Erdheim-Chester disease: a rare histiocytosis (case report and review of the literature)

We report a case of Erdheim-chester disease, a rare non-langerhans histiocytosis revealed by polydipsia-polyuria syndrome in a 26 years old woman, trated by interferon with a good response.

Glomérulonéphrite extra-membraneuse et syndrome myélodysplasique: une association rare

Les syndromes myélodysplasiques peuvent s’accompagner de maladies auto-immunes. L’atteinte rénale au cours de ces syndromes est rare. Dans ce cas, les glomérulopathies prédominent cette atteinte. La glomérulonéphrite extra-membraneuse est exceptionnellement reportée en association avec un syndrome myélodysplasique. Nous rapportons dans ce papier le cas d’une patiente présentant une glomérulonéphrite associée à une anémie révélant un syndrome myélodysplasique de faible risque. Dans la lumière de ce cas, nous faisons une courte revue de la littérature des cas précédemment publiés et nous discutons le lien pathogénique entre ces deux entités.

Hemoglobinosis C in Morocco : A report of 111 cas

BACKGROUND

- Hemoglobin C is a hemoglobin variant encountered worldwide. The regionswith high prevalence are West Africa and South-East Asia.The objective of this study is to report cases of hemoglobin C disease brought together during these last twelve years in the Laboratory of Biochemistry and Toxicology of RabatMilitary Hospital Mohammed V (MHIMV).

METHODS

- This was a retrospective study including111 cases of hemoglobin C disease collected in the Laboratory of Biochemistry of the MHIMVover the past 12 years. A questionnairewasfulfilledwith the epidemiological data,clinical data and the results of the biological explorations. The screening of the hemoglobin variant in this study included several biochemical (hemoglobin electrophoresis at acid and alkalinepH) and hematological tests.

RESULTS

- Sex-ratio was equal to 1,22. The age at the time of diagnosis ranges between 4 and 80years old, with the mean of 38. North-West regions of Morocco seem most affected. The most frequent reasons for prescription of the hemoglobin's studywere: biological abnormalities, splenomegaly and anemic syndrome. Blood smear reveals frequently anisopoikilocytosis and red blood target. The biochemical tests contribute to the diagnosis and reveal various and varied etiological groups: heterozygous A/C (75%),homozygous C/C (8%), double heterozygous S/C (9%),C/β+-thal (6%) andC/O-Arab (2%). Conclusion - The results of the present descriptive study are in line with the literature data. The importance of genetic counseling and the installation of a national card of systematic neonatal tracking seemto be unavoidable.

[Acquired amegacaryocytic thrombocytopenic purpura hiding acute myeloid leukemia]

Le purpura thrombopénique amégacaryocytaire acquis est une pathologie très rare caractérisé par une thrombopénie sévère liée une réduction ou une disparition des mégacaryocytes au niveau de la moelle osseuse. Il peut être primaire idiopathique ou secondaire à de nombreux états pathologique dont des hémopathies. Nous rapportons le cas d'un patient de 24 ans admis pour prise en charge d'un syndrome hémorragique mis sur le compte d'un purpura thrombopénique immunologique. Le diagnostic a été redressé en une amégacaryocytose aquise après un échec de la corticothérapie et la réalisation d'un myélogramme. Le patient a été mis sous traitement par ciclosporine avec une évolution rapide vers une leucémie aigue myéloblastique. La progression d'une amégacaryocytose acquise vers une leucémie aigue est rapporté mais généralement pas aussi rapidement et surtout précéder par un syndrome myélodysplasique ou une aplasie médullaire. Cette observation impose un suivi strict et rapproché de ces pathologies d'apparence bénigne.

