Methotrexate-associated lymphoproliferative disorder with histopathological features of histiocytic necrotizing lymphadenitis.

An 84-year-old Japanese woman suffering from rheumatoid arthritis (RA), who had been treated with methotrexate (MTX) for 15 years, was admitted to our hospital for generalised lymphadenopathy, thrombocytopenia, anaemia, elevated aminotransferases, and elevated CRP levels. Pathological findings of cervical lymph node biopsy were compatible with histiocytic necrotising lymphadenitis (HNL). Small lymphocytes positive for Epstein-Barr virus (EBV)-encoded small RNA were detected in the tissue. We suspected a MTX-associated lymphoproliferative disorder (MTX-LPD), withdrew MTX and administered leucovorin (folic acid). The patient's symptoms gradually resolved following discontinuation of MTX. We considered that this patient developed HNL as an MTX-LPD when EBV was reactivated. This is the first case of HNL associated with MTX treatment for RA, which we report here along with clinical course.

Pleural involvement of diffuse large B-cell lymphoma mimicking malignant pleural mesothelioma.

Diffuse large B-cell lymphoma (DLBCL) is a common cancer in haematology. We report a case of DLBCL mimicking malignant pleural mesothelioma (MPM). A 75-year-old man with a 1-week exacerbation of dyspnoea on exertion and right pleural effusion on chest radiography was admitted to our hospital. Positron emission tomography/computed tomography revealed diffuse pleural thick lesions and massive pleural effusion, and these lesions had accumulation of fluorodeoxyglucose. Because we suspected MPM or lung cancer, we performed a biopsy with thoracoscopy to confirm the diagnosis. A biopsy of the pleural effusion with thoracoscopy revealed DLBCL. Chemotherapy was immediately selected, and the diffuse thickened pleural wall and massive pleural effusion of the right chest were significantly improved after two cycles of chemotherapy.

Therapy-related acute myeloid leukemia after chemotherapy in extensive disease-small cell lung cancer.

We experienced therapy-related acute myeloid leukemia (t-AML) in a patient with extensive disease-small cell lung cancer (ED-SCLC). This case is rare and has educational message because ED-SCLC has a poor prognosis and often cannot survive until developing therapy related hematological malignancy. Furthermore this case had unique chromosomal abnormalities. With recent advances in chemotherapy and radiotherapy, the prognosis of lung cancer has improved, while t-AML has been increasing in frequency.

Acquired Factor V Inhibitor.

Inhibitors directed against factor V rarely occur, and the clinical symptoms vary. We herein report the case of a patient who presented with a decreased factor V activity that had decreased to <3 %. We administered vitamin K and 6 units of fresh frozen plasma, but she thereafter developed an intracerebral hemorrhage. It is unclear whether surgery >10 years earlier might have caused the development of a factor V inhibitor. The treatment of acquired factor V inhibitors is mainly the transfusion of platelet concentrates and corticosteroids. Both early detection and the early initiation of the treatment of factor V inhibitor are thus considered to be important.

[Acquired hemophilia A developing at bilateral renal bleeding: a case report].

A 82-year-old woman with asymptomatic gross hematuria was referred to us for a consultation. Computed tomography and magnetic resonance imaging revealed hydronephrosis in the right kidney and retrograde pyelography showed a filling defect in the right renal pelvis. Cystoscopy revealed gross hematuria from right ureteral orifice concomitant with superficial papillary bladder tumor (catheterized urine cytology: positive) (transurethral resection of bladder tumor UC G1 pTa). She was diagnosed with right renal pelvic carcinoma, and we performed a total right nephroureterectomy. Histolopathological findings showed no evidence of malignancy, but extensive hemorrhaging was observed in the subepithelium. There was hematoma in the retoroperitoneum and she suffered from endotoxic shock after the operation. In the post-operative period, she showed complications involving left renal bleeding. She was diagnosed with acquired hemophilia A based on a decline in factor VIII activity, prolonged APTT and the presence of anticoagulant. Although we administered steroids to her, her general condition deteriated and she died of postrenal renal failure 37 days after the operation. To our knowledge, this is the fourth case worldwide and the third case in Japan of acquired hemophilia A discovered by renal bleeding.

Clinical efficacy of halophilic lactic acid bacterium Tetragenococcus halophilus Th221 from soy sauce moromi for perennial allergic rhinitis.

BACKGROUND: Recently, some common foods in daily life, especially lactic acid bacteria, have been found to have anti-allergic effects. We previously isolated a halophilic lactic acid bacterium, Tetragenococcus halophilus Th221, from soy sauce moromi, a mixture of koji and salt solution, and showed that it possesses an immunomodulatory activity that promotes T helper type 1 immunity. METHODS: To evaluate the anti-allergic effects of Th221, we performed a randomized, double-blind, placebo-controlled study in 45 subjects with perennial allergic rhinitis (PAR) treated by oral administration of Th221 (high dose, 60 mg/day, 15 subjects; low dose, 20.4 mg/day, 15 subjects) or a placebo (15 subjects) for 8 weeks. RESULTS: There were no significant differences among the groups that ingested Th221 and the placebo group regarding the disease severities, total nasal symptom scores and total nasal sign scores examined by physicians. However, the disease severity examined by physicians significantly improved in the high-dose group at the end of the trial compared with the beginning (p < 0.05). The total score for nasal symptoms of subjects who received a high dose of Th221 also showed a significant improvement at the end of the trial compared with the beginning (p < 0.01). According to the subjects' diaries, significant improvements in sneezing and rhinorrhea were observed during some periods in the high-dose group. The change in serum total immunoglobulin E improved significantly at the end of the trial compared with the beginning in this group (p < 0.05). The safety of Th221 treatment was confirmed by laboratory tests and inspection of the general condition of each subject. CONCLUSIONS: Th221 can be expected to safely improve the symptoms of PAR.

An evaluation of the clinical efficacy of tomato extract for perennial allergic rhinitis.

BACKGROUND: Recently, some common foods in daily life have been found to have anti-allergic effects. We have reported that tomato extract (TE) could possibly inhibit histamine release and mouse ear-swelling responses. Moreover, it is reported that TE could relieve the symptoms for Japanese cedar pollinosis. METHODS: To evaluate the anti-allergic effect of TE, we performed a randomized, double-blind, placebo-controlled study in 33 patients with perennial allergic rhinitis (PAR) using oral administration of TE (360 mg per day) or placebo for 8 weeks. RESULTS: We found that the sneezing score significantly decreased in the TE group at the end of the trial compared to the beginning (P < 0.05). There were decreasing tendencies of rhinorrhea and nasal obstruction in the TE group. The patients' quality of life was significantly improved in the TE group after 8 weeks of treatment (P < 0.05), but not in placebo group. A significant improvement in total symptom scores, combining sneezing, rhinorrhea and nasal obstruction, was observed after oral administration of TE for 8 weeks (P < 0.01). The safety of TE treatment was confirmed by laboratory tests and inspection of general conditions. CONCLUSIONS: TE can be expected to safely improve the nasal symptoms of PAR.