A novel use of early radiation therapy in the treatment of hyperbilirubinemia in a patient with primary hepatic lymphoma and chronic hepatitis C.

Lymphomas arising in the liver are extremely rare. Here, we describe a case of Hepatitis C virus infection with primary hepatic lymphoma (PHL) presenting with hyperbilirubinemia. A 45-year-old African American male presented with abdominal pain, pruritus, and itching for two days. CT of abdomen and pelvis with contrast showed numerous masses in the liver. The liver biopsy was consistent with diffuse large B cell lymphoma (DLBCL). Conventional chemotherapy was avoided initially because of hyperbilirubinemia. Hence, radiation therapy was given initially to reduce his bilirubin levels and tumor size. The patient was able to complete six cycles of rituximab combined with cyclophosphamide, adriamycin, vincristine, and prednisone (R-CHOP) chemotherapy and achieved a complete response verified by positron emission tomography-computed tomography (PET-CT). PHL should be considered when there are numerous space occupying liver lesions seen on imaging. Hyperbilirubinemia may be a reason for delay in treatment for some of these patients. Hence, the role of radiation therapy prior to treatment with R-CHOP is an alternative to management for stage IV diffuse large B cell lymphoma.

Klebsiella ozaenae sepsis in a young healthy male

Introduction: K. ozaenae is a weak pathogenic organism known to cause primary atrophic rhinitis or ozena. There are few reports that the bacteria could cause serious invasive infection in debilitated patients. This is fi rst report of K. ozaenae in a young previously healthy adult. Case presentation: A 34-year-old Filipino male with no signifi cant previous medical history presented with severe frontal headache of two days duration with fever and chills. Blood and serum work-up showed leukocytosis, mild thrombocytopenia, hypomagnesemia, hypokalemia, and hypophopatemia. Liver function test indicated elevated bilirubin and transaminases. CT of the head indicated sinus disease including mucoperiosteal-like thickening of the right maxillary sinus, left mastoid hypoaeration and sclerosis characteristics of chronic infl ammation. Blood culture grew gram negative rods identifi ed as Klebsiella ozaenae species. Conclusion: Klebisella ozaenae sepsis is rarely reported in medical literature. There are about 12 case reports all of which identifi ed with one or more chronic conditions causing decline in patient immunity resulting in invasive infection by the weak pathogen. Our patient is a young physically active adult male with no identifi able risk factors except chronic ozena-like infection that might serve as a source for haematologic seeding.