Unusual gingival actinomycosis post allogeneic hematopoietic stem-cell transplant: case report.

BACKGROUND: Allogeneic hematopoietic stem cell transplant (allo-HSCT) is used to treat several hematological diseases, but immunosuppression during allo-HSCT facilitates opportunistic microbial growth in tissues, such as actinomycosis. An effective diagnosis of opportunistic diseases is essential for correct management of the disease and preservation of the immunosuppressed patient's life. CASE DESCRIPTION: A 57-year-old female patient was diagnosed with extranodal nasal type NK/T cell lymphoma and underwent curative treatment with allo-HSCT. Twenty-one days after the last clinical follow-up, the patient presented a necrotizing lesion in the papilla region between the first and second molars of the second quadrant. Histopathological analysis showed the presence of a bacterial cluster consistent with Actinomyces infection, and a dense lymphoid infiltrate was also observed. Immunohistochemistry for CD20, CD3, and CD56 was performed to exclude the possibility of the recurrence of extranodal NK/T cell lymphoma. Oral microbiota profiling showed a huge increase in the abundance of Actinomyces bacteria in the subgingival region three weeks prior to appearance of the lesion. CONCLUSIONS: Opportunistic infections with an unusual clinical appearance are confounding factors in therapeutic decision-making. We present for the first time a case of actinomycosis in the gingival papilla region following allo-HSCT. We also highlight how microbiota profiling through next-generation sequencing could be used to anticipate bacterial infection diagnosis.

Primary nodal peripheral T-cell lymphomas: diagnosis and therapeutic considerations

Nodal peripheral T-cell lymphomas are a rare group of neoplasms derived from post-thymic and activated T lymphocytes. A review of scientific articles listed in PubMed, Lilacs, and the Cochrane Library databases was performed using the term "peripheral T-cell lymphomas". According to the World Health Organization classification of hematopoietic tissue tumors, this group of neoplasms consists of peripheral T-cell lymphoma not otherwise specified (PTCL-NOS), angioimmunoblastic T-cell lymphoma (AITL), anaplastic large cell lymphoma-anaplastic lymphoma kinase positive (ALCL-ALK+), and a provisional entity called anaplastic large cell lymphoma-anaplastic lymphoma kinase negative (ALCL-ALK-). Because the treatment and prognoses of these neoplasms involve different principles, it is essential to distinguish each one by its clinical, immunophenotypic, genetic, and molecular features. Except for anaplastic large cell lymphoma-anaplastic lymphoma kinase positive, which has no adverse international prognostic index, the prognosis of nodal peripheral T-cell lymphomas is worse than that of aggressive B-cell lymphomas. Chemotherapy based on anthracyclines provides poor outcomes because these neoplasms frequently have multidrug-resistant phenotypes. Based on this, the current tendency is to use intensified cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP) regimens with the addition of new drugs, and autologous hematopoietic stem cell transplantation. This paper describes the clinical features and diagnostic methods, and proposes a therapeutic algorithm for nodal peripheral T-cell lymphoma patients...

Primary nodal peripheral T-cell lymphomas: diagnosis and therapeutic considerations.

Nodal peripheral T-cell lymphomas are a rare group of neoplasms derived from post-thymic and activated T lymphocytes. A review of scientific articles listed in PubMed, Lilacs, and the Cochrane Library databases was performed using the term "peripheral T-cell lymphomas". According to the World Health Organization classification of hematopoietic tissue tumors, this group of neoplasms consists of peripheral T-cell lymphoma not otherwise specified (PTCL-NOS), angioimmunoblastic T-cell lymphoma (AITL), anaplastic large cell lymphoma-anaplastic lymphoma kinase positive (ALCL-ALK(+)), and a provisional entity called anaplastic large cell lymphoma-anaplastic lymphoma kinase negative (ALCL-ALK(-)). Because the treatment and prognoses of these neoplasms involve different principles, it is essential to distinguish each one by its clinical, immunophenotypic, genetic, and molecular features. Except for anaplastic large cell lymphoma-anaplastic lymphoma kinase positive, which has no adverse international prognostic index, the prognosis of nodal peripheral T-cell lymphomas is worse than that of aggressive B-cell lymphomas. Chemotherapy based on anthracyclines provides poor outcomes because these neoplasms frequently have multidrug-resistant phenotypes. Based on this, the current tendency is to use intensified cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP) regimens with the addition of new drugs, and autologous hematopoietic stem cell transplantation. This paper describes the clinical features and diagnostic methods, and proposes a therapeutic algorithm for nodal peripheral T-cell lymphoma patients.

Dealing with bone marrow biopsies in the staging of classical Hodgkin lymphoma: an old issue revisited in the (18)F-fluorodeoxyglucose-positron emission tomography era.

Bone marrow biopsy is recommended for staging of classical Hodgkin lymphoma. The aim of this study was to compare bone marrow evaluation by histology with that obtained by (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET). One hundred and three cases of Classical Hodgkin Lymphoma were reviewed. All patients were submitted to FDG-PET evaluation. Bone marrow biopsy results were compared with clinical data and FDG-PET results. Ninety-one cases had available bone marrow biopsies. Overall, there were 16 positive and one suspect case. In five cases, the FDG-PET scan was positive and biopsy was negative: 1/5 was found to correspond to a bone fracture, 3/5 showed marked reactive bone marrow changes and in 1/5 no explanation for the discrepancy was found. FDG-PET showed high sensitivity, supporting the idea that when it is negative, biopsy could be avoided. Care should be taken in patients with a positive FDG-PET, where confirmation by bone marrow biopsy should be recommended.

Burkitt lymphoma mimicking acute pancreatitis.

