Progressive Dyspnea and Hypoxemia With Diffuse Pulmonary Infiltrates in a Previously Healthy Woman.

CASE PRESENTATION: A 50-year-old woman presented with 3 months of cough, dyspnea, and fatigue. She also reported new fevers, night sweats, and a rash on her face and torso. On presentation she was tachycardic and tachypneic, with oxygen saturation of 81% on 2 L/min of oxygen. She was in mild respiratory distress. Results of the physical examination were remarkable for tender left cervical and axillary adenopathy and bibasilar pulmonary crackles. She had an acneiform rash on her face, chest, and back, consisting of multiple nonblanching erythematous or violaceous macules and papules (Fig 1) and had conjunctival edema. Admission laboratory test results were significant for a WBC count of 56,000, of which 79.5% were lymphocytes. Hemoglobin and platelet levels were normal. She was admitted for further management.

Myeloblasts and atypical bone marrow: Fortuitous discovery of the filiarial nematode loa loa in the bone marrow during a work-up for prolymphocytic T-cell leukemia.

Loiasis is a chronic cutaneous disease caused by a filarial nematode for whom humans are the only definitive host: Loa loa, an African eyeworm transmitted by Chrysops flies. The parasite is seen on blood smears, in the skin, or during its ocular migration, but rarely on a bone marrow smear. We report the case of a 57-year-old Gabonese woman whose bone marrow aspiration during a work-up for T-cell leukemia fortuitously found Loa loa filariae.

Concomitant T-cell prolymphocytic leukemia and visceral leishmaniasis: A case report.

RATIONALE: T-cell prolymphocytic leukaemia (T-PLL) is a rare aggressive lymphoid disease featured by a significant increased lymphocyte count and obvious hepatosplenomegaly with poor prognosis. The concomitant presentation of T-PLL and visceral leishmaniasis (VL) has not previously been reported. PATIENT CONCERNS: The patient initially suffered from anorexia, skin pigmentation, fever and hepatosplenomegaly. Bone marrow smear described leishmania and antibody test was positive. VL was diagnosed and he was given antimony gluconate therapy. His symptoms recurred. DIAGNOSIS: A combination of serological rk39 test, morphologic evaluation and immunophenotyping by flow cytometry finally supported the diagnosis of concomitant VL and T-PLL. OUTCOMES: Amphotericin B was used for the treatment of VL first and a referral for treating T-PLL after recovery from VL was suggested. Unfortunately, the patient requested to be discharged. Telephone follow-up indicated that he died a few days after leaving the hospital. LESSONS: Due to the rarity of the disease combination, the pathogenesis association of T-PLL and VL is unclear. However, a duly diagnosis is crucial for treatment. In immunosuppressed patients due to malignancies and treatment, VL should be considered as an opportunistic infection. In VL infections, the clinical manifestations mimicking hematological malignancies may cover up the underlying disease. Under such conditions, a complete work-up based on laboratory test is necessary to achieve a correct diagnosis.

Encephalitozoon hellem in a patient with CD4+ T-cell prolymphocytic leukemia: case report and genomic identification.

Five cases of microsporidioses among leukemic patients, 4 in myeloid-leukemic patients and 1 in a chronic lymphocytic leukemia, have been described until now. We report a case of microsporidiosis and the genomic identification of Encephalitozoon hellem in a patient with CD4(+) T-cell prolymphocytic leukemia.

Cytomegalovirus retinitis: an unusual presentation as vitreous hemorrhage.

PURPOSE: The purpose of this report is to describe an unusual presentation of vitreous hemorrhage (VH) in a patient with an immunosuppressive condition. METHODS: Retrospective case report. RESULTS: A 72-year-old woman with known T-cell prolymphocytic leukemia treated with a course of alemtuzumab presented to our department with a VH in her left eye after a fall. An initial diagnosis of hemorrhagic posterior vitreous detachment was made. However, as the VH was resolving, she was found to have underlying vitritis, occlusive vasculitis, and a pale optic nerve head. Vitreous biopsy confirmed cytomegalovirus retinitis. Despite treatment with intravenous foscarnet and oral valganciclovir, her vision continued to remain poor because of the severe damage from the retinal vasculitis and residual VH. CONCLUSION: As indications for immunosuppression increase, the incidence of cytomegalovirus retinitis in non-HIV-immunosuppressed patients is expected to rise. Therefore, in this subgroup of patients, we should be aware of any underlying retinitis especially in cases with an unusual presentation of VH.

T-cell prolymphocytic leukemia with extensive cardiovascular infiltrate leading to multiple myocardial infarctions and cardiac death.

