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PubMed1995

Protracted and recurrent methicillin-resistant Staphylococcus aureus bacteremia despite defervescence with vancomycin therapy.

Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia persisted for 46 days in a 63-year-old patient and recurred over 98 days in a 79-year-old patient, despite vancomycin therapy. Although the fever resolved, patient 1 developed a spinal epidural abscess 38 days after beginning therapy and patient 2 sustained multiple relapses. A time-kill study demonstrated a reduced vancomycin killing rate in both isolates when compared to the killing rate of a control MRSA strain. The bacteremia persisted after increasing the vancomycin dose to achieve trough levels of 15-20 micrograms; it cleared after adding gentamicin. These cases illustrate that MRSA bacteremia may persist during vancomycin therapy despite resolution of fever and may lead to delayed complications, and that adding gentamicin may be necessary for ultimate clearance of the bacteremia.

Aged↗

PubMed1990

[T-cell malignant lymphoma with hemophagocytic histiocytosis, hyperferritinemia and disseminated intravascular coagulation syndrome].

A 57-year-old man was admitted to our hospital with high fever and nasal obstruction. The diagnosis of T cell type malignant lymphoma (T-ML) was made by the biopsy of left nasal cavity tumor. After admission, his general condition was improved by chemotherapy and radiotherapy, but relapsed a month later. He was then treated with chemotherapy, and the partial remission was obtained. During the clinical course, he had a high fever again without any significant infections or exacerbation of T-ML. The data of coagulation system showed DIC. The levels of serum ferritin and LDH were extremely elevated. Bone marrow aspiration showed markedly increased hemophagocytic histiocytes. These data suggested that he was complicated by DIC and hyperferritinemia closely associated with hemophagocytic histiocytosis a part from the underlying T-ML. Causes of DIC and hyperferritinemia associated with hemophagocytic histiocytosis in the present case were discussed.

Disseminated Intravascular Coagulation↗

PubMed1995

[Thrombotic thrombocytopenic purpura disclosing cancer: apropos of 2 cases].

Thrombotic thrombocytopenic purpura (TTP) causes severe haemolytic anaemia, thrombopenia, fever and neurological and renal involvement. Currently five large aetiologic groups have been identified: viral or bacterial infection, drugs, conjunctive tissue diseases, pregnancy and solid tumours. We observed two cases resulting from an adenocarcinoma. In the first case, a 71-year-old man with chronic silicosis, the presenting signs were asthenia, fever, epistaxis with diffus purpura and spontaneous haematomas of the lower limbs. Diagnosis of TTP was based on routine laboratory tests and the patient responded well to fresh frozen plasma. On the 5th day of treatment, haemoglobin level dropped sharply and melana occurred. Upper digestive tract endoscopy revealed a tumoural formation of the antrum-fundic junction and histology examination of the biopsy confirmed the diagnosis of adenocarcinoma. Ten months after gastrectomy the patient was in excellent health with no relapse of the TTP. In the second case, the presenting signs included spontaneous haematomas, rectorrhagia and low grade fever. Microscopic haematuria and renal failure were observed in addition to the biological syndrome of TTP. The patient responded poorly to fresh frozen plasma and packed cell transfusions. Plasma exchange was equally unsuccessful. The disease continued a fulminant course and the diagnosis of adenocarcinoma located in a pulmonary lymph nodes was made at autopsy. These rare cases of TTP caused by cancer emphasize the importance of a thorough aetiological research. Plasma exchange has been shown to be effective but mortality at 1 year approximately 85% in cancer related cases. Early diagnosis and specific anti-cancer therapy might improve prognosis. We report our personal experience with 16 other similar cases.

Adenocarcinoma↗

PubMed2005

A case of Epstein-Barr virus-associated natural killer/T-cell lymphoma presenting as dermatomyositis: extranodal relapse after 7 years in remission.

A 56-year-old Japanese man was admitted to our hospital due to a fever of unknown origin. He had had a history of extranodal natural killer (NK)/T-cell lymphoma, nasal type, and had been in complete remission for 7 years until June 2003, when he developed high fever, eyelid swelling, and muscular weakness. Serum creatine kinase levels were elevated. Histopathological examination of skin and muscle biopsy specimens revealed subcutaneous infiltration of lymphoid cells positive for CD3, CD56, and Epstein-Barr virus-encoded small nuclear RNA-1. We report this unique case of Epstein-Barr virus-associated lymphoma mimicking dermatomyositis.

