Lymph system disease
Category: Illness or disabilities
Introduction and description
The lymph system is an extensive network of vessels that resemble veins, but which are not either arteries or veins.
The system contains a colourless or pale yellow liquid that is called lymph (from Latin lympha "water goddess") which has a composition similar to tissue fluid [the fluid found in and bathing cells] but it contains more fatty substances, protein and white blood cells.
Around the body are a number of organs which connect up the system, the largest of which is the spleen. Other organs include the adenoids [pharyngeal tonsils], tonsils, appendix, thymus and vessels within the bone marrow.
Along with these larger organs are numerous little sacs called lymph nodes. This network of conduits called lymphatic vessels carry the lymph unidirectionally towards the heart.
There are between five and six hundred lymph nodes in the human body, many of which are grouped in clusters in different regions as in the underarm and abdominal areas. Lymph node clusters are commonly found at the base of limbs (groin, armpits) and in the neck, where lymph is collected from regions of the body likely to sustain pathogen contamination from injuries.
The lymph system is a closed system. Fluid enters through the walls of lymphatic vessels, which can stretch to hold more fluid as necessary. The lymphatic system has no heart to pump lymph round the body. Lymphatic vessels can contract, but the circulation of lymph depends mainly on external pressure, lymph is squeezed along vessels by the pressure associated with breathing, intestinal movements and the movements of skeletal muscles.
Names, names, names
In examining diseases of the lymph system it makes no sense to separate the various connecting organs, despite the fact that many medical textbooks do.
The lymph system is a system and as such if one part goes wrong it affects all the other parts.
The numerous names given to the various symptom combinations of disease of the lymph system also simply confuse the issue, names like Lymphadenopathy, which refers to enlarged lymph nodes; Lymphedema which is the swelling caused by the accumulation of lymph; Lymphangiomatosis which describes cysts or lesions on lymphatic vessels. Then we have Lymphoma which refers to a tumour - leukemias and lymphomas are now considered to be tumors of the same type. They are called "leukemia" when in the blood or marrow and "lymphoma" when in lymphatic tissue.
Lymphangiosarcoma is a malignant soft tissue tumor, whereas lymphangioma is a benign tumor. Lymphangioleiomyomatosis is another sort of benign tumor. And so it goes on.
Purpose of the system
There are four main but inter-related purposes of the lymph system. In order to understand these it may help to read the description in the Science section that describes the Immune system.
Defence against disease
Functionally the lymph system plays a key part in our defences against disease:
- The lymph nodes produce and store the white blood cells called lymphocytes and also filter out foreign particles, bacteria and dead tissue before these enter the blood stream
Lymph nodes are traditionally regarded as having three compartments, the cortex, paracortex and medulla. B and T cells home to separate areas within these compartments, interact with antigen presenting cells, and undergo clonal expansion. PMID: 17067937
- The adenoids and the tonsils - are our first line of defence against pathogens that enter through the nose and mouth. They both contain antigen producing cells, so to remove these organs is madness - utter madness. All sorts of infections - ear, nose and throat - can result if these are damaged or removed...
The human palatine tonsils and the nasopharyngeal tonsil are considered the defense mechanism against ingested or inhaled foreign pathogens. ..... IgA-producing cells and OVA-specific antibody-producing cells were identified in the tubal tonsils. PMID: 17050308
Eustachian tube dysfunction caused by adenoids hypertrophy is the etiologic factor of secretory otitis media [an ear infection]. PMID: 16463762
- The spleen stores an emergency supply of blood as well as being a store of white blood cells. The spleen also makes antibodies and removes antibody-coated pathogens.
The spleen combines the innate and adaptive immune system in a uniquely organized way. The structure of the spleen enables it to remove older erythrocytes from the circulation and leads to the efficient removal of blood-borne microorganisms and cellular debris. This function, in combination with a highly organized lymphoid compartment, makes the spleen the most important organ for antibacterial and antifungal immune reactivity. A better understanding of the function of this complex organ has been gained from recent studies. PMID: 16056254
- The appendix - supplies a back up store of bacteria for the Intestine. The Intestine is totally dependent upon its flora both to function and to provide a first line of defence against pathogens, as such those without an appendix are at some risk. "When we get a severe gut infection such as cholera ....., the beneficial bacteria in our gut are depleted. The appendix allows them to be restored"
The association of the cecal appendix with substantial amounts of immune tissue has long been taken as an indicator that the appendix may have some immune function. Recently, an improved understanding of the interactions between the normal gut flora and the immune system has led to the identification of the appendix as an apparent safe-house for normal gut bacteria. .... This bacterial safe-house, .... is important in the event of diarrheal illness, ...... appendicitis [is] associated with modern hygiene and medicine. PMID: 2137049
... an interesting finding. It is worth noting that the appendix has 'substantial lymphatic tissue', as such it may have more roles, not yet discovered.
