A case of leukemic pleural infiltration in atypical chronic myeloid leukemia

Pleural effusion in chronic myeloid leukemia (CML) is poorly understood and rarely reported in the literature. When the pleural effusion is caused by leukemic pleural infiltration, the differential white blood cell count of the effusion is identical to that of the peripheral blood, and the fluid cytology reveals leukemic blasts. We report here a case of bilateral pleural involvement of atypical CML in an 83-yr old male diagnosed with pancreatic cancer with abdominal wall metastasis and incidental peripheral leukocytosis. Based on bone marrow examination, chromosome analysis and polymerase chain reaction he was diagnosed with Philadelphia chromosome negative, BCR/ABL gene rearrangement negative CML. Following 3 months of treatment with gemcitabine for pancreatic cancer, he developed bilateral pleural effusions. All stages of granulocytes and a few blasts were present in both the pleural fluid and a peripheral blood smear. After treatment with hydroxyurea and pleurodesis, the pleural effusion resolved.     

Clinical Features and Prognosis of Invasive Pulmonary Aspergillosis in Korean Children with Hematologic/Oncologic Diseases

Invasive pulmonary aspergillosis (IPA) is the most frequent form of invasive fungal diseases in immunocompromised patients. However, there are only a few studies on IPA in immunocompromised children in Korea. This study was designed to characterize IPA in Korean children with hematologic/oncologic diseases. Medical records of children with hematologic/oncologic diseases receiving antifungal therapy were reviewed. The enrolled children were divided into the IPA group (proven and probable IPA) and non-IPA group, and the clinical characteristics and prognosis were compared between the two groups. During the study period, 265 courses of antifungal therapy were administered to 166 children. Among them, two (0.8%) episodes of proven IPA, 35 (13.2%) of probable IPA, and 52 (19.6%) of possible IPA were diagnosed. More children in the IPA group suffered from neutropenia lasting for more than two weeks (51.4% vs. 21.9%, P<0.001) and showed halo signs on the chest computed tomography (78.4% vs. 40.7%, P<0.001) than in the non-IPA group. No other clinical factors showed significant differences between the two groups. Amphotericin B deoxycholate was administered as a first line antifungal agent in 33 (89.2%) IPA group episodes, and eventually voriconazole was administered in 27 (73.0%) episodes. Ten (27.0%) children in the IPA group died within 12 weeks of antifungal therapy. In conclusion, early use of chest computed tomography to identify halo signs in immunocompromised children who are expected to have prolonged neutropenia can be helpful for early diagnosis of IPA and improving prognosis of children with IPA.

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Ribosome-lamella complex of leukemic cells in a patient with aggressive NK cell leukemia

A 36-year-old male was admitted to the hospital with anemia and leukopenia. A bone marrow specimen revealed the proliferation of leukemic cells with flower-like nuclei observed in adult T-cell leukemia. The leukemic cells were positive for HLA-DR, CD2, CD7, and CD56. A diagnosis of aggressive NK cell leukemia was made, the patient was treated with induction chemotherapy and cord blood stem cell transplantation, and he is well now. Seen with electron microscopy, some leukemic cells had ribosome-lamella complexes (RLC). This is the first reported case of leukemic cells with flower-like nuclei seen with light microscopy and RLC seen with electron microscopy.     

Fatal Aspergillosis of the Renal Vasculature in a Combined Liver-Kidney Transplant Recipient

Invasive aspergillosis remains a problem in solid organs and haematopoietic stem cell transplants. We report a case of 12-year-old female with primary hyperoxaluria with regular haemodialysis for the end-stage renal disease. She underwent a combined liver and renal transplantation which got infected by aspergillosis. In this case study, it is speculated that the most likely source of Aspergillus was contaminated preservative solution (perfusate), resulting in infection within the donor kidney and subsequent systemic infection in the recipient. This case study calls for critical analysis and needs for the routine culture of the preservative solution before transplantation, to detect any fungal contamination and manage it prophylactically.     

Nasopharyngeal carcinoma mimicking Aspergillosis rhinosinusitis: an unusual case report and review of the literature

Clinical symptoms and imaging features of fungal infection are confused with those of atypical nasopharyngeal carcinoma (NPC), and therefore development of a more effective diagnostic method is essential. It is a common knowledge that there is a significant association between Epstein-Barr virus (EBV) and nonkeratinizing NPC. However, fungal infection may be considered to be a vital etiologic agent contributing to the NPC and more evidence is needed to be approved this theory. We report on a rare case of a patient with atypical nasopharyngeal carcinoma (NPC) who suffered from chronic fungal infection and was diagnosed initially as Aspergillosis. Following anti-aspergillus infection therapy, the repeated deep biopsy of the maxillary sinus and MRI confirmed the diagnosis of nasopharyngeal carcinoma (NPC).     