Traitement des amyloses AL systémiques: à propos de 25 cas

L'amylose AL systémique primitive est un désordre hématologique rare. La plupart des recommandations thérapeutiques sont basées sur des études de phase II ou des comparaisons rétrospectives et des séries de cas. Le but de cette étude était de décrire les cas d'amylose primitive AL et de faire une comparaison entre le protocole standard Melphlan-Dexamethasone et les nouveaux agents dans le traitement de première ligne de ces patients. Il s'agissait d'une étude rétrospective, descriptive et multicentrique, portant sur l'ensemble des cas d'amyloses AL colligées durant une période s'étalant de juillet 2009 à juin 2016 au sein de 2 centres hospitaliers militaires. Vingt cinq patients ont été colligés dans notre série (12 traités par le Melphalan-Dexamethasone et 13 par des protocoles contenant au moins du Bortézomib ou du Lénalidomide). Il n'y avait pas de différence significative entre les 2 groupes en termes de caractéristiques épidémiologiques, cliniques ou pronostiques. Après un suivi médian de 40 mois, la survie globale médiane était de 54 mois dans le groupe melphalan-Dexamethasone et de 60 mois dans le groupe nouvelles thérapeutiques (P = 0,98). Concernant la survie sans progression, elle était de 18 mois pour le groupe traitement standard contre 11 mois pour le 2^ème groupe (P = 0,08). Dans notre petite série nous n'avons pas trouvé une supériorité des nouvelles thérapeutiques par rapport au protocole classique. Ce résultat doit être confirmé par la réalisation d'une vraie étude prospective surtout en raison du coûtde ces nouvelles molécules qui ne sont pas toujours accessibles surtout dans les pays en voie de développement.

Hemophagocytic lymphohistiocytosis complicating a T-cell rich B-cell lymphoma

Background

Hemophagocytic lymphohistiocytosis in adults is often secundary to an infection or a neoplasm. In this last case, T cell lymphomas are the most frequent causes. Hemophagocytic lymphohistiocytosis secundary to a B cell lymphoma has been rarely reported.

Case presentation

We describe a case of a hemophagocytic lymphohistiocytosis complicating a T-cell rich B-cell lymphoma treated with conventionnal chemotherapy leading to a complete remission.

Conclusion

Prompt etiologic diagnosis and treatment of hemophagocytic lymphohistiocytosis leads to satisfactory outcome.

Prognostic factors predicting overall survival in Moroccan patients with myelodysplastic syndrome

BACKGROUND

Prognostic scores are an indispensable tool in the management of myelodysplastic syndromes.

AIM

Identify prognostic factors influencing overall survival of patients with myelodysplastic syndromes.

METHODS

We included all patients with myelodysplastic syndromes treated in the clinical hematology department of the military hospital of Rabat (Morocco).

RESULTS

Seventy-four patients were included. The sex ratio [M / F] was 1.8. The median age was 65.5 years. The median follow-up was 45 months. The karyotype prognostic was good in 74%. In univariate analysis, prognostic factors influencing overall survival are: Age (p = 0.024), karyotype (p = 0.033), rate of bone marrow blasts (p = 0.002), transfusion dependence (p = 0.002), number of cytopenias (p = 0.001), hemoglobin (p = 0.009) and neutrophil count (p = 0.003). In multivariate analysis the only prognostic factor that influenced overall survival was the karyotype (p = 0.036). Transfusion dependence (p = 0.072) and the rate of marrow blasts (p = 0.107) was close to significance. The WHO Prognostic Scoring System (WPSS), the International Prognostic Scoring System (IPSS) and the Revised International Prognostic Scoring System (RIPSS) influence overall survival with a statistical significance (p <0.001).

CONCLUSION

Our study confirms the prognostic value of the karyotype and validated the WPSS, the IPSS and the RIPSS scores as significant predictors of overall survival in Moroccan patients with myelodysplastic syndromes.

Risk factors and scoring system for predicting bacterial resistance to cefepime as used empirically in haematology wards

OBJECTIVES

Bacterial resistance is of growing concern in haematology wards. As the inappropriate administration of empirical antibacterial may alter survival, we studied risk factors for resistance to our usual empirical first-line antibacterial therapy, cefepime.

