Cases reported "Leukemia, Myeloid"

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1/126. Systemic candidiasis with candida vasculitis due to candida kruzei in a patient with acute myeloid leukaemia.

    candida kruzei-related systemic infections are increasing in frequency, particularly in patients receiving prophylaxis with antifungal triazoles. A Caucasian male with newly diagnosed acute myeloid leukaemia (AML M1) developed severe and persistent fever associated with a micropustular eruption scattered over the trunk and limbs during induction chemotherapy. blood cultures grew candida kruzei, and biopsies of the skin lesions revealed a candida vasculitis. He responded to high doses of liposomal amphotericin b and was discharged well from hospital.
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2/126. Lymphoid antigens on blast cells in the agranular metamorphosis of chronic myelogenous leukaemia.

    Undifferentiated blasts from a Ph'-positive chronic myelogenous leukaemia (CML) in terminal metamorphosis were reacted in an indirect immunofluorescence test with antilymphocytic globulins (AHLGs), raised against cultured lymphoblasts, thoracic duct and peripheral blood lymphocytes from healthy donors. After proper myeloid and/or monocytic absorptions the AHLGs interacted strongly with the undifferentiated blasts of CML, while this was not true for parallel controls with non-lymphoid leukaemias, both acute and chronic. The intensity of fluorescence, as determined by the use of a microfluorimeter, on these agranular blasts was comparable to the positivity of lymphoid cells from acute and chonic lymphatic leukaemias. These findings lend further support to the conception of a lymphoblast-like variety of terminal blastic crisis in chronic myelogenous leukaemia.
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3/126. Pure red cell aplasia evolving through the hyperfibrotic myelodysplastic syndrome to the acute myeloid leukemia: some pathogenetic aspects.

    The authors report a 58-year-old female who originally presented with acquired pure red cell aplasia (PRCA). At diagnosis, the karyotype was normal, the serum erythropoietin level was highly elevated and no T-cell mediated inhibition of erythropoiesis was demonstrated in coculture studies. Conventional immunosuppressive therapy proved ineffective. A year later a diagnosis of hyperfibrotic myelodysplastic syndrome was assessed. The sequential bone marrow examinations in the course of the three years showed a progressive increase in bone marrow fibrosis, erythroid hyperplasia and dysmegakaryocytopoiesis, terminating in the acute myeloid leukemia. This sequence of the events included the appearance of del(5)(q13q33), four years after setting a diagnosis of PRCA. The authors suggest that the absence of both cytogenetic abnormality and the signs of dyshematopoiesis at the diagnosis of PRCA does not exclude ultimately a "clonal" category of the disease. Thus, repeated hematological and cytogenetical reevaluations are recommended.
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4/126. Lineage switch in childhood leukemia with monosomy 7 and reverse of lineage switch in severe combined immunodeficient mice.

    Morphophenotypic lineage switches occur in a small percentage of those with acute leukemia, and the underlying mechanisms are not clear. In this study, we attempted to induce a lineage switch in acute myelocytic leukemia (AML) with monosomy 7, whose lineage had switched from acute T-lymphocytic leukemia (T-ALL) during chemotherapy, in severe combined immunodeficient (SCID) mice. Although the transplanted myeloid cells were engrafted in SCID mice without cytokine administration, T-ALL developed in SCID mice treated with recombinant human granulocyte-macrophage colony-stimulating factor or recombinant human interleukin 3. Analysis of the nucleotide sequences of the rearranged T-cell receptor gamma-chain (TCR-gamma) gene revealed that this lineage switch resulted from the selection of the T-lineage subclone in SCID mice, which had expanded at onset. In addition, we found that the T-lineage and myeloid cells belonged to the distinct subclones, which were different in TCR-gamma gene rearrangements, but were derived from a common clone with an identical N-ras gene mutation for both subclones. In in vitro cultures, only the myeloid subclone grew; the T-lineage subclone failed to grow even in the presence of recombinant human granulocyte-macrophage colony-stimulating factor or recombinant human interleukin 3. These results suggested that the initial diagnostic T-lymphoid subclone, whose growth was dependent on these cytokines and the hematopoietic microenvironment, emerged from a bipotential T-lymphoid/myeloid leukemic stem cell, and further genetic event(s) induced the myeloid subclone, which grew independently of these cytokines and the microenvironment.
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5/126. aspergillus fumigatus endophthalmitis in a patient with acute myeloid leukaemia.

