Breakthrough Hormographiella aspergillata Infection in a Patient with Acute Myeloid Leukemia Receiving Posaconazole Prophylaxis: A Case Report and Review

Breakthrough invasive infections occur in immunosuppressed patients while they are receiving antifungal agents for both prophylaxis and therapy. Under such conditions, unusual fungal infections emerge. Hormographiella aspergillata is considered an uncommon human pathogen and causes devastating infections. Here, we present a case report of necrotizing pneumonia caused by H. aspergillata as a breakthrough infection in a neutropenic patient and review all previous cases of H. aspergillata infection reported in the literature.

     

急性单核细胞白血病M5转为急性红白血病M6一例病例分析及文献复习

目的:红白血病为临床少见的急性髓系白血病亚型,白血病克隆转换不常见,在国内外文献中有关报道少见.通过对一例由急性单核细胞白血病转化的急性红白血病(acute erythroid leukemias,AEL)的病例分析,学习并探讨急性红白血病的临床特点及实验室检查特征,提高对急性红白血病疾病特点及白血病克隆转化的认识.方法:报道一例初诊为急性单核细胞白血病,后转为急性红白血病的患者.期间对其进行持续的细胞形态学,遗传学及分子生物学监测.结果:患者首次入院诊断为急性单核细胞白血病,经过一个疗程化疗后,骨穿显示从急性单核细胞白血病转为急性红白血病.随后再进行了一个疗程化疗,化疗结束后患者好转出院.后因经济原因,患者未继续治疗,2月后随访,患者死亡.结论:本例急性单核细胞性白血病化疗后转为红白血病.究其机制,可能有:一.发病是粒-单定向祖细胞和红系定向祖细胞同时受损,只是早期单核细胞系异常表现明显,红系异常早期表现不明显.或疾病起源于更早期造血干细胞,导致单核系和红系均有异常.二.在疾病过程中,骨髓微环境的变化,诱导红系异常而导致红白血病的发生.经过分析,本病例中,疾病可能起源于更早期造血干细胞的可能性较大,而骨髓微环境在疾病变化过程中则起到了重要的作用.这一结果有待进一步临床观察研究和肯定.提醒临床医生,提高动态的诊断和治疗意识,将有助于该疾病的预防、诊断和治疗.     

Combined Medical and Surgical Management of Hepatic Mucormycosis in an Adult with Acute Myeloid Leukemia: Case Report and Review of the Literature

Mycopathologia - Hepatic mucormycosis is a disease caused by a ubiquitous fungus which is especially important in patients with hematologic malignancies. We present a case of an adult patient with...     

Invasive Geotrichum clavatum Fungal Infection in an Acute Myeloid Leukaemia Patient: A Case Report and Review

Invasive Geotrichum clavatum fungal infections are extremely rare and unusual, occurring nearly exclusively in patients experiencing prolonged neutropenia during the treatment for acute myeloid leukaemia. Several groups of cases of fatal G. clavatum infection were reported in France between 2011 and 2012, but the ecological niche has not yet been identified. We report a case of a 32-year-old patient with acute myeloid leukaemia who developed G. clavatum sepsis with primary peritonitis, hepatic nodular lesions, and multivisceral failure during aplasia after induction followed by salvage chemotherapy. He was treated with voriconazole and is still alive 1 year after with controlled disease. We then discuss the epidemiological, clinical, and therapeutic features of these serious fungal infections compared to the published data.     

Disseminated Amphotericin-Resistant Fusariosis in Acute Leukemia Patients: Report of Two Cases

