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Cureus May 2023()and coronavirus disease 2019 (COVID-19) infections can have overlapping symptoms. Recently, the association and outcomes of coinfection have been studied. We present...
()and coronavirus disease 2019 (COVID-19) infections can have overlapping symptoms. Recently, the association and outcomes of coinfection have been studied. We present the case of an 83-year-old lady with Parkinson's disease (PD) who was admitted with pneumonia secondary to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. She was treated with empiric antibiotics ampicillin-sulbactam and azithromycin, along with antiviral therapy remdesivir and baricitinib, and dexamethasone. The patient developed severe infection with a leukemoid reaction. She was treated with intravenous metronidazole and oral vancomycin without any improvement. Before she could receive a fecal microbiota transplant, her infection progressed to fulminant colitis, and she required emergent surgery. The patient developed several complications post-surgery and succumbed to the severe illness. Our patient's multiple comorbidities and an underlying COVID-19 infection predisposed her to severe illness. This case emphasizes the long-standing discussion on antibiotic stewardship and encourages a debate on the role of immunosuppressant antiviral medications and underlying PD in predisposing patients to a severe infection.
PubMed: 37265903
DOI: 10.7759/cureus.38401 -
Cureus Apr 2023Acute myeloid leukemia (AML) is a complex and aggressive malignancy that occurs due to genetic mutations and subsequent stem cell overproduction. We report a case of a...
Acute myeloid leukemia (AML) is a complex and aggressive malignancy that occurs due to genetic mutations and subsequent stem cell overproduction. We report a case of a patient with AML and a highly fatal, uncommon TP53 mutation who developed dermatologic manifestations. This report serves to highlight the importance of dermatologic findings in underlying leukemia and educate healthcare providers on the diagnosis and treatment of a rare TP53 mutation in AML.
PubMed: 37139024
DOI: 10.7759/cureus.37012 -
Annals of Medicine and Surgery (2012) Apr 2023Leukemoid reaction (increase in leucocyte count >50 ×10 cell/l) occurs due to reactive causes of bone marrow and is diagnosed after excluding the malignant...
UNLABELLED
Leukemoid reaction (increase in leucocyte count >50 ×10 cell/l) occurs due to reactive causes of bone marrow and is diagnosed after excluding the malignant haematological disorder. Leukemoid reaction is a rare clinical presentation in metastatic renal cell carcinoma and is said to have a rare prognosis. This case has had been reported in the line of SCARE criteria.
CASE PRESENTATION
A case of a 35-year-old female with no known previous co-morbidities presented with a history of abdominal pain in the right flank region for 2 months, fever and cough for 2 months. Physical examination showed palpable mass and tenderness in the right flank and investigations showed leukemoid reaction in peripheral blood smear. The patient was initially treated with strong intravenous antibiotics with suspicion of pyelonephritis in another centre, despite which the patient still had elevated leucocyte count and referred to our centre, where the patient was evaluated for elevated leucocyte count and with further investigations, ruled out any malignant haematological disorder. Final diagnosis of renal cell carcinoma was made by renal mass biopsy. The patient underwent targeted therapy with sunitinib. The patient expired and further investigation and follow-up were not possible.
CONCLUSION
The lack of data and evidence of extensive diagnostic tests is the reason we are unable to assume leukemoid reaction as a poor prognostic factor in case of metastatic renal cell carcinoma. The presence of other paraneoplastic syndromes with renal cell carcinoma might have resulted in the poor prognosis that cannot be excluded.
PubMed: 37113841
DOI: 10.1097/MS9.0000000000000513 -
Pathobiology : Journal of... 2024The incidence of myelodysplastic syndrome and acute myeloid leukemia is significantly increased in children with Down syndrome (DS). Within the revised 2016 WHO edition,...
INTRODUCTION
The incidence of myelodysplastic syndrome and acute myeloid leukemia is significantly increased in children with Down syndrome (DS). Within the revised 2016 WHO edition, these entities are jointly classified as myeloid leukemia associated with DS (ML-DS). Additionally, infants with DS may develop transient abnormal myelopoiesis (TAM) which is histomorphologically similar to ML-DS. While TAM is self-limiting, it is associated with an increased risk of subsequently developing ML-DS. Differentiating TAM and ML-DS is challenging but clinically critical.
METHODS
We performed a retrospective review of ML-DS and TAM cases collected from five large academic institutions in the USA. We assessed clinical, pathological, immunophenotypical, and molecular features to identify differentiating criteria.
