RESUMEN
BACKGROUND: Visceral Leishmaniasis should be suspected in every patient with a history of splenomegaly, fever, and pancytopenia. It is one of the most dangerous forms of infection and prompt recognition is the key to positive outcome. CASE PRESENTATION: A 20-month-old Caucasian male patient was brought to our hospital as an outpatient with the complaint of persistent fever, which did not improve with empiric antibiotic treatment (> 96 hour after the initial dose). The antibiotic treatment had been prescribed by primary care physician at polyclinic, who also referred the patient to hematologist due to anemia, who prescribed iron supplement. Despite multiple subspecialist visits, bicytopenia was, unfortunately, left unidentified. Upon physical examination no specific signs were detected, however, spleen seemed slightly enlarged. Patient was admitted to the hospital for further work-up, management and evaluation. Abdominal ultrasound, complete blood count and c-reactive protein had been ordered. Hematologist and infectionist were involved, both advised to run serology for Epstein-Barr Virus and Visceral Leishmaniasis. The latter was positive; therefore, patient was transferred to the specialized clinic for specific management. CONCLUSION: Both in endemic and non-endemic areas the awareness about VL should be increased among the medical professionals. We also recommend that our colleagues take the same approach when dealing with bicytopenia and fever, just as with pancytopenia and fever. The medical community should make sure that none of the cases of fever and pancytopenia are overlooked, especially if we have hepatomegaly and/or splenomegaly.
Asunto(s)
Anemia Ferropénica , Infecciones por Virus de Epstein-Barr , Leishmaniasis Visceral , Pancitopenia , Humanos , Masculino , Lactante , Leishmaniasis Visceral/complicaciones , Leishmaniasis Visceral/diagnóstico , Leishmaniasis Visceral/tratamiento farmacológico , Pancitopenia/diagnóstico , Anemia Ferropénica/complicaciones , Esplenomegalia/etiología , Herpesvirus Humano 4 , Fiebre/etiología , Antibacterianos/uso terapéutico , Errores DiagnósticosRESUMEN
BACKGROUND: Vitamin B12, or cobalamin deficiency, an infrequent clinical entity in pediatric age, is found almost solely in breastfed infants whose mothers are purely vegetarian, non-supplemented or with pernicious anemia. Megaloblastic anemia in infants presents with generalized weakness or irritability. METHODS: Diagnosis is usually centered on complete blood count, vitamin dosing, and peripheral smear, which may show macrocytes, hypersegmented neutrophils, reticulocytopenia and a raised mean corpuscular volume (MCV Ë 100 fL). Pancytopenia has also been noted. RESULTS: We report an exclusive breastfed nine-month-old female child who presented with irritability, developmental delay, and difficulties in introducing new foods. Her initial blood count revealed pancytopenia. Vitamin B12 levels were found to be reduced. Maternal levels of Vitamin B12 were also found to be borderline low. The child was treated as per protocols, and improvement was evidenced with the return of hematological parameters to the regular and gradual advancement of milestones. CONCLUSIONS: We aim to underscore the importance of megaloblastic anemia as an important and rare cause of anemia in infancy.
Asunto(s)
Anemia Megaloblástica , Anemia Perniciosa , Pancitopenia , Deficiencia de Vitamina B 12 , Humanos , Lactante , Niño , Femenino , Pancitopenia/diagnóstico , Pancitopenia/complicaciones , Anemia Megaloblástica/diagnóstico , Anemia Megaloblástica/etiología , Deficiencia de Vitamina B 12/complicaciones , Deficiencia de Vitamina B 12/diagnóstico , Vitamina B 12 , Anemia Perniciosa/tratamiento farmacológico , Anemia Perniciosa/etiologíaRESUMEN
Megaloblastic anaemia due to vitamin B12 and folic acid deficiency is uncommon in infancy and rarely reported in infants below 3 months of age. We hereby report a case of megaloblastic anaemia in a 9-weeks old infant having fever from 7th week of life. Blood picture showed pancytopenia and diagnosis was confirmed on bone marrow biopsy and serum level of vitamins. Patient positively responded to vitamin B12 and folic acid supplementation. Infants with pancytopenia even younger than 2 months, should also be investigated for vitamin B12 and folate deficiency. Mother of the baby was not antenatally investigated for anaemia. Prompt antenatal diagnosis and treatment of mothers can reduce the incidence in the infants.
