A Rare Presentation of Plasmablastic Lymphoma in a HIV-negative Male Status-post Liver Transplantation

Introduction: Plasmablastic lymphoma, a rare and aggressive form of Non-Hodgkins lymphoma, rarely presents as a retroperitoneal mass.  There are no case reports in the literature of plasmablastic lymphoma presenting in living, HIV-negative patient status post liver transplantation.Presentation of Case: We report the case of a 63 year-old HIV-negative male status post liver transplant who presented with weakness and obstructive uropathy. Imaging showed a large mass in the retroperitonium. Biopsy revealed plasmablastic lymphoma. CHOP therapy was initiated and after six cycles, the retroperitoneal mass regressed in size; however, cytology from pleural fluid revealed that the disease remained. It has been 9 months since initial diagnosis and he was started on salvage chemotherapy with ESHAP however he subsequently developed a treatment related myelodysplastic syndrome with trisomy 12.Conclusions: The present case is used to explore the presentation and treatment of plasmablastic lymphoma, and to review the literature concerning the rarity of this disease in the setting of a HIV-negative patient status post solid organ transplantation

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Characterization and source apportionment of the coarse-mode fraction of settled dust in a public school classroom

Dust settled onto surfaces in indoor environments is a complex mixture of particles generated from numerous outdoor, indoor, occupant and occupant activity related sources. This project developed a methodology for the systematic collection and analysis of settled dust in an indoor environment. Samples were analyzed using polarized light microscopy for the purpose of determining its composition and to investigate the relative contributions of various particle sources.Prior to the field study, several operations were undertaken to ensure the collection of representative samples and acquisition of statistically significant data. First, a reference database of particle types common to indoor environments was compiled. To evaluate the performance of settled dust collection techniques, a dust settling chamber was designed, built and performance tested. Using this settling chamber, adhesive tape and microvacuum sampling were compared to direct deposition, both methods were found to collect representative samples. The analytical parameters of a light microscopic analysis protocol were optimized. A three dimensional sampling array was then developed to ensure systematic sampling of settled dust, and implemented in two elementary school classrooms.Field study results identified 39 different particle types in settled dust samples including organic particles such as skin, starch grains, and plant/insect debris; particle aggregates; the minerals silica, calcium carbonate, clay, and gypsum; cellulose, cotton, synthetic and carpet fibers; synthetic vitreous fibers; black and white opaque particles, residue from cleaning solutions, waxes and polishes; and paint residue from children\u27s arts and craft paint. Twenty different particle types were found to comprise 94% of the particles characterized. The sources for these 20 particle types were found to originate from outdoors, indoors and from the occupants and their activities. Each was found to contribute about a third of the different particle types identified in the settled dust. Although this method was used in the investigation of a \u27non-problem\u27 school and determined the composition of a \u27normal\u27 dust, this method can easily be used to assess many different types of buildings and environments including those with known problems

Extraoral plasmablastic lymphoma with intravascular component and MYC translocation

Plasmablastic lymphoma (PBL) is an uncommon, clinically aggressive, Epstein-Barr virus–driven B-cell lymphoma that was initially described in tumors of relatively young human immunodeficiency virus–positive men. Subsequent to initial reports, the clinical and pathological spectrum of this disease has been expanded such that, now, PBL is recognized to be a heterogeneous disease entity. Plasmablastic lymphoma has been seen in clinical settings outside those initially reported and has been shown to demonstrate a variety of morphologic patterns. We describe a case of extraoral PBL in an human immunodeficiency virus–infected patient with a computed tomography–identified heterogeneously enhancing mass in the stomach. Histologically, a prominent intravascular component was identified. Fluorescent in situ hybridization analysis for MYC/IGH (immunoglobulin heavy chain) rearrangement t(8;14) identified fusion signals, confirming the presence of MYC rearrangement. The presence of a prominent intravascular in our case is unique. To our knowledge, these findings have not been observed in the previous reports of PBL. The observation of this vascular component supports the heterogeneity of PBL and may be an indicator of tumor aggressiveness. We were able to demonstrate the MYC/IGH rearrangement in our case of PBL. The interplay between Epstein-Barr virus and this MYC rearrangement may be similar to what is observed in Burkitt lymphoma, another clinically aggressive non–Hodgkin lymphoma

Detection of Group B Streptococci in Lim Broth by Use of Group B Streptococcus Peptide Nucleic Acid Fluorescent In Situ Hybridization and Selective and Nonselective Agars▿

The sensitivity, specificity, and positive and negative predictive values for the detection of group B streptococci from Lim enrichment broth with sheep blood agar (SBA), with selective Streptococcus agar (SSA), and by a peptide nucleic acid fluorescent in situ hybridization (PNA FISH) assay were as follows: for culture on SBA, 68.4%, 100%, 100%, and 87.9%, respectively; for culture on SSA, 85.5%, 100%, 100%, and 94.1%, respectively; and for the PNA FISH assay, 97.4%, 98.3%, 96.1%, and 98.9%, respectively

Quantification of Sickle Cells in the Peripheral Smear as a Marker of Disease Severity

Blinded readers examined peripheral smears of 108 children with steady sickle cell (SC) disease and controls by counting ten 100× microscope fields and calculating percent of irreversible and reversible SC from total red cell population SC index (SCI). SCI was correlated to disease severity, and transfusion, hydroxyurea, or neither. Controls had a mean of 0.28% SC (range 0-0.64). Children with hemoglobin SS had a mean SCI of 5.12% ± 5.37 (range 0-30). SCI increased 0.33% with each increasing year (p 0.64 were 3.32 times as likely to experience clinical complications (p = 0.0124). Although blood transfusions and hydroxyurea decreased percent of SC, 72% treated patients had SCI >0.64, correlating with persistent sickling. This standardized method quantifies SC in peripheral smears. Percent of SC increased with age and correlated with disease severity, especially hemolytic complications, providing readily available information with minimal or no extra cost

Central nervous system manifestations of marginal zone B-cell lymphoma

Primary or secondary central nervous system (CNS) involvement by marginal zone B-cell lymphoma (MZBCL) is rare. A retrospective analysis of patients was done with MZBCL involving the CNS, diagnosed and treated at our institution between 2004 and 2010. We identified 10 MZBCL patients with primary (six) or secondary (four) CNS involvement. Five patients presented with primary dural lymphoma and were treated with surgical resection, whole-brain radiation, or systemic chemotherapy. Only one patient had CNS relapse 5 years later. A single patient with primary intraocular lymphoma achieved clinical remission with ocular radiotherapy and systemic chemotherapy. Four patients had ocular MZBCL within 5 years of the initial diagnosis of primary ocular adnexal MZBCL and primary splenic MZBCL. There was no evidence of local recurrence in all but one who developed systemic relapse after 3 years of follow-up. Primary or secondary CNS involvement by MZBCL display indolent clinical behavior and have a generally favorable prognosis, underlining the importance of their differentiation from aggressive lymphomas that more commonly involve the CNS