Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
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Volume 56, Issue 1
Displaying 1-16 of 16 articles from this issue
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Picture in Clinical Hematology
Review
  • Severe fever with thrombocytopenia syndrome, an emerging infectious disease for hematologists
    Masaki YASUKAWA
    2015 Volume 56 Issue 1 Pages 3-8
    Published: 2015
    Released on J-STAGE: February 04, 2015
    DOIhttps://doi.org/10.11406/rinketsu.56.3
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    Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by tick-borne SFTS virus infection that was first described in rural areas of China in 2011. Since then, SFTS has also been found in the western part of Japan in 2013. The clinical pictures of SFTS are characterized by abrupt onset of fever and gastrointestinal symptoms, followed by a progressive decline in platelet and white blood cell counts. Disseminated intravascular coagulation and hemophagocytic lymphohistiocytosis are also frequently observed in the patients with advanced phase of SFTS. No specific treatment of SFTS is available, and avoiding tick bites is an important way to prevent the infection of SFTS virus. Standard precautions should be applied to SFTS patients to prevent human-to-human transmission of SFTS virus. Since ticks bearing SFTS virus are found in all area of Japan including Hokkaido, this disease has become a substantial risk to public health in all parts of Japan.
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Case Reports
  • Cardiac and breast diffuse large B-cell lymphoma with pericardial effusion and AV-block
    Tatsuki TOMIKAWA, Takayuki TABAYASHI, Michihide TOKUHIRA, Reiko WATANA ...
    2015 Volume 56 Issue 1 Pages 9-15
    Published: 2015
    Released on J-STAGE: February 04, 2015
    DOIhttps://doi.org/10.11406/rinketsu.56.9
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    Primary cardiac lymphoma is extremely rare and is associated with a poor prognosis. In most cases, cardiac involvement occurs as a late symptom and the diagnosis is thus delayed. We herein report a 35-year-old woman with cardiac diffuse large B-cell lymphoma (DLBCL) with breast infiltration. The patient was admitted to our hospital based on an initial presentation with dyspnea on exertion, chest pain, and a hard mass of the left breast. Echocardiography revealed a mass in the right atrium wall and interatrial septum, and massive pericardial effusion. ECG showed atrioventoricular block. We promptly performed a needle biopsy of the breast mass, which showed CD5-positive DLBCL, non-GCB type. The serum HIV reaction was negative. We thus diagnosed this patient as having cardiac and breast CD5-positive DLBCL, stage IVA, based on the massive pericardial effusion. The patient's prognosis was apparently poor. Therefore, she received 3 cycles of R-CHOP chemotherapy followed by autologous peripheral blood stem cell transplantation (PBSCT), resulting in a complete response. In general, cardiac lymphoma is associated with high mortality and has a poor prognosis. This case demonstrates that rapid and appropriate diagnosis, and immediate intensive chemotherapy followed by PBSCT might be necessary for the treatment of extranodal lymphoma indicative of a poor prognosis.
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  • Diagnosis of disseminated bone marrow carcinomatosis from gastric carcinoma initially presenting as asymptomatic anemia
    Hisaharu SHIKATA, Masaki MARUTA, Masahiko KANEKO
    2015 Volume 56 Issue 1 Pages 16-20
    Published: 2015
    Released on J-STAGE: February 04, 2015
    DOIhttps://doi.org/10.11406/rinketsu.56.16
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    A 75-year-old man who had undergone subtotal gastrectomy for advanced gastric cancer 18 years previously with no signs of recurrence visited our hospital because of anemia detected by medical examination. Although no clinical abnormalities were evident, treatment with iron and vitamin B12 was started. However, because serum ALP was elevated, metastatic bone cancer was suspected. Subsequently, upper gastrointestinal endoscopy revealed findings suggestive of residual gastric cancer, and examination of a biopsy specimen demonstrated signet ring cell carcinoma. Furthermore, cells in a bone marrow biopsy sample showed morphology similar to that of cells obtained by stomach biopsy. FDG-PET demonstrated FDG accumulation only in the bone and residual stomach. The final diagnosis was bone metastasis from residual gastric cancer, and disseminated carcinomatosis of the bone marrow. Thereafter, pancytopenia progressed rapidly, and the patient died due to disseminated intravascular coagulation. When serum ALP is elevated in patients with a history of gastric cancer, bone marrow carcinomatosis should be suspected irrespective of symptoms, and imaging studies and bone marrow examination should be performed.
