Differentiating Leukostasis From COVID-19 Pneumonia: Clinical and Radiological Perspectives for the Right Decision-Making.

Leukostasis is a non-infectious complication of acute leukemia. Pathophysiologically, it is characterized by an accumulation of blasts in the pulmonary capillaries. Clinically, this syndrome of hyperleukocytosis or leucocytosis leads to pulmonary and/or neurological lesions. This is why it must be treated urgently to prevent it from progressing to acute respiratory distress. In 2020, the World Health Organization (WHO) declared a pandemic caused by a novel coronavirus called SARS-CoV-2, which may cause respiratory distress or other clinical, biological, and radiological signs that some may confuse with those of leukostasis. In this context, we present a compelling case study of a 64-year-old patient with no notable pathological antecedents and not vaccinated against COVID-19, who presented with acute respiratory distress. The purpose of our article is to succeed in differentiating between the two pneumopathies, thus making it possible to orient the doctor toward the right decision-making. As known, early recognition enables timely interventions, reducing disease progression and associated complications while also preventing unnecessary treatments, optimizing healthcare resources, and advancing medical knowledge for improved patient care in both acute leukemia and COVID-19 management.

Ocular Manifestations in Hematological Disorders.

Background Ophthalmic manifestations are a common feature in hematological malignancies and may be divided into two groups: those attributable to the disease's infiltration of the eye, and the ocular consequences due to blood abnormalities. This study aims to determine the prevalence of ocular manifestations and their association with the different hematological disease subgroups. Materials and methods We conducted a retrospective and observational study enrolling 137 consecutive patients on active treatment or follow-up for hematological malignancies from January 2016 to January 2020 at the Cheikh Khalifa International University Hospital. All patients underwent a standardized and comprehensive ophthalmic evaluation. Results Ocular involvement was primarily disclosed in acute myeloid leukemia (AML), non-Hodgkin's lymphoma (NHL), and multiple myeloma (MM). We herein report the different ocular changes divided into anterior segment manifestations, posterior segment manifestations, dry eye disease, and ocular adnexa findings. Patients with leukemia had a significantly higher rate of lesions in the ocular posterior segment (p < 0.001). Despite the high prevalence of anterior segment and ocular adnexa findings in lymphoma patients, no significant association emerged between these lesions and the aforementioned condition. In addition, dry eye disease was found in all instances without any association with the disease itself. Conclusions Awareness of ocular pathology in hematological malignancies is important as it may precede systemic diagnosis or be a sign of recurrence. We should also be concerned about the side effects of treatments, predominantly, dry eye disease. Therefore, periodic ophthalmic assessment throughout the disease's course, as well as interdisciplinary coordination of care, is crucial to promote early diagnosis and treatment, hence improving long-term outcomes.

Neutropenic Enterocolitis as a Complication of Autologous Stem Cell Transplant in Patients With Multiple Myeloma: A Case Series.

Neutropenic enterocolitis (NE) is a rare but severe complication occurring in neutropenic patients undergoing intensive chemotherapy. Mortality is high, so early diagnosis is required to start urgent medical or surgical treatment. Data analysis of the development of NE after hematopoietic stem cell transplantation remains scarce. The aim of this case series is to discuss five out of 100 patients receiving autologous stem cell transplants (ASCTs) for multiple myeloma complicated with NE between 2016 and 2020 in the hematology department of the Cheikh Khalifa International University Hospital, Casablanca, Morocco. The patients were diagnosed with IgA and IgG multiple myeloma and aged between 58 to 64 years. They received induction therapy with four cycles of a triplet regimen including a proteasome inhibitor, an immunomodulatory drug, and corticosteroids, allowing a complete remission. Intensification was based on ASCT with melphalan at 200 mg/m2. The period of aplasia was marked by the sudden appearance of NE, diagnosed based on clinical, biological, and imaging criteria. Treatment included antibiotherapy and supportive care. We report no complications in our cases, nor the need for surgical care. Therefore, we consider that early diagnosis and treatment allowed a good evolution in our case series. The management of NE must be multidisciplinary associating hematologists, gastroenterologists, radiologists, and biologists. More studies and trials are needed to establish specific diagnostic criteria and better treatment options.

Eosinophilic Fasciitis and Smoldering Multiple Myeloma: An Exceptional Association in Young Adults.

Eosinophilic fasciitis (EF) or Shulman's fasciitis is a rare condition characterized by subcutaneous edematous induration sparing the face and distal extremities and progressing to skin sclerosis. Its association with other pathologies, notably hemopathies, is described in the literature, but its association with smoldering multiple myeloma remains very rare, especially in a younger subject.

Kikuchi-Fujimoto's Disease or Histiocytic Necrotizing Lymphadenitis Following mRNA COVID-19 Vaccination: A Rare Case.

