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Panda A, Chandrashekhara SH, Nambirajan A, Mishra P. Idiopathic myelofibrosis with disseminated hepatosplenic, mesenteric, renal and pulmonary extramedullary haematopoeisis, portal hypertension and tuberculosis: initial presentation and 2 years follow-up. BMJ Case Rep 2016; 2016:bcr-2016-217854. [PMID: 28011890 DOI: 10.1136/bcr-2016-217854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 35-year-old man with a 12-year history of idiopathic myelofibrosis (IMF) presented in 2014 with fatigue and abdominal distension. CT scan revealed massive hepatosplenomegaly with focal splenic lesions, soft tissue around renal pelvis, mesenteric masses compressing bowel loops and perilymphatic nodules in lungs. There was portal hypertension, ascites, pleural effusion, bilateral psoas abscesses and necrotic retroperitoneal lymphadenopathy. MRI additionally revealed hypointense periportal infiltrative lesions in liver, not seen on CT scan. None of these lesions showed diffusion restriction. Biopsy from mesenteric masses revealed extramedullary haematopoeisis. Aspiration from psoas abscess confirmed tuberculosis. Follow-up after 6 weeks of ruxolitinib (JAK2 tyrosine kinase inhibitor) and 9 months of antitubercular therapy revealed resolution of psoas abscesses and lymph nodes. Mild reduction was noted in mesenteric masses and ascites while perirenal soft tissue had increased. Follow-up imaging after another 1 year of ruloxitinib showed new-onset bilateral paravertebral and presacral foci of extramedullary haematopoeisis.
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Affiliation(s)
- Ananya Panda
- All India Institute of Medical Science, New Delhi, India
| | | | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Pravas Mishra
- Department of Hematology, All India Institute of Medical Science, New Delhi, India
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Henriquez-Camacho C, Martinez-Barranco P, Velasco M, Villafuerte-Gutierrez P, Losa J. Nontuberculous mycobacterial infection in a patient with myelofibrosis: case report and concise review. Clin Case Rep 2015; 3:438-41. [PMID: 26185644 PMCID: PMC4498858 DOI: 10.1002/ccr3.268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/21/2014] [Accepted: 03/03/2015] [Indexed: 11/09/2022] Open
Abstract
A 70-year-old patient having massive refractory ascites in the course of idiopathic myelofibrosis was diagnosed of peritoneal extramedullary hematopoiesis and developed an overwhelming nontuberculous mycobacterial infection. The case describes this unusual infection and highlights the need for additional studies to confirm the etiology of ascites in primary myelofibrosis.
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Affiliation(s)
- Cesar Henriquez-Camacho
- Infectious Disease Section, Internal Medicine Unit, Hospital Universitario Fundacion Alcorcon Madrid, Spain
| | | | - Maria Velasco
- Infectious Disease Section, Internal Medicine Unit, Hospital Universitario Fundacion Alcorcon Madrid, Spain
| | | | - Juan Losa
- Infectious Disease Section, Internal Medicine Unit, Hospital Universitario Fundacion Alcorcon Madrid, Spain
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Brenner K, Pohlman L, Muldowney I, Petersen D, Schermerhorn T. Peritoneal EMH in a Dog with Immune-Mediated Hemolytic Anemia. J Am Anim Hosp Assoc 2013; 49:329-32. [DOI: 10.5326/jaaha-ms-5869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Extramedullary hematopoiesis (EMH) is the process by which normal blood cells are produced outside the bone marrow. In humans, EMH effusions are rare and are characterized by the presence of megakaryocytes, immature erythrocytes, immature leukocytes, or combinations of those cells. To the authors’ knowledge, this is the first report to describe a case of peritoneal EMH effusion in a dog. A 5 yr old castrated male shorthaired dachshund presented with a 2 day history of pigmenturia and inappetence. A complete blood count revealed regenerative anemia with marked agglutination, spherocytosis, and an acute inflammatory leukogram characterized by a neutrophilia, regenerative left shift, and monocytosis. Ultrasound-guided aspiration of peritoneal effusion yielded a sample of high nucleated cellularity predominantly composed of mature and immature neutrophils and erythroid precursor cells. The patient was diagnosed with primary immune-mediated hemolytic anemia with concurrent EMH peritoneal effusion. The following case description and discussion explore the clinical findings associated with the unusual effusion and outline the possible pathogenesis by which the EMH effusion may have arisen in the dog.