Free flap coverage of extensive soft tissue defect in cutaneous aspergillosis: a case report

Isolated fungal soft-tissue infections are uncommon, but may cause severe morbidity or mortality. Aspergillosis infection is rare, but the frequency in increasing over the last two decades. Here, we present a patient with cutaneous aspergillosis of his right elbow with unusual clinical and radiological features suggestive of a malignant disease, which remained undiagnosed for an extended period of time. The patient presented with necrotic, black-colored skin ulcerations. We completely removed the skin ulcer with the surrounding erythematous skin lesion, and then we reconstructed the area with thoracodorsal perforator free flap. The biopsy specimen contained septate hyphae with dichotomous branching, which is morphologically consistent with a finding of Aspergillus. After surgery, we initiated antifungal medication therapy with amphotericin B and itraconazole. At the time of follow-up, the elbow with the reconstructed flap had fully healed, and no recurrent disease was found.     

Blood cultures in paediatric patients: a study of clinical impact

PURPOSE: Blood cultures form a critical part of evaluation of patients with suspected sepsis. The present study was undertaken to study the risk factors, duration of incubation for obtaining positive cultures and the clinical impact of the culture report. METHODS: A total of 220 samples from 107 pediatric patients presenting with suspected bacteraemia were processed aerobically. RESULTS: Cultures were positive in 18.7% of the samples. Most of the positive cultures were obtained after 24 hours of incubation of the broth and no isolates were obtained beyond day 4 of incubation. Therapy was modified in 54.23% of the patients after receipt of culture report. CONCLUSIONS: Incubation beyond four days (unless with specific indication like enteric fever) may be unnecessary for issuing a negative culture report. Repeated isolation of doubtful pathogens confirms true bacteraemia. Early culture report increases therapeutic compliance.     

Meningeal relapse in a patient with acute promyelocytic leukemia: a case report and review of the literature

The involvement of central nervous system is rare in acute promyelocytic leukemia (APL). We report a APL patient of a 41 yr-old Korean male who presented with fever and petechia. Complete molecular remission was achieved with all-trans retinoic acid (ATRA), idarubicin, and cytarabine. Ten months later, he complained of a mild headache. The results of the physical examination and the complete blood counts were normal. The examination of cerebrospinal fluid showed the presence of promyelocyte. Bone marrow studies showed cytogenetic remission but with molecular relapse. He was treated with intrathecal and systemic chemotherapy.     

Prospective evaluation of blood cultures in a Turkish university hospital: epidemiology, microbiology and patient outcome

The aims of this prospective study were to: (1) determine the rate of blood culture contamination; (2) describe and compare the epidemiologic, clinical and microbiological characteristics of hospital- and community-acquired bloodstream infections; and (3) determine the mortality resulting from bloodstream infections. The rate of true bacteremia was 12.1%, and 10.7% of cultures were contaminated. Of the 567 episodes of bloodstream infection, 73.4% were hospital-acquired, and 26.6% were community-acquired. The most commonly isolated microorganisms were staphylococci (44%, methicillin resistant 69.4%), enterococci (15%) and Escherichia coli (12.5%) in hospital-acquired episodes, and Brucella spp. (21.9%), E. coli (19.2%) and Staphylococcus aureus (14.6%, methicillin resistant 9.1%) in community-acquired episodes. While the overall mortality rate was 25.4%, death attributable to bloodstream infections was 16.6% in hospital-acquired episodes and 13.9% in community-acquired episodes. The highest mortality occurred in patients with bacteremia due to Pseudomonas aeruginosa (37.5%) in hospital-acquired episodes, and in patients with bacteremia due to Streptococcus pneumoniae (50%) in community-acquired episodes. Underlying diseases, severity of illness, presence of bladder catheter, previous use of antibiotics, tracheal intubation and adequacy of treatment were found to be significantly associated with death.     

First case of proven invasive pulmonary infection due to Trichoderma longibrachiatum in a neutropenic patient with acute leukemia

Trichoderma species are saprophytic filamentous fungi that can be found all over the word. These fungi show increasing medical importance as opportunistic human pathogens, particularly in immunocompromised patients. Invasive infections due to Trichoderma are rare and definitive diagnosis is complex to achieve because of the lack of specific diagnosis tools. We report in this work the first proven case of invasive pulmonary infection due to T. longibrachiatum in a 69-year-old white male with hematologic malignancy. The patient was successfully treated initially with voriconazole alone followed by a combination of voriconazole and caspofungine.     

