Assuntos
Haplótipos/genética , Janus Quinase 2/genética , Leucemia Mieloide Aguda/genética , Transtornos Mieloproliferativos/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Genótipo , Humanos , Leucemia Mieloide Aguda/patologia , Masculino , Pessoa de Meia-Idade , Transtornos Mieloproliferativos/patologia , Polimorfismo de Nucleotídeo Único/genética , Adulto JovemRESUMO
Invasive mycoses are pre-eminent causes of morbidity and mortality in the allogeneic stem cell transplant setting. In spite of novel diagnostic modalities, the timely and specific identification of invasive mycoses still remains challenging. We analyzed the case history of 97 consecutive patients receiving 103 allogeneic stem cell transplants between January 2003 and October 2006 performed by a single team at 2 transplant centers in Budapest, Hungary. All patients with febrile neutropenia not responding to broad-spectrum antibacterial therapy received amphotericin B deoxycholate empirically. In cases of proven or probable invasive aspergillosis, intravenous voriconazole was instituted. Patients who failed to improve on initial therapy were treated with an antifungal combination, while responders were switched to oral voriconazole. A total of 38 patients died following allografting. Both centers had an autopsy rate of 100% due to central health care regulations. An infectious cause of death could be identified in 15 cases, invasive fungal disease being the most prevalent and accounting for 10 fatalities. Six patients died of invasive aspergillosis, while invasive candidiasis and mucormycosis led to a fatal outcome in 2 cases each. Despite the regular use of galactomannan antigen detections and imaging, an ante mortem diagnosis of proven/probable invasive fungal disease could only be established in 4 of 10 autopsy-verified cases (aspergillosis: 3, candidiasis: 1, mucormycosis: 0). In the remaining 6 patients, deep mycoses were missed clinically and were revealed only by postmortem histology. Present diagnostic and therapeutic strategies still seem to be suboptimal for the management of invasive fungal diseases in the high-risk allogeneic stem cell transplant population.
Assuntos
Antifúngicos/uso terapêutico , Aspergilose/diagnóstico , Candidíase/diagnóstico , Transplante de Células-Tronco Hematopoéticas , Micoses/diagnóstico , Administração Oral , Adolescente , Adulto , Antifúngicos/administração & dosagem , Aspergilose/tratamento farmacológico , Aspergilose/mortalidade , Autopsia , Candidíase/tratamento farmacológico , Candidíase/mortalidade , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Micoses/mortalidade , Transplante Homólogo , Resultado do TratamentoRESUMO
The authors present a case of monocytic aleukemic leukemia cutis in which skin symptoms were the sole manifestation of the leukemia during the first year and a half of the disease. Diagnostic difficulties, the importance of immunohistochemical markers, and the prognosis and therapy of aleukemic leukemia cutis are discussed.
Assuntos
Leucemia Mielomonocítica Aguda/patologia , Leucemia/patologia , Infiltração Leucêmica/patologia , Pele/patologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia por Agulha , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Leucemia/diagnóstico , Leucemia/tratamento farmacológico , Leucemia Mielomonocítica Aguda/diagnóstico , Leucemia Mielomonocítica Aguda/tratamento farmacológico , Infiltração Leucêmica/diagnóstico , Infiltração Leucêmica/tratamento farmacológicoRESUMO
The authors present a 39 year old female patient with acute monoblastic leukemia, at whom during a year and a half the disease was manifested only with specific skin symptoms (leukemia cutis). Diagnostic difficulties, importance of immunhistochemic markers, as well as diagnostic, prognostic and therapeutic role of aleukemic leukemia cutis are discussed.
