebred dogs appeared to be more susceptible to both diseases. In general, RMSF had a more rapid and severe course of clinical illness than did ehrlichiosis, but acute ehrlichiosis was difficult to differentiate from RMSF. Both diseases were characterized by fever, depression, lymphadenopathy, and signs of neurologic dysfunction; petechial hemorrhages or other signs of hemorrhagic diathesis were evident only in a small proportion of cases. Anemia, leukopenia, and thrombocytopenia were more common in dogs with ehrlichiosis, whereas those with RMSF more often had leukocytosis and thrombocytopenia. Hypoalbuminemia was found in dogs with both diseases, but those with ehrlichiosis usually had concurrent hyperglobulinemia. High serum alkaline phosphatase activity and serum cholesterol concentration, and low serum calcium concentration were more common in dogs with RMSF than with ehrlichiosis. Rising serum titers or positive direct immunofluorescence for Rickettsia rickettsii in skin biopsy specimens were used to confirm RMSF, whereas a single serum titer for Ehrlichia canis enabled detection of ehrlichiosis. In the absence of neurologic deficits and when dogs were treated with tetracycline, dogs with RMSF made a more rapid and consistent recovery than did dogs with ehrlichiosis.     

Canine Rocky Mountain Spotted fever: a retrospective study of 30 cases

Rocky Mountain spotted fever (RMSF) was diagnosed in 30 dogs examined at North Carolina State University, Veterinary Teaching Hospital between 1984 and 1997. Historical, physical examination, and laboratory abnormalities were reviewed. Diagnostic criteria included a four-fold rise in antibody titer to Rickettsia rickettsii (R. rickettsii) (n=15) or a single R. rickettsii antibody titer of 1:1,024 or greater (n=15; when this initial titer was determined one week or more after the onset of clinical signs). Fifteen (50%) dogs were greater than seven years of age, and 13 (43%) dogs were between two and seven years of age. There was no sex predilection. Only five (17%) dogs had a history of known tick exposure. Presumably due to delayed diagnosis, dogs with antibody titers of 1:1,024 or greater at the time of presentation had a higher incidence of more severe neurological dysfunction (e.g., ataxia, hyperesthesia, vestibular disease, and seizures) and cutaneous lesions (e.g., hyperemia, edema, petechiae, ecchymoses, and necrosis). Laboratory findings included anemia, leukocytosis accompanied by toxic granulation of neutrophils, hypoalbuminemia, and coagulation abnormalities; signs were generally more severe in the 15 dogs with R. rickettsii antibody titers of 1:1,024 or greater at the time of presentation. Twelve (40%) dogs in this study were severely thrombocytopenic (less than 75 x10(3) platelets/microl; reference range, 200 to 450 x 10(3)/microl), without clinical evidence of fulminant disseminated intravascular coagulation. In this study, the survival rate following R. rickettsii infection was 100%.     

Tick infestation and spotted-fever group Rickettsia in shelter dogs, California, 2009

In response to an outbreak of Rocky Mountain spotted fever (RMSF) in Baja California in early 2009, dogs at two shelters in neighbouring Imperial County, California, were evaluated for ectoparasites. Brown dog ticks (Rhipicephalus sanguineus), a recognized vector for RMSF, were found on 35 (30%) of 116 dogs but all ticks tested negative for Rickettsia rickettsii by PCR.     

Central nervous system dysfunction associated with Rocky Mountain spotted fever infection in five dogs

Five dogs from the northeastern United States were presented with clinical signs of neurological disease associated with Rocky Mountain spotted fever (RMSF) infection. Four of the five dogs had vestibular system dysfunction. Other neurological signs included paresis, tremors, and changes in mentation. All of the dogs had an elevated indirect fluorescent antibody titer or a positive semiquantitative enzyme screening immunoassay titer for Rickettsia rickettsii at the time of presentation. Although a higher mortality rate has been reported for dogs with neurological symptoms and RMSF infection, all of the dogs in this study improved with appropriate medical therapy and supportive care.     

