RESUMO
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.
Assuntos
Arterite de Células Gigantes/etiologia , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico , Retina/patologia , Vasculite/etiologia , Xantomatose/etiologia , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , HumanosRESUMO
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.
Assuntos
Transplante de Medula Óssea/efeitos adversos , Cateterismo Venoso Central/efeitos adversos , Mediastinite/etiologia , Nutrição Parenteral/efeitos adversos , Doença Aguda , Neoplasias da Mama/terapia , Feminino , Febre/etiologia , Glucocorticoides/uso terapêutico , Humanos , Mediastinite/diagnóstico por imagem , Mediastinite/tratamento farmacológico , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Transplante AutólogoRESUMO
We report a fatal case of pulmonary tuberculosis masquerading as diffuse alveolar hemorrhage after autologous stem cell transplant.
Assuntos
Hemorragia/diagnóstico , Pneumopatias/diagnóstico , Alvéolos Pulmonares , Tuberculose Pulmonar/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , MasculinoRESUMO
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.
Assuntos
Arritmias Cardíacas/etiologia , Transplante de Medula Óssea/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Adolescente , Adulto , Idoso , Pressão Sanguínea , Criopreservação , Eletrocardiografia , Feminino , Humanos , Hipertensão/etiologia , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
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.
Assuntos
Anemia Hemolítica Autoimune/etiologia , Doenças Autoimunes/etiologia , Transplante de Medula Óssea/efeitos adversos , Doença de Hodgkin/terapia , Púrpura Trombocitopênica/etiologia , Linfócitos T/imunologia , Adulto , Anemia Hemolítica Autoimune/imunologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Autoanticorpos/imunologia , Doenças Autoimunes/imunologia , Linfócitos B/imunologia , Linfócitos B/patologia , Medula Óssea/patologia , Transplante de Medula Óssea/imunologia , Terapia Combinada , Evolução Fatal , Feminino , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/imunologia , Humanos , Hiperplasia , Infarto/etiologia , Cooperação Linfocítica , Infarto do Miocárdio/etiologia , Púrpura Trombocitopênica/imunologia , Terapia de Salvação , Baço/irrigação sanguínea , Síndrome , Linfócitos T/patologia , Fatores de Tempo , Transplante AutólogoRESUMO
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.
Assuntos
Anemia Aplástica/patologia , Cromossomos Humanos Par 18/genética , Isocromossomos/genética , Leucemia Mieloide Aguda/genética , Pré-Leucemia/patologia , Doenças dos Trabalhadores Agrícolas/tratamento farmacológico , Doenças dos Trabalhadores Agrícolas/patologia , Anemia Aplástica/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Humanos , Cariotipagem , Leucemia Mieloide Aguda/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Praguicidas/efeitos adversos , Pré-Leucemia/tratamento farmacológicoRESUMO
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.
Assuntos
Anemia Refratária/genética , Cromossomos Humanos Par 1 , Cromossomos Humanos Par 22 , Translocação Genética , Idoso , Feminino , Humanos , Cariotipagem , PrognósticoRESUMO
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.
Assuntos
Aberrações Cromossômicas/genética , Síndromes Mielodisplásicas/genética , Idoso , Aberrações Cromossômicas/patologia , Bandeamento Cromossômico , Transtornos Cromossômicos , Feminino , Amplificação de Genes , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/patologiaRESUMO
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.
Assuntos
Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/patologia , Megacariócitos/patologia , Complicações Neoplásicas na Gravidez , Adolescente , Feminino , Humanos , Cariotipagem , Leucemia Megacarioblástica Aguda/patologia , Gravidez , Complicações Neoplásicas na Gravidez/patologiaRESUMO
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.
Assuntos
Cromossomos Humanos Par 1 , Mieloma Múltiplo/genética , Translocação Genética , Idoso , Feminino , Humanos , CariotipagemRESUMO
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.
Assuntos
Cromossomos Humanos Par 4 , Leucemia Mieloide/patologia , Trissomia , Doença Aguda , Adulto , Antígenos CD/análise , Antígenos CD7 , Antígenos de Diferenciação de Linfócitos T/análise , Biomarcadores Tumorais/análise , Antígenos CD13/análise , DNA Nucleotidilexotransferase/análise , Diagnóstico Diferencial , Evolução Fatal , Humanos , Leucemia Mieloide/classificação , Leucemia Mieloide/diagnóstico , Leucemia Mieloide/genética , Masculino , Proteínas de Neoplasias/análise , Fenótipo , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Proto-Oncogene Mas , Proto-OncogenesRESUMO
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.
Assuntos
Neoplasias Gastrointestinais/etiologia , Linfoma não Hodgkin/complicações , Neoplasias Pancreáticas/complicações , Síndrome do Intestino Curto/complicações , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
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.
Assuntos
Aberrações Cromossômicas , Linfoma/genética , Neoplasias Pleurais/genética , Adulto , Idoso , Neoplasias da Medula Óssea/genética , Neoplasias da Medula Óssea/secundário , Neoplasias do Sistema Nervoso Central/genética , Neoplasias do Sistema Nervoso Central/secundário , Empiema Pleural/genética , Empiema Pleural/patologia , Feminino , Humanos , Cariotipagem , Linfoma/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Pleurais/patologiaRESUMO
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.
Assuntos
Inibidor de Coagulação do Lúpus/metabolismo , Linfoma Difuso de Grandes Células B/complicações , Trombose/etiologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico por imagem , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Transtornos Linfoproliferativos/complicações , Masculino , Prednisona/uso terapêutico , Cintilografia , Trombose/diagnóstico por imagem , Vincristina/uso terapêuticoRESUMO
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.
Assuntos
Neoplasias Cardíacas/diagnóstico , Plasmocitoma/diagnóstico , Adulto , Diagnóstico Diferencial , Emergências , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Plasmocitoma/complicações , Plasmocitoma/cirurgiaRESUMO
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.
Assuntos
Neoplasias da Medula Espinal/complicações , Siringomielia/etiologia , Adulto , Terapia Combinada , Feminino , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Imageamento por Ressonância Magnética , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/secundário , Neoplasias da Medula Espinal/terapia , Siringomielia/diagnósticoRESUMO
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.
Assuntos
Transplante de Medula Óssea , Cateterismo Venoso Central/efeitos adversos , Infecções/etiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Feminino , Humanos , Incidência , Infecções/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de RiscoRESUMO
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.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bacteriemia/microbiologia , Bactérias Anaeróbias/isolamento & purificação , Neutropenia/induzido quimicamente , Neutropenia/complicações , Estomatite/microbiologia , Adolescente , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Citarabina/efeitos adversos , Eubacterium/isolamento & purificação , Fusobacterium necrophorum/isolamento & purificação , Humanos , Idarubicina/efeitos adversos , Leucemia Mielomonocítica Aguda/tratamento farmacológico , Masculino , Mucosa Bucal/microbiologia , Estomatite/tratamento farmacológicoRESUMO
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.
Assuntos
Fator V/genética , Distrofias Musculares/complicações , Distrofias Musculares/genética , Deficiência de Proteína C/complicações , Deficiência de Proteína C/genética , Trombose/etiologia , Trombose/genética , Humanos , Masculino , Pessoa de Meia-Idade , MutaçãoRESUMO
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.