Subject(s)
Paraganglioma/complications , Peripheral Nervous System Neoplasms/complications , Vagus Nerve , Chronic Disease , Combined Modality Therapy , Computed Tomography Angiography , Cough/etiology , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Paraganglioma/diagnosis , Paraganglioma/therapy , Peripheral Nervous System Neoplasms/diagnosis , Peripheral Nervous System Neoplasms/therapy , Positron-Emission TomographyABSTRACT
Tacrolimus has become an important cornerstone in the prevention of rejection after kidney transplantation. However, its use has been complicated by several side effects, including chronic allograft nephropathy, diabetes mellitus, arterial hypertension, and neurotoxicity. Tacrolimus-induced neutropenia is a less recognized, but potentially harmful complication. Three patients with severe neutropenia developing within 3 months after kidney transplantation are described. After having excluded other well known causes, tacrolimus was considered the most probable culprit. Definitive proof of this hypothesis was obtained by discontinuation of tacrolimus and switching to cyclosporine, which led to recovery of white blood cell count in all three patients.
Subject(s)
Immunosuppressive Agents/adverse effects , Kidney Transplantation , Neutropenia/chemically induced , Tacrolimus/adverse effects , Cyclosporine/therapeutic use , Drug Substitution , Drug Therapy, Combination , Female , Granulocyte Colony-Stimulating Factor/therapeutic use , Humans , Male , Middle Aged , Neutropenia/blood , Neutropenia/drug therapy , Severity of Illness IndexABSTRACT
Here we present the case of a patient with diagnosis of chronic lymphocytic leukaemia (CLL) on routine protocol biopsy 3 months following kidney transplantation. Genetic analysis confirmed the origin of the malignancy, being the recipient. Differential diagnosis with post-transplant lymphoproliferative disorder (PTLD) is extremely important in order to avoid unnecessary devastating treatment. This case is challenging, both in terms of making the correct diagnosis and in terms of optimal treatment. The case underscores that it is extremely important to distinguish between a pre-existing lymphoma diagnosis after transplantation and a true PTLD as the treatment options of both are very divergent.
Subject(s)
Kidney Failure, Chronic/complications , Kidney Failure, Chronic/surgery , Kidney Transplantation , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Leukemia, Lymphocytic, Chronic, B-Cell/pathology , Aged , Biopsy , Humans , Male , Postoperative PeriodABSTRACT
In recent years, there has been a tremendous increase in the number of clinical studies with monoclonal antibodies and small molecules in the treatment of hematological malignancies. Clinical observations have shown that some of these molecules may also aid in the treatment of immune-mediated hematological disorders. Moreover, immunotherapy has become an important treatment cornerstone in other, non-hematological, auto-immune diseases. This paper reviews the current state of the use of these new molecules in the treatment of the most frequently encountered immune-mediated hematological disorders: auto-immune hemolytic anemia (AIHA), idiopathic thrombocytopenic purpura (ITP), and thrombotic thrombocytopenic purpura (TTP).