THORACIC RADIOGRAPHIC FINDINGS IN DOGS INFECTED WITH RICKETTSIA RICKETTSII

Sixteen beagle dogs were injected intradermally with Rickettsia rickettsii. The dogs were divided into four groups (n=4):1) infected, non-treated withdoxycycline;3) infected, treated with doxycycline and an anti-inflammatory dose of corticosteroid;4) infected, treated with ocular fluoresein angiograhphy was performed on days 6, 10, 17 post-inoculatin.A mild interstitial lung opacitywas noted in4/16 dogs on day 6, 5/16 on day 10 and 17 post-inculatin. Increased retinal vascular permeability was noted n 8/16 dogs on day 6,3/16 on day 10 and 1/16 on day 17 post-inoculation. Correlatin between the presence of radiographic and retinal lesions was not signigicant (p=0.08). Elevan, naturally infected, dogs with thoracic radiographs and an final diagnosis of RMSF were also evluated. Four of the 11 dogs had an unstructu4red inteerstitial pattern. Dogs with acute, experimentally-infected or naturally-occurring RMSF may have subtle pulmonary changes characterized by an unstructured interstitial patteern.     

Seroprevalence of spotted fever group rickettsiae in canines along the United States–Mexico border

Portions of northern Mexico are experiencing a re‐emergence of Rocky Mountain spotted fever (RMSF), a tickborne disease caused by Rickettsia rickettsii, a member of the spotted fever group of rickettsiae (SFGR). Infection with R. rickettsii can result in serious and life‐threatening illness in people and dogs. Canine seroprevalence has been used as a sentinel for human RMSF in previous studies. This study aims to quantify SFGR seroprevalence in canines in three northern Mexican states and identify risk factors associated with seropositivity. A total of 1,136 serum samples and 942 ticks were obtained from dogs participating in government sterilization campaigns and from animal control facilities in 14 Mexican cities in three states. SFGR antibodies were detected using indirect immunofluorescence antibody assays at titre values ≥1/64. Six per cent (69 dogs) showed antibodies to SFGR, with the highest seroprevalence reported in Baja California (12%), Coahuila (4%) and Sonora (4%). Dogs from Baja California had three times higher odds of having SFGR antibodies compared to dogs from Sonora (OR = 3.38, 95% CI, 1.81–6.37). Roughly one quarter (25%) of surveyed dogs were parasitized by ticks (Rhipicephalus sanguineus sensu lato) at the time of sample collection. A portion of collected ticks were tested for rickettsial DNA using polymerase chain reaction. Positive samples were then sequenced, showing evidence of SFGR including R. massiliae, R. parkeri and R. rickettsii. Dogs that spent the majority of time on the street, such as free‐roaming or community‐owned dogs, showed a greater risk of tick infestation, seropositivity, bearing seropositive ticks, and may play a pivotal role in the spread of SFGR among communities. Estimating the seroprevalence of SFGR in the canine population can help public health campaigns target high‐risk communities for interventions to reduce human RMSF cases.     

Implications of presumptive fatal Rocky Mountain spotted fever in two dogs and their owner

A dog was examined because of petechiation, an inability to stand, pale mucous membranes, a possible seizure, and thrombocytopenia. Tick-borne illness was suspected, but despite treatment, the dog died. Eight days later, a second dog owned by the same individual also died. The dog was not examined by a veterinarian, but Rocky Mountain spotted fever (RMSF) was suspected on the basis of clinical signs. Two weeks after the second dog died, the owner was examined because of severe headache, fever, nausea, vomiting, decreased appetite, lethargy, and a fine rash on the body, face, and trunk. Despite intensive treatment for possible RMSF, the owner died. Although results of an assay for antibodies to Rickettsia rickettsii were negative, results of polymerase chain reaction assays of liver, spleen, and kidney samples collected at autopsy were positive for spotted fever group Rickettsia spp. These cases illustrate how dogs may serve as sentinels for RMSF in humans and point out the need for better communication between physicians and veterinarians when cases of potentially zoonotic diseases are seen.     