METHODS

We retrospectively studied 103 first episodes of bacteraemia recorded in our haematology department over 2.5 years. Risk factors for cefepime-resistance were identified by multivariate logistic regression with backward selection (P < 0.05). A scoring system for predicting cefepime-resistance was built on independent factor, with an internal validation by the bootstrap resampling technique.

RESULTS

38 (37%) episodes were due to Gram-negative bacteria. Fifty (49%) were due to bacteria resistant to cefepime. Cefepime resistance was significantly associated with a decreased survival at day 30 (P < 0.05). Three risk factors were independently associated with cefepime-resistance: acute lymphoblastic leukaemia; ≥18 days since hospital admission; and receipt of any β-lactam in the last month. Patients with ≥2 of these risk factors had a probability of 86% (CI 95%, 25 to 100%) to carry a cefepime-resistant strain.

CONCLUSION

Using our scoring system should reduce the indication of very broad antibacterial regimens in the empirical, first-line treatment of febrile hematology patients in more than 80% of the cases.

[Orbital mantle cell lymphoma]

Ophthalmological involvement in mantle cell lymphoma is rare. An 84-year-old man presented with bilateral proptosis. Orbital biopsy established the diagnosis of mantle cell lymphoma. The diagnosis of mantle cell lymphoma is anatomopathological and immuno-histochemical. Orbital involvement is found most often in advanced stages of the disease, but may be the presenting sign as in the case of our patient. Treatment has improved with the use of rituximab, especially in elderly patients not eligible for autologous hematopoietic stem cell transplant.

Monoclonal gammopathies in a Moroccan military hospital

The aim of this study was to describe biological features and aetiology of monoclonal gammopathy diagnosed during a 10-year period in the biochemistry department of the Moroccan Military Hospital Mohamed V in Rabat. The study was performed from 1 January 2000 to 31 December 2009. The records of 261 patients living in the Rabat area in which either serum protein electrophoresis and serum and/or urine immunofixation were performed at the biochemistry department of Military Instruction Hospital in Rabat were analysed. A cohort of 182 (70%) men and 79 (30%) women, the mean ± SD (range) ages were 60.21 ± 12.56 years. All patients were Caucasian. Electrophoresis found that 211 (80.84%) of the patients had a monoclonal gammopathy. Immunofixation confirmed that 251 (96.17%) patients had a monoclonal band in serum. In our cohort, MM was the most frequent diagnosis, our patients were late diagnosed.

[Rare cause of severe hypoplasia: gelatinous transformation of bone marrow ]

Nous rapportons chez une patiente de 17 ans un cas rare d’hypoplasie sévère avec transformation gélatineuse de la moelle osseuse dont l’étiologie spécifique reste mystérieuse malgré un bilan diagnostique et étiologique assez détaillé. La transformation gélatineuse (encore appelée atrophie séreuse, ou moelle de déprivation) est caractérisée par l’association d’une hypoplasie médullaire et d’une infiltration interstitielle par une substance gélatineuse amorphe formée de mucopolysaccharides acides. Elle s’accompagne d’anomalies sanguines périphériques qui sont variables, souvent modérées et non corrélées à la gravité de l’atteinte centrale. Sa pathogénie, encore mal connue, est très certainement liée à la dénutrition chronique et les pathologies associées à une cachexie.

[Cutaneous blastomycosis revealing intravascular B-cell lymphoma: a case in Morocco]

