11/39. cunninghamella bertholletiae infection (mucormycosis) in a patient with acute T-cell lymphoblastic leukemia.cunninghamella spp. are unusual opportunistic pathogens that have been identified with increased frequency in immunocompromised patients. Clinical infection by this fungus is almost always devastating and usually fatal. Infections with this group of organisms have been seen most frequently in patients with hematological malignancy. Here we report the case of a patient with acute leukemia who developed multiorganic failure as a consequence of hematological dissemination by cunninghamella bertholletiae. The case highlights the mortality associated with this fungal infection in immunocompromised patients, confirms the risk factors associated with non-candida fungal infections and shows a clinical presentation mimicking myocardial infarct and cerebrovascular stroke.- - - - - - - - - - ranking = 1keywords = malignancy (Clic here for more details about this article) |
12/39. mycobacterium xenopi infection in an immunosuppressed patient with Crohn's disease.A 48 year old patient with active Crohn's disease presented with bilateral nodules over his lungs resembling malignant metastasis. Bronchoscopic and pathological examination of the airways and sputum did not show any malignancy. After 6 weeks mycobacterium xenopi was cultured from his bronchial washings while all other cultures remained negative. Treatment was started with rifampicin, ethambutol, and clarithromycin and, after 9 months of treatment, there was an almost complete resolution of his chest radiograph.- - - - - - - - - - ranking = 1keywords = malignancy (Clic here for more details about this article) |
13/39. Successful renal transplantation following prior bone marrow transplantation in pediatric patients.Improving survival rates following pediatric bone marrow transplantation (BMT) will likely result in greater numbers of children progressing to end-stage renal disease (ESRD) because of prior chemotherapy, irradiation, sepsis, and exposure to nephrotoxic agents. Renal transplantation remains the treatment of choice for ESRD; however, the safety of renal transplantation in this unique population is not well established. We report our experience with living related renal transplantation in three pediatric patients with ESRD following prior BMT. Two patients with neuroblastoma and ESRD because of BMT nephropathy, and one patient with Schimke immuno-osseous dysplasia and ESRD because of immune complex mediated glomerulonephritis and nephrotic syndrome. Age at time of BMT ranged from 2 to 7 yr. All patients had stable bone marrow function prior to renal transplantation. Age at renal transplant ranged from 8 to 14 yr. All three patients have been managed with conventional immunosuppression, as no patient received a kidney and BMT from the same donor source. These patients are currently 7 months to 6 yr status post-living related transplant. All have functioning bone marrow and kidney transplants, with serum creatinine levels ranging 0.6-1.2 mg/dL. There have been no episodes of rejection. One patient with a history of grade III skin and grade IV gastrointestinal-graft-vs.-host disease (GI-GVHD) prior to transplantation, had a mild flare of GI-GVHD (grade I) post-renal transplant and is currently asymptomatic. The incidence of opportunistic infection has been comparable with our pediatric renal transplant population without prior BMT. One patient was treated for basal cell carcinoma via wide local excision. Renal transplantation is an excellent option for the treatment of pediatric patients with ESRD following BMT. Short-term results in this small population show promising patient and graft survival, however long-term follow-up is needed. Pre-existing immune system impairment and bone marrow function should be taken into consideration when weighing different immunosuppressive agents for renal transplantation. patients who have undergone renal transplantation following BMT are at high risk for opportunistic infections and malignancy, and need life-long medical surveillance.- - - - - - - - - - ranking = 1keywords = malignancy (Clic here for more details about this article) |
14/39. Rhinocerebral mucormycosis: an unusual case presentation.Rhinocerebral mucormycosis is a rapidly fatal fungal disease which involves the nose, paranasal sinuses, orbit and central nervous system. The fungal infection is usually secondary to immunosuppression, diabetic acidosis, or antibiotic, steroid or cytotoxic therapy. It can also occur in patients suffering from burns, malignancy and haematological disorders. Current treatment consists of correction of the underlying disorder, repeated debridement of the wound in combination with intravenous amphotericin b. This paper describes our experience with a case of rhinocerebral mucormycosis. This is an unusual case in which mucormycosis was seen in a young female where no underlying cause was found. She responded to surgical debridement in combination with intravenous amphotericin b.- - - - - - - - - - ranking = 1keywords = malignancy (Clic here for more details about this article) |
15/39. pneumocystis carinii infection in the middle ear.pneumocystis carinii is the opportunistic pathogen frequently causing pneumonitis in the acquired immunodeficiency syndrome. Extrapulmonic manifestation of P carinii is unusual and is commonly associated with severe systemic illness, other immune deficiency status, malignancy, or immune suppression. We describe a case of acquired immunodeficiency syndrome with manifestations of P carinii otitis media with severe otalgia and conductive hearing loss.- - - - - - - - - - ranking = 1keywords = malignancy (Clic here for more details about this article) |
16/39. Treatment of patients with hematologic neoplasm, fever, and neutropenia.Choices of empirical antibiotic therapy for patients with febrile neutropenia must be made with very little information about the source and site of infection. The clinician is aided by recognition of the subtle signs and symptoms of infection in immunocompromised patients. National guidelines should be applied according to the microbiological patterns and trends in drug resistance at each institution. Case studies are provided to illustrate these challenges in daily practice.- - - - - - - - - - ranking = 0.334228515625keywords = neoplasm (Clic here for more details about this article) |