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  • Acute renal tubular damage caused by disseminated Trichosporon infection in primary myelofibrosis
    Joji SHIMONO, Yutaka TSUTSUMI, Hiroyuki OHIGASHI
    2015 Volume 56 Issue 1 Pages 21-24
    Published: 2015
    Released on J-STAGE: February 04, 2015
    DOIhttps://doi.org/10.11406/rinketsu.56.21
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    A 70-year-old man received a course of therapy that consisted of prednisolone, cyclosporine, and etoposide due to hemophagocytic syndrome which had developed during primary myelofibrosis. He also received micafungin (MCFG) as prophylaxis against a potential fungal infection. We diagnosed febrile neutropenia due to the hemophagocytic syndrome therapy and candidemia because Candida species were detected in blood cultures. He received liposomal amphotericin B (L-AMB) for the candidemia but did not respond to this treatment. Oliguria was diagnosed and renal failure progressed rapidly. We suspected that his renal failure had been induced by the antibiotics. We thus changed the antibiotic regimen but he died of progressive renal failure. We performed renal necropsy and diagnosed acute interstitial tubular nephritis, due to a yeast-like fungus that generally invades the renal tubules. The yeast-like fungus was later identified as Trichosporon asahii, rather than candida, by blood cultures. An immunocompromised host receiving MCFG for acute progressive renal failure requires an appropriate antifungal drug considering the possibility of disseminated Trichosporon.
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  • Myelofibrosis ameliorated after treatment for nontuberculous mycobacterial infection
    Tatsuya SAITO, Keiichiro HATTORI, Tomoko YAMASHITA, Mikako UEDA, Keigo ...
    2015 Volume 56 Issue 1 Pages 25-29
    Published: 2015
    Released on J-STAGE: February 04, 2015
    DOIhttps://doi.org/10.11406/rinketsu.56.25
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    A 42-year-old female was admitted to our hospital because of continuous fever, anemia, and immature myeloid cells in peripheral blood. Bone marrow biopsy revealed severe myelofibrosis (MF). We performed computed tomography and identified several swollen mediastinal lymph nodes and nodules in the right upper lung. Lymph node biopsy showed an infection with Mycobacterium intracellulare (M. intracellulare), a nontuberculous mycobacterium (NTM). Antituberculosis drugs led to remission of the NTM infection. Bone marrow biopsy revealed marked improvement in MF and red blood cell infusion was not required after therapy. No prior cases of concomitant NTM with M. intracellulare and MF have been reported. This is thus the first reported case showing improvement of myelofibrosis after NTM treatment. This case report offers valuable insights into the pathology of MF.
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  • Acute painful crisis in a female Nigerian patient with sickle cell disease
    Sayaka NIN, Masanori SEKI, Koichiro MAIE, Akihiro KURODA, Kana MIYAMOT ...
    2015 Volume 56 Issue 1 Pages 30-34
    Published: 2015
    Released on J-STAGE: February 04, 2015
    DOIhttps://doi.org/10.11406/rinketsu.56.30
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    We report a 38-year-old Nigerian woman with sickle cell disease. Sickle cell disease had been diagnosed when she experienced her first sickle cell crisis episode at age 8 years. Thereafter, she had infrequent minor episodes. She visited a hospital presenting with fever, anemia, jaundice, and systemic pain, and was then transferred to our hospital. Together with rehydration and red blood cell transfusion, analgesics and antibiotics were prescribed, and produced gradual improvement of all symptoms and signs. The patient was discharged on day 9 of hospitalization. Sickle cell crisis is an acute painful episode caused by occlusion of arterioles. The degree of pain and accompanying symptoms, as well as the frequencies of crises, are variable. Moreover, one third of individuals with sickle cell disease never experience a crisis. As our society becomes increasingly globalized, the probabilities of encountering sickle cell disease patients will be higher.
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Short Reports
  • Successful treatment with azacitidine for myelodysplastic syndrome with large vessel vasculitis
    Mai MISHIMA, Masanori MAKITA, Yasuhisa SANDO, Yoshikazu YAMAMOTO, Yasu ...
    2015 Volume 56 Issue 1 Pages 35-37
    Published: 2015
    Released on J-STAGE: February 04, 2015
    DOIhttps://doi.org/10.11406/rinketsu.56.35
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    Paraneoplastic inflammation of the large vessels is a rare complication of myelodysplastic syndrome (MDS), and patients with MDS and systemic vasculitis have a poor prognosis. We present a 66-year-old male with MDS and large vessel vasculitis treated with azacitidine. Azacitidine administration improved his clinical symptoms, high fever and thickening of the arterial wall, and he achieved a complete bone marrow remission. However, 1 year later he showed progression of MDS. For MDS with vasculitis, intensive therapy, the same as that given to the high-risk group, should be considered and azacitidine administration may represent an efficacious treatment.