Burkitt lymphoma (BL) is a highly aggressive B cell lymphoma, presenting in extranodal sites or as an acute leukemia. Three clinical variants of BL are recognized: endemic BL, sporadic BL and immunodeficiency associated BL. Sporadic BL is seen worldwide, mainly in children and young adults involving the abdominal organs mostly the ileocaecal area. Pancreatic involvement is rare. The authors report a unique case of abdominal Burkitt lymphoma, initially diagnosed and treated as acute pancreatitis. Clinically, the patient presented severe abdominal pain and vomiting. Imaging findings were suggestive of inflammatory involvement of the pancreas, heading treatment towards this hypothesis. Unfortunately, the patient died during the diagnostic work up, and the autopsy findings demonstrated advanced Burkitt lymphoma with extensive involvement of pancreatic parenchyma and other organs within the abdominal cavity. Once Burkitt lymphoma is a potentially curable disease, early diagnosis is crucial for better outcomes.

Disseminated neuroendocrine neoplasm with undetected primary tumor.

Since the 19th century, neuroendocrine neoplasms (NEN) have been identified. Right up to the present day, the nomenclature is still under debate reflecting the heterogeneity of these tumors. Although some of them are slow growing, some can be fearfully aggressive and may develop in almost any organ of the abdomen, thorax, neck, skin, and gonads. The most commonly observed sites of NEN are the lung and the gastroenteropancreatic system (GEP), where more than 50 entities have been observed. In case of a NEN of unknown primary tumor, the histopathological diagnostic workup includes immunohistochemistry for chromogranin A and synaptophysin, followed by specific tissue markers. Clinical presentation is very diverse, depending on the primary site and functionality of the tumor. In the case of the GEP-NEN, the main symptoms are abdominal pain, diarrhea, weight loss, gastrointestinal bleeding, or bowel obstruction. The presence of neuropsychiatric symptoms is not insignificant in this group of tumors. The authors report a case of a 51-year-old man who sought medical attention because of a three-month history of a consumptive disease. The diagnostic workup disclosed a diffuse nodular infiltration of the lungs, hypokalemia, and hypercalcemia in a cachectic patient. The clinical investigation could not proceed because of an infectious intercurrence, which led to the fatal outcome. Autopsy findings showed a diffuse metastatic NEN. The primary tumoral site could not be demonstrated with the available immunohistochemical panel.

Estudo da transmissão da leishmaniose tegumentar americana no Distrito Federal / Study on the transmission of American cutaneous leishmaniasis in the Federal District

O objetivo do estudo foi caracterizar a leishmaniose tegumentar em pacientes do Distrito Federal, investigar infecção subclínica nos moradores das localidades dos pacientes e identificar as espécies de flebotomíneos e leishmanias. Foram selecionados pacientes atendidos no Hospital Universitário de Brasília de agosto de 2006 a junho de 2007. Parentes e vizinhos dos mesmos foram submetidos à intradermorreação de Montenegro e imunofluorescência indireta. Foram capturados flebotomíneos nas localidades de origem dos pacientes e identificados quanto às espécies, bem como foram identificadas as espécies de leishmanias encontradas nos pacientes. Foram registrados 10 casos autóctones de leishmaniose tegumentar. Em 32 moradores, foi realizada intradermorreação, com positividade de 71,8 por cento. Trinta e sete imunofluorescências realizadas foram negativas. Foram capturadas Lutzomyia whitmani, inclusive no domicílio/peridomicílio e Lutzomyia flaviscutellata. O percentual de positividade das intradermorreações de Montenegro sugere infecção subclínica dos moradores. A captura do vetor Lutzomyia whitmani no peri/intradomicílio sugere transmissão peri/intradomicíliar.

The objectives of this study were to characterize cutaneous leishmaniasis in patients from the Federal District, investigate subclinical infection in people living in the same localities as patients and identify the species of Phlebotomus and Leishmania. Patients attended at the University Hospital of Brasília between August 2006 and June 2007 were selected. Relatives and neighbors of the patients underwent the Montenegro intradermal test and indirect immunofluorescence. Phlebotomines were caught at the localities where the patients came from and their species were identified. The species of Leishmania in the patients were also identified. Ten autochthonous cases of cutaneous leishmaniasis were recorded. The intradermal test was done on 32 local residents and 71.8 percent were positive. Immunofluorescence was performed on 37 individuals and all of them were negative. Lutzomyia whitmani was caught, including in domestic/peridomestic areas, along with Lutzomyia flaviscutellata. The percentage of positive Montenegro intradermal tests suggests that the local residents had subclinical infection. Capture of the vector Lutzomyia whitmani in domestic/peridomestic areas suggests that domestic/peridomestic transmission was occurring.

[Study on the transmission of American cutaneous leishmaniasis in the Federal District]. / Estudo da transmissão da leishmaniose tegumentar americana no Distrito Federal.

The objectives of this study were to characterize cutaneous leishmaniasis in patients from the Federal District, investigate subclinical infection in people living in the same localities as patients and identify the species of Phlebotomus and Leishmania. Patients attended at the University Hospital of Brasília between August 2006 and June 2007 were selected. Relatives and neighbors of the patients underwent the Montenegro intradermal test and indirect immunofluorescence. Phlebotomines were caught at the localities where the patients came from and their species were identified. The species of Leishmania in the patients were also identified. Ten autochthonous cases of cutaneous leishmaniasis were recorded. The intradermal test was done on 32 local residents and 71.8% were positive. Immunofluorescence was performed on 37 individuals and all of them were negative. Lutzomyia whitmani was caught, including in domestic/peridomestic areas, along with Lutzomyia flaviscutellata. The percentage of positive Montenegro intradermal tests suggests that the local residents had subclinical infection. Capture of the vector Lutzomyia whitmani in domestic/peridomestic areas suggests that domestic/peridomestic transmission was occurring.