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Affiliation(s)
- Karen Brenner
- Department of Clinical Sciences (K.B., I.M., T.S.) and Department of Diagnostic Medicine/Pathobiology (L.P., D.P.), Kansas State University, Manhattan, KS
| | - Lisa Pohlman
- Department of Clinical Sciences (K.B., I.M., T.S.) and Department of Diagnostic Medicine/Pathobiology (L.P., D.P.), Kansas State University, Manhattan, KS
| | - Ian Muldowney
- Department of Clinical Sciences (K.B., I.M., T.S.) and Department of Diagnostic Medicine/Pathobiology (L.P., D.P.), Kansas State University, Manhattan, KS
| | - Don Petersen
- Department of Clinical Sciences (K.B., I.M., T.S.) and Department of Diagnostic Medicine/Pathobiology (L.P., D.P.), Kansas State University, Manhattan, KS
| | - Thomas Schermerhorn
- Department of Clinical Sciences (K.B., I.M., T.S.) and Department of Diagnostic Medicine/Pathobiology (L.P., D.P.), Kansas State University, Manhattan, KS
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Hasrouni E, Rogers HJ, Tabarroki A, Visconte V, Traina F, Afable M, Sekeres MA, Maciejewski JP, Tiu RV. A case of mistaken identity: When lupus masquerades as primary myelofibrosis. SAGE Open Med Case Rep 2013; 1:2050313X13498709. [PMID: 27489629 PMCID: PMC4857264 DOI: 10.1177/2050313x13498709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Autoimmune myelofibrosis is an uncommon hematologic disease characterized by anemia, bone marrow myelofibrosis, and an autoimmune feature. Myelofibrosis is often associated with other conditions, including infections, nutritional/endocrine dysfunction, toxin/drug exposure, and connective tissue diseases, including scleroderma and systemic lupus erythematosus. Absence of clonal markers (JAK2) and heterogeneity of the symptoms often complicate the diagnosis. Case presentation: Here, we present two cases of systemic lupus erythematosus–induced autoimmune myelofibrosis. The first case is of a 36-year-old African American female with diagnosis of systemic lupus erythematosus at the age of 12 years. The second patient is a 44-year-old African American male with family history of systemic lupus erythematosus who developed anemia and constitutional symptoms later on. Both patients showed hypercellularity and fibrotic changes of the bone marrow. Moreover, mutational analysis showed that both patients were wild type for JAK2 (V617F and exon 12) and MPL (exon 10). Conclusions: These two cases illustrate that anemic patients with fibrotic changes in the bone marrow without other clinicopathologic features associated with primary myelofibrosis in the presence of clinical manifestations and history of an autoimmune disease should suggest an autoimmune myelofibrosis. These cases demonstrate that a good clinical history combined with molecular technologies and pathomorphologic criteria are helpful in distinguishing between primary myelofibrosis and a nonclonal myelofibrosis from an associated condition.
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Affiliation(s)
- Edy Hasrouni
- Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Heesun J Rogers
- Department of Clinical Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Tabarroki
- Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Valeria Visconte
- Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Fabiola Traina
- Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA; Hematology and Hemotherapy Center/University of Campinas (Hemocentro-UNICAMP), Campinas, Sao Paulo, Brazil
| | - Manuel Afable
- Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mikkael A Sekeres
- Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA; Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Hematologic Oncology & Blood Disorders, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jaroslaw P Maciejewski
- Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA; Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Hematologic Oncology & Blood Disorders, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ramon V Tiu
- Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA; Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Hematologic Oncology & Blood Disorders, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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