Route of repair and signalling
The lacteals into which fatty acids are absorbed in the small intestine are small branches of the lymphatic system and also the main route by which cholesterol makes its way into the blood. The enriched lymph originating in the lymphatics of the small intestine is called chyle.
Cholesterol is an essential structural component of animal cell membranes, and the raw material for the manufacture of Vitamin D. Without cholesterol we may become infertile, our sex drive may lower, and we will be Vitamin D deficient. The lymphatic system also transports substances such as fatty acids, and some enzymes. Both cholesterol and fatty acids are cell repair substances, thus the lymph system is the major route by which repair substances can get to cells after attack.
Immune system signalling
The lymph system appears to be a pathway for certain hormones which act as immune system regulators. Hormones can thus act as immunomodulators, altering the sensitivity of the immune system. For example, female sex hormones are known immunostimulators. By contrast, male sex hormones such as testosterone seem to be immunosuppressive. Other hormones appear to regulate the immune system as well, most notably prolactin and growth hormone. It is unclear from research which hormones are to be found in the lymph system, but there is enough evidence that hormones are present. The key question remaining is which hormones.
It has been shown that hormones and related substances are present in the lymph draining from the ovary, testis, adrenal and thyroid (Daniel, Gale & Pratt, 1963). In addition, insulin is present in the lymph of the thoracic duct (Daniel & Henderson, 1966). As such the lymph sytem may be a very major supplier of hormones to the body in addition to the blood circulatory system.
Removal and transport of interstitial fluid
Mammalian cells are bathed in a fluid called tissue fluid. This fluid forms the immediate environment of the cells, it is the source of water, oxygen and nutrients. It also receives excretory substances from the cells. The chemical composition, temperature and pH of the tissue fluid are very important to the cells. If the conditions are unsuitable, a cell may not function efficiently or it may even die.
Most tissue fluid is recycled via the blood circulatory system. Blood at the arterial end of a capilary is under high pressure and this pressure is sufficient to force water and nutrients into the spaces between cells. Blood pressure at the venous end of the capillaries is much lower and the reverse process takes place as water, salts and waste products flow back into the capillary.
But not all tissue fluid circulates back into the venous ends of capillaries. Some of its drains into the lymphatic system.
I think it should be apparent from the section on the purposes of the lymph system, that any problems with the system is going to affect every part of the body causing anything from infertility to heart disease.
But there are immediate symptoms which tell you that something is wrong with your lymph system.
When the lymph system becomes damaged or blocked or is being attacked by a pathogen, a number of symptoms may become immediately evident.
Swelling and tenderness - If a pathogen attacks the body the lymph system firstly produces white blood cells often very rapidly and these then become active engulfing bacteria or viruses and secreting antibodies to kill them. The accumulation of white blood cells and dead or engulfed pathogens can cause the lymph nodes to become swollen and tender. The adenoid, for example, also known as a pharyngeal tonsil or nasopharyngeal tonsil, is a mass of lymphatic tissue situated posterior to the nasal cavity, in the roof of the nasopharynx, where the nose blends into the throat.
An enlarged adenoid can become nearly the size of a ping pong ball and completely block airflow through the nasal passages. Even if the enlarged adenoid is not substantial enough to physically block the back of the nose, it can obstruct airflow enough so that breathing through the nose requires an uncomfortable amount of work, and inhalation occurs instead through an open mouth. The enlarged adenoid can also obstruct the nasal airway enough to affect the voice without actually stopping nasal airflow altogether.
Oedema - Lymph vessels can be blocked by a number of pathogens or by damage. This can result in a build up of lymph and tissue fluid which can cause oedema or it can become much worse causing massive swelling of tissues.
The effect of blocked lymph vessels can be seen in people suffering from elephantiasis. In this case the blocking agent is a parasite called Wucheria bancrofti which most commonly affects the legs.