Asunto(s)
Anemia Megaloblástica , Médula Ósea/patología , Deficiencia de Ácido Fólico , Ácido Fólico , Deficiencia de Vitamina B 12 , Vitamina B 12 , Anemia Megaloblástica/sangre , Anemia Megaloblástica/diagnóstico , Anemia Megaloblástica/etiología , Anemia Megaloblástica/terapia , Diagnóstico Diferencial , Diagnóstico Precoz , Intervención Médica Temprana/métodos , Insuficiencia de Crecimiento/diagnóstico , Insuficiencia de Crecimiento/etiología , Ácido Fólico/administración & dosificación , Ácido Fólico/sangre , Deficiencia de Ácido Fólico/complicaciones , Deficiencia de Ácido Fólico/diagnóstico , Humanos , Lactante , Masculino , Pancitopenia/diagnóstico , Pancitopenia/etiología , Atención Prenatal/normas , Resultado del Tratamiento , Vitamina B 12/administración & dosificación , Vitamina B 12/sangre , Deficiencia de Vitamina B 12/complicaciones , Deficiencia de Vitamina B 12/diagnóstico , Vitaminas/administración & dosificaciónAsunto(s)
Antibacterianos/uso terapéutico , Ciprofloxacina/uso terapéutico , Infecciones por VIH/complicaciones , Hepatitis/diagnóstico , Pancitopenia/diagnóstico , Infecciones por Salmonella/diagnóstico , Infecciones por Salmonella/tratamiento farmacológico , Salmonella/aislamiento & purificación , Enfermedad Aguda , Terapia Antirretroviral Altamente Activa , Fatiga/etiología , Fiebre/etiología , Infecciones por VIH/tratamiento farmacológico , Hepatitis/tratamiento farmacológico , Hepatitis/microbiología , Humanos , Ictericia/etiología , Masculino , Pancitopenia/etiología , Resultado del Tratamiento , Pérdida de Peso , Adulto JovenRESUMEN
Introduction and aim. Non-cirrhotic idiopathic portal hypertension (NCIPH), also known as hepatoportal sclerosis (HPS) is a disease of uncertain etiology. However, various pathophysiological mechanisms has been postulated, including chronic or recurrent infections and exposure to drugs or toxins. In this context, it appears to be of multifactorial etiology or resulting from a portal vascular endothelium aggression. It is important to consider whether the use of dietary supplements and herbs can trigger or contribute to the occurance of HPS. We report a possible association of HPS with the consumption of herbals and / or dietary supplements. MATERIAL AND METHODS: We describe two cases of HPS in patients without known etiology causes associated with this disease. RESULTS: Both patients were females who were diagnosed with HPS following the consumption of Herbalife® products and putative anorexigenic agents in the form herbals infusions. Image-based analysis and the assessment of the histopathological alterations found in the livers confirmed the diagnosis. The histopatological analysis of liver samples from both patients showed portal tracts enlarged by fibrosis with disappearance or reduction in the diameter of the portal vein branches. In many portal tracts, portal veins branches were replaced by aberrant thin-walled fendiforme vessels. The bile ducts and branches of the hepatic artery show normal aspects. CONCLUSION: After the exclusion of other etiologic factors and a comprehensive analysis of clinical history, consumption of Herbalife® products and anorexigenic agents was pointed-out as a puttative predisposing factor for the development of the disease.
Asunto(s)
Depresores del Apetito/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Hipertensión Portal/inducido químicamente , Cirrosis Hepática/inducido químicamente , Hígado/efectos de los fármacos , Pancitopenia/inducido químicamente , Preparaciones de Plantas/efectos adversos , Vena Porta/efectos de los fármacos , Esplenomegalia/inducido químicamente , Adulto , Biopsia , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Enfermedad Hepática Inducida por Sustancias y Drogas/patología , Femenino , Humanos , Hipertensión Portal/diagnóstico , Hipertensión Portal/patología , Hígado/irrigación sanguínea , Hígado/patología , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/patología , Persona de Mediana Edad , Pancitopenia/diagnóstico , Pancitopenia/patología , Vena Porta/patología , Valor Predictivo de las Pruebas , Factores de Riesgo , Esclerosis , Esplenomegalia/diagnóstico , Esplenomegalia/patología , Hipertensión Portal Idiopática no CirróticaAsunto(s)
Péptidos y Proteínas de Señalización Intercelular/efectos adversos , Radioisótopos de Yodo/efectos adversos , Radioisótopos de Yodo/uso terapéutico , Pancitopenia/etiología , Traumatismos por Radiación/diagnóstico , Traumatismos por Radiación/etiología , Trasplante de Células Madre/efectos adversos , Terapia Combinada , Femenino , Humanos , Persona de Mediana Edad , Pancitopenia/diagnóstico , Radiofármacos/efectos adversos , Radiofármacos/uso terapéutico , Dosificación RadioterapéuticaRESUMEN
Toxoplasmosis is one of the life-threatening infections that can occur after hematopoietic stem cell transplantation (HSCT) and also solid organ transplantation. The standard treatment for toxoplasmosis is combination therapy with pyrimethamine and sulfadiazine, both of which inhibit folate metabolism. Therefore, therapy with these agents could result in marrow toxicity including megaloblastic anemia or pancytopenia, which is reversible or preventable with folate supplementation. Transplant-associated microangiopathy (TAM) is another situation where folate is required to compensate for increased erythropoiesis due to hemolysis after allogeneic HSCT. Here, we report a case of severe marrow toxicity manifesting as pancytopenia due to low-dose pyrimethamine, which was triggered by TAM after HSCT.
