Association of temporal arteritis, retinal vasculitis, and xanthomatosis with multiple myeloma: case report and literature review.

Bone pain, anemia, renal failure, and paraproteinemia are common manifestations in patients with multiple myeloma. In this article, we describe an elderly woman with multiple myeloma who had unusual manifestations of cutaneous xanthomatosis, temporal arteritis, and retinal vasculitis. The literature of the dermatologic, ocular, and rheumatologic manifestations of multiple myeloma is reviewed, and the clinical significance of vasculitis in multiple myeloma is discussed.

Acute mediastinitis secondary to leakage of parenteral nutrition from a migrated central venous catheter in a patient undergoing autologous bone marrow transplant.

We describe an unusual case of pyrexia of unknown origin in a patient undergoing autologous bone marrow transplantation for metastatic breast cancer. The fever was due to extravasation of lipid-containing hyperalimentation fluid from a migrated central venous catheter into the mediastinum, resulting in mediastinitis and pleurisy. The fever persisted despite broad-spectrum antibiotics and amphotericin B, and finally responded to steroids.

Mycobacterium tuberculosis infection masquerading as diffuse alveolar hemorrhage after autologous stem cell transplant.

We report a fatal case of pulmonary tuberculosis masquerading as diffuse alveolar hemorrhage after autologous stem cell transplant.

Cardiac arrhythmia after infusion of cryopreserved stem cells.

A retrospective study of the cardiovascular side-effects of 17 patients during and after receiving unpurged cryopreserved autologous bone marrow and/or peripheral blood stem cells was performed. Fourteen (82%) patients developed cardiac arrhythmia, of which 11 (65%) developed sinus bradycardia, four (24%) second degree heart block and one patient had complete heart block. The onset of sinus bradycardia occurred at 15-513 (median 56) min and the onset of heart block ranged from 30 to 680 (median 234) min after starting the stem cell infusion. Hypertension was noted in seven patients (41%) and usually occurred within 2 hours of infusion. There was no mortality or symptoms associated with these findings. Since some of these arrhythmias could be quite severe as assessed electrophysiologically, continuous cardiac monitoring should be considered during and after the infusion of cryopreserved stem cells.

Evans syndrome after autologous bone marrow transplant for recurrent Hodgkin's disease.

The association of immune thrombocytopenic purpura (ITP) and autoimmune hemolytic anemia (AIHA) with Hodgkin's disease has been known for many years. Autoimmune cytopenia has also been described in patients that have undergone allogeneic or autologous bone marrow transplantation. We report a rare case of Evans syndrome in a patient 3 years after autologous bone marrow transplantation for recurrent Hodgkin's disease.

Development of minimally differentiated acute myeloblastic leukemia with novel isochromosome 18p and antecedent aplastic anemia.

We describe a case of acute myeloblastic leukemia with a novel isochromosome 18, i(18)(p10), preceded by aplastic anemia for six months. The patient is a cotton grower chronically exposed to pesticides. The significance of this chromosomal abnormality is unknown. The possible relationship to the preceding history of aplastic anemia and occupational pesticide exposure is speculated on. The possible mechanism of the association of acute leukemia and aplastic anemia is discussed.

Translocation (1;22) in refractory anemia and the prognostic significance of karyotypic abnormalities in refractory anemia.

The most common cytogenetic abnormalities associated with myelodysplastic syndromes are deletions of chromosomes 5 and 7 and trisomy 8. Reciprocal translocation is relatively uncommon in refractory anemia. We describe a case of refractory anemia associated with trisomy 8 and a derivative chromosome 22 resulting from t(1;22)(q11;q11.2). The diseases and the role of the various genes that are mapped to these breakpoints are discussed. The prognostic significance of karyotypic abnormalities in refractory anemia are reviewed.

Double minute chromosomes and myelodysplastic syndrome: a case report and literature review.

Double minute chromosomes (dmin) occur in about 3.3-10.6% of acute leukemia, especially in the elderly. However, dmins are relatively rare in myelodysplastic syndrome (MDS). We describe a case of refractory anemia with excess blasts associated with complex cytogenetic abnormalities, dmins, and brief survival.

Translocation t(15;17) in acute myelogenous leukemia with atypical megakaryoblastic features: diagnostic, clinical, and therapeutic implications.

We describe the first reported case of acute myelogenous leukemia with characteristics of megakaryoblastic differentiation and the t(15;17) chromosomal translocation, which has been associated with promyelocytic leukemia. The diagnostic, clinical, and therapeutic implications are discussed.

Unusual presentation of multiple myeloma with "jumping translocation" involving 1q21. A case report and review of the literature.

We describe a case of multiple myeloma with unusual manifestations consisting of cutaneous xanthomatosis, temporal arteritis, retinal vasculitis with a complex karyotype, and a "jumping translocation" involving 1q21. The literature of cytogenetic studies of multiple myeloma and of jumping translocation is reviewed.

Biphenotypic M0 acute myeloid leukemia with trisomy-4.

