Primary localized amyloidosis in nasopharynx: a case report

Nasopharyngeal amyloidosis is an extremely rare benign tumour. It is divided into localized or systemic amyloidosis. It is more common in men. Clinical presentation includes nasal blockage, epistaxis and reduced hearing. Classical positive Congo red stain and appearance of apple green birefringence on polarized microscopy confirms the diagnosis of amyloidosis. We present a case of nasopharyngeal amyloidosis in a 44-year old lady who presented with acute hearing loss for 1 week with epistaxis mimicking nasopharyngeal carcinoma. Clinical examination showed a nasopharyngeal mass with biopsy proven AA amyloidosis. She is now cured of amyloidosis following endoscopic transnasal excision of tumour. We discuss on the similarity of presentation between nasopharyngeal carcinoma; the commonest malignant tumour in our region and the much rarer nasopharyngeal amyloidosis as well as highlighting the importance in early recognition of the latter in view of its known risk of systemic involvement

Double trouble: concurrent cytomegalovirus and BK polyomavirus infections in a patient who underwent kidney transplantation

A 19-year-old student, who had received a kidney from her mother and had moderate cytomegalovirus (CMV) infection risk, received triple immunosuppression (IS) with corticosteroids, tacrolimus, and mycophenolate sodium (MPS). The patient was treated with pulse corticosteroids for borderline rejection at 1-month posttransplantation, but subsequently developed a urinary tract infection, which was resolved with intravenous administration of antibiotics. In the 4th month after transplantation, the patient was diagnosed with hydronephrosis secondary to a ureteric stricture, which required surgery. Simultaneously, her BK polyomavirus-nucleic acid titer (BKV-NAT) and CMV-NAT increased to 391 IU/mL and 241 IU/mL, respectively. Accordingly, her MPS dosage was reduced and, ultimately, withheld. While her CMV-NAT decreased to undetectable levels; her BKV-NAT titer remained persistently high (14,743 to 22,088 IU/mL). The everolimus was then added to minimize tacrolimus exposure, and her BKV-NAT titer subsequently reduced to 2,575 IU/mL. Simultaneously her renal allograft biopsy showed severe tubulitis with macronuclei positivity for simian virus 40 which indicated the presence of BKV. Besides, the typical CMV associated cytoplasmic and nuclear eosinophilic inclusions also seen in the immunohistochemical analyses. Oral valganciclovir and intravenous immunoglobulin were then administered to the patient and her kidney function partially improved subsequently. She was later discharged without any clinical evidence of rejection