Journal Article↗

PubMed2004

Relapse of idiopathic thrombocytopenic purpura caused by influenza A virus infection: a case report.

We report a patient with idiopathic thrombocytopenic purpura (ITP) in remission, who relapsed as a result of an influenza A virus infection. A 41-year-old woman presented with fever elevation, coughing, and generalized petechiae. Her platelet count had decreased to 1 x 10(9)/l. She had been diagnosed with ITP at age 23, and continuous complete remission had followed steroid therapy and splenectomy. Influenza A antigen was positive in her pharyngeal aspirate, and oseltamivir was effective for her symptoms. Findings of a bone marrow smear were typical for ITP. Steroid therapy resulted in a second complete remission. Although the development of ITP caused by influenza infection and a relapse caused by an influenza vaccination have been previously described, a relapse caused by a sporadic infection has never been documented to our knowledge. Physicians should carefully monitor the hematological data of influenza patients, especially those with ITP, even in remission.

Adult↗

PubMed1996

[Infectious endocarditis caused by Q fever. Apropos of a clinical case].

Endocarditis is a rare, but some times fatal, complication of Q fever. Its diagnosis is difficult and it is based on non-specific cardiac findings and a high title of phase I antibodies. The treatment is based on tetracyclines alone or in combination with cotrimoxazole, for long periods of time. The therapeutic efficacy is evaluated by the measurement of phase I antibodies, every three months. The relapses are frequent despite the long period of antibiotic therapy. We report what is probably the first case of Q fever prosthesis endocarditis in Portugal, as a complication following an acute episode of Q fever.

Adult↗

PubMed1976

The management of typhoid fever.

The diagnosis of typhoid fever requires clinical alertness and ready laboratory support, blood cultures being most important. Chloramphenicol remains the standard drug specific for acute typhoid fever while cotrimoxazole is a useful alternative. Both of these are also useful in the treatment of relapses. The importance of supportive treatment cannot be over-emphasized. The treatment of intestinal complication is mainly conservative. Steroid is useful in the toxic delirious state. The management of chronic typhoid carriers is still an unsolved problem. To exclude the chronic carriers from handling food and to give advice on meticulous attention to personal hygiene is still the best way of public health control.

Ampicillin↗

PubMed2002

Nursing implications of mylotarg: a novel antibody-targeted chemotherapy for CD33+ acute myeloid leukemia in first relapse.

PURPOSE/OBJECTIVES: To review the nursing implications of gemtuzumab ozogamicin (Mylotarg(r), CMA-676, Wyeth Pharmaceuticals, Philadelphia, PA), a novel monoclonal antibody-targeted chemotherapy agent for relapsed acute myeloid leukemia (AML). DATA SOURCES: Published articles, abstracts, book chapters, manufacturer information, unpublished clinical trial data, and personal experiences with gemtuzumab ozogamicin. DATA SYNTHESIS: Conventional chemotherapy for AML is associated with toxicities that often limit treatment options when AML relapses. Gemtuzumab ozogamicin is a humanized recombinant anti-CD33 monoclonal antibody linked to calicheamicin, a potent cytotoxic agent. The antibody targets the CD33 antigen found on the surface of leukemic blast cells and myeloid precursors. This targeting effect reduces the toxicity of gemtuzumab ozogamicin. The efficacy and tolerability of gemtuzumab ozogamicin have been documented in relapsed AML, particularly in patients 60 years of age or older, who often have no other treatment options. As with other monoclonal antibody therapies, an "infusion syndrome" (i.e., fever and chills) may occur but can be managed effectively when administration guidelines are used. CONCLUSIONS: Gemtuzumab ozogamicin is the first of a new class of targeted therapies for the treatment of relapsed AML. A number of implications for nurses exist. IMPLICATIONS FOR NURSING: Nurses must be knowledgeable about gemtuzumab ozogamicin preparation and administration, patient selection and monitoring, and intervention procedures. This knowledge is necessary to accurately inform patients and their families of the possible course of treatment and potential side effects.

