RESUMO
Development of post-chemotherapy histiocyte-rich pseudotumor (PHP) is an underrecognized event following therapy in lymphoma patients and may mimic residual tumor using current therapy monitoring protocols. We report a series of 5 patients with PHP along with a review of the literature. In our series, we describe 3 patients with persistent hypermetabolic masses by positron emission tomography-computed tomography, one with persistent terminal ileal nodules on endoscopy, and one with bone marrow involvement, a site not associated with mass-like disease. Twenty-three patients with long-term follow-up were identified from our series and review of the literature. Forty-four percent of patients received additional therapy, and only 4% of patients died of lymphoma. This study illustrates that PHPs are not identified using current lymphoma therapy monitoring algorithms and may result in overtreatment with risk for additional therapy-related complications. The need for confirmatory tissue biopsy in this setting is recommended.
Assuntos
Histiócitos , Linfoma/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasia ResidualAssuntos
Infecções por Adenovirus Humanos/diagnóstico , Creatinina/sangue , Febre de Causa Desconhecida/etiologia , Transplante de Rim , Complicações Pós-Operatórias/diagnóstico , Pielonefrite/diagnóstico , Doença Aguda , Infecções por Adenovirus Humanos/sangue , Adulto , Biomarcadores/sangue , Humanos , Masculino , Complicações Pós-Operatórias/sangue , Pielonefrite/sangue , Pielonefrite/etiologiaRESUMO
We present the case of a 16-year-old boy who presented with fatigue, polyuria, and polydipsia while on chemotherapy for his relapsed acute lymphoblastic leukemia (ALL). Blood gas examination confirmed the diagnosis of hyperosmolar hyperglycemic state. The etiology for his hyperglycemia was most likely a result of oral glucocorticoid therapy combined with asparaginase therapy-both are a cornerstone of induction chemotherapy for ALL. The patient was aggressively rehydrated with saline, and medications were administered to correct his hyperkalemia. He was then slowly brought to euglycemia with a continuous infusion of insulin. Although hyperosmolar hyperglycemic state is rare during the treatment of ALL, frontline providers should be aware of this diagnosis because of the significant risk of hypovolemic shock and death if correction of hyperglycemia occurs prior to complete fluid resuscitation.
Assuntos
Coma Hiperglicêmico Hiperosmolar não Cetótico/induzido quimicamente , Quimioterapia de Indução/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Adolescente , Hidratação/métodos , Humanos , Coma Hiperglicêmico Hiperosmolar não Cetótico/diagnóstico , Coma Hiperglicêmico Hiperosmolar não Cetótico/terapia , Quimioterapia de Indução/métodos , Insulina/uso terapêutico , MasculinoRESUMO
Child neglect is the most common form of child maltreatment and accounts for 60% of all cases reported to child protective services. Whereas physical and emotional neglect account for a quarter of the reported cases of child neglect, educational neglect accounts for half of the cases. We describe a 7-month-old infant with several manifestations of physical and emotional neglect including excessive quietness, failure to thrive, global developmental delay, and a gastric lactobezoar. In addition, our patient had a fine, lateral nystagmus likely due to being kept in the dark for long periods. To our knowledge, this is the first reported case of acquired nystagmus due to visual deprivation from child neglect.