Repetition of Helicobacter cinaedi infections during chemotherapy for malignant lymphoma

A 70-year-old male, who had undergone resection of gastric malignant lymphoma in 1992, presented with cervical lymph node swelling in January 2008. Pathological examination of the lymph node biopsy demonstrated recurrence of malignant lymphoma, and he was treated with the R-CHOP regimen. Although he did not develop fever during the first through third course of R-CHOP, from the fourth course, he repeatedly demonstrated fever over 38°C for about one week after each course of chemotherapy, despite the absence of neutropenia. Helicobacter cinaedi infection was confirmed by blood culture each time. Although it is difficult to diagnose Helicobacter cinaedi infection by the standard culture method, increased numbers of recent reports especially in immunocompromised patients have emphasized the importance of diagnosing Helicobacter cinaedi infection.     

Helicobacter cinaedi bacteremia with cellulitis after ABO-incompatible living-donor liver transplantation: Case report

Helicobacter cinaedi (H. cinaedi), a Gram-negative spiral-shaped bacterium, is an enterohepatic non-Helicobacter pylori Helicobacter species. We report the first case of H. cinaedi bacteremia with cellulitis after liver transplantation. A 48-year-old male, who had been a dog breeder for 15 years, underwent ABO-incompatible living-donor liver transplantation for hepatitis C virus-induced decompensated cirrhosis using an anti-hepatitis B core antibody-positive graft. The patient was preoperatively administered rituximab and underwent plasma exchange twice to overcome blood type incompatibility. After discharge, he had been doing well with immunosuppression therapy comprising cyclosporine, mycophenolate mofetil, and steroid according to the ABO-incompatible protocol of our institution. However, 7 mo after transplantation, he was admitted to our hospital with a diagnosis of recurrent cellulitis on the left lower extremity, and H. cinaedi was detected by both blood culture and polymerase chain reaction analysis. Antibiotics improved his symptoms, and he was discharged at day 30 after admission. Clinicians should be more aware of H. cinaedi in immunocompromised patients, such as ABO-incompatible transplant recipients.     

Recurrent bacteremia with Helicobacter cinaedi: case report and review of the literature

Background

A reliable prediction of the causative agent of community-acquired pneumonia (CAP) is not possible based on clinical features. Our aim was to test, whether the measurement of the expression of complement receptors or Fcγ receptors on neutrophils and monocytes would be a useful preliminary test to differentiate between bacterial and viral pneumonia.

Methods

Sixty-eight patients with CAP were studied prospectively. Thirteen patients had pneumococcal pneumonia; 13 patients, influenza A pneumonia; 5 patients, atypical pneumonia, and 37 patients, aetiologically undefined pneumonia. Leukocyte receptor expression was measured within 2 days of hospital admission.

Results

The mean expression of complement receptor 1 (CR1) on neutrophils was significantly higher in the patients with pneumococcal pneumonia than in those with influenza A pneumonia. The mean expression of CR1 was also significantly higher in aetiologically undefined pneumonia than in influenza A pneumonia, but there was no difference between pneumococcal and undefined pneumonia.

Conclusion

Our results suggest that the expression of CR1 is higher in classical bacterial pneumonia than in viral pneumonia. Determination of the expression of CR1 may be of value as an additional rapid tool in the aetiological diagnosis, bacterial or viral infection, of CAP. These results are preliminary and more research is needed to assess the utility of this new method in the diagnostics of pneumonia.     

Pericardial constriction due to malignant lymphoma

We experienced a case of T-cell lymphoma demonstrating diastolic heart failure as an initial manifestation. An 81-year-old Japanese male was admitted to the University of Tokyo Hospital because of progressive dyspnea and general fatigue. Clinical presentation was congestive heart failure and cervical lymphadenopathy. Right heart catheterization revealed "dip and plateau" waveforms in right ventricular pressure, which suggested a constrictive nature of heart failure. Gallium scintigram showed marked uptake in the heart. Biopsy from a cervical lymph node confirmed the diagnosis of malignant lymphoma of T-cell origin. Diastolic heart failure remained after successful chemotherapy. Autopsy revealed pericarditis with severe adhesion of the pericardium and the epicardium.     

Acute exacerbation of hepatitis due to reactivation of hepatitis B virus with mutations in the core region after chemotherapy for malignant lymphoma

A 43-year-old Japanese man who was positive for hepatitis B surface (HBs) antigen and HB e antibody, underwent chemotherapy for non-Hodgkin’s lymphoma. After the chemotherapy he suffered from acute exacerbation of hepatitis because of reactivation of HBV. Recovery was achieved with interferon-α, glucagon-insulin therapy, and plasma exchange. Mutations were detected in codons 97, 100, 129, and 131 of the core region of HBV. The peptide encoded from the core region including such mutations possibly had greater antigenicity to induce cytotoxic T cell activity in the host. Core region mutations may be a crucial cause of the acute exacerbation of hepatitis B seen after chemotherapy.     