White urine - Chyluria - also called chylous urine, is a medical condition involving the presence of chyle in the urine stream, which results in urine appearing milky white. It is caused by a blockage in the lymph system. Once the lymph channels are blocked, one may open into the kidney hilum or ureter or sometimes into the bladder and chyle can leak into the urinary tract resulting in milky white urine. Blood sometimes mixes with the urine resulting in haemato-chyluria.
Skin eruptions and disease - one of symptoms which is often missed, because the connection between it and the lymph system is not understood, is psoriasis. Where the lymph system is damaged or blocked via surgery or a pathogen, inflammation will occur followed by weeping of the lymph fluid out of the area via the skin. Eczema can follow a similar pattern and for the same reasons.
Psoriasis is an inflammatory disease with dynamic interactions between the immune system and the skin. The IL-23/Th17 axis plays an important role in the pathogenesis of psoriasis, although the exact contributions of IL-23 and IL-17 in vivo remain unclear. PMID: 21346238
A number of skin diseases may follow the same pattern - the lymph system may be blocked by pathogens or the lymph nodes may be swollen as a result and acne, spots, pimples and bumps may then appear.
The skin has a dual function as a barrier and a sensory interface between the body and the environment. To protect against invading pathogens, the skin harbours specialized immune cells, including dermal dendritic cells (DDCs) and interleukin (IL)-17-producing γδ T (γδT17) cells, the aberrant activation of which by IL-23 can provoke psoriasis-like inflammation. ..... Interactions between the autonomic nervous system and immune cells in lymphoid organs are known to [take place] PMID: 24759321
Fungal infections, nail pitting and ridging - A person with a damaged lymph system is in effect immunocompromised in those areas to which the lymph cannot reach and fungal infection often occurs on the skin and in the nails. Trichosporon for example, is a genus of anamorphic fungi. All species of Trichosporon are yeasts. Most are typically isolated from soil, but several species occur as a natural part of the skin microbiota of humans and other animals.
Trichosporon (T.) asahii can cause superficial skin infections and can be an opportunistic pathogen that produces potentially fatal systemic infections in immunocompromised hosts. We report a case of lower limb infection due to T. asahii in an immunocompetent patient who displayed no evidence of underlying disease. There is a strong possibility that our patient had been colonized at the infection site as part of the normal skin flora. After ..an accidental fall and fracture of the right shoulder blade, a 61-year-old woman experienced severe edema and redness in the right lower limb and received topical treatment with iodine solution and antibiotics without improvement. She presented at our Outpatient Clinic with cellulitis and lymphedema. PMID: 24476611
In effect, the fall may have damaged her lymph system and with a damaged lymph system, infection set in. You can see that in the cases of elephantiasis shown above there is not just swelling, but fungal infection as well.
The main causes of the diseases of the lymph system are as follows
A number of parasites are known causes of lymph system diseases, but one of the most vicious cause what is called Lymphatic filariasis - Filariasis (or philariasis) - a parasitic disease caused by an infection with roundworms of the Filarioidea type. These are spread by blood-feeding black flies and mosquitoes.
In India 553 million persons are estimated to live in areas endemic for LF; approximately 21 million have symptomatic filariasis. Of the approximately 16.02 million cases of lymphedema caused by LF globally, 7.44 million (46.4%) are in India. ...... In 2003 the need in resource-poor countries for morbidity control of lymphatic filariasis (LF) became clear, prompting the study by the Institute of Applied Dermatology in Kerala, India. Under this study, self help and family members assisted in home-based care, combining compression bandaging, yoga exercises, heat therapy using steaming, and skin care according to Ayurvedic medicine. Lymphedema presents with different patterns in the skin with gross changes in the epidermis, dermis, or subcutaneous tissue. Skilled and time-consuming counselling is important to give patients support. An almost immediate reduction in inflammatory episodes from 80.4% to 8.6% shows up within 2 or 3 weeks, and therefore, intake of antibiotics can be stopped. The second major response is reduction in the size of the limb. Volume reduction for large-sized limbs at 3 months is 39%, with a confidence interval of 4.9 to 5.9 L. PMID: 22354118
Bacterial infection of any sort can result in swelling of the lymph nodes closest to the infection. Thus a swollen lymph node in these cases is itself a symptom of a series infiltration of a pathogen.