Lymphocytic neoplasm involving the heart is not common and usually presents with pericardial effusion or focal myocardial infiltration. Myocardial infarctions due to leukemic infiltration of the coronary arteries are rarely reported. We present the case of a 52-year-old Guatemalan man with a one-year history of untreated T-cell prolymphocytic leukemia. He was admitted to our hospital for chemotherapy and evaluation of a pulmonary cavitary lesion by wedge resection. During sedation, the patient experienced acute respiratory failure and hypovolemic shock, from which he could not be resuscitated. Autopsy revealed that leukemic cells extensively infiltrated the aorta, myocardium, and coronary arteries. The lumina of the 3 major coronary artery branches showed 70% to 95% stenosis, with multifocal remote myocardial infarctions. Tumor cells were also detected in the lungs and other organs. The acute cardiorespiratory insufficiency secondary to leukemia-particularly the extensive infiltration of the coronary arteries and myocardium, and the multiple myocardial infarctions-eventually resulted in cardiac death.

[Splenic rupture associated with aggressive conversion of indolent T-cell prolymphocytic leukemia].

A 65-year-old man was diagnosed with leukocytosis in a routine medical examination. Further laboratory examinations showed increased LDH and sIL-2R levels in the serum. There was no evidence of infiltrative lesions or organomegaly. Bone marrow aspiration revealed many atypical small-sized lymphocytes without apparent nucleoli. Flow cytometric analysis of atypical lymphocytes was positive for T-cell markers, and chromosome analysis showed a normal karyotype. He was diagnosed with the small cell variant of T-PLL. Approximately 34 months later, having received no treatment, his cervical lymph nodes increased in size and number, and his white blood cell count, LDH and sIL-2R levels also rapidly increased. He was then admitted to our hospital. Bone marrow aspiration and cervical lymph node biopsy revealed complex chromosome abnormalities including inv(14)(q11;q32). Computed tomography showed swollen lymph nodes all over his body and hepatosplenomegaly. On the fourth hospital day, spontaneous splenic rupture occurred. Transcatheter arterial embolization was unsuccessful and the patient died. We report this case with rare autopsy findings.

[T-cell prolymphocytic leukemia revealed by spinal cord compression]. / Leucémie prolymphocytaire T révélée par un syndrome de compression médullaire.

T-cell prolymphocytic leukemia is a lymphoid hematologic malignancy of T origin, mature, individualized well by the clinical, morphological, and immunophenotypic as well as cytogenetic aspects. We report the case of a 39-year-old man admitted in our department because of a spinal cord compression. The cerebrospinal fluid analysis had revealed an increased albuminemia level; MRI evoked a vertebral infiltration by a malignancy. Evolution was characterized by the appearance of a tumor syndrome and a peripheral lymphocytosis. Immunophenotyping and the lymph node biopsy concluded of a diagnosis of a T-cell prolymphocytic leukemia. To our knowledge, we report here the first case of T-cell prolymphocytic leukemia revealed by a spinal cord compression.

T-cell prolymphocytic leukemia: A rare disease in an elderly female.

PURPOSE: To present a case report of an 83-year-old female with underlying dementia and a 1-2 month history of left upper quadrant pain. This report includes a review of the morphology of T-cell prolymphocytic leukemia (PLL), diagnosis, and the treatment options considered. DATA SOURCES: T-cell PLL is a rare blood disorder that represents a very small number of all chronic leukemias. An extensive review of scientific literature related to the cell morphology and pathology of this disease, as well as clinical trials of treatment options provided the background for this case report. CONCLUSION: A diagnosis of T-cell PLL was made after a computed tomography scan of the abdomen confirmed splenomegaly and a bone marrow biopsy showed a hypercellular marrow infiltrated with numerous small lymphocytes, consistent with this disease. Currently, there is no optimal treatment for T-cell PLL, but alemtuzumab has shown success with extending survival 1-3 years. IMPLICATIONS FOR PRACTICE: This case presented several ethical and practical challenges for this patient and her family in making a decision for chemotherapy treatment. This case underscores the need for the physicians and nurse practitioners to establish a collaborative relationship with patient, family, and other care providers when advocating for or against treatment.

Generalized leukaemia cutis from a small cell variant of T-cell prolymphocytic leukaemia presenting with exfoliative dermatitis.

T-cell prolymphocytic leukaemia (T-PLL) is a rare, aggressive neoplasm of mature T lymphocytes. The small cell variant occurs in approximately 20% of T-PLL patients. The skin findings of leukaemia consist of leukaemia-specific skin lesions, which are infiltrated by leukaemia cells, and non-specific lesions. The former type of lesion signifies leukaemia cutis. Leukaemia cutis presents clinically as tumours, nodules, or patches on the scalp, face and trunk. We report here an 82-year-old Korean male patient who presented with erythema, erosion, vesicles, and scales on his entire body with no clear underlying cause. He had been treated with oral retinoids, steroids, and phototherapy for the diagnoses of drug eruption, pityriasis rubra pilaris, and exfoliative dermatitis at other hospitals. We suspected a hidden malignancy and diagnosed small cell variant T-PLL through blood and bone marrow examination. A skin biopsy specimen showed dense infiltration of small lymphocytes in the dermis. Most of the atypical lymphocytes stained positively with CD markers such as CD2, CD3, CD4, CD5, CD7 and CD8, thereby confirming the presence of leukaemia cells. To our knowledge, this is the first case of generalized leukaemia cutis from small cell variant of T-PLL presenting with exfoliative dermatitis over the whole body.