Pulmonary nocardiosis in an immunocompetent patient

Nocardiosis is an uncommon bacterial infection caused by aerobic actinomycetes in the genus Nocardia. This pathogen generally causes opportunistic infection in immunocompromised hosts although infection has also been reported in immunocompetent patients. In this manuscript, we report a case of pulmonary nocardiosis without evident signs of an immunocompromising illness. A 14-years-old girl was admitted with fever, productive cough, weight loss, anorexia and occasionally bloody sputum since 2 months before. Nocardia was detected in the smear and culture of sputum. A sulfamethoxazole-trimethoprim combination 'was administered, and the clinical findings improved. It is suggested that pulmonary nocardiosis should be considered in the differential diagnosis of chronic pulmonary symptoms even in non immunocompromised patients

Chronic meningitis in acute promyelocytic leukemia [a case report]

The occurrence of extramedullary disease [EMD] at presentation or at relapse has long been considered a rare event in Acute Promyelocytic Leukemia [APL]. Our purpose from recent reports of EMD at presenting in APL have raised increasing concern about one of causes of chronic meningitis. This study describe a case of acute promyelocytic leukemia [APL] in 25 years old female patient admitted in Emam Reza hospital, presenting with severe headache and vomiting and showed signs of meningeal irritation as well as papilledema. Cytocentrifuge examination of CSF showed an excess of promylocytes, but peripheral blood didn't show any abnormal cell or blasts where as BMA showed increase of promyelocyte with multiple auer rod. After 2 weeks of aleukemic phase, this patient developed hematologic picture of APL diagnosed myeloid origin cells with myelopperoxidase stain. She was diagnosed as having leukemic meningitis and after 3 weeks in spite of chemotherapy, she dead Leukemic relapse or first presentation of leukemia may be the etiology of aseptic meningitis. Rarely central nervous. system leukemia and leukemic meningitis are associated with normal bone marrow and sometimes patients at Aleukemic phase present with meningitis. therefore we suggested that in patients with aseptic meningitis cerebrospinal fluid cytospine smear should be evaluated for neoplasic and leukemic cells

Interferon plus lamivudine in treatment of chronic hepatitis B in patients unresponsive to lamivudine monotherapy

Introduction: Interferon alfa has antiviral and immunomedulatory effects that can induce virologic and biochemical remission in chronic hepatitis B [CHB] infection

Material and Methods: Lamivudine 100mg per day and Interferon a-2b 10megaut3 times per week were given for 26 weeks to 22 adult patients with Liver biopsy-proved chronic Hepatitis B who had been treated with Lamivudine at least 52 weeks. The virologic, immunophoresis, Liver function tests and hematologic assays were evaluated

Results: the aim of this study was to evaluate the efficacy of high dosages of Interferon plus standard dosages of Lamivudine in precoremutant or lamivudine resistant chronic Hepatitis B. 3. Groups of patients were found; group. I: HBeAg - tive, HBeAb + live, HBV DNA PCR + tive CHB [6 pts]. Group II: HBeAg - tive, HBeAb - tive, HBV DNA PCR + tive CHB [5 pts]. ,Group III: HBeAg + tive, HBeAb - tive, HBV DNA PCR + tive CHB [11 pts]. Clearance of HBV DNA occurred in 3 pts in group III and Ipt in each group I and II. Aminotransferase normalization in 9 pts in group III and 4 pts in group I and II

Conclusion: A six-months course of high dosages of INF a-2b in Combination with Lamivudine in patients with CHB infection made a sustained depression of HBV in HBeAg positive CHB. Significant studies with more patients are needed to confirm this study