RESUMEN
A 59-year-old man with pancytopenia underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography for suspected carcinomatosis. The scan revealed diffuse bone marrow uptake, prompting further investigation. Bone marrow analysis revealed no malignant cells; however, erythroblasts with cytoplasmic vacuolization were observed. Subsequent testing showed low serum copper and ceruloplasmin levels, indicating copper deficiency. Copper supplementation resulted in significant improvement in cytopenia. Notably, the bone marrow uptake on subsequent scans decreased significantly. This case highlights the importance of considering copper deficiency as a potential cause of diffuse bone marrow uptake of 18F-fluorodeoxyglucose on positron emission tomography/computed tomography.
RESUMEN
Hemophagocytic lymphohistiocytosis (HLH) is a rare condition with high mortality. We report a case of a 74-year-old woman with rheumatoid arthritis who developed HLH secondary to pyelonephritis due to Escherichia coli infection following infliximab treatment. Bone marrow aspiration showed proliferation of histiocytes with hemophagocytosis. The patient died despite treatment with intravenous antibiotics intravenous methylprednisolone and intravenous immunoglobulin. Cytokine levels were measured and are discussed.
Asunto(s)
Anticuerpos Monoclonales/efectos adversos , Antirreumáticos/efectos adversos , Artritis Reumatoide/complicaciones , Infecciones por Escherichia coli/complicaciones , Inmunosupresores/efectos adversos , Linfohistiocitosis Hemofagocítica/etiología , Pielonefritis/complicaciones , Anciano , Antibacterianos/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/inmunología , Médula Ósea/patología , Infecciones por Escherichia coli/tratamiento farmacológico , Resultado Fatal , Femenino , Histiocitos/patología , Humanos , Huésped Inmunocomprometido , Inmunoglobulinas Intravenosas/uso terapéutico , Inmunosupresores/uso terapéutico , Infliximab , Meropenem , Metilprednisolona/uso terapéutico , Pielonefritis/tratamiento farmacológico , Tienamicinas/uso terapéuticoRESUMEN
A 64-year-old male consulted our clinic due to pancytopenia. Bone marrow appearance was consistent with multiple myeloma and an IgG-κ type M component was detected on electroimmuno-diffusion of urine. MP therapy (melphalan 2 mg/ day, prednisolone 10 mg/day) was started on an outpatient basis, but the pancytopenia worsened. The patient was then admitted to our hospital, and a course of Velcade therapy (bortezomib 2. 4 mg day 1, 4, 8, 11) was started. After a course of Velcade therapy, side effects such as gastrointestinal dysfunction appeared. A month after the disruption of the chomotherapy, the patient suddenly died. The autopsy report stated that the atrial blood showed 19, 200/µL of white blood cells and 39% of plasma cells, and a slight infiltration was found in liver, kidney and vessels. Two days before death, the blood picture showed no plasma cells. The cause of death was considered to be aggressive multiple myeloma.
Asunto(s)
Mieloma Múltiple/patología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Autopsia , Biopsia , Ácidos Borónicos/uso terapéutico , Bortezomib , Resistencia a Antineoplásicos/efectos de los fármacos , Resultado Fatal , Humanos , Masculino , Melfalán/administración & dosificación , Melfalán/uso terapéutico , Persona de Mediana Edad , Mieloma Múltiple/tratamiento farmacológico , Invasividad Neoplásica , Prednisolona/administración & dosificación , Prednisolona/uso terapéutico , Pirazinas/uso terapéuticoRESUMEN
A 71-year-old man presented with gradually progressing cognitive decline following acute febrile exanthematous disorder. The MRI showed an abnormality in the bilateral limbic systems. An elevation of cerebrospinal fluid (CSF) protein with lymphocyte pleocytosis was noted. Immunoblot of the CSF revealed the presence of anti-white matter antibodies that mainly recognized astrocytes. Intravenous steroid followed by oral steroid reduced the symptoms to a remarkable degree. The patient has now been successfully sustained with steroid for more than two years. We considered that this case is classified as non-paraneoplastic limbic encephalitis, and acquired autoimmunity played a major role in the pathogenesis of this case.