17/39. Nonfatal pulmonary trichoderma viride infection in an adult patient with acute myeloid leukemia: report of one case and review of the literature.trichoderma species have been recognized to be pathogenic in immunosuppressed hosts with increasing frequency. trichoderma species are responsible for continuous ambulatory peritoneal dialysis associated peritonitis and infections in immunocompromised patients with a hematologic malignancy or solid organ transplantation. trichoderma longibrachiatum is the most common species involved in these infections. We report the first case of nonfatal pulmonary infection caused by trichoderma viride in leukemia patient. It had a successful answer to new antifungal agents as voriconazole and caspofungin. trichoderma viride was isolated from pulmonary aspirate culture from a 54-year-old female who had received chemotherapy for acute myeloid leukemia. The minimal inhibitory concentrations for the organism were the following: amphotericin b (0.25 microg/mL) and voriconazole (2 microg/mL). Initially, she was treated unsuccessful with liposomal amphotericin b and voriconazole and caspofungin were added later. The patient is alive. We report one case along review of the literature.- - - - - - - - - - ranking = 1keywords = malignancy (Clic here for more details about this article) |
18/39. Rapid development of an immunoblastic lymphoma and death in children following cadaveric renal transplantation.We report on three children who underwent cadaveric renal transplantation and subsequently developed an immunoblastic lymphoma, leading to death in two patients. The development of the lymphoma occurred following a multi-drug immunosuppression regimen ending with monoclonal antilymphocyte (OKT3) treatment for biopsy-proven cellular and vascular acute rejection. These patients represent three of 11 children who received OKT3 treatment for rejection in the last 18 months at this institution. Following the diagnosis of lymphoma, all three patients were treated by transplant nephrectomy, cessation of immunosuppression, and administration of intravenous acyclovir. The first two patients died at 4 days and 4 weeks, respectively, after the definitive diagnosis was made with widespread metastatic disease. The remaining child is a short-term survivor (13 months), free of demonstrable malignancy. Multidrug regimens for immunosuppression have a profound effects on T cell function. These effects, when combined with a primary infection by the Epstein-Barr virus, are implicated in the rapid development of the lymphomas and are responsible for the death of these two children.- - - - - - - - - - ranking = 1keywords = malignancy (Clic here for more details about this article) |
19/39. cryptococcosis of the larynx in a patient with AIDS: an unusual cause of fungal laryngitis.We have presented a case of unsuspected cryptococcal laryngitis, clinically masquerading as Kaposi's sarcoma in a patient with AIDS. The spectrum of laryngeal disease in AIDS patients includes a variety of infections and neoplasms, which can be treated satisfactorily when accurate and timely diagnosis is made.- - - - - - - - - - ranking = 0.08355712890625keywords = neoplasm (Clic here for more details about this article) |
20/39. The causes of death in patients with human immunodeficiency virus infection: a clinical and pathologic study with emphasis on the role of pulmonary diseases.The clinical records and autopsy data of 75 patients dying with AIDS were reviewed to determine the frequency of individual diseases diagnosed premortem and postmortem, the significance of pulmonary processes found in the lungs at autopsy, and the clinical and pathologic causes of death. cytomegalovirus (CMV) infection was identified histologically either premortem or postmortem in 81% of patients. The lungs and adrenal glands were infected most commonly. Only one-half of CMV infections were recognized premortem. Pneumocystis pneumonia and Kaposi sarcoma occurred in 68% and 59% of patients, respectively, but were not unsuspected premortem in any patient. Visceral involvement with Kaposi sarcoma, however, was frequently recognized only at autopsy. While disseminated M. avium-intracellulare infection was common (31% of patients), histologically documented pulmonary disease was uncommon (3% of patients). Cryptococcal infection, diagnosed in 10 patients, was confined to the central nervous system in only 1 patient. toxoplasma, in contrast, infected the brain of only 6 patients. All 75 patients had one or more disease processes identified in their lungs or pleurae at autopsy. These processes included opportunistic infections in 76% of patients, neoplasms in 37% (Kaposi sarcoma in 36% and lymphoma in 3%), and other processes in 60%. The most prevalent pathogen, CMV was found in pulmonary tissue from 44 patients and caused significant disease in 21 patients. Five patients died due to CMV pneumonia. pneumocystis carinii was found at autopsy in 24 patients. In spite of treatment, pneumocystis pneumonia was fatal in 11 patients. One patient died with concomitant CMV and pneumocystis pneumonia. Kaposi sarcoma, identified in the lungs of 23 patients, led to death in 5 patients via upper airway obstruction, hemorrhage, or parenchymal destruction. Other fatal pulmonary processes included bacterial pneumonia in 9 patients, idiopathic diffuse alveolar damage in 5, cryptococcosis in 2, and pulmonary hemorrhage in 1. Specific clinical criteria were used to determine the cause of death due to organ system failure. Fifty-one percent of patients died due to respiratory failure; 16% from neurologic disease; 17% from hypotension that was not caused by respiratory, neurologic, or cardiac disease; and 3% from cardiac dysfunction. Thirteen percent of deaths did not meet the clinical criteria defining these 4 categories. This clinical assessment was combined with autopsy data to identify specific diseases as causes of death.(ABSTRACT TRUNCATED AT 400 WORDS)- - - - - - - - - - ranking = 0.08355712890625keywords = neoplasm (Clic here for more details about this article) |
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