Recurrent Massive Subcutaneous Hemorrhage in Neurofibromatosis Type 1: A Case Report

Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder that has three major features: multiple neural tumors, cafe-au-lait spots, and pigmented iris hamartomas (Lisch nodules). The purpose of this case report is to advise physicians of the danger associated with the progression of fast-onset massive hemorrhage to hemodynamic instability, which mandates rapid treatment to prevent the development of a life-threatening condition. A 64-yr-old woman with NF-1 was admitted to the Emergency Department (ED) because of a rapidly growing, 10x5x3 cm-sized mass on the left back area. She had previously undergone surgery for a large subcutaneous hematoma, which had developed on her right back area 30 yr before. She became hemodynamically unstable with hypotension during the next 3 hr after admission to ED. Resuscitation and blood transfusion were done, and the hematoma was surgically removed. The mass presented as a subcutaneous, massive hematoma with pathologic findings of neurofibroma. We report a case of NF-1 that presented as recurrent, massive, subcutaneous hemorrhage on the back region combined with hypovolemic shock.

Functional Differences of the Lymphocytes in Nasal Polyps between Allergic and Non-Allergic Patients

Lymphocytes can produce various kinds of cytokines which are responsible for the development of the infectious and allergic inflammation. We focused on the role of the lymphocyte in the pathogenesis of the nasal polyp. This study was designed to evaluate the functional differences of the lymphocytes between allergic and non-allergic polyp. Lymphocytes were obtained from peripheral blood and tissues of polyp in 12 patients with non-allergic polyp, 7 patients with allergic polyp and 5 normal subjects as control. Cytokines were measured with ELISA from each group of lymphocytes after stimulation with Concanavalin A (Con A). We compared the production of interleukin (IL)-2, IL-4, tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma between the non-allergic and allergic groups. The levels of IL-4 and IL-6 from polyp tissue lymphocytes were higher in allergic group, while those of IL-2 and IFN-gamma were higher in non-allergic group. The levels of IL-4, IL-6 and TNF-alpha from peripheral blood lymphocytes were higher in allergic group, and IFN-gamma was higher in non-allergic group. These results suggest that cytokine productivity of the polyp tissue lymphocytes appear to be parallel to that of the peripheral blood lymphocytes in each group and shows distinct pattern of ytokine production between two groups.