A Case of Rare Subtype of Multiple Myeloma: Secondary Plasma Cell Leukemia.

Description Plasma cell leukemia is a rare, aggressive form of multiple myeloma with the presence of circulating plasma cells in the peripheral blood. There are two types of plasma cell leukemia, primary and secondary, depending on if there was previous evidence of multiple myeloma. The diagnostic criterion of plasma cell leukemia is based on a percentage (>20%) or an absolute number of (≥2 × 109/L) plasma cells in the peripheral circulation. We present the clinical course of a rare case of secondary plasma cell leukemia in a patient from the time of initial diagnosis of multiple myeloma, its remission period of about 5 years, and its final progression into refractory secondary plasma cell leukemia. This case report details the patient's presenting symptoms, pertinent laboratory and diagnostic imaging findings, and histopathology of peripheral blood and bone marrow. This case report presents a chronological comparison of key laboratory findings that manifest the progression of multiple myeloma into secondary plasma cell leukemia. It also offers a brief review of the literature for the diagnosis and treatment of plasma cell leukemia.

Rifampin-Induced Acute Intravascular Hemolysis Leading to Heme Pigment-Related Kidney Injury.

Rifampin-induced acute kidney injury is very rare. Most cases of acute renal injury from rifampin use are related to acute tubular necrosis and acute interstitial nephritis. In this case report, we detail a unique presentation of rifampin-associated acute intravascular hemolysis and subsequent tubular injury in a tuberculosis patient. The patient had presented to the hospital with acute kidney injury and oliguria from intravascular volume depletion secondary to intractable vomiting. The patient had stopped taking his antituberculosis medications two weeks before hospitalization. At the time of hospital admission, his antituberculosis regimen of rifampin and isoniazid was reinstituted. Within four days of initiation of rifampin, he developed acute hemolytic anemia. His kidney biopsy revealed hemoglobin pigment deposition in the kidney tubules. Rifampin was discontinued, and he received a total of eight hemodialysis treatments spanning over 17 days. Subsequently, after discontinuing rifampin, his anemia and oliguria resolved with renal function markedly improved to near normal baseline levels. This case report also offers a review of known mechanisms of rifampin-induced acute hemolysis and acute renal failure, along with a discussion of contemporary literature.

A Rare Case of Human Papillomavirus-associated High-grade Neuroendocrine Carcinoma of the Hypopharynx.

We present a case of primary small cell carcinoma of the hypopharynx (SCCH), with a rare association with human papillomavirus (HPV). A comparison is made to 11 previously known, well-documented cases of SCCH with a review of the literature concerning SCCH. Our patient's age of 23 years is the lowest among all previously reported cases, with an age range of 35-75. HPV association with SCCH is a rare new entity and eight HPV subtypes were identified in our case by ribonucleic acid (RNA) in-situ hybridization. The important common features among the previously reported 11 cases and our case include: (a) piriform sinus of the hypopharynx as the primary site in all cases, (b) a majority of patients presented with dysphagia and a neck mass, and (c) most patients had locoregional involvement at the time of presentation as opposed to distant metastasis. HPV-associated SCCH is extremely rare, with potentially aggressive clinical behavior, and needs much more research to further elucidate both the diagnostic and therapeutic approaches.

Integration of Andrographis paniculata as Potential Medicinal Plant in Chir Pine (Pinus roxburghii Sarg.) Plantation of North-Western Himalaya.

The integration of Andrographis paniculata under Pinus roxburghii (Chir pine) plantation has been studied to evaluate the growth and yield for its economic viability and conservation. It was grown on three topographical aspects, namely, northern, north-western, and western, at a spacing of 30 cm × 30 cm, followed by three tillage depths, namely, minimum (0 cm), medium (up to 10 cm), and deep (up to 15 cm) tillage. The growth parameters, namely, plant height and number of branches per plant, were recorded as significantly higher on western aspect and lowest on northern aspect except for leaf area index which was found nonsignificant. However under all tillage practices all the growth parameters in both understorey and open conditions were found to be nonsignificant except for plant height which was found to be significantly highest under deep tillage and lowest under minimum tillage. The study of net returns for Andrographis paniculata revealed that it had positive average annual returns even in understorey conditions which indicate its possible economic viability under integration of Chir pine plantations. Hence net returns can be enhanced by integrating Andrographis paniculata and this silvimedicinal system can be suggested which will help utilizing an unutilized part of land and increase total productivity from such lands besides conservation of the A. paniculata in situ.