Acute Disease↗

PubMed2000

Children's cancer group trials of interleukin-2 therapy to prevent relapse of acute myelogenous leukemia.

PURPOSE: Up to 80% of children with acute myelogenous leukemia treated with intensive chemotherapy achieve remission; however, a large proportion of patients develops recurrent disease. Because interleukin (IL)-2 can induce remission in patients with overt evidence of acute myelogenous leukemia, we hypothesized that it might prevent relapse when administered to patients in first remission after intensive consolidation chemotherapy. A pilot Children's Cancer Group (CCG) trial (CCG-0941) demonstrated the feasibility of this approach, and we initiated a prospective randomized trial (CCG-2961) to further evaluate the safety and potential efficacy of IL-2 therapy in preventing relapse of acute myelogenous leukemia. PATIENTS AND METHODS: In trial CCG-0941, 21 pediatric patients in complete remission following induction and consolidation chemotherapy on protocol CCG-2941 received IL-2 therapy. In CCG-2961, 79 patients in complete remission were randomized as of February 1999 to receive either IL-2 (n = 39) or no further therapy. In both trials, recombinant IL-2 was given at a dose of 9 million IU/m2/d by continuous intravenous infusion for 4 days. After 4 days of rest, IL-2 was resumed at a dose of 1.6 million IU/m2/d for 10 days by continuous infusion. We monitored patients for toxicity and relapse. RESULTS: The majority of patients treated with IL-2 in these two trials experienced some degree of fever. Seven of 60 patients (12%) had clinically significant rashes, and grade 3 vascular leak syndrome and hypotension have each been observed in five patients (8%). Hypotension resolved promptly after treatment with intravenous fluids. No patients have experienced renal toxicity or required cardiac vasopressors or transfer to an intensive care unit; there have been no treatment-related deaths. Overall, the incidence and severity of adverse events remain similar in the two trials. Total projected accrual to the IL-2 randomization is anticipated to be 326 patients, and relapse and survival data remain blinded. CONCLUSION: The dose and schedule of IL-2 used in these two trials continue to be reasonably well tolerated by children with acute myelogenous leukemia in first remission. Any conclusions with regard to efficacy must await completion of the randomized trial.

Adolescent↗

PubMed1982

Meningosis prophylaxis with intrathecal 198Au-colloid and methotrexate in childhood acute lymphocytic leukemia.

Since 1972, telecobalt irradiation plus intrathecal methotrexate (ITMTX) has been successfully replaced in Jena by intrathecal colloidal radioactive gold (198Au) plus ITMTX for meningosis prophylaxis in leukemia. Seventy-three children with acute lymphocytic leukemia (ALL) were given 1.24-4.89 mCi (45.8-181 MBq) of colloidal 198Au IT after successful initiation of remission. During cytostatic therapy, the following relapses occurred: meningosis leucaemica, five patients (6.8%); bone-marrow relapse and the meningosis leucaemica, one patient; and bone-marrow relapse, 20 patients (27.4%). In 18 children, combination chemotherapy was terminated after two and a half or three years of treatment. After that time, one meningeal relapse and six bone-marrow relapses occurred. Within the first 24 hours after application of radioactive gold, headaches, vomiting, and fever occurred in less than 10% of the children. An apathy syndrome, leukecephalopathy, or severe infections, were not observed in a single case. Radioactive gold spreads in the subarachnoid space and is phagocytized by the arachnoidea. The tumoricide effect extends selectively over the space of distribution of the latent meningosis leucaemia. The cerebral parenchyma remains unaffected by radiation. Thus, radioactive gold may be preferable to telecobalt irradiation in preventing central nervous system leukemia.

Bone Neoplasms↗

PubMed1989

A case of Vogt-Koyanagi-Harada syndrome in a patient affected by Hodgkin's disease.

The Vogt-Koyanagi-Harada (VKH) syndrome, a disease of unknown origin, characterized by inflammation of the uveal tract, retina and meninges, was observed in a patient with Hodgkin's disease (HD) who had been treated with chemotherapy and radiotherapy. Ten years later the patient developed a cluster of neurological symptoms and signs (fever, pain, bilateral hypoacousia, dizziness, uveitis and psychiatric disorder) which were initially interpreted as a relapse of HD. The diagnosis of VKH syndrome was thereafter suspected from the clinical findings, response to therapy and further evolution. During the follow-up (14 months) the patient showed a varying course; hypoacousia remained unaltered while uveitis recurred and only a partial improvement was obtained by immunosuppressive therapy.