RESULTS
Forty cases were identified: 28 ML-DS and 12 TAM. Several features were diagnostically distinct, including younger age in TAM (p < 0.05), as well as presentation with clinically significant anemia and thrombocytopenia in ML-DS (p < 0.001). Dyserythropoiesis was unique to ML-DS, as well as structural cytogenetic abnormalities aside from the constitutional trisomy 21. Immunophenotypic characteristics of TAM and ML-DS were indistinguishable, including the aberrant expression of CD7 and CD56 by the myeloid blasts.
DISCUSSION
The findings of the study confirm marked biological similarities between TAM and ML-DS. At the same time, several significant clinical, morphological, and genetic differences were observed between TAM and ML-DS. The clinical approach and the differential diagnosis between these entities are discussed in detail.
Topics: Infant; Child; Humans; Down Syndrome; Mutation; Leukemoid Reaction; Leukemia, Myeloid, Acute
PubMed: 36996802
DOI: 10.1159/000530431 -
IDCases 2023is a common cause of community acquired pneumonia and although most cases are mild, complications sometimes occur. Cold agglutinin hemolysis is a known complication of...
is a common cause of community acquired pneumonia and although most cases are mild, complications sometimes occur. Cold agglutinin hemolysis is a known complication of infection, and usually presents as a mild and transient hemolysis. Here we present a case of infection with in a 64-year-old male that caused life threatening hemolysis that required multiple blood transfusions. The patient also presented with acute kidney failure and a marked leukemoid reaction and thrombocytosis. This is a very rare combination of symptoms that could have led the clinicians to suspect a more virulent etiology than , thereby delaying adequate antibiotic treatment.
PubMed: 36687368
DOI: 10.1016/j.idcr.2023.e01689 -
Translational Pediatrics Dec 2022Neonatal leukemoid reaction (NLR) is often accompanied by infectious or non-infectious diseases, a low birth weight, sepsis, prematurity, ventricular hemorrhage, and...
BACKGROUND
Neonatal leukemoid reaction (NLR) is often accompanied by infectious or non-infectious diseases, a low birth weight, sepsis, prematurity, ventricular hemorrhage, and bronchial dysplasia. It has an incidence rate of 1.3-15% and a mortality rate of about 41.4%. Previous studies on NLR have largely focused on its pathogenesis and clinical cases, but little is known about its prognostic laboratory indicators. We found that some of the NLR exhibited obviously elevation in liver function tests like aspartate transaminase (AST) and lactate dehydrogenase (LDH) which were not took by all the LR infants. The necessity for liver function tests for the prognosis of NLR was still unclear.
METHODS
A total of 39 premature infants with NLR at the First Hospital of Jilin University between March 2016 and March 2017 were included in this retrospective cohort study. The infants were divided into death and cured group based on the clinical outcomes. Premature infants with LR and death were defined as the case group (n=14), while infants without death were defined as the control group (n=25). Confounding factors such as age and gender between the two groups were controlled. Blood routine tests, including the white blood cell (WBC) count and subtypes, and liver function, and clinical features were recorded and analyzed. T tests were used to examine the differences in the laboratory indicators between the NLR and control groups. Receiver operating characteristic curves (ROCs) and areas under the curve (AUCs) were used to examine laboratory indicators for prognosis.
RESULTS
For predicting clinical outcomes, the ROC curves showed that the cut-off values for AST and LDH were 279 and 1,412 U/L, respectively. The sensitivity and specificity for AST were 92% and 71.43%, respectively, with an AUC of 0.894, while the sensitivity and specificity for LDH were 88% and 78.57%, respectively, with an AUC of 0.911.
CONCLUSIONS
This innovative study investigated the NLR prognosis depending on laboratory tests. We found that serum AST and LDH levels had reliable predictive value in determining adverse outcomes of NLR.
PubMed: 36643666
DOI: 10.21037/tp-22-543 -
The Malaysian Journal of Pathology Dec 2022Anaplastic large cell lymphoma, ALK-positive is a mature T-cell neoplasm that accounts for 10- 20% of paediatric non-Hodgkin lymphoma. Its frequency in infants and very... (Review)
Review
Anaplastic large cell lymphoma, ALK-positive is a mature T-cell neoplasm that accounts for 10- 20% of paediatric non-Hodgkin lymphoma. Its frequency in infants and very young children is exceedingly rare and was rarely documented in the literature. The disease prognosis in this agegroup is unknown. We report two male patients who were diagnosed with ALCL-ALK(+) at the ages of 12 and 14 months, both presented with fever and leukemoid reaction, one was in stage I and the other in stage IV diseases. They were treated with APO-based chemotherapy and remained in complete remission for more than 7 years. To our knowledge, this is the first report that describes the long-term survival of ALCL-ALK(+) at very young age.
