ABSTRACT
The hypereosinophilic syndrome (HES) is a rare yet frequently fatal disorder of unknown etiology characterized by markedly elevated eosinophil counts and subsequent multiple organ failure due presumably to eosinophil-derived protein toxicity. We describe the laboratory and anatomic findings in a 15-year-old female with extraordinarily high circulating levels of eosinophil major basic protein (MBP) who sustained a precipitous cardiac death secondary to a massive myocardial infarction. Postmortem examination showed marked cardiomegaly with extensive recent left ventricular infarction. Occlusive thrombosis of small blood vessels was evident in the myocardium, spleen, lungs, and kidneys. Immunofluorescent staining showed massive MBP deposition in multiple organ parenchyma including the heart, renal glomeruli, adrenal cortex, bronchioles, and other visceral organs, suggesting a causal relationship. We hypothesize on the mechanisms of eosinophil toxicity in HES.
Subject(s)
Hypereosinophilic Syndrome/complications , Hypereosinophilic Syndrome/pathology , Myocardial Infarction/complications , Ribonucleases , Adolescent , Blood Proteins/metabolism , Brain/pathology , Eosinophil Granule Proteins , Fatal Outcome , Female , Humans , Hypereosinophilic Syndrome/blood , Liver/pathology , Lung/pathology , Magnetic Resonance Imaging , Multiple Organ Failure/complications , Multiple Organ Failure/pathology , Myocardial Infarction/pathology , Myocardium/pathology , Spleen/pathologyABSTRACT
After receiving ceftriaxone intravenously, a boy with leukemia died suddenly of massive hemolysis. The diagnosis was made retrospectively only after a similar case of sudden fatal immune hemolysis after intravenous administration of ceftriaxone was reported.
Subject(s)
Ceftriaxone/adverse effects , Death, Sudden, Cardiac/etiology , Hemolysis/drug effects , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Ceftriaxone/administration & dosage , Child, Preschool , Fatal Outcome , Humans , Male , Retrospective StudiesABSTRACT
All methods of organ preservation depend upon hypothermia to depress metabolism during storage. Yet, hypothermia may represent the rate-limiting factor in organ preservation. A new perfusate has been developed which supports organ preservation without extreme hypothermia. The perfusate consists of a complex fluid supplemented with an oxygen carrying perfluorocarbon emulsion, Oxygent (Alliance Pharmaceutical Corp,). The perfusate was used to preserve canine kidney autografts using pulsatile preservation at 32 degrees C and static storage at 25 degrees C. Upon autografting the dogs produced urine within minutes of reperfusion. These results indicate the new perfusate may have significant potential in organ preservation without extreme hypothermia.