Asunto(s)
Anemia Hemolítica/inducido químicamente , Antiprotozoarios/efectos adversos , Trasplante de Médula Ósea/efectos adversos , Pancitopenia/etiología , Pirimetamina/efectos adversos , Anemia Hemolítica/diagnóstico , Profilaxis Antibiótica , Antiprotozoarios/uso terapéutico , Ácido Fólico/uso terapéutico , Humanos , Masculino , Pancitopenia/diagnóstico , Pirimetamina/uso terapéutico , Toxoplasmosis/tratamiento farmacológico , Toxoplasmosis/prevención & control , Adulto JovenRESUMEN
Only a dozen cases of pancytopenia caused by copper deficiency have been reported. We report the case of an 81-year-old man who underwent total gastrectomy for gastric cancer. He received total parenteral nutrition without trace element supplementation for 6 months. Serum levels of copper and ceruloplasmin were low, but serum zinc was normal. The administration of copper into TPN led to rapid improvement in anemia and neutropenia. We review 11 previous cases of copper-deficient cytopenia, categorized into two groups according to etiology, and define the characteristic symptom of copper malabsorption caused by excess Zn as peripheral neuropathy.
Asunto(s)
Cobre/deficiencia , Pancitopenia/complicaciones , Pancitopenia/diagnóstico , Enfermedades del Sistema Nervioso Periférico/complicaciones , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Anciano de 80 o más Años , Cobre/sangre , Humanos , Masculino , Pancitopenia/sangre , Enfermedades del Sistema Nervioso Periférico/sangreRESUMEN
Benzene can result in bone marrow suppression. Chronic benzene poisoning (CBP) can be found among workers with excessive benzene exposure. CBP could give the appearance of different types of disorders such as leukopenia, agranulocytosis, anemia, pancytopenia, aplastic anemia (AA), myelodysplastic syndrome (MDS), and leukemia. This paper describes 43 CBP cases with the patients' ages ranging from 18 to 36 years (average: 23 years). Among them, 13 (30%) were male and 30 (70%) were female. Their job titles were furniture maker, shoemaker, industrial painter and metal shop worker. Their work durations ranged from 1.5 to 72 months (average: 14 months). Benzene levels in these workplaces exceeded 30 mg/m3. Ten of the 43 cases (23%) were diagnosed as mild cases of CBP, another 10 (23%) were moderate, and 23 (53%) were severe. Treatment for CBP included the following: cessation of benzene exposure, general supportive therapy, antibiotics, vitamins, corticosteroids, androgens, colony-stimulating factors (G-CSF, GM-CSF), blood component therapy, and traditional Chinese medicine. Thirty-three (77%) of the cases recovered completely, nine (21%) cases improved, and one (2%) died. In general, prognosis of CBP cases is optimistic when appropriate treatment is given. However, a few of the benzene-induced AA cases showed no response to treatment, which raises questions about the traditional view of the pathogenesis of the illness. Furthermore, only a part of the population with the same level of benzene exposure would suffer from the disease. Still, CBP cases with the same benzene exposure level exhibited different extents of severity of the illness. This evidence suggests strongly the existence of individual susceptibility. Detection of the biological markers regarding the individual susceptibility would be valuable for screening workers who are not suitable to be exposed to benzene.
Asunto(s)
Contaminantes Ocupacionales del Aire/envenenamiento , Benceno/envenenamiento , Enfermedades Profesionales/tratamiento farmacológico , Exposición Profesional , Adolescente , Corticoesteroides/uso terapéutico , Adulto , Andrógenos/uso terapéutico , Anemia Aplásica/diagnóstico , Anemia Aplásica/tratamiento farmacológico , Médula Ósea/efectos de los fármacos , Médula Ósea/patología , China , Femenino , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Factor Estimulante de Colonias de Granulocitos y Macrófagos/uso terapéutico , Humanos , Exposición por Inhalación , Masculino , Enfermedades Profesionales/diagnóstico , Pancitopenia/diagnóstico , Pancitopenia/tratamiento farmacológico , Proteínas RecombinantesAsunto(s)
Terapia por Acupuntura/efectos adversos , Síndromes Mielodisplásicos/inducido químicamente , Anciano , Diagnóstico Diferencial , Femenino , Migración de Cuerpo Extraño/complicaciones , Oro/efectos adversos , Humanos , Dolor de la Región Lumbar/terapia , Síndromes Mielodisplásicos/diagnóstico , Lesiones por Pinchazo de Aguja/diagnóstico , Lesiones por Pinchazo de Aguja/etiología , Pancitopenia/diagnóstico , Pancitopenia/etiología , Intensificación de Imagen RadiográficaRESUMEN
El reporte trata de una niña de 4 años con retraso mental y convulsiones, quien estuvo recibiendo durante 2 meses 130 mg/kg valproato de sodio ocasionándole anemia, plaquetopenia, leucopenia e hipoproteinemia. Al cabo de 2 semanas se disminuyó el valproato a 30 mg/kg y se observó la normalización de las alteraciones hematológicas presentadas.