Female↗

PubMed1992

Erysipelas-like skin lesions associated with Campylobacter jejuni septicemia in patients with hypogammaglobulinemia.

Three cases are reported of hypogammaglobulinemic males with recurrent Campylobacter jejuni septicemia and erysipelas-like cellulitis without diarrhoea. In one patient Campylobacter jejuni grew from skin biopsy specimens. The findings in another patient were strongly suggestive of osteomyelitis caused by Campylobacter jejuni. Since the susceptibility of hypogammaglobulinemic patients to infection with Campylobacter jejuni is probably related to a lack of serum bactericidal activity against Campylobacter jejuni due to lack of IgM, two patients in whom previous antimicrobial treatment failed were treated with plasma infusions. This regimen supplemented with imipenem resulted in cure of these relapsing infections. Campylobacter jejuni septicemia must be considered in hypogammaglobulinemic patients who present with periodic fever and cellulitis.

Adult↗

PubMed2006

Thoracoscopy in pediatric pleural empyema: a prospective study of prognostic factors.

PURPOSE: The indications for thoracoscopy remain imprecise in cases of pleural empyema. This study aimed to identify preoperative prognostic factors to help in the surgical decision. METHODS: From 1996 to 2004, 50 children with parapneumonic pleural empyema underwent thoracoscopy either as the initial procedure (n = 26) or after failure of medical treatment (n = 24). Using multivariate analysis, we tested the prognostic value of clinical and bacteriological data, the ultrasonographic staging of empyema, and the delay before surgery. Outcome measures were technical difficulties, postoperative complications, time to apyrexia, duration of drainage, and length of hospitalization. RESULTS: The clinical and bacterial data did not significantly predict the postoperative course. Echogenicity and the presence of pleural loculations at ultrasonography were not independent significant prognostic factors. A delay between diagnosis and surgery of more than 4 days was significantly correlated (P < .05) with more frequent surgical difficulties, longer operative time, more postoperative fever, longer drainage time, longer hospitalization, and more postoperative complications, such as bronchopleural fistula, empyema relapse, and persistent atelectasia. CONCLUSION: The main prognostic factor for thoracoscopic treatment of pleural empyema is the interval between diagnosis and surgery. A 4-day limit, corresponding to the natural process of empyema organization, is significant. The assessment of loculations by ultrasonography alone is not sufficient to predict the postoperative course.

Bacterial Infections↗

PubMed2005

Fulminant Epstein-Barr virus (EBV)-associated T-cell lymphoproliferative disorder with hemophagocytosis following autologous peripheral blood stem cell transplantation for relapsed angioimmunoblastic T-cell lymphoma.

Post-transplant lymphoproliferative disorder (PTLD) is a complication that can develop after either solid-organ or hematopoietic stem cell transplantation (HSCT). T-cell PTLD is a rare disorder, especially following autologous HSCT. Here we report a case of T-cell PTLD which occurred after autologous peripheral blood stem cell transplantation (PBSCT) for relapsed angioimmunoblastic T-cell lymphoma (AILT). Three months after the transplant, the patient developed fever with elevated plasma Epstein-Barr virus (EBV)-PCR values. The patient subsequently developed pneumonitis, hepatomegaly and marked pancytopenia due to hemophagocytosis. The patient died of multi-organ failure, despite antiviral and steroid pulse therapy. Our post-mortem study confirmed the marked proliferation of EBV-infected T-cells that differed from the original AILT clone and macrophages/histiocytes were observed in the marrow, liver, lymph nodes and lungs. Phagocytosis was most evident in the bone marrow. The patient's AILT remained in complete remission. To the best of our knowledge, this is the first case of fulminant EBV-associated T-cell lymphoproliferative disorder (LPD) following autologous HSCT.

Antigens, CD↗

PubMed1997

Amphotericin B is superior to sodium antimony gluconate in the treatment of Indian post-kala-azar dermal leishmaniasis.