Blastomycosis is a systemic fungal infection caused by a thermally dimorphic fungus, Blastomyces dermatitidis. The incidence in immunocompromised patients has increased in the last two decades. A 55-year-old man consulted for inflammatory nodules on the forearm. Biopsy of one nodules showed a pseudoepitheliomatous hyperplastic epidermis overlaying a dense agranulomatous inflammatory infiltrate containing free-formed ovoid bodies enclosing giant macrophageous cells. These findings were consistent with blastomycosis. After a month of treatment cutaneous lesions regressed partially but the patient's general status continued to deteriorate with the appearance of an edematous-ascitic syndrome and icterus. Laboratory blood testing demonstrated cholestasia and abdominal ultrasound showed hepatosplenomegaly. Needle liver biopsy revealed giant B-cell lymphomatous infiltration of the hepatic ducts. The patient's condition worsened rapidly and he died five months after diagnosis despite four rounds of chemotherapy. Blastomycosis is rare in Morocco. Primary infection is usually a pneumonic process. Isolated cutaneous infection is possible but uncommon. To our knowledge the association of blastomycosis and intravascular lymphoma has not been previously reported. In immunocompromised patients, clinical findings can be alarming and the outcome can be rapidly fatal.

[Non-secreting myeloma associated with nephrotic syndrome]

The non-secreting myeloma is a rare form of myeloma. Its association with a nephrotic syndrome is exceptional. The observation which we report below described the history of a 66 years old patient who presents a non-secreting myeloma revealed by a nephrotic syndrome. Various assumptions on the mechanism of no excretion were put forth. Nevertheless, several points are to be elucidated as for the pathogenesis of the association non-secreting myeloma and nephrotic syndrome.

Efficacité du rituximab dans la leucémie à tricholeucocytes

INTRODUCTION

Rituximab is an alternative treatment for hairy cell leukemia, when the standard treatments are unavailable.

CASE

An 82-year-old woman was diagnosed with hairy cell leukemia. The severity of her neutropenia ruled out purine analogs, while heart disease and age both contraindicated use of interferon. Rituximab, in four weekly treatments, was effective from the first treatment and the positive response was sustained thereafter.

DISCUSSION

Rituximab may be used to treat hairy cell leukemia, especially for patients refractory to purine analogs or after relapse or in the case of severe neutropenia, when interferon is contraindicated.

Ocular adnexal marginal zone B cell lymphoma: a clinical and pathologic study of 23 cases

To better characterize ocular adnexal marginal zone lymphoma of mucosa-associated lymphoid tissue (MZL-MALT), we analyzed the clinical and pathologic features of 23 patients (11 men, 12 women, median age 66 years). The tumor was confined to one ocular structure in 18 cases (conjunctiva, n=8; orbit, n=8; or lacrimal gland, n=2). Concurrent extraorbital disease was detected by the staging procedure in five patients, and preferentially involved other MALT sites. Histogenetic B cell marker studies, available in 13 cases, showed an early post-germinal center (GC) phenotype (BCL-6(-)/IRF4(+)/CD138(-)) (n=5) or a late post-GC phenotype (BCL-6(-)/IRF4(+)/CD138(+)) (n=8), which could be helpful for discrimination from other types of small-B cell lymphoma. BCL10 was positive in 12 of 13 patients tested, with nuclear (n=4) or cytoplasmic (n=8) immunoreactivity. These staining patterns ruled out t(1;14)(p22;q32) translocation. T(11;18)(q21;q21), another MZL-MALT-specific translocation, was detected by reverse transcriptase polymerase chain reaction in four of 15 patients tested. Clinical outcome was excellent but the overall relapse rate was 26.1% with a median follow-up of 39 months (range 6-132 months). Regardless of the disease stage at diagnosis, combined chemotherapy and radiotherapy seemed to be more effective than chemotherapy alone in ocular adnexal MZL-MALT, as persistent complete remission was achieved in nine patients receiving combination therapy, while six of 14 patients treated with chemotherapy alone relapsed.

[Hepatosplenic and kidneys candidasis complicating an acute myeloblastic leukemia. A case treated with voriconazole and caspofungin]

We report the observation of hepato-splenic and kidneys candidiasis complicating the chemotherapy of a myeloblastic leukemia (LAM5b). Following the lack of effectiveness of a first line treatement, using amphotericine B liposomale and 5-fluorocytosine, implementation of an association of new molecules, a triazole of second generation (voriconazole) and an echinocandine (caspofungine) has allowed a successful result.