Diffuse bilateral retinal hemorrhages in an infant with a coagulopathy and prolonged cardiopulmonary resuscitation.

We report a case of diffuse bilateral retinal and optic nerve sheath hemorrhages in an 8-week-old boy who was found unresponsive. The child underwent prolonged cardiopulmonary resuscitation and was noted on admission to have a coagulopathy. An autopsy determined the cause of death to be a myocardial infarct in the distribution of an anomalous coronary artery. This case demonstrates the difficulty that may occur in establishing whether child abuse caused death in the setting of another potential cause of mortality.

Burkitt s lymphoma variant of post-transplant lymphoproliferative disease (PTLD).

The occurrence of posttransplant lymphoproliferative disorder (PTLD) in solid organ allograft recipients can be quite varied in clinical presentation, histopathological characteristics and frequency. A variety of lymphomas can develop as a PTLD although some types appear infrequently and remain poorly understood in this clinical setting. In this report, we describe two cases of Burkitt s lymphoma presenting as a PTLD following liver transplantation. The recipients were 12 and 44 years of age and displayed gastrointestinal involvement by the tumors several years following transplant. The tumors displayed the typical histological features of Burkitt s lymphoma and were markedly positive for EBV. The tumors displayed similar immunophenotypic characteristics by flow cytometry and had rearrangements of the immunoglobulin J-H heavy chain. The tumors required aggressive chemotherapy and a cessation of immunosuppressive therapy. This report demonstrates that Burkitt s type lymphomas can develop in the posttransplant setting and that these tumors contain morphologic, cytofluorographic and molecular features identical to Burkitt s lymphomas that occur in non-transplant patients. Our experience is that these PTLD- Burkitt s lymphomas behave aggressively and require intensive chemotherapeutic intervention.

Arrhythmogenic right ventricular dysplasia in the elderly.

Arrhythmogenic right ventricular dysplasia (ARVD) is a form of cardiomyopathy characterized by fibrofatty infiltration of the right ventricle that leads to cardiac arrhythmias, usually sustained ventricular tachycardia or ventricular fibrillation. ARVD typically becomes recognized in young adults. The authors report a case of an octogenarian in whom third-degree atrioventricular block, low cardiac output syndrome, and failure to capture the pacer stimuli developed. ARVD was diagnosed at autopsy based on fibrofatty replacement of the right ventricle. To date, this case represents the oldest patient ever diagnosed with ARVD reported in the literature.