Acute renal failure and rhabdomyolysis in a patient with infectious mononucleosis: a case report

We report a very rare case of acute renal failure and rhabdomyolysis in an Intensive Care treated 20-years-old male with upper airway obstruction due to Epstein-Barr infection. In our opinion this was a manifestation of the very rare and potentially lethal propofol infusion syndrome and not a direct complication of the underlying infection, although renal biopsy was not performed in our patient

Recurrent Jarisch-Herxheimer reaction in a patient with Q fever pneumonia: a case report

Q fever is a zoonotic disease caused by coxiella burnetii. The Jarisch-Herxheimer reaction (JHR) is associated with the antibiotic treatment of certain bacterial infections. We report a very rare case of a 36-year-old male with Q fever pneumonia that resulted in recurrent ARDS and presented the JHR during his treatment. The patient was admitted for treatment of community acquired pneumonia. He developed ARDS, was intubated and placed on mechanical ventilation. Doxycycline was empirically added to his antibiotic regiment. The patient presented an acute rise in temperature, tachycardia, tachypnea, hypoxia, hypotension and a temporary deterioration of his chest x-ray. The same 6-hour-long reaction which is known as JHR was presented another 3 times. Cultures were negative but antibodies against coxiella burnetii were positive. This case reminds us that any deterioration of a patient treated in the ICU should not be considered as a new septic episode and time should be allowed for the antibiotic regiments

Allogeneic hematopoietic stem cell transplantation in non‐Hodgkin lymphoma in Switzerland, 30 years of experience: Sooner is better

Abstract Due to relatively high nonrelapse mortality (NRM), allogeneic hematopoietic stem cell transplantation (allo‐HSCT) in non‐Hodgkin's lymphoma (NHL) remains the ultimate line of treatment but the only curable approach in a setting of relapse/refractory disease. Here, we conducted a retrospective, multicenter, registry‐based analysis on patients who underwent allo‐HSCT for NHL in Switzerland, over 30‐year (1985–2020) period. The study included 301 allo‐HSCTs performed for NHL patients in three University Hospitals of Switzerland (Zurich, Basel and Geneva) 09/1985 to 05/2020. We assessed in univariate and multivariable analysis the impact on survivals (overall survival [OS], relapse free survival [RFS], relapse incidence [RI], and non‐treatment related mortality [NRM]). The maximum follow‐up was 25 years with median follow‐up for alive patients of 61 months. The median age at allo‐HSCT was 51 years. Three‐ and ‐year OS was ‐ 59.5% and 55.4%; 3‐ and 5‐year PFS was 50% and 44%; 3‐ and 5‐year NRM was 21.7% and 23.6%. RI at 3 and 5 years was 27.4% and 34.9%. In conclusion, our analysis of the entire Swiss experience of allo‐HSCT in patients with NHL shows promising 5‐ and possibly 10‐year OS and relatively acceptable NRM rates for such population, the majority being not in complete remission (CR) at the time of transplantation

Saignements d’origine indéterminée : approche diagnostique et thérapeutique

A bleeding tendency is a frequent cause of hematological consultation. However, despite extensive biological investigations, no hemostasis abnormality is identified in the majority of patients, leading to the diagnosis of bleeding of unknown cause (BUC). Overall, the pathogenesis of BUC is most likely of multifactorial etiology and the accumulation of minor alterations in fibrin clot structure, fibrinolysis, platelet function and thrombin generation can tip the balance of hemostasis towards the bleeding side. In recent years, unconventional biological explorations have found new hemorrhagic abnormalities. Therapeutic options are limited but are usually effective to prevent bleeding.Une tendance hémorragique est une cause fréquente de consultation hématologique. Toutefois, malgré des investigations biologiques étendues, aucune anomalie de l’hémostase n’est identifiée dans la majorité des cas. Il s’agit donc de saignements d’origine indéterminée. Dans l’ensemble, ceux-ci sont le plus vraisemblablement d’étiologie multifactorielle, et l’accumulation d’altérations mineures au niveau de la structure du caillot de fibrine, de la fibrinolyse, de la fonction plaquettaire et de la génération de thrombine peut faire basculer l’équilibre de l’hémostase du côté hémorragique. Ces dernières années, des explorations biologiques non conventionnelles ont permis de mettre en évidence de nouvelles anomalies hémorragipares. Les possibilités thérapeutiques sont peu nombreuses mais s’avèrent efficaces