We report here a rare case of biphenotypic M0 acute myeloid leukemia (AML) associated with trisomy 4. The literature of trisomy 4 in acute leukemia was reviewed. M2 and M4 AML are the most common FAB subtypes associated with trisomy 4. The clinical course of this entity is generally comparable with other non-trisomy 4 cases of AML. Despite the speculation made when first described, no specific environmental toxin has been found to be associated with this entity. C-kit oncogene has been mapped to chromosome 4 recently, and the role of this proto-oncogene in leukemogenesis of trisomy 4 associated leukemia should be further investigated.

Primary pancreatic lymphoma associated with short bowel syndrome: review of carcinogenesis of gastrointestinal malignancies.

We describe a case of stage IE diffuse small cleaved B-cell lymphoma involving primarily the head of pancreas in a patient with chronic malabsorption as a result of short bowel syndrome. The association of chronic malabsorption with lymphoma and other cancer is reviewed. The possible role of dietary fat as an etiologic link to this association is speculated.

Non-pyothorax-associated primary pleural lymphoma with complex karyotypic abnormalities.

We describe a case of non-pyothorax-associated primary pleural lymphoma with bone marrow and central nervous system involvement, and complex karyotypic abnormalities involving nullisomy chromosome 17 and multiple breakpoints that are commonly associated with acute leukemia and myeloproliferative diseases.

Progressive thrombosis after treatment of diffuse large cell non-Hodgkin's lymphoma and concomitant lupus anticoagulant.

We report a case of diffuse large cell non-Hodgkin's lymphoma with concomitant lupus anticoagulant at initial diagnosis. Progressive thrombosis occurred despite radiologically proven response of the lymphoma after chemotherapy treatment. Extraordinary bone scintigraphy with multiple "cold" lesions probably due to bone ischemia is described.

Extramedullary plasmacytoma of the heart presenting as cardiac emergency. Review of literature.

A case of extramedullary plasmacytoma of the heart was described and the literature was reviewed. Prompt surgical intervention is recommended to patients with mechanical obstruction leading to severe hemodynamic disturbance. Systemic chemotherapy or radiotherapy should be considered after the emergency has been settled.

Secondary syringomyelia due to intramedullary spinal cord metastasis. Case report and review of literature.

Intramedullary spinal cord metastasis is relatively rare. We describe a patient having intramedullary spinal cord metastasis associated with syringomyelia, confirmed by magnetic resonance imaging, in a patient who had poorly differentiated carcinoma of the lung. The patient responded to treatment with steroids and radiotherapy, with complete resolution of neurologic symptoms and syringomyelia.

Increased incidence of central venous catheter-related infections in bone marrow transplant patients.

In view of an apparent increase of central venous catheter-related infections among our bone marrow transplant (BMT) patients, a retrospective study of infectious complications of central venous catheters was conducted. During 1992, 147 central venous catheters were placed in 133 patients. The overall infection rate of all catheters was 3.3 per thousand catheter-days (bacteremia 1.8, site infection 1.5). Patients scheduled for BMT had the highest infection rate of 11.5 (bacteremia 6.7, site infection 4.8). HIV patients had an infection rate of 6.6 per thousand catheter-days (bacteremia 3.8 and site infection 2.8) and patients with other diagnoses had a rate of 2.4 (bacteremia 1.3 and site infection 1.1). The difference of infection risk among the three groups is statistically significant (logrank p < .0001). In analyzing the 11 BMT patients more carefully, 14 catheters were placed. Of these, 9 catheters were removed, 8 (89%) of which were secondary to infection. Multivariate analysis showed that patients under 50 and BMT patients were more likely to develop catheter-related infection. While the cause of this complication is not known at present, the possible association with PBSC harvest is of much concern.

Anaerobic bacteremia in a neutropenic patient with oral mucositis.

An increasing number of anaerobic bloodstream infections in neutropenic cancer patients have been reported in the last decade. The type of anaerobes isolated from most of these patients suggests an oral source of infection. We describe a case of anaerobic bacteremia in a neutropenic patient with oral mucositis that highlights the importance of considering these organisms when selecting empiric prophylactic or therapeutic antimicrobial regimens, especially in the setting of periodontal disease or oral mucositis.

Thrombotic risk of muscular dystrophy: protein C deficiency, factor V Leiden, and myotonic dystrophy.

While patients with hereditary muscular disorder are more sedentary and believed to be at risk of thrombosis, there is little literature on thrombosis associated with hereditary muscular disorder. We report a rare case of double heterozygous type I protein C deficiency and factor V Leiden in a patient with classic myotonic dystrophy.

Jejunal adenocarcinoma presenting as iron deficiency in a young man.

A 30-year-old man presented with iron deficiency anemia and occult blood in his stools. Both upper and lower gastrointestinal tract endoscopy were initially unrevealing. This case illustrates the importance of small bowel follow through/enteroclysis supplemented by endoscopic examination and biopsy for adenocarcinoma of the proximal jejunum.