Gynecomastia after chemotherapy for lymphoma

Although development of gynecomastia in a patient with cancer may indicate persistence or regrowth of a tumor, we studied three patients with lymphoma in whom development of gynecomastia during or after chemotherapy did not portend a poor outcome. In all patients, serum testosterone levels were normal, serum luteinizing hormone (LH) levels were high-normal or elevated, and serum follicle-stimulating hormone (FSH) levels were clearly elevated. The serum estradiol level of one patient was elevated at the onset of gynecomastia, but it fell to normal as the gynecomastia resolved spontaneously over a three-month period during which the patient received no chemotherapy. In a second patient, gynecomastia resolved over a period of eight months while the patient continued on maintenance chemotherapy, and he remains clinically well in remission 21/2 years after onset of gynecomastia. In the third patient, gynecomastia developed while the patient was in complete remission and off of all therapy, and it remained unchanged for the duration of a 21/2-year remission without therapy. Gynecomastia after chemotherapy for lymphoma is not an ominous prognostic sign and does not necessarily indicate the need for alteration of the treatment regimen.     

Reversible complete atrioventricular block due to malignant lymphoma

An 83-year-old man was hospitalized due to general fatigue anddyspnoea. He was diagnosed as having complete atrioventricular(AV) block due to cardiac involvement by a malignant lymphoma.Eleven days after the initiation of chemotherapy, the completeAV block disappeared and only a first degree AV block remained.     

Disappearance of complete atrioventricular block after chemotherapy for malignant lymphoma: a case report

A 77-year-old man with malignant lymphoma presented with dizziness and exertional dyspnea. Physical examination revealed marked bradycardia (36 beats/min). Twelve-lead electrocardiography showed complete atrioventricular block with narrow QRS escape beats. Gallium scintigraphy demonstrated significant abnormal uptake in the heart. Transesophageal echocardiography showed a thick interatrial septum with increased echogenecity. He underwent chemotherapy under external temporary pacing with a suspected diagnosis of complete atrioventricular block secondary to cardiac invasion of malignant lymphoma. Atrioventricular conduction progressively improved and the complete atrioventricular block disappeared. He is currently well and has required no cardiac pacing for 6 months. We conclude that complete atrioventricular block may be reversible in some patients with malignant lymphoma, even in the elderly.     

Esophageal stricture following complete remission after chemotherapy for malignant lymphoma in an elderly patient

A 75-year-old woman was given a diagnosis of malignant lymphoma (non-Hodgkin, diffuse large B cell type, stage IIA) at our hospital on August 2003. She received six courses of rituximab-based chemotherapy (R-CHOP regimen) and then she achieved complete remission. On August 16, 2004, she was readmitted in our hospital for difficulty in swallowing. Upper gastrointestinal endoscopy reveled esophageal stricture and an ulcerative lesion on the esophageal mucosa. The X-ray examination of the upper gastrointestinal tract reveled a severe esophageal stricture with niches and hiatus hernia. No malignancy was seen on CT scanning, gallium radioisotope scanning and histological examination of biopsy specimens with the upper gastrointestinal endoscopy. The physical examination showed gibbosity, and MR imaging showed multiple compression spined fractures. Finally, we diagnosed benign esophageal stricture with reflux esophagitis. She underwent laparoscopic partial esophagectomy in September 21, 2004, and the postoperative course was satisfactory. The pathological findings showed benign esophageal stricture caused by esophagitis. We report here a case of esophageal stricture following complete remission after chemotherapy for malignant lymphoma in an elderly patient.     

努力提高恶性淋巴瘤规范化治疗的水平

恶性淋巴瘤 (ＭＬ)包括霍奇金淋巴瘤 (ＨＬ)和非霍奇金淋巴瘤 (ＮＨＬ)两大类。近年来ＮＨＬ的发病率明显升高 ,而ＨＬ则有所下降 ,ＭＬ已成为人们关注的重要疾病之一。一、ＭＬ病理分类的演进196 5年制定的ＨＬ的Ｒａｙ分类一直使用了 30多年。ＮＨＬ的分类则经历了几次较大的变化 ,2 0世纪 70年代以前的分类基础是形态学和组织病理学 ,以后出现了几种基于免疫分型的分类方法。 1994年提出了修改的欧美淋巴瘤分类 (ＲＥＡＬ分类 ) [1] ,在此基础上 ,ＷＨＯ于 2 0 0 0年提出了淋巴造血系统肿瘤的新的病理分类方法。这一分类包含了所有淋巴造…     

Feasibility and obstacles in home chemotherapy for malignant lymphoma

Home care has become a treatment option for cancer patients; however, medical practice at patients' homes has been expected mainly for terminal care in Japan. Most physicians believe that it is difficult to treat patients with hematologic malignancy at home because they frequently develop complications requiring urgent interventions. We herein report the case of an 80-year-old patient with advanced follicular lymphoma who safely received aggressive chemotherapy at home and finally died due to disease progression at the hospital. Home chemotherapy can be a feasible and potentially novel treatment option for some patients with hematologic malignancy, although the clinical course of the present patient suggested that patient selection is critical for the safe operation of home chemotherapy and that it is important to educate families on how to evaluate patients' conditions and how to cope with aggravation and admission arrangements in back-up hospitals.     

