Haemolytic anaemia after oral artemether-lumefantrine treatment in a patient affected by severe imported falciparum malaria.

Artemisinin and its derivatives are essential components of artemisinin-based combination therapies for treating severe falciparum malaria. In this paper, we describe the occurrence of haemolysis after oral artemether-lumefantrine treatment. To the best of our knowledge, this is the second reported case of a patient affected by severe falciparum malaria with haemolytic anaemia that is likely associated with oral artemether-lumefantrine treatment.

Clinical and endoscopic presentation of primary gastric lymphoma: a multicentre study.

BACKGROUND: Although the stomach is the most frequent site of intestinal lymphomas, few data are available on both clinical endoscopic presentation of gastric lymphoma and possible differences between low-grade and high-grade lymphomas. METHODS: Clinical, histological and endoscopic records of consecutive patients with primary low-grade or high-grade lymphoma diagnosed were retrieved. Symptoms were categorized as 'alarm' or 'not alarm'. The endoscopic findings were classified as 'normal' or 'abnormal'. RESULTS: Overall, 144 patients with primary gastric lymphoma were detected, including 74 low-grade and 70 high-grade lymphoma. Alarm symptoms, particularly persistent vomiting and weight loss, were more frequently present in patients with high-grade lymphoma than in those with low-grade lymphoma (54% vs. 28%; P = 0.002). Low-grade lymphomas presented as 'normal' appearing mucosa (20% vs. 0%; P = 0.0004) or petechial haemorrhage in the fundus (9% vs. 0%; P = 0.02) more frequently than high-grade lymphomas, being also more often confined to the antrum (47% vs. 27%, P = 0.03) and associated with Helicobacter pylori infection (88% vs. 52%, P < 0.0001). On the contrary, high-grade lymphomas presented more commonly as ulcerative type (70% vs. 52%; P = 0.03), being also more frequently diagnosed in stage >I when compared with low-grade lymphomas (70% vs. 21%, P < 0.0001). CONCLUSIONS: The overall prevalence of alarm symptoms is quite low and may be absent in more than 70% of patients with low-grade lymphoma.

Bone marrow CD34+ progenitor cells may harbour HIV-DNA even in successfully treated patients.

The issue about bone marrow hematopoietic progenitor cells harbouring HIV-DNA in infected patients is still under scrutiny. We studied nine HIV-infected individuals undergoing bone marrow aspiration for diagnostic purposes. In all patients, even in those receiving successful antiretroviral therapy for several years, HIV-DNA was detected in purified CD34+ lineage-bone marrow progenitor cells. This finding, although not conclusive due to the low number of patients examined, adds further evidence that current treatment strategies may be insufficient to resolve latent infection in bone marrow CD34+ hematopoietic progenitor cells.

Successful treatment with lamivudine for reactivated hepatitis B infection following chemotherapy for non-Hodgkin's lymphoma.

Reactivation of hepatitis B virus (HBV) infection in subjects receiving cytotoxic treatment for non-Hodgkin's lymphoma (NHL) is well documented. This report describes the case of a 69-year-old male chronic HBV carrier who developed severe flare-up of hepatitis B following chemotherapy for large B-cell NHL. Prior to chemotherapy, the patient had normal liver function tests and was negative for HBV DNA by polymerase chain reaction (PCR) assay. HBV reactivation consisted of a rise in hepatic transaminases (peak alanine aminotransferase=1178 IU/ml), hyperbilirubinemia (7.1 mg/dl), and high levels of serum HBV DNA (63.6 x 10(6) copies/ml). A liver biopsy revealed highly active hepatitis and confluent necroses. Lamivudine treatment (100 mg daily) resulted in rapid loss of hepatitis B virus DNA, resolution of hepatitis, and clinical recovery. The patient is still in remission for NHL. Lamivudine is effective in the control of HBV reactivation following chemotherapy.

Autoimmune hemolytic anemia during alpha interferon treatment in nine patients with hematological diseases.

BACKGROUND. A number of side effects have been observed in patients treated for hematological diseases with alpha-interferon (IFN). In several cases side effects consisted of immunological disorders. Autoimmune hemolytic anemia (AIHA) is the most typical example of an IFN-induced immune-mediated complication. CASE SERIES. In 10 years we observed 9 patients with various hematological disorders who developed AIHA during IFN treatment. The interval between the start of IFN treatment and the onset of acute hemolysis suggests a dual pattern of occurrence: (1) early onset (interval 1 to 21 days), seen in patients who had anti-RBC antibodies before IFN treatment; (2) late onset (interval 3-38 months), in patients with no history of anti-RBC antibodies at the start of treatment. Discontinuation of IFN, often associated with prednisone treatment, caused prompt hematological recovery in all cases; anti-erythrocyte antibodies persisted in the first group of patients and disappeared in the second. CONCLUSIONS. In rare cases IFN may cause AIHA. The immunological derangement caused by IFN seems to act at two different levels: enhanced destruction of antibody-coated RBCs and induction of autoreactive B-cells. As for the possibility of other preexisting immunological disorders, AIHA (even latent) is a contraindication to IFN treatment. Patients treated with IFN need accurate monitoring to guard against for the development of autoimmune disorders.