急性白血病外周血白细胞直方图、粒／单比值和血小板变化的临床意义

目的和方法：用ＣｏｕｌｔｅｒＪＴ－ＩＲ血细胞计数仪检测５５例急性白血病患者血象，探讨外周血细胞和血小板数变化在急性白血病诊治中的临床意义。结果：不同类型急性白血病无特异的白细胞直方图图型，８７３％的患者在化疗前有Ｍｏ峰面积增多；５０９％的患者呈Ｍｏ峰单峰图形。化疗前患者粒／单化值较正常人低，而与化疗后未缓解（ＮＲ）者差别不显著；化疗后完全缓解（ＣＲ）者粒／单比值显著高于ＮＲ者。在缓解时，患者粒／单比值和血板数同时较治疗前高，而未缓解时，两者均较治疗前低     

Cerebral aspergilloma presenting as atypical meningioma in an immunologically competent patient: a case report

A 36-year-old man presented with history suggestive of intracranial space occupying lesion. Computed tomography of brain revealed a large lobulated, extra axial, hyperdense lesion in the right fronto-temporal region extending up to to the right frontal and ethmoidal sinuses, eroding the bone, enhancing homogeneously with contrast, which was suggestive of atypical meningioma. He had no predisposing factors that could lead to the suspicion of opportunistic infection. Craniotomy and total excision of the lesion was done. Histopathological study revealed aspergilloma.     

An atypical case of islet cell hyperplasia in a wistar rat

The present article describes an unusual proliferative islet finding observed incidentally in a young male Wistar rat in a 2-week toxicity study. Histologically, the islet lesion was characterized by diffuse enlargement of the islets, which consisted of peripheral proliferation of non-insulin-containing islet cells surrounding normal-appearing insulin-containing cells in the center. To the authors' knowledge, this is the first report of spontaneous proliferative islet lesion composed of non-insulin-containing cells in young rats.     

Blood loss in the minimally invasive posterior approach to total hip arthroplasty: a comparative study

AIMS: Our primary aim was to evaluate whether there is really less bleeding in patients for whom the minimally invasive posterior approach is used in comparison with the direct lateral approach for primary total hip arthroplasty. Our secondary aim was to evaluate the clinical functional results after six months as well as the postoperative radiographic result. METHODS: In a comparative non-random prospective study, 76 adult patients underwent elective total hip arthroplasty using one of two approaches. The minimally invasive posterior approach (34 cases; mini-incision group) was compared with the standard direct lateral approach (42 cases; control group). RESULTS: Lower total estimated bleeding (means of 1083.5 ml versus 1682.3 ml; p < 0.001) and lower intraoperative bleeding (means of 745.6 ml versus 1282.8 ml; p < 0.001) were found in the mini-incision group. There was, however, no difference in the volume of blood drained after the operation (means of 340 ml and 399 ml; p = 0.77). There was also a difference between the two groups regarding the need for allogenic transfusion (8.8% in the mini-incision group versus 28.6%, p = 0.02). We observed a better clinical result in the mini-incision group (p = 0.002) despite the lack of difference between the two groups in relation to the radiographic result. DISCUSSION: Our results draw attention to the possibility that other authors may have underestimated blood losses when using minimally invasive approaches. CONCLUSION: The minimally invasive approach gave rise to a positive final impression with regard to lower blood loss.     

Recurrent intraparenchimal haemorrhages in a patient with cerebral amyloidotic angiopathy: description of one autopsy case

Cerebral amyloidotic angiopathy represents the most frequent cause of lobar haematoma in young patients and represents 5-10% of the non-traumatic cerebral haemorrhages. In the present work, we describe one autoptic case of recurrent cerebral haemorrhages in a 58-year-old woman. Macroscopically in the brain multiple haemorragic areas were present in the right frontal pole, right frontal and temporo-parietal lobes with homolateral ventricular inundation. The histological, histochemical, immunohistochemical, ultrastructural and biomolecular investigations confirmed the presence of amyloid deposits in the middle-size and little-size cerebral arteries. We report, moreover, a novel mutation (Leu705Val) within the Abeta sequence of a AbetaPP in a family with autosomal dominant, recurrent intracerebral hemorrhages beginning in the sixth decade of life.     

A tale of 2 cousins: An atypical and a typical case of abetalipoproteinemia

Abetalipoproteinemia (ABL) is a rare recessive genetic disease caused by mutations of the MTTP gene. This disease is characterised by a defect in the lipidation of APO B and the absence of VLDL and chylomicron production. Patients affected by ABL present neurological, hemalogical and gastro-intestinal symptoms due to deficiency in lipophilic vitamins and fat malabsorption. We herein report the case of two cousins, one presenting classical symptoms of abetalipoproteinemia and one presenting a much attenuated phenotype. The proband carried a novel combination of MTTP mutations, the 1867+1G>A and the R540C mutations. This patient never received any vitamin supplements and was relatively free of symptoms despite an undetectable APO B concentration. Her cousin was homozygous for 1867+1G>A MTTP mutation and presented most of the classical symptoms of ABL. In conclusion we report a very unusual kindred where on affected member is strongly symptomatic of ABL whereas the other presents very mostly asymptomatic disease suggesting that ABL can present itself with a very incomplete clinical penetrance.