Anaplastic T-cell lymphoma presenting as fatal acute liver failure

Acute liver failure (ALF) is an uncommon manifestation of liver disease and constitutes a medical emergency for which early identification is necessary. Hepatic involvement by hematologic malignancies although frequent, rarely causes severe hepatic dysfunction. Even more, acute hepatic failure as the first manifestation of a hematologic malignancy is extremely uncommon, although some cases have been reported in the literature. We describe the case of a 61 y/o puertorrican veteran who developed acute hepatic failure secondary to massive infiltration of the liver by a recurrent non-Hodgkin's lymphoma.

Response to combination therapy of interferon alfa-2b plus ribavirin in Hispanics with chronic hepatitis C

OBJECTIVE: To evaluate the response rate of Hispanics with chronic hepatitis C to combination therapy of interferon alfa-2b plus ribavirin and to assess its adverse events. BACKGROUND: Hepatitis C virus may lead to chronic infection and multiple complications. Response to combination therapy of interferon plus ribavirin has been studied in many populations. African Americans have been found to have a lower response rate than Caucasians. However, little data exist for Hispanics. METHODS: Hispanic patients from Puerto Rico with chronic hepatitis C were eligible for the study between November 1997 and February 2000. The Institutional Review Boards of the participating institutions approved the study. Written informed consents were obtained. Combination therapy was given for 48 weeks and patients were followed for 24 weeks after treatment. Analysis of response to therapy was performed in an intention-to-treat basis. RESULTS: The most frequent adverse event was anemia (89%), associated to ribavirin. Sustained response was 23% for naive patients, 45% for relapsers, and 8% for non-responders to previous interferon monotherapy (p < 0.001). Data to analyze response was not available in 27% of patients. Hispanic patients had a low response rate to combination therapy. CONCLUSIONS: Response rates to combination therapy for Hispanic naive and previously non-responder patients are lower than in other reported populations. This may be due to a high prevalence of genotype 1 in Puerto Rico, which is associated to poor response. The higher response rate of relapsers, similar to those reported previously, was expected since these patients showed a previous response to interferon monotherapy. Ethnic factors may play a role in the response to therapy and should be further studied to determine proper treatment strategies for this population.

Infections caused by parvovirus B19

Parvovirus B19 was discovered in 1974 by Cossart et al; is a single stranded unenveloped DNA virus, which virion is isometric, uniform and has icosagedral symmetry. B19 infection has been found in all countries, it is almost certainly world-wide in distribution. Infections occurs most frequently in late winter, spring and early summer months and are transmitted by respiratory route. Erythema infectiosum is the most common manifestation of human parvovirus B19 infection, is most commonly acquired between 4 and 10 years of age and at least 60 of adults are seropositive. Erythema Infectiosum is characterized by three stages of rash that involves the face and may also involves trunk and extremities. In adult patients, particularly women, arthralgia or arthritis have been associated with up to 80 of Erythema Infectiosum casually starts in the small joints of the hand. Maternal parvovirus B19 infection with or without rash, can affect fetus. Transient aplastic crisis can be caused by HPV B19 in patient who have increased rate of RBC destruction or loss. Others diseases or symptoms complexes may be associated with B19 infection in the coming years as this virus and its infections continues being an interesting field of investigation