Unusual presentation of hairy cell leukemia: a case series of four clinically unsuspected cases

Hairy cell leukemia (HCL) is characterized by pancytopenia and usually associated with massive splenomegaly, however the same may not be true in the clinical settings. Here we report four cases of HCL and all of them were without the classical clinical feature of splenomegaly. This is an observational study conducted between January 2013 to March 2014 where we could diagnose ten cases of HCL in Department of Hematology, All India Institute of Medical Sciences, New Delhi. Of these, four cases attracted attention because of absence of classical clinical features of HCL. Of the four cases, three presented with weakness/fatigability while fourth patient presented with recurrent respiratory tract infection. Surprising finding in these cases was absence of splenomegaly, both clinically and on imaging which demerit the suspicion of HCL clinically. All four had bi/pancytopenia and bone marrow examination coupled with immunophenotypic analysis confirmed the diagnosis of HCL. Three patients received chemotherapy with cladribine and achieved complete hematological remission. One patient did not receive chemotherapy due to poor general condition and was subsequently lost to follow up. To conclude, HCL can and do present without splenomegaly and this should not restrain one from suspecting HCL based on histomorphology which needs to be further confirmed by ancillary techniques. This finding in our series could be because these cases were picked early in their natural course of the disease. A high index of suspicion is essential for diagnosing and appropriately managing such cases.

Myocardial infarction following bee sting

Bee stings are commonly encountered worldwide. Various manifestations after bee sting have been described. Local reactions are common. Unusually, manifestations like vomiting, diarrhoea, dyspnoea, generalised oedema, acute renal failure, hypotension and collapse may occur. Rarely vasculitis, serum sickness, neuritis and encephalitis have been described which generally develop days to weeks after a sting. Acute coronary syndromes after hymenoptera stings and other environmental exposures are referred to as the Kounis syndrome or allergic myocardial ischaemia and infarction. We report a 60 year old male who developed myocardial infarction after multiple bee stings over his body.

Hot electron attenuation of direct and scattered carriers across an epitaxial Schottky interface

Hot electron transport of direct and scattered carriers across an epitaxial NiSi2/n-Si(111) interface, for different NiSi2 thickness, is studied using ballistic electron emission microscopy (BEEM). We find the BEEM transmission for the scattered hot electrons in NiSi2 to be significantly lower than that for the direct hot electrons, for all thicknesses. Interestingly, the attenuation length of the scattered hot electrons is found to be twice as large as that of the direct hot electrons. The lower BEEM transmission for the scattered hot electrons is due to inelastic scattering of the injected hot holes while the larger attenuation length of the scattered hot electrons is a consequence of the differences in the energy distribution of the injected and scattered hot electrons and the increasing attenuation length, at lower energies, of the direct hot electrons in NiSi2.