For example; Cat-scratch disease (CSD) is a bacterial infection spread by cats. The disease spreads when an infected cat licks a person's open wound, or bites or scratches a person hard enough to break the surface of the skin. About three to 14 days after the skin is broken, a mild infection can occur at the site of the scratch or bite. The infected area may appear swollen and red with round, raised lesions and can have pus. Later, the person's lymph nodes closest to the original scratch or bite can become swollen, tender, or painful.
But many other bacteria are implicated
We performed bacteriologic studies of specimens harvested from arteries of amputated ischemic legs, leg varices, and tissue fluid/lymph and lymphatics in lymphedema.
Calf arteries contained isolates in 61% and femoral arteries in 36%, whereas normal cadaveric organ donors' arteries in 11%. ... The majority of isolates belonged to the coagulase-negative staphylococci and Staphylococcus aureus; however, highly pathogenic bacteria were also detected..... .... Lymph and epifascial lymphatics limb contained bacteria in 60% and 33% samples, respectively and controls in 7%. Most were S. epidermidis, susceptible to all antibiotics except penicillin. Cryptic bacteria ...may play a pathologic role in surgical site infections. PMID: 26046245
Again, because the lymph system is a part of the immune response to a pathogen, swelling or tenderness in an area in which lymph nodes are present could indicate a virus. Interestingly any number of viruses have been implicated in this when the person not only did not know they were infected with a virus, but where the virus reappears from an infection that could have been caught many years ago. This serves to emphasise the fact that many viruses are not defeated by the immune system but simply lie low waiting for a time of stress and low immunity to strike again. For example:
J Neuropathol Exp Neurol. 2014 Jul;73(7):729-31. Epstein-barr virus in the central nervous system and cervical lymph node of a patient with primary progressive multiple sclerosis - Serafini B, Rosicarelli B, Aloisi F, Stigliano E. PMID: 24918642
For the reasons stated above, any vaccine which uses live attenuated viruses [or bacteria] may be the cause of lymph system disease, not only at the time of vaccination but later, in those cases where the virus is not entirely eliminated at the time of vaccination.
An increasingly large number of pharmaceuticals cause lymph system disease. The following links take you to the eHealthme website where a full list of the pharmaceuticals that have caused various forms of lymph system disease are shown along with the number of Adverse Health reports for each pharmaceutical.
- Lymphadenoid goiter - LINK
- Lymphatic obstruction - LINK
- Lymphedema - LINK
- Lymph nodes swollen - LINK
- Lymph node tuberculosis - LINK
- Lymphoblastic lymphoma - LINK
- Lymphocytic lymphoma - LINK
- Lymphoma - LINK
- Lymphoma non Hodgkin's - LINK
The following table shows all the disease of the lymph system caused by one statin. [Avorstatin]. The information comes from eHealthme and was correct as at May 2015. The table also gives us a good idea of the number of names for the various symptoms of lymph system disease and thus why it is so difficult to see trends or diagnose correctly, but it is also indicative of the effects many pharmaceuticals have in causing widespread lymph system disease.
Lymphatic Duct Injury
Lymphatic Duct Rupture
Lymphatic System Neoplasm
Lymph Follicular Hypertrophy
Lymph Gland Infection
Lymph Node Abscess
Lymph Node Calcification
Lymph Node Cancer Metastatic
Lymph Node Fibrosis
Lymph Node Infection
Lymph Node Pain
Lymph Node Palpable
Lymph Nodes Scan Abnormal
Lymph Nodes - Swollen
Lymph Node Tuberculosis
Lymphoblast Count Increased
Lymphocyte Count Abnormal
Lymphocyte Count Decreased
Lymphocyte Count Increased
Lymphocyte Morphology Abnormal
Lymphocyte Percentage Abnormal
Lymphocyte Percentage Decreased
Lymphocyte Percentage Increased
Lymphocyte Stimulation Test Positive
Lymphocyte Transformation Test Positive
Lymphocytotoxic Antibody Positive
Lymphoid Tissue Hyperplasia
Surgery and other physical damage
Unwise removal of key lymph system organs - the adenoids, the appendix and the tonsils, for example - as well as surgery on the spleen and thymus may all have serious long term consequences. What is less obvious is that surgery to other parts of the body may also cause blockage of the system or malfunction.
The lymph system nodes and drainage channels are interwoven with numerous organs of the body, muscles and fascia. There are between five and six hundred lymph nodes in the human body, and surgery can easily result in damage, blockage and disruption. Surgery which has apparently been successful in repairing one organ may result in damage to the lymph system which has much greater long term consequences.
