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Gupta D, Goldberg L, Dickinson A, Hughes M, Anand V, Stokke J, Corden MH. An 8-Year-Old Boy With Prolonged Fever and Subcutaneous Nodules. Pediatrics 2022; 149:186710. [PMID: 35490281 DOI: 10.1542/peds.2021-052974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
An 8-year-old boy with asthma presented with prolonged fever, malaise, extremity weakness, polyarthralgias, malar rash, and subcutaneous nodules. Physical examination was remarkable for a faint malar rash, flesh-colored papules on the dorsal aspect of the fingers, arthritis of multiple joints in the hands, and subcutaneous nodules. The nodules were firm, nontender, and distributed over multiple extremities and the trunk. The patient was admitted to expedite workup. Initial laboratory test results revealed leukopenia, mild elevation of the aminotransferases, an elevated erythrocyte sedimentation rate, and normal level of creatine kinase. His echocardiogram was normal. Infectious disease studies were negative. Additional examination revealed dilated capillaries in his nail beds and bilateral hip weakness. MRI of his extremities was negative for myositis or calcification of the nodules. We obtained a biopsy of the subcutaneous nodules, and because the patient remained afebrile during the hospitalization, we discharged him from the hospital with outpatient follow-up. Our expert panel reviews the course of the patient's evaluation and investigation, as well as the implications of his diagnosis based on the tissue pathology from the nodule biopsy.
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Affiliation(s)
| | | | | | - Meagan Hughes
- Dermatology.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Vikram Anand
- Infectious Diseases.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jamie Stokke
- Cancer and Blood Disease Institute.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mark H Corden
- Hospital Medicine, Department of Pediatrics, Children's Hospital Los Angeles.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
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Galtier J, Parrens M, Milpied N. [Peripheral T cell lymphomas: diagnosis and treatment]. Rev Med Interne 2020; 41:829-837. [PMID: 32674892 DOI: 10.1016/j.revmed.2020.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 10/23/2022]
Abstract
Peripheral T cell lymphomas are rare malignancies with aggressive course, with several different subtype described in the 2016 WHO classification. Their distribution across the world is heterogenous, with marked difference between Western and Asian country. Their clinical presentation often comprise extra-nodal involvement, B symptoms and immune system disorder which can lead to wrong diagnosis orientation. Make a right diagnosis need a experienced pathologist in close collaboration with clinical datas. Peripheral T cell lymphomas are in general associated with poor prognosis when treated with anthracyclines-based regimen, and several studies and trials focused on the use of intensified regimen or novel targeted agents, whose proper indication still remain to be clarified.
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Affiliation(s)
- J Galtier
- CHU Bordeaux, Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Haut-Leveque, F-33000 Bordeaux, France.
| | - M Parrens
- CHU Bordeaux, Unité de pathologie, Hôpital Haut-Leveque, F-33000 Bordeaux, France
| | - N Milpied
- CHU Bordeaux, Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Haut-Leveque, F-33000 Bordeaux, France
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3
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Kawahigashi T, Kitagawa I, Tanaka E. Angioimmunoblastic T-cell lymphoma accompanied by pure red cell aplasia: A case report. World J Clin Oncol 2020; 11:405-411. [PMID: 32874954 PMCID: PMC7450812 DOI: 10.5306/wjco.v11.i6.405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Angioimmunoblastic T-cell lymphoma (AITL) is a peripheral T-cell lymphoma, which is a rare subtype of lymphoma. Patients with AITL often have skin lesions, which are observed in 50% of all cases; the chief complaint of this patient was palpable purpura. AITL often complicates autoimmune or hematological disorders; however, among these, pure red cell aplasia (PRCA) is a very rare complication of AITL. We herein report a case of AITL with PRCA.
CASE SUMMARY A 77-year-old Japanese man presented to our hospital with complaints of loss of appetite for 2 mo and a 10-d history of palpable purpura. On physical examination, the patient was afebrile but had bilateral multiple palpable purpuric lesions over the lower extremities, lower abdomen, and part of the upper extremities. Moreover, lymphadenopathy of the bilateral inguinal, cervical, and supraclavicular nodes was noted. Laboratory and imaging studies and skin biopsy were conducted but were inconclusive. Based on inguinal lymph node excisional biopsy, we diagnosed the patient with AITL. Subsequently, the patient developed progressive normocytic normochromic anemia that necessitated almost daily blood transfusion. The clinical presentations and results of bone marrow assessment were consistent with those of PRCA, which is associated with AITL. Chemotherapy was initiated but was not effective. The patient refused further chemotherapy and opted to continue receiving best supportive care.
CONCLUSION PRCA is an extremely rare complication of AITL. As the pathophysiology remains unclear, further research is warranted.