Kikuchi-Fujimoto disease (KFD), also known as necrotizing histiocytic lymphadenopathy, is a rare and benign lymph node disorder that mainly occurs in young women. It is clinically characterized by fever with tender and painful cervical lymphadenopathy mostly; however, all areas of lymph nodes can be involved. This disorder is often mistaken for malignant lymphoma or infection. The precise pathophysiology of KFD remains unknown, but it is theorized that it may be post-viral or associated with an autoimmune disease. The diagnosis is based on the histological analysis of the excised involved lymph node. The treatment is mainly supportive with favorable outcomes within a few weeks or months. In this case, we present a 24-year-old woman without a past medical history, who consulted for painful bilateral cervical lymphadenopathy associated with fever that has been evolving for one month following the coronavirus disease 2019 (COVID-19) vaccination. The initial diagnostic workup was performed and the diagnosis of KFD was confirmed based on the histopathological findings of the excised lymphadenopathy. Therapeutic management was based on oral corticosteroid treatment with clinical and radiological improvement after a few days without recurrence during follow-up. This article aims to report a rare case of KFD in a patient after receiving the messenger ribonucleic acid (mRNA)-based COVID-19 vaccine. Therefore, this case highlights the possible association between COVID-19 vaccination and KFD and this should be considered in the differential diagnosis.

Acute Myeloid Leukemia Revealed by a Palatal Necrosis: A Rare Case Report.

Acute myeloid leukemia (AML) is an aggressive hematological malignancy due to genetic alterations characterized by an overproduction of neoplastic clonal myeloid stem cells in both the bone marrow and peripheral blood. We report a case of a 43-year-old man referred to the department of hematology with a three-week history of palatal pain and weakness. The physical examination revealed an ecchymosis on the left hard palatal mucosa and necrosis. The maxillofacial computerized tomography (CT) scan revealed large osteolysis of the left maxillary bone and a fistulated soft palate. The lesion's biopsy showed an acute polymorphic inflammation with no sign of malignancy. Laboratory findings revealed anemia, thrombocytopenia, elevated lactic dehydrogenase, and elevated serum ferritin. The diagnosis was subsequently confirmed by a peripheral-blood smear revealing 60% of circulating blasts and bone marrow aspiration with 80% of blast infiltration. The latter was further classified through cytogenetic studies as an AML with deletion of chromosome 7q. This case report aims to highlight the need for clinicians to be aware of palatal necrosis as an initial manifestation of the disease and to emphasize the role of multidisciplinary collaboration between dental surgeons, oral and maxillofacial surgeons, and hematologists for early detection and treatment.

Hemophagocytic lymphohistiocytosis associated with HBV-HCV coinfection in adult: Case report.

The case reported is the first case in Morocco to our knowledge. The reason for sharing this case is to facilitate knowledge transfer between physicians, caring for adult patients with HLH, with the aim to improve the outcome of these patients.

Hodgkin's lymphoma presenting with an unusual horizontal Nystagmus and vertigo.

Neurological presentation of paraneoplastic syndromes is rare. They are often difficult to diagnose, especially when they precede the diagnosis of cancer. Hodgkin's lymphoma is associated with several paraneoplastic neurological syndromes such as cerebellar degeneration and dermato/polymyositis. Peripheral vestibular syndrome is uncommon presentation of these paraneoplastic syndromes. We report the case of a 52-year-old man with no prior medical history who presented to the otolaryngology clinic with vertigo precipitated by nystagmus, nausea and weight loss. Diagnostic workup revealed a nodular sclerosing variant of Hodgkin's lymphoma without paraneoplastic antibodies. The patient's symptoms resolved after institution of chemotherapy, radiotherapy and vestibular rehabilitation. Hodgkin's lymphoma has been reported to be associated with many paraneoplastic syndromes with neurological presentation in which peripheral vestibular syndrome is an uncommon one. Sometimes it can be the only presenting symptom of an unknown Hodgkin's lymphoma. This create a real diagnostic challenge for clinicians specially when paraneoplastic antibodies are negative. Chemotherapy and radiotherapy as treatment of the underlying disease is of a big benefit if started as early as possible.

[Diffuse interstitial lung disease revealing adult T-Cell leukemia/lymphoma (HTLV-1)]. / Pneumopathie interstitielle diffuse révélant la leucémie-lymphome à cellules T de l'adulte HTLV1.

Adult T-Cell Leukemia/Lymphoma is a tumoral proliferation of activated mature T lymphoid cells whose causative agent is a retrovirus known as Human T-cell leukemia virus type 1. This virus rarely causes inflammatory bronchioloalveolar disorders. We report the case of a patient hospitalized with diffuse interstitial lung disease and whose etiological assessment revealed adult T-Cell Leukemia/Lymphoma (HTLV-1).