Topics: Infant; Humans; Male; Child; Child, Preschool; Anaplastic Lymphoma Kinase; Receptor Protein-Tyrosine Kinases; Lymphoma, Large-Cell, Anaplastic; Follow-Up Studies; Prognosis
PubMed: 36591719
DOI: No ID Found -
Hematology. American Society of... Dec 2022Children with Down syndrome (DS) have a greater than 100-fold increased risk of developing acute myeloid leukemia (ML) and an approximately 30-fold increased risk of...
Children with Down syndrome (DS) have a greater than 100-fold increased risk of developing acute myeloid leukemia (ML) and an approximately 30-fold increased risk of acute lymphoblastic leukemia (ALL) before their fifth birthday. ML-DS originates in utero and typically presents with a self-limiting, neonatal leukemic syndrome known as transient abnormal myelopoiesis (TAM) that is caused by cooperation between trisomy 21-associated abnormalities of fetal hematopoiesis and somatic N-terminal mutations in the transcription factor GATA1. Around 10% of neonates with DS have clinical signs of TAM, although the frequency of hematologically silent GATA1 mutations in DS neonates is much higher (~25%). While most cases of TAM/silent TAM resolve without treatment within 3 to 4 months, in 10% to 20% of cases transformation to full-blown leukemia occurs within the first 4 years of life when cells harboring GATA1 mutations persist and acquire secondary mutations, most often in cohesin genes. By contrast, DS-ALL, which is almost always B-lineage, presents after the first few months of life and is characterized by a high frequency of rearrangement of the CRLF2 gene (60%), often co-occurring with activating mutations in JAK2 or RAS genes. While treatment of ML-DS achieves long-term survival in approximately 90% of children, the outcome of DS-ALL is inferior to ALL in children without DS. Ongoing studies in primary cells and model systems indicate that the role of trisomy 21 in DS leukemogenesis is complex and cell context dependent but show promise in improving management and the treatment of relapse, in which the outcome of both ML-DS and DS-ALL remains poor.
Topics: Infant; Infant, Newborn; Child; Humans; Child, Preschool; Down Syndrome; Leukemoid Reaction; GATA1 Transcription Factor; Leukemia, Myeloid, Acute; Mutation
PubMed: 36485097
DOI: 10.1182/hematology.2022000395 -
Cureus Oct 2022The neonatal leukemoid reaction is an acute response of the body to stress. Any inflammatory processes in the newborn period may lead to an increase in the white blood...
The neonatal leukemoid reaction is an acute response of the body to stress. Any inflammatory processes in the newborn period may lead to an increase in the white blood cell (WBC) count. Hyperleukocytosis refers to an extremely elevated leukocyte count beyond 100,000/cubic millimeter (cumm). Here, we report a case of a leukemoid reaction in a newborn who presented with fever, swelling over the neck, and failure to thrive. Peripheral smear showed the presence of all precursors of white blood cells, but no blast cells were seen. Fine needle aspiration cytology (FNAC) did not show any abnormal cells or any evidence of leukemia. Hence, the diagnosis of a leukemoid reaction was made. Hyperleukocytosis presenting as palpable lymphadenopathy in a neonate is a rare finding that was seen in this case secondary to septicemia.
PubMed: 36415433
DOI: 10.7759/cureus.30454 -
Cureus Sep 2022Leukocytosis is defined by an increased WBC count in the peripheral blood. This can be caused by many pathologies from benign conditions such as stress, infection, and...
Leukocytosis is defined by an increased WBC count in the peripheral blood. This can be caused by many pathologies from benign conditions such as stress, infection, and inflammation or malignant origins such as leukemia. Although leukocytosis is regularly encountered clinically and has many etiologies making a definitive diagnosis, at times, may be difficult. A case of severe leukocytosis requires careful consideration of symptoms and confirmation with serial complete blood count (CBC) testing before pursuing further invasive testing such as bone marrow biopsy. Here, we report the case of a 78-year-old male patient who, after a cardiac arrest, presented with reactive hyperleukocytosis mimicking acute monocytic leukemia.
PubMed: 36299948
DOI: 10.7759/cureus.29508