Chronic lymphocytic leukemia associated with myelodysplastic syndrome with ring sideroblasts.

Diagnosis of myelodysplastic syndrome/acute myeloid leukemia (MDS/AML) and chronic lymphocytic leukemia (CLL) in the same patient is extremely rare. We describe a 69-year-old CLL patient who developed MDS with ring sideroblasts 1 year after diagnosis of CLL and without any previous treatment. Diagnosis was based on flow cytometry, bone marrow aspirate morphology, and iron stain. Our findings indicate that the 2 disorders belong to 2 different hematopoietic clones in this patient. In cases of worsening anemia in CLL patients, it is recommended that an iron stain be performed on bone marrow aspirates to exclude a coexistent malignancy such as refractory anemia with ring sideroblasts.

Essential thrombocythemia with myelofibrosis transformed into acute myeloid leukemia with der(1;15)(q10;q10): case report and literature review.

Translocations involving chromosomes 1 and 15 are uncommon in hematologic malignancies. So far, only 42 cases have been reported with t(1;15) as a reciprocal or complex chromosomal abnormalities. We herein report the first case in the literature, to our knowledge, of a 44-year-old female with essential thrombocythemia and severe myelofibrosis who developed acute myeloid leukemia (AML-M4) with der(1;15)(q10;q10) after 13 years of treatment. In addition, we reviewed the literature for all up-to-date published cases with t(1;15).

Massive pulmonary embolism associated with Factor V Leiden, prothrombin, and methylenetetrahydrofolate reductase gene mutations in a young patient on oral contraceptive pills: a case report.

Factor V Leiden (Factor V G1691A), prothrombin gene mutation G20210A, and homozygous C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene are known to predispose venous thromboembolism (VTE). We present herein a rare case of a young woman heterozygous for these mutations and taking oral contraceptive pills for less than 2 months, diagnosed to have massive deep venous thrombosis and bilateral pulmonary embolism. The patient was managed for 10 days in the hospital and discharged home on oral anticoagulants. This case suggests that screening for these factors in people with family history of thrombosis and in relatives of patients with these mutations is highly recommended to prevent fatal consequences. In addition, a new guideline for treatment and prophylaxis with anticoagulant for these patients and others who are at risk of developing VTE (American College of Chest Physicians [ACCP] guidelines-Chest 2008) has been published recently. Our recommendation is to promote for the internationally published algorithms through their application, where necessary, to prevent any future thrombotic morbidity or mortality incidents.

Tigecycline in vitro activity against commonly encountered multidrug-resistant gram-negative pathogens in a Middle Eastern country.

The lack of data from the Middle East warranted studying tigecycline in vitro activity in Lebanon against consecutive multidrug-resistant (MDR) bacteria, including extended-spectrum beta-lactamases producing clinical isolates of Escherichia coli (n = 150), Klebsiella pneumoniae (n = 100), and Acinetobacter spp. (n = 64) using the standard disk diffusion method. Tigecycline-resistant and intermediate findings were as follows: E. coli, 0% and 0%; K. pneumoniae, 3% and 16%; and Acinetobacter spp., 0% and 2%. These values were substantially lower than those determined for amikacin, gentamicin, tobramycin, ciprofloxacin, piperacillin/tazobactam, amoxicillin/clavulanic acid, and trimethoprim/sulfamethoxazole. This study demonstrates the excellent activity of tigecycline against the increasingly encountered MDR bacteria in Lebanon. The introduction of this effective and viable drug for the initial or recommended treatment of serious infections caused by such highly resistant pathogens is an asset for patients in this country and elsewhere.