Disseminated fusariosis has emerged as a significant, usually fatal infection in immunocompromised hosts despite antifungal treatment. We describe here two patients with acute leukemia who developed disseminated amphotericin-resistant fusariosis, and review of six studies of cases series in the literature. Two Fusarium solani strains were isolated from blood and skin cultures of one patient, and one strain from the blood culture of the second patient. Both patients died despite antifungal treatment. Strains were identified by sequencing of ITS1 and ITS4 regions. Random amplified polymorphic DNA analysis of the three F. solani isolates showed a low degree of similarity. Screening for Fusarium spp. contaminants within our facility was negative. Using the CLSI M-38-A2 broth dilution method and E tests^®, we found that the MICs were low for voriconazole (0.12 and 0.5 mg/L, respectively), unexpectedly high for amphotericin B (≥8 and ≥32 μg/mL, respectively) and itraconazole (≥16 mg/ml). Patients with leukemia or persistent neutropenia should be assessed for disseminated fungal infections, including biopsy and skin cultures. Antifungal susceptibility tests are important due to the possibility of the strains being amphotericin resistant. Treatments must be aggressive, with high doses of antifungals or combined therapy.     

慢性戊肝重叠急性乙肝患者一例报道并文献复习

目的:探讨慢性戊型病毒性肝炎合并急性乙型病毒性肝炎的发病机制、诊断、治疗及其预后。方法:回顾我院收治的一例慢性戊型病毒性肝炎合并急性乙型病毒性肝炎患者的临床资料,并结合文献探讨戊型病毒性肝炎及乙型病毒性肝炎的发病机制,总结其诊断及治疗经验,并评价其预后。结果:该患者戊肝抗体长期阳性,被诊断为慢性戊型病毒性肝炎,但合并急性乙型病毒性肝炎后,经治疗乙肝表面抗原转阴后戊肝抗体Ig M也阴转。结论:慢性戊型病毒性肝炎合并急性乙型病毒性肝炎患者经治疗后可同时出现乙肝表面抗原转阴,戊肝抗体阴转,预后可较好。     

Bloodstream Infection of a Cancer Patient by Cystobasidium minutum: A Case Report and Literature Review

Mycopathologia - Emergent fungal infections are uncommon conditions which frequently lead to death. To our knowledge, only a few cases of invasive infection by...     

High-Dose Cytarabine in Acute Myeloid Leukemia Treatment: A Systematic Review and Meta-Analysis

The optimal dose, scheme, and clinical setting for Ara-C in acute myeloid leukemia (AML) treatment remain uncertain. In this study, we performed a meta-analysis to systematically assess the impact of high-dose cytarabine (HDAC) on AML therapy during the induction and consolidation stages. Twenty-two trials with a total of 5,945 de novo AML patients were included in the meta-analysis. Only patients less than 60 year-old were included in the study. Using HDAC in induction therapy was beneficial for RFS (HR = 0.57; 95% CI, 0.35–0.93; P = 0.02) but not so for CR rate (HR = 1.01; 95% CI, 0.93–1.09; P = 0.88) and OS (HR = 0.83; 95% CI, 0.66–1.03; P = 0.1). In consolidation therapy, HDAC showed significant RFS benefits (HR = 0.67; 95% CI, 0.49–0.9; P = 0.008) especially for the favorable-risk group (HR = 0.38; 95% CI, 0.21–0.69; P = 0.001) compared with SDAC (standard dose cytarabine), although no OS advantage was observed (HR = 0.84; 95% CI, 0.55–1.27; P = 0.41). HDAC treatment seemed less effective than auto-BMT/allo-BMT treatment (HR = 1.66, 95% CI, 1.3–2.14; P<0.0001) with similar OS. HDAC treatment led to lower relapse rate in induction and consolidation therapy than SDAC treatment, especially for the favorable-risk group. Auto-BMT/allo-BMT was more beneficial in prolonging RFS than HDAC.     

Significant Hypercortisolism During Fractionated Radiotherapy in a Patient with a Large Corticotroph Adenoma: A Case Report and Literature Review

