RESUMO
BACKGROUND: Thrombotic microangiopathies (TMA) are systemic vasoocclusive disorders associated with significant morbidity and mortality. Rapid and reliable diagnosis of TMA is critical. The diagnosis is complicated by a lack of objective and sensitive laboratory testing as well as multiple concurrent diseases, including infectious processes. CASE STUDY: We report two cases of disseminated histoplasmosis associated with TMA manifestations in renal transplant recipients, including one patient with histologically documented renal microthrombi; both patients were referred for plasma exchange. After the diagnosis of histoplasmosis, the treatment plan was changed to antifungal medications, reduced immuno-suppression, and supportive care, with progressive resolution of TMA manifestations. CONCLUSION: TMA occurs in transplant populations in association with infections, medications, and other factors. Appropriate management includes recognition and treatment of possible etiological factors. Disseminated histoplasmosis should be considered in transplant patients presenting with TMA.
Assuntos
Síndrome Hemolítico-Urêmica/diagnóstico , Histoplasmose/diagnóstico , Transplante de Rim/efeitos adversos , Púrpura Trombocitopênica Trombótica/diagnóstico , Adulto , Antifúngicos/uso terapêutico , Diagnóstico Diferencial , Gerenciamento Clínico , Feminino , Histoplasmose/etiologia , Histoplasmose/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Troca Plasmática , TromboseAssuntos
Neoplasias da Orelha/patologia , Orelha Interna/patologia , Doenças do Labirinto/patologia , Lipoma/patologia , Neoplasias da Orelha/complicações , Neoplasias da Orelha/cirurgia , Orelha Interna/cirurgia , Feminino , Perda Auditiva/etiologia , Perda Auditiva/patologia , Perda Auditiva/cirurgia , Humanos , Doenças do Labirinto/complicações , Doenças do Labirinto/cirurgia , Lipoma/complicações , Lipoma/cirurgia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
A standard bone marrow examination may be done in patients with a known nonhematologic malignancy in order to evaluate the presence or absence of metastatic disease. A 300-cell-count differential of the aspirate is often performed in these cases. However, the clinical utility of the differential count has never been assessed. A retrospective review was performed on 107 bone marrow reports from 86 patients with a documented nonhematologic malignancy to determine the clinical usefulness of the differential counts in this patient population. Two cases out of 107 had clinically relevant findings from the aspirate differential. One patient had an increase in plasma cells (7%) and one had left-shifted granulopoiesis with 19% blasts. In most instances, the performance of an aspirate differential adds little clinically useful information in patients undergoing bone marrow examination for metastatic disease. There are cost savings associated with omitting the routine aspirate differential as either technologist- or pathologist-time in performing the differential is decreased.