Histologic comparison of skin biopsy specimens collected by use of carbon dioxide or 810-nm diode lasers from dogs

OBJECTIVE: To compare histologic artifacts caused by carbon dioxide (CO2) or 810-nm diode surgical lasers used to obtain small biopsy specimens of skin from healthy dogs. DESIGN: Prospective study. ANIMALS: 4 dogs. PROCEDURE: 21 skin biopsy specimens were collected from each dog. Three biopsy specimens were obtained with a CO2 or an 810-nm diode laser at 3 operating settings each, and 3 biopsy specimens were obtained with a 6-mm biopsy punch instrument (controls). After processing, biopsy specimens were examined for artifacts related to laser-tissue interactions. Microscopically visible char was measured from the lateral edge of each specimen obtained with a laser. RESULTS: There were no significant differences among mean char distances in biopsy specimens obtained with the CO2 laser at various settings. Mean char distance was significantly greater in all skin biopsy specimens obtained with the diode laser, compared with those obtained with the CO2 laser. Mean char distance was significantly greater in biopsy specimens obtained with the 810-nm diode laser at high power, compared with biopsy specimens obtained with the 810-nm diode laser at low power. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that the CO2 laser caused less thermal injury at margins of skin biopsy specimens; therefore, if a surgical laser is used for removal of cutaneous masses or to obtain skin biopsy specimens, use of the CO2 laser is recommended. Veterinarians performing a biopsy by using a surgical laser should be aware that laser-induced artifacts may render small biopsy specimens useless for providing accurate histologic diagnosis.     

Correlation between fine-needle aspiration cytology and histopathology in the evaluation of cutaneous and subcutaneous masses from dogs and cats

BACKGROUND: Fine-needle aspiration cytology (FNAC) is commonly used as a diagnostic procedure to evaluate superficial and deep masses in animals. However, few studies have addressed the accuracy of FNAC in the evaluation of cutaneous and subcutaneous masses in a clinical setting. OBJECTIVE: The purpose of this study was to compare the accuracy of FNAC as compared with histopathology in the diagnosis of cutaneous and subcutaneous masses from dogs and cats. METHODS: Cytologic and histopathologic specimens obtained between 1999 and 2003 from 292 palpable cutaneous and subcutaneous masses obtained from 242 dogs and 50 cats were retrospectively evaluated. Cytologic samples were obtained by FNA and histopathologic samples were collected by surgical biopsy or at necropsy. Concordance was determined and the accuracy of FNAC for the diagnosis of neoplasia was determined using histopathology as the gold standard. RESULTS: Of 292 specimens, 49 (from 44 dogs and 5 cats) were excluded due to poor cellularity of the cytologic specimen (retrieval rate 83.2%, n = 243). A cytologic diagnosis of neoplasia was obtained in 176 cases (175 true positives and 1 false positive compared with histopathology). Sixty-seven cytology samples were classified as non-neoplastic (46 true negatives, 21 false negatives compared with histopathology). Overall, the cytologic diagnosis was in agreement with the histopathologic diagnosis in 90.9% (221/243) of cases. For diagnosing neoplasia, cytology had a sensitivity of 89.3%, a specificity of 97.9%, a positive predictive value of 99.4%, and a negative predictive value of 68.7%. CONCLUSIONS: The results of this study confirmed FNAC as a reliable and useful diagnostic procedure for the evaluation of palpable cutaneous and subcutaneous lesions in small animal practice.     

Ocular manifestations of Rocky Mountain spotted fever in dogs

Dogs were examined ophthalmoscopically to determine the prevalence and type of ocular lesions associated with naturally acquired Rocky Mountain spotted fever (RMSF). In a consecutive series of 11 dogs with serologically confirmed RMSF, 9 had ocular involvement reflecting various degrees of vascular damage, including subconjunctival hemorrhage, hyphema, anterior uveitis, iris stromal hemorrhage, retinal petechiae, and focal areas of retinal edema and perivascular inflammatory cell infiltrate. The ophthalmic lesions generally were mild, and most resolved without complication after systemic administration of appropriate antibiotics. The high prevalence of ocular lesions in these dogs suggested that critical ophthalmologic evaluation is a useful diagnostic tool for the early detection and management of RMSF in dogs.     

