ABSTRACT
Splenomegaly is a common finding in chronic hepatitis B infection. We present the case of a man with an acute flare of chronic hepatitis B infection, where splenomegaly in absence of portal hypertension led to the diagnosis of splenic marginal zone lymphoma (SMZL) with bone marrow involvement. Adequate suppression of the hepatitis B virus (HBV) viral load with tenofovir resulted in complete remission of the lymphoma.
Subject(s)
Hepatitis B, Chronic/complications , Lymphoma, B-Cell, Marginal Zone/etiology , Splenic Neoplasms/etiology , Adenine/analogs & derivatives , Adenine/pharmacology , Adenine/therapeutic use , Bone Marrow/metabolism , Bone Marrow/pathology , Hepatitis B virus , Hepatitis B, Chronic/drug therapy , Humans , Immunohistochemistry , Male , Middle Aged , Organophosphonates/pharmacology , Organophosphonates/therapeutic use , Remission Induction/methods , Tenofovir , Viral Load/drug effectsABSTRACT
OBJECTIVE AND DESIGN: Non-islet cell tumour induced hypoglycaemia (NICTH) is a paraneoplastic phenomenon that is associated with the formation of several isoforms of pro-insulin like growth factor 2 (pro-IGF-II), or so called "big" IGF-II. Disturbance of ternary complex formation by big IGF-II is assumed to be a crucial early event in the pathogenic cascade of hypoglycaemia. By size-exclusion chromatography, we investigated complex formation by adding different naturally occurring isoforms of pro-IGF-II to pooled normal adult serum. Results were compared with the analysis of the serum from a patient with NICTH. RESULTS: Gel filtration experiments with the serum of a patient with NICTH demonstrated that ternary complex formation was severely compromised. The various forms of pro-IGF-II did not induce a shift of IGF-binding protein 3 (IGFBP-3) from 150kD towards smaller binary complexes in the normal adult serum, suggesting that they did not interfere with the interaction between the acid labile subunit and IGFBP-3. Instead, unglycosylated recombinant pro-IGF-II[1-104] was capable of forming a 150kD complex. In contrast, predominantly glycosylated and unglycosylated pro-IGF-II[1-87] eluted in the free unbound form. We showed that mature IGF-II and isoforms of pro-IGF-II were able to phosphorylate the IGF-I receptors of MC7 cells, albeit to a markedly lesser extent than IGF-I. When the patient's serum was tested in this system, the IGF-I receptor phosphorylation activity was considerably less than that in sera from age matched healthy individuals. CONCLUSION: We postulate that, alongside the presence of big IGF-II in the circulation, additional steps are required to stimulate the release of IGF-II and pro-IGF-II isoforms from IGFBPs in vivo. These factors may be proteases, that are present in the local environment of the tumour and in insulin-sensitive tissues.
Subject(s)
Carcinoma, Hepatocellular/metabolism , Chromatography, Gel/methods , Hypoglycemia/metabolism , Insulin-Like Growth Factor Binding Proteins/metabolism , Insulin-Like Growth Factor II/metabolism , Liver Neoplasms/metabolism , Paraneoplastic Syndromes/metabolism , Protein Precursors/metabolism , Adult , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/pathology , Humans , Hypoglycemia/etiology , Hypoglycemia/pathology , Liver Neoplasms/complications , Liver Neoplasms/pathology , Male , Paraneoplastic Syndromes/complications , Paraneoplastic Syndromes/pathology , Phosphorylation , Protein Isoforms , Tyrosine/metabolismSubject(s)
Abdominal Abscess/diagnosis , Abdominal Pain/diagnosis , Entomophthorales/isolation & purification , Fever/diagnosis , Zygomycosis/diagnosis , Abdominal Abscess/drug therapy , Abdominal Abscess/etiology , Abdominal Abscess/surgery , Abdominal Pain/drug therapy , Abdominal Pain/etiology , Abdominal Pain/surgery , Adult , Antifungal Agents/therapeutic use , Fever/drug therapy , Fever/etiology , Fever/surgery , Humans , Ketoconazole/therapeutic use , Male , Treatment Outcome , West Indies , Zygomycosis/complications , Zygomycosis/drug therapy , Zygomycosis/surgeryABSTRACT
A 42-year-old woman presented with lowered consciousness, ataxia and ophthalmoplegia; MRI of the brain revealed abnormalities compatible with Wernicke encephalopathy (thiamine deficiency).
Subject(s)
Consciousness Disorders/etiology , Thiamine/therapeutic use , Wernicke Encephalopathy/diagnosis , Adult , Alcohol Amnestic Disorder/diagnosis , Consciousness Disorders/drug therapy , Female , Humans , Wernicke Encephalopathy/complications , Wernicke Encephalopathy/drug therapyABSTRACT
A case of Lemierre's syndrome is reported. Although Fusobacterium species are commonly associated with this presentation, Prevotella bivia was the causative micro-organism identified in this case. The finding that disseminated anaerobic sepsis followed primary EBV infection led to the construction of a hypothetical model of infection.
