[Rapid exacerbation of thrombotic microangiopathy accompanied by electrocardiogram abnormality leading to death].

A 73-year-old female was hospitalized with thrombotic microangiopathy (TMA) diagnosis because of consciousness disturbance, anemia, thrombocytopenia, renal dysfunction, and electrocardiogram abnormality. The patient died on day 12 of the symptom onset. The immunohistochemical analysis of microclot found in the autopsy of coronary artery confirmed TMA. It was suggested that the relationship to collagen disease by antinuclear antibody positive and the necessity of initiating circulation management and plasma exchange immediately before approximately 1×104 of platelets for the prognosis. The findings suggested considering TMA at the time of an unidentified shock, particularly acute adrenal insufficiency.

[Diffuse large B-cell lymphoma with intravascular involvement of neoplastic CD5-positive cells].

A 77-year-old man was admitted because of fever. A small number of large CD20-positive neoplastic cells were seen in the bone marrow specimen. Clinical symptoms improved with oral prednisolone. After 11 months, abdominal CT scan revealed a liver mass. The biopsy specimen from the liver mass showed diffuse infiltration of large CD20-positive neoplastic cells. The patient was diagnosed as having diffuse large B-cell lymphoma. It was of particular interest that only neoplastic B cells within small blood vessels in the liver mass were positive for CD5. The patient died of lymphoma three months after diagnosis.