Chemotherapy as Treatment for Acute Myeloid Leukemia (AML)-Induced Facial Nerve Palsy

Acute myeloid leukemia (AML) is a disorder of the myeloid cell line that can manifest infrequently as a granulocytic sarcoma with infiltration into bone and soft tissue. Consequently, cranial nerve neuropathy due to AML infiltration can result in variable neurological deficits, including facial nerve palsy. Here, we present the case of a patient presenting with unilateral facial nerve palsy with evidence of AML in cerebrospinal fluid (CSF) cytology and bilateral opacification of the mastoid air cells suggestive of AML infiltration into the mastoid process. Patient demonstrated improvement of facial palsy after administration of intrathecal chemotherapy without need for surgical intervention. We further examine known cases reported to date on the use of chemotherapy and surgical intervention in management of facial nerve palsy as a consequence of AML infiltration of the mastoid bone. Notably, there appears to be a correlation between mastoid bone infiltration seen on imaging and facial nerve palsy in patients with known history of AML that may be treated without need for surgical intervention or biopsy

Progression of a hepatosplenic gamma delta T-cell leukemia/lymphoma on hyperCVAD/MTX and ara-C: literature review and our institutional treatment approach

A 24-year-old male presented with abdominal pain, fever, and palpable splenomegaly. His differential count revealed myelocytes, metamyelocytes, and nucleated red cells. A bone marrow biopsy confirmed a diagnosis of hepatosplenic gamma delta T-cell leukemia/lymphoma. We describe here our center\u27s diagnostic and treatment approach for this rare leukemia

Taking abdominal pain seriously: a case of aggressive dedifferentiated liposarcoma

Case Description: A 64 year-old female with history of PE on Eliquis with IVC filter placement, tobacco dependence, and class III obesity presents with abdominal discomfort and bilateral leg swelling. Physical examination showed a distended abdomen and bilateral leg edema and tenderness. Doppler ultrasound of the lower extremities showed extensive bilateral lower extremity deep vein thromboses (DVT). Patient developed oliguria and acute kidney injury, and ultrasound of the kidney was obtained. Kidney U.S. showed two large masses in the abdomen and pelvis. CT of the abdomen/pelvis demonstrated a mesenteric mass measuring up to 26 cm in the right mid-abdomen with multiple adjacent smaller masses. Patient underwent IR biopsy of the mass which showed a malignant neoplasm, with core biopsies showing spindled and epithelioid cells. Molecular studies were positive for MDM2 amplification, with focal weak staining for CD10 and inhibin. These features were indicative of a dedifferentiated liposarcoma given presence of MDM2; however, a poorly differentiated sex cord stromal tumor was also possible given weak staining by inhibin and CD10. Patient was not a surgical candidate but was a candidate for systemic chemotherapy. She received treatment with one cycle of Adriamycin, Ifosfamide, and Mesna (AIM) which was complicated by Ifosfamide-induced encephalopathy. She then received palliative radiation therapy and unfortunately passed secondary to cardiac arrest from suspected pulmonary embolism. Discussion: Liposarcomas (LPS) are rare mesenchymal neoplasms involving the deep soft tissues. Dedifferentiated liposarcomas (DDLPS) are high-grade aggressive neoplasms typically occur in the retroperitoneum, and have six-fold the rate of local and metastatic recurrence and disease-specific mortality than that of well-differentiated liposarcomas (WDLPS). In patients with abdominal discomfort and bilateral extremity deep thromboses, a malignant process must be on the differential. DDLPS is a focal outgrowth from precursor WDLPS lesions; therefore, early detection of these tumors is key to prompt diagnosis and management.https://scholarlycommons.henryford.com/merf2020caserpt/1021/thumbnail.jp

Upper‐extremity deep venous thrombosis after whole blood donation: report of three cases from a single blood center

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111919/1/trf13034.pd

The long shadow of socioeconomic deprivation over the modern management of acute myeloid leukemia – time to unravel the challenges

Abstract Biological and non-biological variables unrelated to acute myeloid leukemia (AML) preclude standard therapy in many settings, with “real world” patients under-represented in clinical trials and prognostic models. Here, using a case-based format, we illustrate the impact that socioeconomic and anthropogeographical constraints can have on optimally managing AML in 4 different healthcare systems. The granular details provided, emphasize the need for the development and targeting of socioeconomic interventions that are commensurate with the changing landscape of AML therapeutics, in order to avoid worsening the disparity in outcomes between patients with biologically similar disease

