Toxic epidermal necrolysis in a patient with severe aplastic anemia treated with cyclosporin A and G-CSF.

Toxic epidermal necrolysis (TEN) and severe aplastic anemia (SAA) are rare nonpredictable side effects of several drugs. To our knowledge there are no reports on the coexistence of these two disorders. This study presents a 23 year-old man with TEN diagnosed 6 days after treatment with aminophenazone, paracetamol and phenoxymethylpenicillin. The resolution of the skin disorder was observed after few days of treatment with G-CSF and cyclosporin A. In contrast, SAA only partially responded to treatment with these agents.

Plasmablastic lymphoma in a patient with chronic lymphocytic leukemia heavily pretreated with cladribine (2-CdA): an unusual variant of Richter's syndrome.

Patients with chronic lymphocytic leukemia (CLL) may develop a large-cell transformation known as Richter's syndrome (RS). RS usually presents as diffuse large-cell lymphoma (DLCL) or its immunoblastic variant, and it can be recognized simultaneously with CLL or even 23 yr after its diagnosis. We describe an unusual case of CLL treated with cladribine (2-CdA) in whom DLCL of the plasmablastic type (PBL) developed 4 yr after CLL (Rai IV) diagnosis and 1.5 yr after the 10th course of 2-CdA treatment. Immmunologic, cytogenetic, and molecular studies performed at the time of CLL and PBL coappearance indicated that both tumors originated from different B-cell progenitors. Both malignancies were refractory to VAD (vincristine, doxorubicin, dexamethasone)-based chemotherapy, and only partial response was achieved with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) salvage treatment. However, the patient died 6 months after the occurrence of RS due to rapid progression of PBL. This is the first description of a CLL patient who developed an unusual plasmablastic variant of RS. Recently, the PBL entity has been identified among DLCL associated with the human immunodeficiency virus (HIV) infection. We suggest that in our CLL patient heavily pretreated with 2-CdA, PBL arose as a second clone due to the prolonged and severe state of the host's immunosuppression. Overall survival with current strategies is poor, and further insight into the natural history, biology, and treatment of PBL are needed.

Atypical chronic myelogenous leukemia following immunosuppressive therapy for severe aplastic anemia.

Late clonal complications of aplastic anemia (AA) such as acute leukemia, myelodysplastic syndromes or paroxysmal nocturnal hemoglobinuria have been recognized for a long time. To our knowledge, chronic myelogenous leukemia (CML) as a late complication of severe aplastic anemia has as yet not been reported. We report here a case of AA treated successfully with antilymphocytic globulin and cyclosporin in whom Ph1 negative, BCR/ABL negative CML developed 8 years after diagnosis of AA. This case of atypical, secondary CML was refractory to treatment with interferon alpha and hydroxyurea.

A survey of aflatoxin levels in peanut meal imported into Poland for animal feedingstuffs.

Peanut meals (366 samples) imported into Poland from Brazil and India during 1984-86 for use in animal feedingstuffs were analysed for aflatoxins B1 and B2. Average levels of contamination were 71 micrograms per kg for aflatoxin B1 and 16 micrograms per kg for aflatoxin B2 with total concentrations ranging from 2 to 750 micrograms per kg.

Levels of aflatoxin B1, bacteria and fungi in feed and food in 1971 - 1987.

Totally 39% out of 8371 feed and their component samples were contaminated by aflatoxin B1. Mean contamination was 36µg/kg with maximum yield 10100 µg/kg. Contamination of samples by total count of organisms, mean contamination and maximum yield, respectively was: 1) bacteria 99%, 2.2×10(6), 2.4×10(8); 2) proteolytic bacteria 94%, 1.2×10(5), 3.0×10(6);3) moulds 98%, 1.3×10(5), 9.0×10(6); 4) yeasts 44 %, 3.3×10(4), 3.6×10(6). The samples were contaminated in 92 % byAspergillus spp, in 71% byAspergillus flavus, in 83% byPenicillium spp, and in 20% byFusarium spp with mean contamination 8.3×104, 1.1×10(3), 4.2×10(4), 5.0×10(3) , and maximum yield 6.8×10(6), 1.0×10(5), 5.0×10(6), 1.5×10(6), respectively. Totally 8.5% of strains were aflatoxinogenic and 4.4% of the strains were isolated from feed and 21 % of the strains from grain/nut.