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Affiliation(s)
- Teiko Kawahigashi
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Izumi Kitagawa
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Eri Tanaka
- Department of Hematology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
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Clark-Knowles KV, Dewar-Darch D, Jardine KE, Coulombe J, Daneshmand M, He X, McBurney MW. Modulating SIRT1 activity variously affects thymic lymphoma development in mice. Exp Cell Res 2018; 371:83-91. [PMID: 30059665 DOI: 10.1016/j.yexcr.2018.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/25/2018] [Accepted: 07/26/2018] [Indexed: 12/30/2022]
Abstract
SIRT1 is a protein deacetylase with a broad range of biological functions, many of which are known to be important in carcinogenesis, however much of the literature regarding the role of SIRT1 in cancer remains conflicting. In this study we assessed the effect of SIRT1 on the initiation and progression of thymic T cell lymphomas. We employed mouse strains in which SIRT1 activity was absent or could be reversibly modulated in conjunction with thymic lymphoma induction using either the N-nitroso-N-methylurea (NMU) carcinogenesis or the nucleophosmin-anaplastic lymphoma kinase (NPM-ALK) transgene. Decreased SIRT1 activity reduced the development of thymic lymphomas in the NMU-treated mice but was permissive for the formation of lung adenomas. Conversely, in the NPM-ALK transgenic mice, decreased SIRT1 activity had a modest promoting effect in the development of thymic lymphomas. The results of the work presented here add to the growing body of evidence that sirt1 is neither an outright oncogene nor a tumor suppressor. These opposing results in two models of the same disease suggest that the influence of sirt1 on carcinogenesis may lie in a role in tumor surveillance.
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Affiliation(s)
| | - Danielle Dewar-Darch
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Karen E Jardine
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Josée Coulombe
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Manijeh Daneshmand
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Xiaohong He
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Michael W McBurney
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, Canada; Department of Medicine, University of Ottawa, Ottawa, Canada; Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada.
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Shih YH, Yang Y, Chang KH, Chen YH, Teng CLJ. Clinical features and outcome of lymphoma patients with pre-existing autoimmune diseases. Int J Rheum Dis 2017; 21:93-101. [DOI: 10.1111/1756-185x.13231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Yu-Hsuan Shih
- Division of Hematology/Medical Oncology; Department of Medicine; Taichung Veterans General Hospital; Taichung Taiwan
| | - Youngsen Yang
- Division of Hematology/Medical Oncology; Department of Medicine; Taichung Veterans General Hospital; Taichung Taiwan
- Internal Medicine; China Medical University; Taichung Taiwan
| | - Kuang-Hsi Chang
- Graduate Institute of Biomedical Sciences; China Medical University; Taichung Taiwan
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Taichung Veterans General Hospital; Taichung Taiwan
- Department of Life Science; Tunghai University; Taichung Taiwan
- Faculty of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Chieh-Lin Jerry Teng
- Division of Hematology/Medical Oncology; Department of Medicine; Taichung Veterans General Hospital; Taichung Taiwan
- Department of Life Science; Tunghai University; Taichung Taiwan
- Faculty of Medicine; Chung Shan Medical University; Taichung Taiwan
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Jachiet V, Mekinian A, Carrat F, Grignano E, Retbi A, Boffa JJ, Ronco P, Rondeau E, Sellam J, Berenbaum F, Chazouillères O, Capron J, Alamowitch S, Chasset F, Frances C, Coppo P, Fain O. Autoimmune manifestations associated with lymphoma: characteristics and outcome in a multicenter retrospective cohort study. Leuk Lymphoma 2017; 59:1399-1405. [DOI: 10.1080/10428194.2017.1379075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Vincent Jachiet
- Service de Médecine Interne-(DHU i2B), Hôpital Saint-Antoine, APHP, Université Paris 06, Paris, France
| | - Arsène Mekinian
- Service de Médecine Interne-(DHU i2B), Hôpital Saint-Antoine, APHP, Université Paris 06, Paris, France
| | - Fabrice Carrat
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Unité de Santé Publique, Paris, France
| | - Eric Grignano
- Service de Médecine Interne-(DHU i2B), Hôpital Saint-Antoine, APHP, Université Paris 06, Paris, France
| | - Aurelia Retbi
- Département d’Information médicale, Hôpital Saint Antoine, APHP, Université Paris 06, Paris, France
| | - Jean-Jacques Boffa
- Service de Néphrologie et Dialyses, Hôpital Tenon, APHP, Université Paris 06, Paris France
| | - Pierre Ronco
- Service de Néphrologie et Dialyses, Hôpital Tenon, APHP, Université Paris 06, Paris France
| | - Eric Rondeau
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, APHP, Université Paris 06, Paris, France
| | - Jérémie Sellam
- Service de Rhumatologie-(DHU i2B), Hôpital Saint Antoine, APHP, Université Paris 06, Inserm UMRS_938, Paris, France
| | - Francis Berenbaum
- Service de Rhumatologie-(DHU i2B), Hôpital Saint Antoine, APHP, Université Paris 06, Inserm UMRS_938, Paris, France
| | - Olivier Chazouillères
- Service d’Hépatologie, Hôpital Saint Antoine, APHP, Université Paris 06, Paris, France
| | - Jean Capron
- Service de Neurologie, Hôpital Saint Antoine, APHP, Université Paris 06, Paris, France
| | - Sonia Alamowitch
- Service de Neurologie, Hôpital Saint Antoine, APHP, Université Paris 06, Paris, France
| | - Francois Chasset
- Service de Dermatologie, Hôpital Tenon, APHP, Université Paris 06, Paris, France
| | - Camille Frances
- Service de Dermatologie, Hôpital Tenon, APHP, Université Paris 06, Paris, France
| | - Paul Coppo
- Service d'Hématologie, Centre de référence des Microangiopathies Thrombotiques, Hôpital Saint Antoine, APHP, Université Paris 06, Paris, France
| | - Olivier Fain
- Service de Médecine Interne-(DHU i2B), Hôpital Saint-Antoine, APHP, Université Paris 06, Paris, France
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