An Epstein-Barr Virus-Associated Leukemic Lymphoma in a Patient Treated with Rabbit Antithymocyte Globulin and Cyclosporine for Hepatitis-Associated Aplastic Anemia

Lymphoproliferative disorders (LPDs) are generally caused by uncontrolled B-cell proliferation induced by the Epstein-Barr virus (EBV) in the setting of impaired EBV-specific T-cell immunity, particularly when there is pharmacological immunosuppression including antithymocyte globulin. We herein present an unusual case of EBV associated with LPD (EBV-LPD) in which LPD occurred 3 weeks after the use of rabbit antithymocyte globulin administered for severe hepatitis-associated aplastic anemia; the patient died of fulminant leukemic lymphoma 5 days after the onset. We also review the pertinent literature on EBV-LPD after immunosuppressive therapy and document the efficacy of EBV viral load monitoring and the need for preemptive therapy. Copyright © 2011 S. Karger AG, Basel

Gaining a deepener understanding the thoughts of female hematopoietic tumor survivors regarding having a child through their life stories

目的造血器腫瘍は治療前に妊孕性温存の手段がとれない場合があり、その人々への支援のため、女性造血器腫瘍サバイバーが、病の中で子どもを持つことへの思いをどのように抱いているか明らかにすることを目的とする。対象と方法18 歳から 35 歳の間に造血器腫瘍と診断され、抗がん剤治療または分子標的薬治療を受けて、寛解中の女性 10 名に対して半構成的面接を行い、対話構築主義に基づいたライフストーリー法で分析した。結果女性造血器腫瘍サバイバーが、結婚を視野に入れていないときは、告知時に【命の危機の前に薄らぐ将来の子どもを持つことの重要性】を感じ、寛解すると【回復した月経に伴う妊孕性への安心感と消えない不妊への不安】が生じた。結婚を考えるにつれて【念のため医師に妊娠可能かを聞く心配】が拭いきれず、不妊は家族形成の契機としての結婚の意味を失うため、【結婚前に子どもを持てないことを知る苦悩】、【病の受け入れを揺るがす子どもを持てない現実への恨み】を抱くようになった。結婚後では【子どもを持てるかより、先立つ死に向かう不安】が強かった。その後、子どもを授かるも【病の治療による胎児の障害への懸念】は続いた。結論女性の人生で “ 子どもを持つことへの思い ” が、結婚を考える時期と病の回復段階の 2 軸を中心に思いが変容していた。そのため一時的な思いではなく、女性の人生全体を考えた理解の仕方というものの重要性が示唆された。PurposeFertility often cannot be preserved in patients with hematopoietic tumors. This study was performed to clarify the thoughts of female hematopoietic tumor survivor on child bearing.MethodsThe study population consisted of 10 women diagnosed with hematopoietic tumors between 18 and 35 years of age, undergoing anticancer drug treatment or molecular targeted therapy, and currently in remission. We conducted a semi-structured interview with the Life Story method based on dialogue building.ResultsWhen not considering marriage, they reported that “The importance of having a child faded compared with the crisis of life” at diagnosis, and “Relief obtained by cure of amenorrhea occurred during remission and indelible anxiety regarding infertility.” When wishing to get married, “Fear concerning infertility, asking the doctor if they can become pregnant” cannot be forgotten. Infertility results in loss of the meaning of marriage as a trigger for family formation, so the respondents reported “Anguish to know that I cannot have children before marriage” and “Resentment toward the reality of infertility that affects acceptance of disease”. After marriage, “Anxiety heading toward death, rather than whether I will have children” was strong. During pregnancy “Concerns about fetal disorders due to treatment of the disease” continued.ConclusionIn the life of a woman, thoughts of having children were transformed around two axes, i.e., the time to consider marriage and the stage of recovery from the disease. Therefore, rather than just capturing temporary thoughts, how to understand the whole life of women was suggested to be important

Posterior reversible encephalopathy syndrome associated with mild COVID-19 infection in a 9-year-old child: A case report and literature review