Unusual Presentation of T-cell Large Granular Lymphocytic Leukemia

Large granular lymphocytic (LGL) leukemia is a rare chronic lymphoproliferative disorder that can arise from T- or natural killer-cell lineages. It is an indolent disease that typically occurs in the sixth decade of life. Most cases of T-cell LGL leukemia (T-LGL) are associated with autoimmune disorders. Patients with T-LGL are generally asymptomatic; however, they can present with symptoms related to neutropenia, infections, and autoimmune disorders. Here, we report two cases of T-LGL in which the patients presented with liver dysfunction

ASSESSMENT OF OSTEOPOROSIS AND ANAEMIA RISK IN PATIENTS ON ANTICONVULSANT THERAPY

Objective: To assess the incidence of osteoporosis and anaemia in patients on anticonvulsant therapy and to educate those under risk.Methods: A prospective observational study was conducted on 50 study participants. The Bone mineral density (BMD), vitamin D, hematological parameters and peripheral smear were noted. Data analyzed using different statistical methods. Patient information brochures for osteoporosis and anaemia were distributed to those on chronic anti-epileptic drug (AED) therapy.Results: The prevalence of osteoporosis was 16% and osteopenia 22%. The BMD of subjects showed an Insignificant reduction in BMD when compared with a standard reference value for south asian population (*P>0.05). The mean BMD in single therapy group was higher compared with multiple therapy groups. BMD of the enzyme-inducing class was less compared with non-enzyme inducing class but was not significant (P>0.05). Duration of therapy was compared with BMD of patients showed a negative correlation. The relationship between duration of therapy and hematological parameters showed a negative correlation (r =-0.128). The mean haematological parameters in single AED therapy were higher when compared with multiple AED therapy. The study demonstrated 40% microcytic hypochromic and 4% macrocytic hypochromic morphology.Conclusion: Chronic therapy with AEDs possesses a significant risk of developing osteoporosis and anaemia. The incidence rate varies according to the type, duration, and mode of therapy. Early detection and management through diet exercise or pharmacotherapy will decrease the incidence of unwanted effects due to AEDs and improve the quality of life.Keywords: Bone mineral density, Antiepileptic drug, Osteoporosi

Impact of COVID-19 Infection on 24 Patients with Sickle Cell Disease One Center Urban Experience, Detroit, MI, USA

The city of Detroit has a large population of individuals with sickle cell disease, and hospitals in Detroit have seen some of the highest numbers of cases of coronavirus disease-19 (COVID-19) in 2020. The purpose of this study was to examine the pathophysiological characteristics of COVID-19 in patients with sickle cell disease or trait to determine whether these patients have unique manifestations that might require special consideration. This retrospective analysis included 24 patients with confirmed COVID-19 and sickle cell disease or trait who were seen at the Henry Ford Hospital, Detroit, MI, USA, between March 1 and April 15 2020. Of the 24 patients, 18 (75.0%) had heterozygous sickle cell trait, one (4.0%) was a double heterozygote for Hb S (HBB: c.20A\u3eT)/β(+)-thalassemia (β(+)-thal), four had sickle cell anemia (β(S)/β(S)) and one (4.0%) had Hb S/Hb C (HBB: c.19G\u3eA) disease. A total of 13 (54.0%) patients required hospitalization. All four patients with sickle cell anemia, developed acute pain crisis. We observed one patient who developed acute pulmonary embolism and no patients developed other sickle cell associated complications. Additionally, three (13.0%) patients required packed red blood cell transfusion without the need of exchange transfusion, and one patient required admission to the intensive care unit (ICU), mechanical ventilation and subsequently died. Patients with sickle cell disease or trait and laboratory-confirmed COVID-19 had a generally mild, or unremarkable, course of disease, with lower chances of intubation, ICU admission and death, but with a slightly longer hospitalization

The long shadow of socioeconomic deprivation over the modern management of acute myeloid leukemia: time to unravel the challenges

Biological and non-biological variables unrelated to acute myeloid leukemia (AML) preclude standard therapy in many settings, with “real world” patients under-represented in clinical trials and prognostic models. Here, using a case-based format, we illustrate the impact that socioeconomic and anthropogeographical constraints can have on optimally managing AML in 4 different healthcare systems. The granular details provided, emphasize the need for the development and targeting of socioeconomic interventions that are commensurate with the changing landscape of AML therapeutics, in order to avoid worsening the disparity in outcomes between patients with biologically similar disease