Surgical resection of malignant lymphoma in the right atrium after systemic chemotherapy

A 74-year-old man was referred to us for evaluation of a tumor in the right atrium (RA). Transesophageal echocardiography (TEE) showed an unmovable 50x60 mm mass in the RA. Based on histological findings of subcutaneous tumors in the right abdominal wall, he was diagnosed as malignant lymphoma (ML), and treated with a THP-COP regimen. Upon completion of first THO-COP therapy, TEE showed marked regression of the mass and division into 3 masses, one of which showed marked floating movement with a small stalk. To prevent the risk of embolic events, surgical resection was performed. Resected tumors were necrotic tissues. Serial imaging of cardiac tumor and surgical resection is desirable to decrease the possibility of embolic complication.     

Sick sinus syndrome after chemotherapy for malignant lymphoma with right atrial tumor at initial presentation

A 56-year-old man was admitted complaining of throat discomfort and dyspnea. He was given a diagnosis of diffuse large B-cell lymphoma on the basis of findings from tumor biopsy specimens of his left pharynx. MRI tomograms and ultrasonic cardiograms revealed a right atrial tumor causing tricuspid stenosis. Although chemotherapy rendered the cardiac tumor indistinct on MRI and UCG images, gallium-67 scintigraphy still demonstrated abnormal cardiac uptake. After 6 courses of CHOP therapy, sick sinus syndrome with syncope suddenly developed in the patient. A cardiac pacemaker was immediately implanted, and radiotherapy was started. The patient's sinus rhythm returned to normal shortly afterward, and the gallium-67 uptake eventually disappeared. In this case gallium-67 scintigraphy was the only diagnostic procedure capable of detecting evidence of residual disease.     

Cardiac malignant lymphoma successfully treated with chemotherapy

We report the case of an 83-year-old woman with diffuse large B-cell lymphoma located in the right cardiac ventricle revealed by acute congestive heart failure. Complete and long-lasting disappearance of the cardiac tumor was observed with monochemotherapy (cyclophosphamide).     

Systemic lupus erythematosus six years following chemotherapy for malignant lymphoma

A 62-year-old woman who developed systemic lupus erythematosus 6 years following chemotherapy for malignant lymphoma is reported.     

Cytolethal distending toxin: a potential virulence factor for Helicobacter cinaedi

Although Helicobacter cinaedi is the most commonly reported enterohepatic helicobacter in humans, there are no reports of virulence factors, and little is known about how it infects and causes disease. In this study, H. cinaedi isolates from humans and animals were examined for production of cytolethal distending toxin (Cdt). Cdt causes distention in cells and arrest in the G2/M phase of cell division. It is encoded by three genes: cdtA, cdtB, and cdtC. cdtB is the most conserved. All isolates except the American Type Culture Collection strain (identified as H. fennelliae) demonstrated Cdt activity and had a cdtB polymerase chain-reaction product homologous with known cdtB. Deduced amino acid sequences of cdtB showed a high (93%-99%) degree of similarity among the H. cinaedi isolates. H. cinaedi shares the production of Cdt with other enteric pathogens, including enterohepatic Helicobacter species. This is the first report of a putative virulence factor in H. cinaedi.     

Successful endoscopic hemostasis for gastric arterial bleeding due to invasion of malignant lymphoma

A 75-year-old male with malignant lymphoma (ML) accompanied with gastric lesion was treated with combination chemotherapy. The patient produced tarry stool on the 4th d, and emergency gastroscopy showed arterial bleeding from the lesion. Hemostasis was achieved by injecting pure ethanol and using hemostatic clips. There is only one previous report on endoscopic hemostasis being effective for bleeding due to lymphoma. Since gastric bleeding causes significant mortality, endoscopic hemostasis should be considered as first-line treatment for ML patients who were treated with chemotherapy.     

Pneumothorax following cytotoxic chemotherapy in malignant lymphoma.

Pneumothorax occurring as a complication of the antitumor effect of cytotoxic chemotherapy has been reported in occasional cases of a variety of tumors. Its occurrence in malignant lymphoma has not been reported heretofore. In this report, we describe two cases of this complication in patients with malignant lymphoma and discuss the possible pathophysiologic mechanisms involved. Because pulmonary involvement with the tumor was found in both cases, pneumothorax could be attributed to the anti-tumor effect of cytotoxic agents on underlying lung involvement in patients with malignant lymphoma.