Cases reported "Hemolysis"

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1/4. bacillus cereus causing fulminant sepsis and hemolysis in two patients with acute leukemia.

    PURPOSE: hemolysis is so rarely associated with bacillus cereus sepsis that only two very well documented cases have been reported. This article reports two unusual cases of bacillus cereus sepsis with massive intravascular hemolysis in patients who had acute lymphoblastic leukemia (ALL). patients AND methods: A 20-year-old woman who was 9 weeks pregnant experienced a relapse of ALL. A therapeutic abortion was performed. During week 4 of reinduction the patient had abdominal pain, nausea, and vomiting, with severe neutropenia but no fever. Her condition deteriorated rapidly with cardiovascular collapse, acute massive intravascular hemolysis, and death within hours of the onset of symptoms. blood cultures were positive for bacillus cereus. Postmortem histologic examination and cultures revealed bacillus cereus and candida albicans in multiple organs. The second patient, a 10-year-old girl, presented with relapsed T-cell ALL. In the second week of reinduction, she had abdominal pain followed by hypotension. Again, no fever was noted. Laboratory studies showed intravascular hemolysis 12 hours after admission. Aggressive support was promptly initiated. Despite disseminated intravascular coagulation; cardiovascular, hepatic, and renal failure; and multiple intracerebral hypodense lesions believed to be infarcts, the patient recovered fully and resumed reinduction therapy. CONCLUSIONS: bacillus cereus infection can have a fulminant clinical course that may be complicated by massive intravascular hemolysis. This pathogen should be suspected in immunosuppressed patients who experience gastrointestinal symptoms and should not be precluded by the absence of fever, especially if steroids such as dexamethasone are being given. Exchange transfusion may be lifesaving in bacillus cereus septicemia associated with massive hemolysis.
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2/4. piroxicam-induced photosensitivity.

    During the last 3 years, 9 patients with a photosensitive eruption related to piroxicam therapy were seen. In all but one, it occurred within 4 days of first exposure to the drug. 7 patients required systemic corticosteroids, and 2 hospitalization. Clinical, histological and provocation studies were not conclusive in classifying the eruption as photoallergic or phototoxic. Experimental studies including photohaemolysis, bacillus subtilis culture and nuclear magnetic resonance showed: (i) in irradiated piroxicam solutions, there was more haemolysis; (ii) in irradiated Petri dishes, piroxicam solutions showed greater inhibition of growth of B. subtilis; (iii) piroxicam's NMR spectrum is not modified after irradiation. The results provide evidence of piroxicam phototoxic potential.
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3/4. Isolation and characterization of two hemolytic phenotypes of vibrio damsela associated with a fatal wound infection.

    Two hemolytic phenotypes of vibrio damsela, isolated from the tissue of a patient with a fatal wound infection, were characterized. The patient had underlying disease, and the wound was associated with an injury inflicted during the handling of a catfish. The phenotypes were morphologically and biochemically similar except for their lecithinase, lipase, and hemolytic activities. When grown on rabbit blood agar, one phenotype (LZ) produced a large zone of hemolysis (10 mm) around the colony, whereas the other type (SZ) produced only a small zone (1 to 2 mm). On sheep blood agar, the differences in hemolytic activity were more subtle. By a modified CAMP test in which V. damsela was streaked perpendicularly to staphylococcus aureus, it was determined that a factor elaborated by the LZ phenotype (but not the SZ phenotype) protected sheep erythrocytes from the hemolysis normally caused by S. aureus toxins. Cell-free filtrates of broth cultures of each phenotype had the same effects on erythrocytes as did the organisms themselves.
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4/4. Community-acquired Acinetobacter pneumonia: a case report.

    A 35-year-old male with glucose-6-phosphate dehydrogenase (G6PD) deficiency was admitted because of right chest (pleuritic) pain, fever, cough with scarce production of blood-tinged sputum, and generalized yellowish discolouration of skin for 2 days. Radiographic examination revealed right lower lobe necrotizing pneumonia. hypotension, dyspnoea and severe haemolysis was noted the next day. Echo-guided lung aspiration and sputum cultures both grew acinetobacter baumannii. Antibiotic therapy was started immediately, but fever persisted and abscess formation was noted 1 week later. After aggressive supportive and antibiotic therapy, he made a slow but complete recovery from the pneumonia, and was then discharged in a stable condition. acinetobacter baumannii is a well-known causative agent of nosocomial infections, particularly in intensive units. Community-acquired pneumonia, however, is quite rare, and usually has a fulminant course and high case fatality rate.
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