The neurologic complications associated with the coronavirus disease 2019 (COVID-19) is becoming more prevalent in children after the appearance of the Omicron strain. An association between COVID-19 and posterior reversible encephalopathy (PRES) has been consistently reported in adults, but little information is available in the pediatric age group. There are only few case reports of COVID-19-related PRES in children, and all of these patients were either on some type of immunomodulatory medications or whose general condition was severe. The present case, a 9-year-old Japanese boy, who had no fever but vomited several times from days 1–4 of a COVID-19 infection had an afebrile seizure on the 8th day of his illness. The patient had no history of hypertension, and had not previously been administered any immunosuppressive drugs before or during the period of his COVID-19 infection. On admission, his physical findings were unremarkable, except for a high blood pressure. The results obtained by brain computed tomography and magnetic resonance imaging were consistent with PRES. The patient recovered with no sequelae after treatment with antihypertensive drugs. Further investigations did not suggest any underlying disease that could have caused the transient hypertension. Although PRES is relatively rare in children, pediatricians should keep in mind that this syndrome can be complicated, even in children with mild COVID-19 infections

Correlation of frontal atrophy with behavioral changes in amyotrophic lateral sclerosis

Background: Recent studies have linked cognitive impairment in amyotrophic lateral sclerosis (ALS) to frontotemporal pathology. Aim: We examined possible associations between behavior changes and regional gray matter volume in early ALS and assessed whether the volume changes were independent of physical impairments. Methods: Seventeen ALS patients with Mini-Mental State Examination ≥24, no need for assistance in daily life, normal respiratory tests (respiratory function test and arterial blood gas analytes), and eleven age-matched controls, underwent structural MRI. Behavioral changes were assessed with family-rating Frontal Systems Behavior Scale (FrSBe). We applied voxel-based morphometry to investigate the correlation between FrSBe and gray matter volume and assessed the correlation of volume with ALS Functional Rating Scale (ALSFRS) and respiratory tests. Results: Current FrSBe were significantly higher than retrospective scores assessing the status before onset, most notably in apathy. The volumes of right middle and left medial frontal gyri in ALS were negatively correlated with FrSBe, whereas they were not correlated with ALSFRS and respiratory tests. The volume of right frontal cluster, but not left medial frontal cluster, was significantly smaller than that of controls. Conclusions: Regional atrophy within frontal lobe was associated with behavioral dysfunction in early ALS, this association was independent of physical factors

Frontal assessment battery and frontal atrophy in amyotrophic lateral sclerosis

Objectives: To determine the potential utility of the frontal assessment battery (FAB)in assessing cognitive impairments in amyotrophic lateral sclerosis (ALS), we investigatedthe association between the FAB score and regional gray matter volume, andascertained whether the regional brain alterations related to cognitive impairmentsoccur in relatively mild stage of ALS.Materials and Methods: Twenty-fourALS patients with a Mini-MentalStateExamination score of >23, a normal score on the Self-RatingDepression Scale, little orno disturbance in speech and handling utensils on the ALS Functional Rating Scale(ALSFRS), and normal measures on respiratory tests (respiratory function test and arterialblood gas analysis), and two age-matchednormal control groups (one for FABassessment and the other for brain morphometry) underwent FAB testing and structuralmagnetic resonance imaging. We applied voxel-basedmorphometry to investigatethe relationship between the FAB score and regional brain alteration, andassessed the relationship between the altered regional brain volume and ALSFRS orrespiratory tests.Results: Frontal assessment battery scores were significantly lower in ALS patientsthan in normal controls. Volume reduction in the right orbitofrontal gyrus in ALS wascorrelated with a lower FAB score. There was no correlation between the right orbitofrontalgyrus volume and ALSFRS or respiratory tests.Conclusions: The results suggest that the FAB is an adequate tool for detecting cognitiveimpairments related to frontal lobe pathology in the relatively mild stage of ALS,independent of physical dysfunctions

Adenovirus pneumonia presenting with nodular shadows on chest X-ray in two unrelated allogeneic bone marrow transplant recipients

Adenoviruses are increasingly recognized as important pathogens following allogeneic stem cell transplantation. We herein report two cases of disseminated adenovirus infection that presented with nodular shadows on chest X-ray after allogeneic bone marrow transplantation from unrelated donors. Both patients died of respiratory failure. Autopsies revealed adenovirus infection of multiple organs. Adenovirus infection should be suspected when nodular lung lesions of unknown origin appear in allogeneic stem cell transplant recipients. © 2014 The Japanese Society of Internal Medicine