Peninsula Biomedical - Case histories
In 1998, as a Christmas present to myself, I had bilateral upper arm liposuction. Dreams of finally being able to wear a sleeveless dress and go out dancing with my husband came to mind and I was excited about the possibility. The surgeon told me that he could really help me. He mentioned that I would have temporary swelling and possibly some unevenness, and also, that I may need to come back to have it redone later on in my life, but that fat cells were being permanently removed and the upper arm heaviness would be a thing of the past.
The day is April 19, 2000. Persistent swelling in my hands led me through two primary doctors and two vascular surgeons. I am given a diagnosis. It's a serious one.
I was diagnosed with bilateral arm lymphedema, stage one. It's a complication of the liposuction procedure. One vascular surgeon broke free enough of the "'ol boy" physician network to say that much, and I admire him for it. It is not an easy thing to speak up.
So here I am. But it's not that simple. I am filled with anger and hopelessness. My dream surgery took away fat, and I got something else, something I was never filled in about, advised about. I will have lymphedema for the rest of my life.
It is worth noting that this is not uncommon. Plastic surgery in general has a record of producing lymphedema, there are a number of papers on PubMed - not of what caused the damage, but of suggested ways of repairing it by lymph node transfer using microsurgery [not always successfully].
Inherited genes and gene mutation
An increasing number of genes are being implicated in malformation of the lymph system. Although gene damage is known, what caused the gene damage is less well researched although Toxins including Nanoparticles are frequently mentioned as being candidates:
GATA2 is a zinc finger transcription factor essential for embryonic and definitive hematopoiesis as well as lymphatic angiogenesis. GATA2 deficiency is caused by a variety of mutations in the GATA2 gene and can have variable presentation, onset and outcome. Patients are susceptible to mycobacterial, viral and fungal infections and can develop myelodysplasia, acute or chronic leukemias, lymphedema and pulmonary alveolar proteinosis. Hematopoietic stem cell transplantation reverses most of the clinical phenotype with good long-term outcomes. PMID: 25397911
some more research results - note the number of diseases caused by lymph system malfunction
The lymphatic vasculature plays a critical role in a number of disease conditions of increasing prevalence, such as ..obesity, blood vascular diseases, and cancer .... investigators have reported that dysregulation of the PI3K pathway is involved in syndromic human diseases that involve abnormal lymphatic vasculatures ....Using near-infrared fluorescence lymphatic imaging (NIRFLI) to phenotype and next generation sequencing (NGS) for unbiased genetic discovery in a family with non-syndromic lymphatic disease, we discovered a rare, novel mutation in INPPL1 that encodes the protein SHIP2, which is a negative regulator of the PI3K pathway, to be associated with lymphatic dysfunction in the family. In vitro interrogation shows that SHIP2 is directly associated with impairment of normal lymphatic endothelial cell (LEC) behavior and that SHIP2 associates with receptors that are associated in lymphedema, implicating its direct involvement in the lymphatic vasculature. PMID: 25383712
The first step is to find the cause and address this. Boosting the immune system is clearly not going to have much effect, because this is the immune system, so this may be one area of severe difficulty when it comes to treating the problem. The second step is to alleviate the symptoms and in this a number of options exist.
We saw that the lymph system is a closed system, it has no heart to pump lymph round the body. The circulation of lymph depends on the pressure associated with breathing, intestinal movements and the movements of skeletal muscles.
The principle benign treatments for any forms of blockage are thus going to depend on exercises that increase the breathing, or exercise the intestines and exercise the muscles.
Exercising and keeping fit
One of the first lines of treatment is Exercising and keeping fit.
Another key treatment is likely to be Controlled breathing. All of the following are likely to be useful as they affect the lungs and the intestines:
- Belly breathing -
- The bellows breathing technique
- Dharana Darshan
- Reverse breathing
- Ocean breath also called Ujjayi pranayama.
- Sahita yoga
- Circular breathing
- Embryonic breathing - used in Qigong.
Another useful treatment is Massage of the affected area - Stimulation of trigger points using acupressure or just general targeted massage. Acupuncture may also be helpful for the same reason, but in general the pressure methods are likely to be more effective. There are, theoretically machines that can also be used if you are unable to get to a person - people are more effective at massage.
Warmth and warm baths
Both warmth, because it opens and expands the body's systems and puts less stress on the immune system and hot baths or Turkish baths are likely to be of help. Similarly saunas may also bring some relief.