Glomerular lesions in dogs infected with Leishmania organisms

OBJECTIVE: To histologically identify glomerular lesions in dogs infected with Leishmania organisms. ANIMALS: 41 dogs (17 sexually intact males and 14 sexually intact and 10 ovariohysterectomized females) that had positive results when tested for leishmaniosis as determined by use of serologic evaluation (indirect fluorescent antibody test, titers of 1:80 to 1:640) and direct microscopic identification of the protozoal organisms. PROCEDURE: Urine samples were collected by use of cystocentesis and examined by qualitative SDS-agarose gel electrophoresis (AGE). All dogs had non-selective (glomerular) or mixed (glomerular and tubular) proteinemia. Specimens were obtained from each dog during ultrasound-assisted renal biopsy and used for histologic examination. Each specimen was stained with H&E, periodic acid-Schiff, Goldner's trichrome, methenamine silver, and Congo Red stains. Specimens were adequate for evaluation when they contained at least 5 glomeruli/section, except for specimens stained with Congo Red in which 1 glomerulus/section was adequate. RESULTS: Examination of renal biopsy specimens revealed various glomerular lesions in all dogs and interstitial or tubular (or both) lesions in 23 of 41 (55%) dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Glomerular lesions that develop in dogs during infection with Leishmania organisms can be classified histologically as mesangial glomerulonephritis, membranous glomerulonephritis, membranoproliferative glomerulonephritis, and focal segmental glomerulonephritis. Tubulointerstitial histopathologic conditions were not observed as the primary lesion, despite being evident in 23 of 41 (55%) dogs. Use of SDS-AGE for qualitative evaluation of proteinuria and successive collection of specimens during renal biopsies following diagnosis of nonselective glomerular proteinuria provides the possibility for early identification of renal lesions.     

Clinical, hematologic, and humoral immune response in female dogs inoculated with Rickettsia rickettsii and Rickettsia montana

Female Beagles were inoculated intradermally with a sublethal dose of Rickettsia rickettsii and R montana. Three dogs (group 1) were inoculated with 2 X 10(2) plaque-forming units (PFU) of R rickettsia and were treated with tetracycline beginning on postinoculation day (PID) 12; 3 dogs (group 2) were inoculated with 2 X 10(2) PFU of R rickettsii but were not treated; 3 dogs (group 3) were inoculated with 2 X 10(2) PFU of R montana. Group-3 dogs failed to seroconvert and were inoculated a second time on PID 68. Groups 1 and 2 dogs inoculated with R rickettsii became depressed and developed occasional inappetence, fever, hematochezia, and ocular lesions. These dogs had a decrease in PCV and RBC count, an initial decrease in WBC count followed by leukocytosis, and a decrease in platelet count. Group-3 dogs inoculated with R montana remained healthy. After R rickettsii inoculation, the serologic response to spotted fever group (SFG) rickettsial antigens (R rickettsii, R rhipicephali, R montana, and R bellii) was similar. The antibody response to R rickettsii was first detected on PID 9, with peak titers reached by PID 20. Serum titers to R rickettsii remained stable or decreased one dilution through PID 120. Of 4 SFG rickettsial antigens, the highest serologic response was to R rickettsii. A cross-reacting antibody response with R rhipicephali and R montana was nearly identical and was only slightly less than the response to R rickettsii. Cross-reacting antibodies to R belli were of lower mean titer and of shorter duration than were cross-reacting antibodies to other SFG rickettsiae.(ABSTRACT TRUNCATED AT 250 WORDS)     

FLUOROSCOPICALLY GUIDED PERCUTANEOUS FINE-NEEDLE ASPIRATION BIOPSY OF THORACIC LESIONS IN DOGS AND CATS

Forty-eight fine-needle aspiration biopsy specimens of intrathoracic lesions were obtained with a Westcott needle by localizing needle placement using TV-monitored, image-amplified fluoroscopy and by detecting changes in tactile sensation. Thiryt-five lesions were pulmonary in origin and 13 were within the mediastinum. Most biospy specimens were obtained with the patients sedated, however, general anesthesia was used in one patient to prevent movement that could have resulted in puncture of a critical structure. The only clinical and radiographic complication from this procedure was pneumothorax, occurring in eight dogs and resulting in one death. Definitive diagnoses were made from tissue obtained from 37 of the 48 lesions sampled for a sensitivity rate of 77.1%. Fine-needle aspiration biopsy was found to be a simple, safe, and accurate diagnostic technique.     

