An Unusual Case of Zero Percent Coagulopathic Factor in a Patient With Polymyalgia Rheumatica.

We present a case of a 74-year-old male with a past medical history of polymyalgia rheumatica that presented as a transfer for evaluation of hematomas of the scrotum, left groin, back, and bilateral thighs. Further questioning revealed hematuria and bleeding gums for the past month. The patient complained of left thigh pain without recent fever, chills, chest pain, or shortness of breath. A physical exam showed hematomas of the left groin, scrotum, bilateral thighs, and back with an ecchymotic appearance.  Initial pertinent laboratory workup showed decreased hemoglobin, leukocytosis, and elevated partial thromboplastin time (PTT). Therefore, a decision was made to obtain a CT angiogram of the abdomen and pelvis, which revealed retroperitoneal hematoma. Further diagnostic workup showed a coagulation factor VIII level of zero percent and mixing studies supporting the presence of an acquired factor VIII inhibitor. Therefore, the patient was treated with rituximab and recombinant factor VIIa, with an improvement of factor VIII levels to normal limits within a week.

Genetic variability of Ganoderma zonatum infecting palms in Florida.

Ganoderma zonatum is a lethal pathogen of palms (Arecaceae) in Florida (USA) because it degrades the wood of the lowest section of the palm trunk. This fungus is widespread throughout Florida, where it has been observed on over 60 species of palms. The authors examined the genetic variability of 25 isolates of G. zonatum obtained in Florida from 12 different palm species and representing 17 unique property locations in eight counties to determine if G. zonatum represents a species complex. The three genomic regions examined were the nuc rDNA ITS1-5.8S-ITS2 region (ITS), the coding region for RNA polymerase II subunit 2 (rpb2) domains 6 and 7, and the partial gene for translation elongation factor 1α (tef1α). The results indicated that variability among these three genomic regions was minimal, and the variability observed was not related to palm host or geographic region within Florida. Thus, in the geographic region surveyed, G. zonatum does not appear to represent a species complex.