Managing the challenge of PTLD in liver and bowel transplant recipients

Post‐transplant lymphoproliferative disorder (PTLD) remains a common complication of liver and bowel transplantion. The ubiquity of Epstein‐Barr virus (EBV) combined with engraftment of organs rich with lymphatic tissue and the requirement of highly immunosuppressive regimens are factors that account for the high frequency and poor prognosis of PTLD in this population. Early detection of the virus followed by pre‐emptive reduction of immunosuppression are essential components in the management of PTLD, but can increase the risk of graft loss. More recently, the anti‐CD20 monoclonal antibody (rituximab) has been shown to improve survival in various transplant populations with PTLD, while other therapeutic options, such as chemotherapy, surgery or radiotherapy, have minimal clinical impact. EBV‐directed cytotoxic T cells have shown promise in the management of PTLD but clinical use is currently limited by lack of technical facilities worldwide.     

Life-threatening hemophagocytic syndrome triggered by disseminated toxoplasmosis in a young patient with previously unknown AIDS

Hemophagocytic syndrome is a rare life-threatening disorder that can be triggered by various conditions such as HIV infection and opportunistic agents. We report a case of disseminated toxoplasmosis complicated with severe hemophagocytic syndrome and revealing an unknown acquired immunodeficiency syndrome. The patient presented with multiple organ failure in intensive care unit. Once diagnosed, he benefitted from etoposide infusion, administration of specific anti-toxoplasmosis treatments and secondary antiretroviral therapy. He was alive at intensive care unit discharge and returned home with little sequalae. This case illustrates both the importance of rapid investigations of hemophagocytic syndrome etiologies in HIV positive patients and the necessity to prompt etoposide and specific treatments in order to improve potentially dramatic outcomes.     

血浆中EB病毒核酸载量与鼻咽鳞状细胞癌分化的关系

目的 探索血浆中EB病毒的定量与鼻咽鳞状细胞癌分化的关系.方法 收集组织学为鳞状细胞癌的鼻咽癌38例,运用免疫荧光法测定血浆中EB病毒DNA水平和外周血CEA含量.结果 不同分化组患者血浆EB病毒定量有统计学差异（P=0.018）.不同分化组患者血CEA无统计学差异（P=0.806）.结论 血浆中EB病毒DNA水平与鳞状细胞癌分化关系密切,血浆中EB病毒定量与组织中的EB病毒RNA水平可能存在着某种关联,并且由此影响着疾病的转归和发展.     

Simultaneous presentation of hemophagocytic syndrome and mesenteric vasculitis in a patient with systemic lupus erythematosus

Abstract

We report an 18-year old female patient with systemic lupus erythematosus (SLE), who developed fever, pancytopenia, abdominal pain, and watery diarrhea. Computed tomography (CT) and bone marrow aspirate revealed lupus mesenteric vasculitis (LMV) and hemophagocytic syndrome (HPS). Serologic tests for Epstein–Barr virus (EBV) indicated its reactivation. This case demonstrates that HPS and concomitant LMV associated with viral reactivation can occur as clinical manifestations of SLE flare.     

The role of Epstein–Barr virus in cancer

Epstein–Barr virus (EBV), discovered > 40 years ago from a Burkitt’s lymphoma biopsy, was the first virus to be directly associated with human cancer. EBV has two distinct life cycles in the human host; a lytic form of infection that produces new infectious virions, and a latent form of infection that allows the virus to persist in a dormant state for the lifetime of the host. EBV has evolved a life cycle that mimics the natural differentiation pathway of antigen-activated B cells, giving the virus access to its site of latent infection, the resting memory B cell. By steering infected cells through the various stages of lymphocyte differentiation, EBV is able to enter a cell type suitable for long-term latent persistence and periodic reactivation. However, its presence in various stages of B-cell development, and its ability to infect certain epithelial cells, can have pathogenic consequences, and can contribute to the development of a diverse group of lymphomas and carcinomas. The presence of EBV in the tumour cells of EBV-associated cancers might provide a basis for specific therapy. This article focuses on the contributions that the virus may play in different types of human cancer, particularly Burkitt’s lymphoma, Hodgkin’s lymphoma, lymphomas and lymphoproliferative diseases in the immunocompromised, and nasopharyngeal and gastric carcinoma.     

人白细胞α型干扰素治疗小儿传染性单核细胞增多症的观察

本文报道用人白细胞α型干扰素治疗传染性单核细胞增多症（ＩＭ）３１例。干扰素用量为１×１０７ｕ，每日肌注一次，连续５～７天。结果：干扰素治疗病例的热程、咽峡炎、淋巴结肿大、肝脾肿大持续时间均较非干扰素治疗组（２７例）明显缩短，其热程缩短１周左右。由此表明干扰素治疗ＩＭ可缩短疾病的病程，有抗ＥＢＶ活性。     

An autopsy case of late-onset Epstein–Barr virus associated post-transplant lymphoproliferative disorders 11 yr after kidney transplantation

Abstract:  A 42-yr-old Japanese female presented with right cervical lymphadenopathy. She had been diagnosed with IgA glomerulonephritis at the age of 19 and had a one-yr history of hemodialysis after giving birth to her first child. At the age of 31, she had a living-related renal transplantation from her mother. On admission, she was diagnosed with diffuse large B-cell lymphoma (DLBL) by lymph node biopsy and was treated with Rituxymab plus CHOP (Rituximab/Cyclophosphamide/Doxorubicin/Vincristine/Prednisone). However, the therapy was not successful, and the patient had a rapidly deteriorating clinical course with elevated Epstein–Barr virus (EBV) loads in her peripheral blood. She died four months after the onset of lymphoma, because of disseminated intravascular coagulation and multiple organ failure. In kidney transplantation, the incidence of post-transplant lymphoproliferative disorders (PTLD) is between 0.4% and 2% and mostly occurs within a year after transplantation, in strong association with EBV infection. Late-onset PTLD, however, is more like standard lymphomas and is rarely induced by EBV. The present case was quite atypical of late-onset PTLD because the patient's high viral load was first detected 11 yr after transplantation and presented as a monomorphic B-cell lymphoma.     

Phototoxicity and photoallergy in man

Photosensitivity is the broad term used to denote adverse reactions to the sun. These reactions may be phototoxic or photoallergic. Phototoxic reactions are much more common than photoallergic reactions. Phototoxic reactions may be photodynamic or nonphotodynamic in nature, the primary difference being that photodynamic reactions require oxygen. Porphyrins are examples of molecules which produce photodynamic responses. The 8-methoxypsoralen photobinding to DNA is an example of a nonphotodynamic reaction. The UVB sunburn response is the most common phototoxic reaction, and it appears to be nonphotodynamic in nature. Photoallergy is uncommon. As with all allergies it is an acquired, altered reactivity dependent on an antigen-antibody or cell-mediated hypersensitivity response. Solar urticaria due to UVB rays is an example of a circulating antibody-dependent reaction, and allergic photocontact dermatitis induced by the halogenated salicylanilides is an example of a cell-mediated response. The mechanisms of these reactions are discussed.     

The effect of nicotine extraction filters on pulse rate and vasomotor activity: A methodological note

Smoking cigarettes through high- or low-nicotine extraction filters produced cardiovascular changes similar to those produced by smoking high- and low-nicotine cigarettes. The methodological implications of these findings are discussed.