Antibiotic treatment for bacterial meningitis caused by Listeria monocytogenes in a patient with multiple myeloma.

Multiple myeloma is a hematolymphoid malignancy, and patients with this disorder are frequently complicated by infection. An 80-year-old woman with multiple myeloma was complicated by bacterial meningitis, and was admitted to our hospital in August 2007. She initially received ceftriaxone, but culture of cerebrospinal fluid detected Listeria monocytogenes. Ampicillin was administered, but headache and pyrexia persisted for 2 weeks, and on cerebrospinal fluid examination, the proliferation of polymorphonuclear leukocytes had not resolved. After medication with meropenem was started, the clinical symptoms completely disappeared, and the abnormalities on cerebrospinal fluid examination resolved. The patient ultimately received meropenem for 27 days, resulting in a cure. In conclusion, meropenem is useful to treat bacterial meningitis caused by L. monocytogenes. This agent is indicated when ampicillin shows inadequate effect or if the patient has an allergy to ampicillin.

[Concurrent chemo-radiotherapy for localized refractory non-Hodgkin's lymphoma--report of two cases].

Localized refractory diffuse large B-cell lymphomas (DLBCL) were treated with concurrent chemo-radiotherapy. Case 1 had right cervical lymphadenopathy. Lymphoma enlarged even after the fourth courses of chemotherapy consisting of cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP). The second case had a pharyngeal tumor and bilateral cervical lymphadenopathy. A lymphoma enlarged after eighth courses of CHOP. Both cases were treated with concurrent chemo-radiotherapy. Chemotherapy consisted of mitoxantrone, methotrexate, ifosfamide,and prednisolone (MMIP). The dose of radiation to the involved sites was 40 Gy. The first case received chemotherapy three days after radiotherapy was started. The second case was treated with chemotherapy, and radiotherapy was begun one day after. Both cases show mucositis and leukopenia. One case received two courses of chemotherapy after chemo-radiotherapy, and the other received no additional chemotherapy. Both cases achieved complete remission after the combined therapy, however, lymphoma in one case recurred three months after the therapy. It is possible that this concurrent chemo-radiotherapy is effective for localized DLBCL which did not disappear after standard chemotherapy.

Pneumothorax associated with malignant lymphoma.

An 82-year-old man was diagnosed with lymphoplasmacytic lymphoma involving multiple lymph nodes and bone marrow. On radiological examinations no involvement of the lung was seen. He was treated with rituximab. Eighteen months later he was complicated with right pneumothorax, and surgery with bullectomy was finally performed. Histological examination disclosed the proliferation of abnormal B lymphocytes near the wall of the bulla and pleura. We conclude that the pneumothorax in this patient was associated with lymphoma. Thus, radiological examination does not disclose lymphomatous lesions, it is possible that lymphoma involves the pleura, and pleural involvement can cause pneumothorax. Surgery is an effective method of treating this rare complication.