Hodgkin lymphoma type of Richter syndrome (HL-type RS) is a rare disease that arises in patients with chronic lymphocytic leukemia (CLL). HL-type RS lesions can manifest in various sites and are often accompanied by related symptoms. This is the first case report to describe diagnosis of HL-type RS after emergency surgery for gastrointestinal perforation caused by the development of a HL-type RS lesion. A 47-year-old man diagnosed with CLL three years prior began treatment with ibrutinib due to worsening anemia and splenomegaly two months prior to the emergency department presentation. Although splenomegaly improved, lymphocytopenia, anemia, and a newly arising mesenteric lymphadenopathy continued to worsen. He presented to the emergency department with abdominal pain, and subsequent surgery revealed small intestinal perforation and mesenteric lymphadenopathy with HL-type RS confirmed by histopathological examination of the resected small intestine. He subsequently received brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A + AVD), which effectively managed the HL-type RS. If CLL clinical presentation deviates from the typical course, an early tissue biopsy should be considered to evaluate for HL-type RS. Given the adoption of the A + AVD regimen as the standard treatment for Hodgkin lymphoma, further research is needed to evaluate its efficacy in HL-type RS.
Anemia , Hodgkin Disease , Intestinal Perforation , Leukemia, Lymphocytic, Chronic, B-Cell , Lymphadenopathy , Lymphoma, Large B-Cell, Diffuse , Humans , Male , Middle Aged , Anemia/complications , Antineoplastic Combined Chemotherapy Protocols , Hodgkin Disease/complications , Hodgkin Disease/diagnosis , Hodgkin Disease/drug therapy , Intestinal Perforation/etiology , Intestinal Perforation/complications , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Lymphadenopathy/drug therapy , Lymphoma, Large B-Cell, Diffuse/pathology , Splenomegaly/complications
Evans syndrome presents as concurrent autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP). Systemic lupus erythematosus (SLE) is the most frequent autoimmune disorder associated with Evans syndrome. We herein report a case of new-onset Evans syndrome associated with SLE after BNT162b2 mRNA coronavirus disease 2019 (COVID-19) vaccination in a 53-year-old woman. Blood examination at diagnosis showed hemolytic anemia with a positive Coombs test and thrombocytopenia. Hypocomplementemia and the presence of lupus anticoagulant indicated a strong association with SLE. Prednisolone administration rapidly restored hemoglobin level and platelet count. This case suggests that mRNA COVID-19 vaccination may cause an autoimmune disorder. Physicians should be aware of this adverse reaction by mRNA COVID-19 vaccination and should consider the benefits and risks of vaccination for each recipient.
Anemia, Hemolytic, Autoimmune/etiology , BNT162 Vaccine/adverse effects , Lupus Erythematosus, Systemic/etiology , Thrombocytopenia/etiology , Vaccination/adverse effects , Anemia, Hemolytic, Autoimmune/diagnosis , Anemia, Hemolytic, Autoimmune/drug therapy , Female , Hematologic Tests/methods , Hemoglobins , Humans , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/drug therapy , Middle Aged , Platelet Count , Prednisolone/administration & dosage , Purpura, Thrombocytopenic, Idiopathic , Risk Assessment , Thrombocytopenia/diagnosis , Thrombocytopenia/drug therapy
We present one of the first studies on source location determination for volcanic earthquakes and characterization of volcanic subsurfaces using data from a distributed acoustic sensing (DAS) system. Using the arrival time difference estimated from well-correlated waveforms and a dense spatial distribution of seismic amplitudes recorded along the fiber-optic cable, we determine the hypocenters of volcanic earthquakes recorded at Azuma volcano, Japan. The sources are located at a shallow depth beneath active volcanic areas with a range of approximately 1 km. Spatial distribution of the site amplification factors determined from coda waves of regional tectonic earthquakes are well correlated with old lava flow distributions and volcano topography. Since DAS observation can be performed remotely and buried fiber-optic cables are not damaged by volcanic ash or bombs during eruptions, this new observation system is suitable for monitoring of volcanoes without risk of system damage and for evaluating volcanic structures.