Parasitologically confirmed cases of post-kala-azar dermal leishmaniasis (PKDL) were treated by infusion with amphotericin B deoxycholate (ABD; 1 mg/kg.day on days 1-20, 21-40 and 61-80) or by intramuscular injection with sodium antimony gluconate (SAG; 20-day courses at 20 mg/kg day, with 20-day, drug-free intervals). Of the 11 patients given ABD, all were cured with the three courses, none relapsed in 12 months of follow-up, all developed mild adverse effects (shivering and fever) because of the infusion, five lost their appetites, and three showed increases in their serum creatinine concentrations (although none exceeded 'normal' limits). In contrast, only seven (63%) of the 11 patients given SAG were considered treatment successes (improvement in lesions by the end of the third course) and these took six courses (two cases), nine courses (four cases) or 10 courses (one case) to cure completely. Two of the patients given SAG developed arthralgia and two others developed non-specific ST changes in their electrocardiograms (ECG), although their ECG were normal between courses. The better cure rate with ABD was not statistically significant, probably because of the small sample size. However, ABD appears to be a superior to SAG in terms of the speed of response and cure, although it is more expensive and has some nephrotoxicity. As the effectiveness of SAG against PKDL is apparently declining over time and the cost of ABD is prohibitive in poor countries such as India, a safe, cheap and more effective drug for the treatment of PKDL is needed.

Adolescent↗

PubMed1995

[Thrombocytopenic purpura associated with primary human herpesvirus-6 infection].

We report here a case of a 5-month-old infant with thrombocytopenic purpura associated with serologically confirmed primary human herpesvirus-6 (HHV-6) infection. His platelet count decreased to 17,000/mm3 on the 3rd day from the onset: Bone marrow aspiration showed that the megakaryocyte count was 129/mm3 and almost all of the them were of the non-platelet forming type. The IgG antibody to HHV-6 by indirect immunofluorescent assay in the sera in acute and convalescent phases were < 10x and 160x, respectively. IgM antibody to HHV-6 in the acute phase was positive. Platelet-associated IgG was also positive. We diagnosed this case as having thrombocytopenic purpura associated with primary HHV-6 infection. Steroid therapy was started for his thrombocytopenic purpura from the 4th day after the alleviation of his fever. His platelet count increased without side effects and became within the normal range without relapse despite discontinuation of steroid therapy. Thrombocytopenic purpura might be one of the complications of primary HHV-6 infection.

Antibodies, Viral↗

PubMed2006

Pulmonary relapse of non-Hodgkin's lymphoma in bilateral upper lobes.

We describe a 68-year-old male patient with diffuse large B-cell lymphoma (DLBCL) who suffered from relapse in bilateral upper lobes of the lung. The patient presented with cough, weakness and fever. A bronchovascular-lymphangitis-like shadow was detected in the bilateral upper lobes on a chest roentgenogram. Although cytological and cytofluorometric examinations revealed no malignant cells in the bronchoalveolar lavage fluid, trans-bronchial lung biopsy (TBLB) showed involvement of DLBCL in the bronchial mucosa. Recurrent lymphoma tends to extend along the bronchovascular bundles, resulting in granulomatous consolidation that may mimic tuberculosis and is likely to involve the lower lobes. Thus, TBLB proved to be essential for the diagnosis of the lung involvement of non-Hodgkin's lymphoma (NHL).

Aged↗

PubMedDate not supplied

Steroids used to desensitize penicillamine allergy in Wilson disease.

Patients with Wilson disease require life-long treatment and penicillamine is the drug of choice. We present a 14-year-old boy with Wilson disease who developed hypersensitivity reaction 2 days after starting penicillamine therapy. His symptoms included fever, maculopapular rash and lip edema. The allergic reaction disappeared when penicillamine was discontinued, but relapsed after reinstituting penicillamine at a lower dose. Desensitization was attempted by introducing steroid therapy, the dose of 0.7 mg per kilogram per day of prednisolone for 2 days, then penicillamine was successfully tolerated. Subsequent tapering of the daily prednisolone dose was performed till it was discontinued one month after treatment began. We suggest that concomitant use of steroid and penicillamine should be used for the treatment of patients who develop penicillamine intolerance.

Adolescent↗