Disseminated Cryptococcosis With Prostate Involvement in a Patient With T-cell Prolymphocytic Leukemia and Prostate Cancer.

T-cell prolymphocytic leukemia (T-PLL) presents unique treatment challenges because of its rarity and aggressiveness. Allogeneic hematopoietic stem cell transplantation offers a potentially curative option, but its safety in patients with concurrent invasive fungal infections and solid malignancies remains uncertain. We present a case of a 68-year-old male with T-PLL who developed disseminated cryptococcal disease with prostate involvement and concurrent prostate cancer (PCa). Despite the challenges, successful control of the infection and radical prostatectomy enabled the patient to proceed safely to allogeneic transplantation. The case highlights the importance of vigilance for unusual infections, such as Cryptococcus, in immunocompromised patients presenting with lower urinary tract symptoms. Clinicians should consider the possibility of PCa in this population, particularly in the context of chronic leukemia. Concurrently, the potential association between fungal prostate infections and PCa warrants further investigation.

A case of severe unprovoked hemorrhage in an elderly male: a case report.

Acquired hemophilia is a rare but potentially fatal clinical condition requiring clinical suspicion to reach to a diagnosis, especially in elder patients. This diagnosis should be suspected in patients that present with unexplained persistent bleeding from skin, soft tissues, and mucosa and have a prolonged aPTT.

Membranous nephropathy and lupus-like syndrome after hematopoietic cell transplantation: a case report.

INTRODUCTION: The kidney is increasingly recognised as a target organ of chronic graft-versus-host disease after hematopoietic cell transplantation in the context of the development of the nephrotic syndrome. Chronic graft-versus-host disease is associated with autoimmune phenomena similar, but not identical, to those observed in various rheumatologic disorders, implicating autoimmunity as an important component of the disease. CASE PRESENTATION: We report the case of a 57-year-old Caucasian man who developed the nephrotic syndrome due to membranous nephropathy in association with recurrent chronic graft-versus-host disease, along with a lupus-like syndrome manifested with pancytopenia, hair loss, positive anti-DNA antibodies and sub-epithelial and mesangial immune deposits. To the best of our knowledge, this is the first case reported in the literature. The nephrotic syndrome subsided soon after he was treated with a short course of cyclosporin with steroids. Unfortunately he died seven months later due to a relapse of leukemia. CONCLUSIONS: Our case report confirms the notion that chronic graft-versus-host disease is characterized by the appearance of autoimmune phenomena similar, but not identical, to those seen in autoimmune diseases. The decision for more immunosuppression has to be weighed against the need for preservation of the graft versus leukemia phenomenon.

Biopsy-proven resolution of renal light-chain deposition disease after autologous stem cell transplantation.

Light-chain deposition disease (LCDD) is caused by an underlying clonal plasma cell dyscrasia in which monoclonal immunoglobulin light chains (LCs) are deposited in tissues, resulting in varying degrees of organ dysfunction. Autologous stem cell transplantation (ASCT) has been reported to stabilize renal function in patients with LCDD, but currently, no evidence of histopathologic resolution of LC deposition after ASCT exists. We present a patient, with severe renal dysfunction due to LCDD, who was treated with high-dose melphalan and ASCT that resulted in a significant and extended period of improved renal function. Four years after the initial improvement, the patient developed nephrotic range proteinuria, without any evidence of relapse of the plasma cell dyscrasia. At that time, a repeat renal biopsy showed complete resolution of LC depositions and development of extensive glomerulosclerosis, thus explaining proteinuria. To the best of our knowledge, this is the first report of a biopsy-proven resolution of renal LCDD following ASCT. A timely application of ASCT should be considered in LCDD to prevent deterioration of renal function in the long run.

Acute renal failure, translocational hyponatremia and hyperkalemia following intravenous immunoglobulin therapy.

BACKGROUND/AIMS: Intravenous immunoglobulin (IVIG) therapy has been associated with renal adverse effects and electrolyte disturbances. METHODS: We retrospectively evaluated a cohort of 66 unselected patients with idiopathic thrombocytopenic purpura, who received 140 courses of IVIG therapy. Acute renal failure (ARF), hyponatremia and hyperkalemia, as potential complications of IVIG therapy, were assessed from 100 IVIG courses with sufficient data for analysis. RESULTS: Thirteen out of 100 (13%) IVIG courses in 10 (15%) patients were complicated with ARF. Risk factors included advanced age, pre-existing renal impairment, use of diuretics and the presence of diabetes mellitus. All patients recovered renal function 1-2 weeks after IVIG infusion. Serum sodium (sNa) fell by 5.7 and 2.7 mmol/l (p < 0.01) in patients with and without ARF, respectively. Correspondingly, serum potassium increased by 0.7 and 0.23 mmol/l (p < 0.01). There was a strong inverse correlation (r = -0.308; p < 0.01) between changes in sNa and creatinine. Changes in serum potassium could be independently predicted by changes in both sNa and creatinine (R(2) = 0.11; p < 0.01). These data suggested that both hyponatremia and hyperkalemia were (a) due to the translocational effect of the osmotic load of sucrose, and (b) largely depended on the extent of IVIG nephropathy. CONCLUSION: In our series, ARF attributable to IVIG therapy, although not rare, was usually mild and fully reversible. High-risk patients were more susceptible to IVIG-related renal complications. Translocational hyponatremia and hyperkalemia following IVIG therapy, although unimportant in patients with normal renal function, may be of clinical significance in patients with severely compromised renal function, resulting in impaired sucrose excretion.

Seeking prescribing patterns in rural Crete: a pharmacoepidemiological study from a primary care area.

INTRODUCTION: Deliberation of drug prescribing patterns is essential in an effort to improve prescribing standards and quality of care. It is vital for pharmaco-epidemiological research. In this study, data from GPs' practices was used to explore variation in the prescribing patterns in a rural area of Crete. This article reports the findings with respect to the patients' age, sex and diagnoses, and discusses them with the broad aim of identifying areas for practice improvement. METHODS: One thousand prescriptions, issued during a one-year period, were pre-selected from the area of Anogia Health Centre in Crete, Greece. A copy of each pre-selected prescription was made, and a short pre-tested questionnaire with supplementary information about the prescription was filled. Age, gender, prescription through a third person's intervention, and renewal of an old prescription, were registered on this questionnaire. Drugs were classified according to the International Classification of Primary Care--Drugs, and diagnoses according to the International Classification of Primary Care. RESULTS: The vast majority of prescriptions, namely n = 285 (74.2%) for male and n = 481 (78.1%) for female patients, were prescribed for individuals between the ages of 50 and 89 years. The 10 most commonly recorded diagnoses were found in 54.2% of the studied prescriptions for the male population, although only 47% for the female. Hypertension, respiratory infections, and ischaemic heart disease were, over all, the most commonly recorded diseases. The drugs commonly recorded for both sexes were paracetamol and furosemide, as well as some antibiotics. Analysis of the prescribing data revealed that more than one in every three prescriptions was prescribed through a third-person contact and 69.8% (n = 698) of the prescriptions were renewal of an older one. For more than 51% of the cases, the patients asked only for a prescription. The diagnosis 'oral contraceptive' was absent in the study, while there was a large consumption of antibiotics. CONCLUSION: The prescribing patterns illustrated in this study present both similarities with and differences from the registered patterns in other studies. The recognition of these patterns is an essential tool for the GPs who are serving rural areas of Crete, and formulation of practical guidelines on the drugs most often prescribed is anticipated to improve the primary care physicians' performance.