In creating this description it became apparent that the seriousness of this disease to human health is simply completely underestimated. The immune system is our first line of defence against pathogens and the lymph system forms a key part of the immune system. Simply put, if this system does not work we die. We can die of any number of diseases, but we will die because we no longer have any defences against disease.
There also appears to be little recognition of just how many people are affected by lymph system problems. If we take just parasite induced lymph system disease we find the following
Although two thirds of the 120 million people infected with lymph-dwelling filarial parasites have subclinical infections, ∼40 million have lymphedema and/or other pathologic manifestations including hydroceles (and other forms of urogenital disease), episodic adenolymphangitis, lymphedema, and (in its most severe form) elephantiasis. PMID: 24044755
This is twice the population of the UK.
Permanent damage to this system or gene mutations may result in a very large number of diseases immediately or later in life and yet the problem does not appear to have been recognised - it should be!
The lymphatic system is fundamentally important to cardiovascular disease, infection and immunity, cancer, and probably obesity--the four major challenges in healthcare in the 21st century. This Review will consider the manner in which new knowledge of lymphatic genes and molecular mechanisms has demonstrated that lymphatic dysfunction should no longer be considered a passive bystander in disease but rather an active player in many pathological processes and, therefore, a genuine target for future therapeutic developments. The specific roles of the lymphatic system in edema, genetic aspects of primary lymphedema, infection (cellulitis/erysipelas), Crohn's disease, obesity, cancer, and cancer-related lymphedema are highlighted. PMID: 24590276
References and further reading
Acta Virol. 1960 Jul;4:233-40. The role of the lymphatic system in experimental infection with tick-borne encephalitis. I. The tick-borne encephalitis virus in the lymph and blood of experimentally infected sheep. MALKOVA D. PMID: 13856112
Scientific American - Your Appendix could save your life By Rob Dunn | January 2, 2012
Lymphedema chronicles - this is a very important website for those with lymph system problems or those who suspect this is what they have. It has a series of case histories of people who have lymphedema principally from surgery, - plastic surgery, surgery for breast and other cancer, and surgery for other sorts of repair work that went very wrong.
- Antifilarial Lead Molecules Isolated from Trachyspermum ammi 027879
- Carum copticum L.: A Herbal Medicine with Various Pharmacological Effects - Antiparasitic activities 027883
- Causes Of Chronic Non-Infectious Diarrhoea In Infants Less Than 6 Months Of Age: Rarely Recognized Entities 027332
- Current status of after-care cures in oncologic patients 016653
- Devil's Claw-a review of the ethnobotany, phytochemistry and biological activity of Harpagophytum procumbens 016804
- Diagnosis and treatment of primary lymphedema. Consensus document of the International Union of Phlebology (IUP)-2013 016657
- Dr Duke's list of Biological activities of Coumarin 018558
- Influence of manual lymphatic drainage on health-related quality of life and symptoms of chronic venous insufficiency: a randomized controlled trial 016655
- Lymphatic pump treatment repeatedly enhances the lymphatic and immune systems 016656
- Lymphedema after breast or gynecological cancer: use and effectiveness of mainstream and complementary therapies 016654
- Mrs Grieve on Fenugreek 016791
- Patent literature on mosquito repellent inventions which contain plant essential oils--a review 016774
- Self care integrative treatment demonstrated in rural community setting improves health related quality of life of lymphatic filariasis patients in endemic villages 016652
- Yoga management of breast cancer-related lymphoedema: a randomised controlled pilot-trial 016651
- A case of Castleman's disease with a variable neuropsychiatric symptomatology 016650
- CNS Diseases and Uveitis 027568
- Creutzfeldt-Jakob disease - hallucinations and visions 016647
- Hallucinations from enlarged hilar lymph nodes and a tumour 016649
- Isoniazid-induced visual hallucinosis in Lymph node tuberculosis 016648
- Louis XVII of France hears celestial music as he dies 027857
- Torisel hallucinations 006926
- West Nile Virus Central Nervous System Infection in Patients Treated With Rituximab: Implications for Diagnosis and Prognosis, With a Review of Literature 027567
- Creutzfeldt-Jakob disease - hallucinations and visions 016647
- Thomas, Elizabeth and Phyllis come to visit 021618
- Louis XVII of France hears celestial music as he dies 027857
- Thomas, Elizabeth and Phyllis come to visit 021618