1/18. The use of monoclonal antibody R92F6 and polymerase chain reaction to confirm the presence of parvovirus B19 in bone marrow specimens of patients with acquired immunodeficiency syndrome.BACKGROUND: parvovirus B19 infection is a cause of chronic anemia and red cell aplasia in patients with acquired immunodeficiency syndrome (AIDS) and in other immunocompromised hosts. anemia in AIDS patients has a multifactorial etiology, with parvovirus B19 infection being an infrequent but nevertheless treatable cause. Therapy with intravenous immune globulin can result in rapid improvement of parvovirus-induced anemia. This treatment is expensive, therefore accurate and rapid confirmation of parvovirus infection is important in providing appropriate and cost-effective therapy. methods: Bone marrow samples from 2 AIDS patients with severe anemia and reticulocytopenia were studied. Bone marrow morphology and serologic studies were evaluated for parvovirus B19 infection. An immunohistochemical method using a monoclonal antibody, R92F6, to B19 capsid proteins was utilized on decalcified, B5-fixed, paraffin-embedded bone marrow biopsies. Bone marrow aspirate cells were examined by electron microscopy for evidence of viral particles. In addition, polymerase chain reaction (PCR) studies using a nested PCR assay to the parvovirus B19 viral genome were performed in a case for which fresh cells were available. RESULTS: Bone marrow findings included marked erythroid hypoplasia with characteristic giant pronormoblasts and intranuclear inclusions. Serologic studies were negative in one case, while the second case showed positive parvovirus B19 immunoglobulin m antibody. Immunohistochemical studies for parvovirus B19 were positive in both cases. The presence of intranuclear virions was demonstrated by electron microscopy and was confirmed by PCR analysis. Both patients were treated with intravenous immune globulin, and subsequent improvement was noted. CONCLUSIONS: Both immunohistochemistry and PCR studies on bone marrow specimens from AIDS patients with anemia are rapid and sensitive methods for the confirmation of parvovirus B19 infection. They are valuable tools, particularly when serologic studies are negative. When PCR is not available, immunohistochemical methods can be useful. The rapid confirmation of parvovirus B19 infection will allow for early and cost-effective therapy.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/18. Inflammatory myofibrohistiocytic proliferation presenting as giant gastric pseudotumor.A 5-year-old boy presented with refractory microcytic anemia, growth failure, and markedly elevated sedimentation rate. Computed tomographic (CT) and upper gastrointestinal study disclosed an ulcerated 9-cm large gastric mass, which proved to be an inflammatory myofibrohistiocytic proliferation (IMP). The characteristic clinical and radiologic features of this rare entity are herein reviewed.- - - - - - - - - - ranking = 4keywords = giant (Clic here for more details about this article) |
3/18. Spontaneous subacute intratumoral hemorrhage of hepatic cavernous hemangioma.We report a case of giant hepatic cavernous hemangioma associated with spontaneous subacute intratumoral hemorrhage. magnetic resonance imaging showed an oval, homogeneous, high-intensity lesion with a low-intensity rim in the original high-intensity tumor on T2-weighted images. On T1-weighted images, this oval lesion showed heterogeneous high intensity with peripheral higher intensity. The histologic specimen confirmed hepatic hemangioma with intratumoral hemorrhage.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
4/18. life-threatening blood loss from scratching provoked by pruritus in the bulky perineal nevocytoma variant of giant congenital melanocytic nevus in a child.We describe a 3-year-old girl with intractable, debilitating pruritus associated with a giant congenital melanocytic nevus, resulting in life-threatening anemia from extensive bleeding skin excoriations. Multiple conventional oral and topical antipruritic medications failed to provide relief, but the patient was successfully treated with the selective serotonin 5-hydroxytryptamine type 3 inhibitor ondansetron, suggesting a serotonin-related mechanism to her pruritus.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
5/18. Masked giant cell arteritis.BACKGROUND: giant cell arteritis (GCA) is the most common vasculitis in the western world and often presents as a diagnostic problem for general practitioners. Prompt diagnosis and treatment is important to prevent potential irreversible complications, with a favourable outcome. OBJECTIVE: This article discusses a case of GCA presenting with mild anaemia, weight loss and high erythrocyte sedimentation rate. DISCUSSION: Anaemia and high inflammatory markers are common blood abnormalities encountered in the elderly population. Even though anaemia as a primary presentation of GCA has been well documented in the past, our case highlights the importance of considering this as a differential diagnosis in the community. Ways of assessing the so-called 'masked GCA' which may enable a better awareness of the diversity of this disease, is also discussed.- - - - - - - - - - ranking = 4keywords = giant (Clic here for more details about this article) |
