Primary intestinal aspergillosis resulting in acute intestinal volvulus after autologous stem cell transplantation in a patient with relapsed non-Hodgkin lymphoma : report on a rare infectious complication and a review of the literature

Objectives: Since primary intestinal aspergillosis is a severe infectious complication with a high morbidity and mortality in immunocompromised patients, we want to draw attention to this rare entity and the importance of early recognition. Methods: We report a case of documented primary intestinal aspergillosis in a patient receiving an autologous stem cell transplantation (SCT). Furthermore, this article gives a short reflection on the occurrence of invasive aspergillosis in autologous SCT and the value of serum galactomannan levels based on literature search and linked with the case. Results: In this case the patient presented on day +8 after autologous SCT for a relapsed diffuse large B-cell lymphoma with an acute abdomen with urgent need for surgical intervention. Biopsy revealed the presence of fungal colonies due to aspergillosis and voriconazole was started. Until that day the systematically taken serum galactomannan tests were all negative or pending. Initially there was some resistance to perform surgery in the presence of neutropenia and thrombocytopenia but in the end it provided the definitive diagnosis and should not be delayed. Until now this patient is in good health and retains a complete remission. Conclusion: With this case, we would like to emphasize that early recognition of primary intestinal aspergillosis is of the utmost importance as it is a rare but serious infectious complication. It should be included in the differential diagnosis of neutropenic patients with sudden onset abdominal pain and ongoing fever, even in the absence of a positive serum galactomannan

Epstein-Barr virus serology and PCR: conflicting results in an immunocompetent host: a case report and review of literature

We present the case of a 27-year-old immunocompetent man who progressively developed a generalized lymphadenopathy and B symptoms. Results of Epstein-Barr virus (EBV) serology were suggestive for a past infection, but the EBV viral load in whole blood was high. Also, core needle biopsy of the largest lymph node showed an image which could fit an EBV-driven reactive lymphoproliferation. Despite the absence of an immune disorder, all medical evidence points to an EBV-driven lymphoproliferative proces. In immunocompetent patients, it seems extremely uncommon to detect a high EBV viral load in the absence of serological evidence of an acute EBV infection or reactivation. We reviewed literature on this topic and on the selection of the appropriate sample type for EBV PCR, as this is known to be a critical point. Serological testing for the diagnosis of EBV infection is the gold standard in immunocompetent patients. Measuring EBV viral load is only recommended when dealing with immunocompromised patients. Although extremely rare, this case report shows that there is a place for EBV PCR in certain situations in immunocompetent patients. Besides, there is still no consensus regarding the specimen of choice for the determination of the EBV viral load. The preferred specimen type seems to depend on the patient's underlying condition

A mini-review on aplastic anemia, illustrated by a case report on bone marrow hot pockets mimicking sclerotic bone metastases

A 61-year-old female presented with pancytopenia with a hemoglobin of 7.6 g/dL, platelet count of 26.000/mu L and neutrophil count of 525/mu L. Bone marrow aspirate showed moderately cellular marrow with a dysplastic erythroid lineage and poor megakaryo- and granulopoiesis without excessive blast count. Trephine biopsy revealed profoundly hypocellular marrow with rare hematopoietic elements. Conventional karyotyping was normal and next generation sequencing revealed no mutations. These findings were compatible with transfusion dependent, non-severe aplastic anaemia (AA) with grade 3 thrombopenia and neutropenia. However, diagnostic workup including CT thorax revealed unexpected sclerotic bone conversions in the spine. Additional whole body SPECT with 99mTc-HDP showed multiple bone lesions in the cervical, thoracic and lumbar spine. CT guided biopsy of D12 surprisingly revealed normal trilineage hematopoiesis. These results were very discrepant from the profoundly hypocellular marrow from the trephine biopsy. It is known that in AA residual hyperactive foci of hematopoiesis can persist; so called 'hot pockets'. MRI is the preferred imaging technique in AA; in most cases a homogeneous fatty bone marrow is found, though some patients present with a heterogeneous marrow with foci of decreased intensity, corresponding with residual foci of hematopoiesis. Imaging studies with PET-CT and PET-MRI confirm these different patterns with respectively homogeneous hypometabolism and hypometabolism with focal hyperproliferation. However, there is no previous literature on the aspect of this focal hematopoiesis on computed tomography. This is the first description of a 'hot pocket' manifesting as a sclerotic bone lesion on CT

P15 TREATMENT PATTERNS OF WALDENSTRÖM’S MACROGLOBULINEMIA IN BELGIUM

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Hodgkin’s lymphoma: Belgina hematology Society guidelines in diagnosis, treatment and follow-up

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