Encephalitis due to a free-living amoeba (Balamuthia mandrillaris): case report with literature review.

BACKGROUND: Amebic infections can spread to the central nervous system with a lengthy but usually fatal course. A typical case is presented to raise awareness of this increasingly reported infectious process that may have a more favorable outcome if diagnosed in its early stages. CASE DESCRIPTION: A 38-year-old male presented with an ulcerating 10 x 8 cm mass on his thigh and smaller skin nodules. In less than 6 months seizures developed due to granulomatous lesions of the brain. Biopsies/excisions of the thigh lesion, a subcutaneous nodule, and a brain lesion were performed. He failed to respond to broad spectrum antibiotics and antineoplastic agents, and died within 6 weeks of the initial MRI scan of the brain. Rare amebic trophozoites were appreciated in the biopsy specimens on post-mortem review, and Balamuthia mandrillaris confirmed as the infecting agent on immunofluorescence studies. CONCLUSIONS: Granulomatous amebic encephalitis is a parasitic infection with a lengthy clinical course before rapid deterioration due to extensive brain lesions is noted. Either early treatment with antimicrobials or-in rare cases-excision of the brain lesion(s) may offer the chance of a cure.

Chronic eosinophilic leukemia and hypereosinophilic syndromes. Proposal for classification, literature review, and report of a case with a unique chromosomal abnormality.

The idiopathic hypereosinophilic syndromes (HES) are rare hematologic disorders characterized by persistent eosinophilia with organ involvement that encompass a wide spectrum of clinical and hematological disease states. We propose a classification scheme to further delineate these patients, and present a case of a 45-year-old male with persistent eosinophilia, severe tissue and hematologic involvement, and trisomy 15. Although multiple cytogenetic abnormalities have been associated with hypereosinophilic syndromes, this is the first reported case where trisomy 15 is the sole chromosomal abnormality.

Marginal zone B-cell lymphomas: an appraisal.

Although the Revised European-American Lymphoma Classification does not utilize the term monocytoid B-cell Lymphoma, there are numerous reasons to support its use in classifying lymphomas of so-called marginal zone B-cell type that contain a distinct population of malignant monocytoid B-cells. In addition, there are other B-cell lymphomas which have very distinctive morphological features, because they show multiple and very well demarcated histologies characterized by presence of cells that appear to be (1) malignant monocytoid B-cells and malignant follicular center cells, or (2) malignant monocytoid B-cells, malignant follicular center cells and malignant plasma cells, or (3) malignant monocytoid B-cells and malignant mantle cells. The neoplastic cells in each of the above three examples show identical light chain restriction and thus they are part of the same neoplastic clone. We believe that there are different types of precursor B-cells (memory or otherwise) for the above cells, and an arrest in differentiation of these precursor B-cells may readily explain the presence of these different morphological combinations. Recognition of these morphological types may lead to further awareness of the possibilities of the existence of multiple, linked pathways of differentiation for lymphoid cells including the possibility of different types of precursor B-cells. Furthermore, an understanding of the uniqueness of monocytoid B-cells would allow pathologists to use terminology that is less redundant and more precise.

Ethylenediamine tetraacetic acid-associated leukoagglutination.

Three cases of ethylenediamine tetraacetic acid (EDTA)-induced leukoagglutination noted on peripheral blood films are reported. Two cases of EDTA-induced agglutination of benign lymphocytes, and one case of EDTA-induced mature neutrophil satellitosis about immature neutrophil were observed. EDTA-induced agglutination of malignant lymphoid cells has been reported in blood films from patients with malignant lymphoma and chronic lymphocytic leukemia. Our two cases are the first reported instances of EDTA-induced agglutination of benign lymphocytes. EDTA-induced agglutination of neutrophils is a well recognized, but uncommon event. This case was unusual because mature neutrophils were rosetted about a central immature granulocyte and no agglutination of mature neutrophils was noted.