Large T-cell lymphoma in a 13-year-old girl with hyperimmunoglobulinemia E syndrome

Pneumocystis jirovecii pneumonia in a baby with hyper-IgE syndrome

A 4-month-old baby with a family history of hyper-IgE syndrome acquired Pneumocystis jirovecii pneumonia. The patient's hyper-IgE syndrome score was low, but a genetic study yielded a STAT3 mutation. P. jirovecii pneumonia can be added to the infections associated with hyper-IgE syndrome. In some cases, it may be the presenting manifestation of this immunodeficiency.

Occupational exposure to high molecular weight allergens and lymphoma risk among Italian adults

OBJECTIVES

Exposure to high molecular weight (HMW) allergens that provoke immune reactivity through an IgE-mediated pathway has been associated with a decreased risk of B-cell lymphoma. The present analysis was conducted to assess the associations between occupational exposure to specific HMW allergens and the risk of B-cell, T-cell, and Hodgkin's lymphomas.

METHODS

We analyzed data from 2,290 incident lymphoma cases and 1,771 population-based controls enrolled in a multicenter study of hematolymphopoietic malignancies conducted in Italy between 1991 and 1993. All cases were histologically or cytologically confirmed. Controls were frequency-matched to cases based on age, sex, and study center. An industrial hygienist evaluated HMW occupational exposure classifications after an asthma-specific job exposure matrix was applied to participants' job histories. Unconditional logistic regression was used to assess associations between occupational exposures that occurred > or = 10 years before the date of lymphoma diagnosis and B-cell, T-cell, and Hodgkin's lymphomas.

RESULTS

Ten percent of cases and 11% of controls were occupationally exposed to HMW allergens. Exposed individuals had a decreased risk for all lymphomas combined (odds ratio, 0.78; 95% confidence interval, 0.63-0.97), particularly for B-cell lymphomas (odds ratio, 0.75; 95% confidence interval, 0.59-0.94). The decreased risks for all lymphomas were also observed when HMW allergen exposure was limited to animal and latex allergens.

CONCLUSIONS

These findings support the hypothesis that occupational exposure to immunologically active HMW allergens is inversely associated with the risk for lymphoma. The effect of exposure to specific allergens warrants further assessment.

Non-Hodgkin's Lymphoma in Job's Syndrome: A Case Report and Literature Review

Job's or hyper immunoglobulin E recurrent infection syndrome (Hyper-IgE syndrome) is a rare, often inherited multisystem disorder, characterized by cutaneous abscesses, pneumonia, elevated IgE levels and skeletal defects. We report a case of a 22-year-old man with Job's syndrome who presented with back pain. He was found to have diffuse large B-cell lymphoma involving his second lumbar vertebrae and spleen. Treatment with dose-adjusted EPOCH-rituximab (DA-EPOCH-R) chemotherapy achieved a complete remission after 4 cycles. A review of reported cases of lymphoma in Job's syndrome indicates an increase in relative risk of 259 (95% confidence interval 102, 416). The cause of the increased risk has yet to be defined but has similarities to a pathogenetic model of AIDS related lymphoma. In previous reports of lymphoma in Job's syndrome, patients presented with extranodal disease and had poor outcomes. With appropriate chemotherapy and hematological support, lymphoma associated with Job's syndrome can achieve complete remission.