診断困難であった81歳女性, 膀胱褐色細胞腫の1例

The clinical feature of bladder pheochromocytoma is usually typical, but the diagnosis is occasionally delayed because of the rarity of this neoplasm. The oldest patient previously reported is 78 years old. In this report, we present an 81-year-old woman with unsuspected bladder pheochromocytoma.膀胱褐色細胞腫の臨床症状は非常に特徴的なものであるが, 膀胱褐色細胞腫自体が非常に稀なものであるために時に診断が遅れることがある.これまでに膀胱褐色細胞腫として報告されている最高齢は78歳である.今回われわれは無症状のため診断が困難であった, 81歳, 女性に発生した膀胱褐色細胞腫の1例を報告する(著者抄録

Characterization of reemergent anti-B red blood cell antibodies in a patient with recurrent acute myeloid leukemia with ABO-incompatible allogeneic peripheral blood stem cell transplantation.

BACKGROUNDIsohemagglutinins against ABO antigens absent on both recipient and donor red blood cells (RBCs) increase or decrease after ABO‐incompatible hematopoietic stem cell transplantation (HSCT). However, few reports have described the changes in the isohemagglutinin titers and the characteristics in patients with recurrent hematologic conditions after ABO‐incompatible HSCT.CASE REPORTA 59‐year‐old female with acute erythroid leukemia received a peripheral blood stem cell transplant from her HLA‐haploidentical daughter. The patient was typed as group O with anti‐ A (4+) and B (4+) isohemagglutinins, while the donor was typed as group B. The bone marrow cells achieved complete donor cell chimerism on Day 13 after HSCT. On Day 120, the patient showed 97% B RBC type with persistent anti‐A (3+) and without anti‐B antibodies. On Day 375, her leukemia relapsed, and recipient type O RBCs and anti‐B antibodies sequentially reemerged. However, clinicolaboratory hemolysis and erythroid aplasia were not detected in the patient.RESULTSThe post‐HSCT sera agglutinated the allo B RBCs, but not the donor B RBCs, while the pre‐HSCT sera agglutinated both RBCs. The burst‐forming/colony‐forming units of erythroid formation from the donor peripheral blood stem cells were impaired by only the pre‐HSCT sera and not by the post‐HSCT sera.CONCLUSIONTo our knowledge, this is the first report investigating the characteristic changes of isohemagglutinins between the pre‐ and post‐HSCT sera in a patient with recurrent acute myeloid leukemia. The present study suggests that the plasma cells producing anti‐donor B RBCs in the patient have been selectively eliminated or induced into an anergic state by the post‐HSCT immunologic reconstruction

Preemptive anti-cytomegalovirus therapy in high-risk (donor-positive, recipient-negative cytomegalovirus serostatus) kidney transplant recipients

Objectives: Universal prophylaxis and preemptive therapy are used to prevent cytomegalovirus (CMV) disease post-transplantation. Data regarding which strategy is superior are sparse, especially in high-risk recipients (donor CMV seropositive (D+) and recipient CMV seronegative (Râ)). Methods: This retrospective, single-center cohort study included recipients who underwent kidney transplantation between 2009 and 2015. The incidence of CMV infection/disease and patient and graft outcomes were analyzed and compared between high-risk recipients (D+/Râ) and intermediate-risk recipients (D+/R+ or Dâ/R+), all managed with preemptive therapy. Results: Of 118 kidney transplant recipients, 21 were high-risk and 97 were intermediate-risk. Over a median follow-up period of 3 years, asymptomatic CMV infection developed significantly more frequently in high-risk patients than in intermediate-risk patients (38.1% vs. 16.5%, p = 0.04), and CMV disease developed in a similar manner (28.6% vs. 3.1%, p < 0.01). Among high-risk patients, CMV infection developed within the first 3 months post-transplantation and CMV disease within the first 9 months post-transplantation. KaplanâMeier analysis showed no difference in the probability of mortality (log-rank p = 0.63) or graft loss (log-rank p = 0.50) between the patient groups. Graft rejection occurred more frequently in high-risk than in intermediate-risk patients, but the difference was not significant (log-rank p = 0.24). Conclusions: These results suggest that further studies on universal prophylaxis in high-risk patients are needed to elucidate whether preventing CMV infection/disease during the early post-transplant period leads to better outcomes, especially in terms of reducing graft rejection. Keywords: Cytomegalovirus, Prophylaxis, Preemptive therapy, Kidney transplantation, Acute rejectio