6/18. Severe anemia due to B19 parvovirus infection in children with acute leukemia in remission.Two children developed severe anemia with reticulocytopenia while on maintenance chemotherapy for acute lymphoblastic leukemia. bone marrow examination revealed marked erythroid hypoplasia and giant megaloblasts without evidence of relapse. One patient had evidence of B19 Parvoviremia at the time of severe anemia but failed to produce anti B19 antibodies. Despite the failure to mount an antibody response, the patient had no recurrence of viremia or anemia during the two years of follow-up after the infection. The other patient had no evidence of viremia or elevated anti-B19 antibodies at the time of anemia. However, when his serum was tested 16 months after the episode of anemia, he had elevated IgG and IgM antibodies against B19 parvovirus. The patient did not experience recurrent viremia or anemia over a two year period. Thus, patients with leukemia are at risk to develop severe anemia when infected with B19 parvovirus.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
7/18. Diffuse hemangiomatosis of the spleen: splenic hemangiomatosis presenting with giant splenomegaly, anemia, and thrombocytopenia.In an elderly patient with oligosymptomatic giant splenomegaly, clinical and laboratory data were nondiagnostic, while nonhomogeneous splenic enlargement was the only finding detected by imaging procedures. splenectomy was performed and diffuse hemangiomatosis of predominantly capillary-type found. The failure of imaging techniques to even hint at the nature of the underlying disorder is comprehensible in view of the organ being essentially replaced in toto by the abnormal vascular channels. Diffuse splenic hemangiomatosis, a rare condition, may cause hypersplenism, and its diagnosis may be elusive because of misleading patterns on imaging.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
8/18. Giant and symptomatic inflammatory polyps of the colon in idiopathic inflammatory bowel disease.Four cases of giant inflammatory polyps were found in a series of 86 consecutive colectomies for inflammatory bowel disease. Two presented a distinctive clinical syndrome of abdominal pain and chronic iron-deficiency anemia due to blood loss. Secondary ulceration of the heads of the polyps accounted for the bleeding and anemia, and the size of the polyps accounted for the abdominal pain. In both cases unusually long portions of colon were involved by the giant polyps. The third and fourth cases had rare complications--reactivation of an enterocutaneous fistula and perforation of an acquired diverticulum. These cases demonstrate that giant inflammatory polyps may produce symptoms independently of the underlying inflammatory bowel disease. In reported cases of giant inflammatory polyps, approximately two-thirds had Crohn's disease and one-third had ulcerative colitis. The transverse colon was the commonest location, pain was the commonest symptom, and the polyps were localized to a short segment of colon in the majority of cases. More than 50% of cases mimicked neoplasm on barium enema. Giant inflammatory polyps may produce a variety of distinctive signs and symptoms and deserve independent recognition.- - - - - - - - - - ranking = 4keywords = giant (Clic here for more details about this article) |
9/18. Asymptomatic giant cell arteritis.A 71-year-old asymptomatic man was investigated because of anemia and an elevated erythrocyte sedimentation rate. Temporal artery biopsy showed that he had active giant cell arteritis. To our knowledge, this is the first report of giant cell arteritis in an asymptomatic patient. giant cell arteritis may remain undiagnosed during life in many cases and may be an important cause of unexplained anemia in the elderly.- - - - - - - - - - ranking = 6keywords = giant (Clic here for more details about this article) |
10/18. Remission of giant lymph node hyperplasia with anemia after radiotherapy.We have described a 51-year-old patient with unresectable mesenteric giant lymph node hyperplasia of the plasma cell type, severe systemic manifestations, and profound anemia. Supression of erythropoiesis may have been related to the presence of a circulating erythropoietic inhibitor produced by the lymphoid tumor. Markedly elevated titers to Epstein-Barr virus capsid antigen suggest that this virus may be important in the etiology of the abnormal lymphoid proliferation. The marked clinical response and decrease in the size of the tumor following irradiation suggests that radiation therapy may be an alternative form of treatment for similar patients with unresectable lesions.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
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