Identification of surgical biopsy borders by use of india ink.

Separation of surgical biopsy borders from artifactual borders created during trimming of biopsy specimens is necessary to avoid misinterpretation of histologic borders. Misinterpretation of a contaminated trimming border as a surgical border may lead to additional surgery and excessive removal of normal tissue. Likewise, a neoplasm may regrow locally or metastasize if a surgical border infiltrated with neoplastic cells is falsely assumed to be an artifactual trimming border. The use of India ink for distinguishing between surgical biopsy borders and artifactual borders was evaluated. Ten normal tissue specimens from 8 types of tissue (skin, small intestine, urinary bladder, bone, muscle, lung, large intestine, and uterus) were obtained from freshly euthanatized dogs. The specimens were painted with India ink and examined for adherence of the ink to the cut surface of the specimen. Adherence of the ink was observed in all specimens with the exception of the cut surface of the lung. Twenty-five biopsy specimens from dogs with clinical cases of disease were similarly painted with India ink and evaluated. Twenty-two were identified as neoplastic and 3 as inflammatory lesions. Wedges of tissue were obtained from the center of the biopsy specimens to purposely create borders that contained neoplastic tissue. These positive controls were painted with India ink to evaluate the effect of the ink on the histologic appearance of the neoplastic cells. Distortion or alteration of the cellular architecture was not observed in any of the normal specimens, specimens from dogs with clinical cases, or positive controls. The use of India ink for delineation of biopsy borders is a simple technique that presents few technical difficulties.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cutaneous neosporosis in two adult dogs on chronic immunosuppressive therapy.

Antemortem diagnosis of generalized ulcerative and pyogranulomatous dermatitis with numerous intralesional tachyzoites was made from skin biopsy specimens from 2 adult dogs on chronic immunosuppressive therapy. A 9-year-old Italian Greyhound was on long-term corticosteroid therapy for the treatment of a lupus-like systemic autoimmune disorder, and a 7-year-old Labrador Retriever had received several months of chemotherapy for lymphosarcoma. The tachyzoites were identified as Neospora caninum by immunoperoxidase immunohistochemistry. Both dogs were treated with clindamycin. Lesions in the Greyhound resolved; however, the Labrador Retriever was euthanized because of evidence of neuromuscular disease, despite improvement of the skin lesions. These 2 cases indicate that cutaneous neosporosis can occur in adult dogs on chronic immunosuppressive therapy. The disease may result from reactivation of a congenital infection and/or a recently acquired primary infection.     

Antibodies to spotted fever-group rickettsiae in dogs in North Carolina

A seroepidemiologic survey was conducted to determine the prevalence of antibodies reactive with 4 spotted fever-group (SFG) rickettsiae in sera of dogs from various geographic regions in North Carolina. Serum specimens were obtained from 600 dogs, and antibody titers were determined, using microimmunofluorescence. Data analysis (setting as the criterion for a positive result, a Rickettsia rickettsii titer greater than or equal to 1:64) overestimated the actual prevalence of canine exposure to this rickettsia. When data were analyzed by considering each dog's serologic response to all 4 rickettsial antigens simultaneously, the prevalence rate for exposure to R montana was 15%, to R rhipicephali was 11%, and to R rickettsii was 5%. A definitive exposure to R bellii was not observed, and the identification of the specific inciting rickettsia could not be established for 13% of the dogs, because of identical highest titers to 2 or more antigens. Our data indicate that canine exposure to R rhipicephali is prevalent in the eastern coastal region, whereas exposure to R montana takes place uniformly throughout the state. Rickettsia rickettsii exposure appears to be more prevalent in the central Piedmont region, but rarely is encountered in the western mountains. Regional seroprevalence for canine R rickettsii exposure approximates that for human exposure. Our findings support earlier suggestions that dogs may serve as environmental sentinels for establishing the geographic prevalence of foci of spotted fever.     