ObjectiveWe describe a patient with a large, invasive corticotroph adenoma who developed severe hypercortisolism shortly after starting fractionated radiotherapy.MethodsWe reviewed the patient’s clinical course, along with relevant literature for similar reported cases.ResultsA 29-year-old man was referred for radiotherapy for a residual and recurrent, invasive corticotroph adenoma. Prior to radiotherapy, he had a normal urine free cortisol (UFC) level of 44.7 μg/24 hours, with minimal symptoms. Within 2 weeks of radiotherapy, he developed hypertension, ankle edema, and hypokalemia (potassium level, 2.8 mEq/L), with a markedly elevated UFC level of 9,203 μg/24 hours. His UFC gradually decreased and normalized by the end of radiotherapy. One month later, the patient became adrenal insufficient, with a nondetectable 24-hour UFC. His adrenal function slowly recovered in 3 months. We are aware of only one previous case report of clinically significant hypercortisolism following radiotherapy in Cushing disease.ConclusionRadiotherapy may result in acute severe hypercortisolism in patients with a large corticotroph adenoma. This uncommon, but clinically significant, acute adverse effect of radiotherapy suggests that clinical observation and biochemical monitoring during or soon after radiotherapy may be indicated. (Endocr Pract. 2014;20:e166-e170)     

慢性髓性白血病患者非血缘供者骨髓移植术后并发甲状腺功能亢进1例并文献复习

目的:分析骨髓移植后引起甲状腺功能亢进的病因、临床特点、治疗及预后.方法:报道l例慢性髓性白血病患者非血缘供者骨髓移植术后并发甲状腺功能亢进随访9年的结果,并复习相关文献.结果:患者男性,21岁,确诊慢性髓性白血病后行非血缘供者骨髓移植,术后+44天,出现持续低热,抗细菌、抗病毒及抗真菌治疗均无效,排除疾病复发,查甲状腺功能提示患者从亚临床甲状腺功能亢进进展为甲状腺功能亢进,给予口服甲巯咪唑治疗2周,患者体温降至正常,血T4、fT4恢复正常,随访9年,慢性髓性白血病无复发,甲状腺功能持续正常.检索文献发现类似报道5例,对其进行归纳分析.结论:骨髓移植术后早期并发甲状腺功能亢进,可能与放化疗预处理及免疫损伤引起的破坏性甲状腺炎相关,有其独特的临床表现,极易被忽视,治疗方面可以尝试应用糖皮质激素及抗甲状腺药物.对于非血缘供者骨髓移植后不明原因发热者,应考虑到甲亢可能.     

Fusarium falciforme Infection of Foot in a Patient with Type 2 Diabetes Mellitus: A Case Report and Review of the Literature

Fungal infections of foot in patients with diabetes are not uncommon; however, foot infection due to Fusarium species has been rarely reported. We report here a case of a 50-year-old male with type 2 diabetes who developed multiple spontaneous nodular lesions on right foot without any systemic symptoms and signs for 6 months. The lesions were unresponsive to broad-spectrum antibacterial treatment. Fine needle aspiration cytology of nodular lesions revealed the presence of fungal hyphae, and Fusarium species was isolated from the same sample which was identified as Fusarium solani species complex: Fusarium falciforme. Radiological investigations and blood culture ruled out any dissemination of the disease. The lesions healed after voriconazole therapy for 3 months. No relapse was noted at the end of the next 6-month follow-up. All reported cases of Fusarium infection of foot in patients with diabetes in English and non-English literature since 1970 have been reviewed.     

Kodamaea Ohmeri Fungemia in an Immunocompetent Patient Treated with Micafungin: Case Report and Review of the Literature

Kodamaea (Pichia) ohmeri is an unusual yeast-form fungus that has recently been identified as an important etiology of fungemia, endocarditis, cellulitis, funguria and peritonitis in immunocompromised patients. We report a case of K. ohmeri fungemia in a 34-year-old hospitalized patient with thrombophlebitis. The patient was admitted to the hospital for evaluation and management of an acquired tracheo-esophageal fistula secondary to an impacted denture. Fever developed on hospital day 22, and physical exam revealed right arm superficial thrombophlebitis at the site of the peripheral venous catheter that was confirmed by Doppler ultrasound. The peripheral vein was removed and blood cultures from hospital day 22 and 23 grew yeast species. The yeast was subsequently identified to be K. ohmeri by Vitek II and API20C and was confirmed by 18S rRNA gene sequencing. The fungemia and right arm phlebitis was successfully treated with a 2-week course of micafungin therapy. This is the first case of K. ohmeri fungemia in a patient that was successfully treated with micafungin.