    A 55-year-old patient developed progressive loss of vision in one eye following induction chemotherapy for acute myeloid leukaemia (AML). aspergillus fumigatus was cultured from vitreal aspirates. The patient was treated with intravenous and intravitreal amphotericin b but suffered complete loss of vision in her right eye. We believe this is the first report of culture-proven aspergillus fumigatus endophthalmitis in a patient treated for a haematological malignancy.
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6/126. Cytogenetic studies of the spleen in chronic granulocytic leukaemia.

    Using a technique of short-term in vitro culture, cytogenetic studies were performed on splenic tissue from 12 patients with chronic granulocytic leukaemia. In eight patients the disease was in its chronic phase and had been treated with busulphan (seven cases) or splenic irradiation (one case). In five of these patients, small numbers of dividing cells possessing the philadelphia (Ph1) chromosome were observed; in one, only Ph1 -negative metaphases, presumably those of lymphocytes, occurred, and in two patients no dividing cells were obtained. In four patients chronic granulocytic leukaemia had undergone metamorphosis to an acute phase: in two of these patients no dividing cells were observed in splenic cultures with or without added phytohaemagglutinin: this result may have been attributable to prior cytotoxic therapy. In cultures from the other two patients in metamorphosis, almost all dividing cells were Ph1 -positve and many cells possessed two Ph1 chromosomes. Full cytogenetic analysis in one of these cases showed that the spleen contained several closely related cell lines, apparently reflecting progressive tumour cell evolution.
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7/126. Pulmonary mucormycosis caused by cunninghamella elegans in a patient with chronic myelogenous leukemia.

    cunninghamella elegans was cultured from autopsy materials of the infected lung of a patient with chronic myelogenous leukemia. The histologic sections revealed extensive growth of nonseptate, broad hyphae in and about the large and small arteries and veins, occluding the vessels. This case is believed to be the second in which human infection by C. elegans has been documented.
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8/126. Discordant patterns of chromosome changes and myeloblast proliferation during the terminal phase of chronic myeloid leukemia.

    A patient with Ph1 positive chronic myeloid leukemia (CML) developed blastic transformation which by morphologic criteria appeared to be localized to the lymphatic system. Chromosome analysis at this time, however, revealed new chromosomal abnormalities in addition to the existing Ph1 in all tissues studied (lymph node, blood, and bone marrow) consisting primarily of extra chromosome numbers 19 and 9 and a second Ph1. Therapy resulted in clinical remission with significant decrease in the aneuploid cell lines. However, these reappeared with recurrence of the blast crisis. Colony formation in semisolid culture of blood and marrow cells at the time of initial blast crisis yielded growth patterns characteristic of CML. On recurrence of the blast crisis after therapy, growth patterns were characteristic of CML in blast crisis or acute myeloblastic leukemia even though blood and marrow still showed relatively low levels of myeloblasts and promyelocytes. Possible explanations are discussed for the disparity in distribution between morphologic and chromosomal abnormalities in this patient.
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9/126. tuberculosis pleurisy due to mycobacterium fortuitum in a patient with chronic granulocytic leukemia.

    A case of tuberculous pleurisy due to mycobacterium fortuitum in a 47-year-old woman with chronic granulocytic leukemia is described. The mycobacterial aetiology of the pleurisy was confirmed by pleural biopsy and by positive culture of M. fortuitum in pleural fluid. Antituberculosis chemotherapy with INH, RMP and EMB, combined initially with prednisolone, was successful in spite of total resistance of the strain to the drugs used. A short review of mycobacterioses and of recent literature on the topic, especially on M. fortuitum, is also presented.
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10/126. Acute arthritis caused by Aeromonas hydrophola: clinical and therapeutic aspects.

    Two cases of aeromonas hydrophila arthritis are reported and a third case present in the literature is reviewed. All three cases occurred in patients with myelogenous leukemia; the knee joint was involved in 2 patients and the metacarpal-phalangeal joint in the third. In the 2 patients presented here, synovial fluid antibiotic levels were measured and were adequate; but A hydrophila was repeatedly cultured from the knee joints, a fact suggesting that other factors, such as normal functioning leukocytes and specific opsonizing antibody against the organism, are also necessary to kill A hydrophila.
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