Comparison of different tissue sampling for PCR-based diagnosis and follow-up of canine visceral leishmaniosis

In this study, different types of tissue sampling for PCR-based diagnosis and follow-up of canine visceral leishmaniosis were compared. Skin, whole blood and lymph node samples were collected from 95 naturally infected dogs living in South Italy, where the disease is endemic. Twenty-nine of these 95 dogs, treated with meglumine administered concurrently with allopurinol for 30 days, and then with allopurinol alone, were monitored during a period of 2 years. The DNA extracted from the clinical specimens was amplified by PCR using as target DNA a 116-bp fragment in the constant region of the kinetoplast DNA minicircle. PCR analysis was more sensitive than indirect immunofluorescence antibody test in detecting Leishmania infection in symptomatic dogs: 99% of lymph node samples resulted positive, whereas 94% of blood samples and 95% of skin samples gave a positive result. PCR analysis of samples from dogs followed up 2 years showed that: (1) all subjects resulted positive in at least one of the three types of samples; (2) all time the dogs had a relapse, PCR resulted positive in all three types of samples; (3) when dogs were apparently healthy, PCR analysis was positive on skin and lymph node samples, but not always on blood samples. Since lymph node sampling is invasive and sometimes difficult in healthy asymptomatic dogs, our results suggest that, independently from the presence or not of cutaneous lesions, skin biopsy represents a good substratum for PCR-based diagnosis and follow-up of canine visceral leishmaniosis.     

Comparison of two sample collection methods for quantitative bacteriologic culture of canine prostatic fluid

Ejaculate, urine, urethral swab specimens, and ultrasonography-guided small-needle prostatic cyst aspiration and/or tissue core biopsy specimens were collected for bacteriologic culture from 25 dogs in which prostatic disease was suspected on the basis of history, clinical signs of disease, or results of physical examination. The prostate gland in each dog was examined ultrasonographically, and the tissue core biopsy specimens were examined histologically and bacteriologically. Two methods were used to assess bacterial prostatitis. In 5 dogs (20%), bacteriologic culture results of paired urethral swab and ejaculate specimens differed from culture results of specimens obtained by needle aspiration of prostatic cyst fluid or tissue core biopsy. The prostate gland in 17 dogs had 1 or more cystic, fluid-filled structures (0.5 to 4.0 cm in diameter). Ultrasonographic appearance of the prostate gland did not have obvious correlation with culture results from dogs of the study. Histologic results of prostatic tissue core biopsy specimens correlated well with culture results.     

Bacterial population and histologic changes in dogs with perianal fistula

Ages of 44 dogs with perianal fistula, ranged from 6 months to 13 years (mean, 5.2 years). German Shepherd Dogs and Irish Setters were statistically (P less than 0.01) over-represented compared with those breeds in a canine hospital population (n = 22,047) for the same period. There was a 2:1 male-to-female ratio, with 38 (86.4%) of dogs sexually intact and 6 (13.6%) of dogs neutered. Eleven types of bacterial organisms were recovered from deep perianal tissues of which Escherichia coli, Staphylococcus aureus, beta-hemolytic streptococci, and Proteus mirabilus were most common. Organisms were not recovered from 7 dogs. Of 93 isolates, 88.3% were susceptible to gentamicin, 80.5% to cephalothin, 79.2% to chloramphenicol, and 74% to trimethoprim-sulfamethoxazole. Fifty-one biopsy specimens from 44 dogs were classified as having early, intermediate-, and late-stage lesions based on the amount of fibrosis, severity of the inflammatory response, and, if present, depth of sinus tracts. In most biopsy specimens, all 3 stages were represented in the same histologic section. In 45 specimens, most inflamed lesions were in the dermis of the zona cutanea. Hidradenitis was present in 22 biopsy specimens and was associated with the formation of epithelial-lined sinus tracts.