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  • Thalidomide-associated hypothyroidism in a patient with multiple myeloma
    Ikue OKAMURA, Takashi IKEDA, Ken SATO, Fumihiko KIMURA
    2015 Volume 56 Issue 1 Pages 38-40
    Published: 2015
    Released on J-STAGE: February 04, 2015
    DOIhttps://doi.org/10.11406/rinketsu.56.38
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    Thalidomide is highly effective against multiple myeloma, but some patients must discontinue this medication due to adverse effects. We present herein an instructive case report on thalidomide-associated hypothyroidism in a patient with multiple myeloma. Thyroid hormone replacement therapy allowed us to restart administration of thalidomide, a potentially life-saving therapy. Known adverse effects of thalidomide, such as lethargy, constipation, and bradycardia, are potential symptoms of hypothyroidism, but we tend to overlook drug-associated hypothyroidism. Our case highlights the importance of routinely testing thyroid function in patients receiving thalidomide therapy.
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  • Primary pulmonary Hodgkin lymphoma diagnosed by CT-guided percutaneous biopsy
    Naoki WATANABE, Isao FUJIOKA, Yasuo AOTA, Jun ANDO, Masaru TANAKA, Yas ...
    2015 Volume 56 Issue 1 Pages 41-43
    Published: 2015
    Released on J-STAGE: February 04, 2015
    DOIhttps://doi.org/10.11406/rinketsu.56.41
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    A 36-year-old woman with a left lung tumor was referred to our hospital since a pathological diagnosis had not been obtained at a previous medical institution. We carried out CT-guided percutaneous lung biopsy with an 18-gauge needle and obtained four samples. Immunological staining revealed the specimens to be CD30- and PAX5-positive, with large dysplastic lymphocytes negative for Bob-1 and Oct-2 with a background of small lymphocytes and eosinophils. Primary pulmonary Hodgkin lymphoma (PPHL) was diagnosed. Although PPHL is very rare, it should be included in the differential diagnosis of lung tumors and immunological staining with CD15 and CD30 is recommended. Furthermore, carefully planned CT-guided lung biopsy is useful for diagnosing PPHL.
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  • Bortezomib-associated acute congestive heart failure in a patient with multiple myeloma
    Yasuo AOTA, Akihiko GOTOH, Naofumi HANYU, Toshihiro HONMA, Michihiko M ...
    2015 Volume 56 Issue 1 Pages 44-47
    Published: 2015
    Released on J-STAGE: February 04, 2015
    DOIhttps://doi.org/10.11406/rinketsu.56.44
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    We report an 81-year-old woman with multiple myeloma who developed acute cardiac injury after receiving bortezomib. The patient received weekly intravenous bortezomib. She developed shortness of breath and bilateral pedal edema on day 19. Electrocardiography showed no ST-T changes but the cardio-thoracic ratio was increased, the ejection fraction was decreased, the ventricular septum showed hypokinesis and mitral regurgitation was noted. We stopped bortezomib and started acute congestive heart failure treatment. ST-T changes were detected after the patient's condition improved. There was no evidence of coronary stenosis on CT angiography. Acute cardiac injury is rare during bortezomib administration, but patients should be monitored carefully during treatment.
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  • Light chain escape followed by leukemic transformation in a patient with IgD myeloma
    Mayumi HATSUSE, Shin-ichi FUCHIDA, Akira OKANO, Satoshi MURAKAMI, Chih ...
    2015 Volume 56 Issue 1 Pages 48-50
    Published: 2015
    Released on J-STAGE: February 04, 2015
    DOIhttps://doi.org/10.11406/rinketsu.56.48
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    A 63-year-old male with multiple myeloma (IgD-λ) received autologous peripheral blood stem cell transplantation (PBSCT) after induction of VAD in March 2008, and obtained a very good partial response. However, he required BOR/DEX and a second PBSCT for relapse, and in August 2012, treatment with LEN/DEX was started. After 4 cycles of LEN/DEX, IgD decreased but FLC-λ increased paradoxically, indicating a clonal change. In January 2013, an LCD regimen was started and after 4 cycles, IgD showed normalization, but his condition worsened as FLC-λ increased. This case showed a fulminant clinical course with light chain escape in this era of treating multiple myeloma with novel agents.
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