A Review of the Bruton Tyrosine Kinase Inhibitors in B-Cell Malignancies

Herpes Simplex Virus Necrotic Lymphadenitis Masquerading as Lymphoma

In immunocompromised patients, the rapid development of lymphadenopathy could pose a few diagnostic challenges. This is important, especially with chronic lymphocytic leukemia and small lymphocytic lymphoma (CLL/SLL) which can manifest with the development of infections or may even progress with transformation into a more aggressive form of the disease. We report a case of a patient with CLL/SLL who presented with fever and worsening dyspnea as well as inguinal lymphadenopathy upon evaluation. The excisional biopsy of affected lymph nodes revealed herpes simplex virus lymphadenitis confirmed by immunohistochemical staining. Flow cytometry showed no progression to diffuse large B-cell lymphoma. This case highlights the importance of considering a broad spectrum of differential diagnoses when assessing lymphadenopathy in immunocompromised patients receiving active immunosuppressive therapy.

Radionuclide Imaging of Invasive Fungal Disease in Immunocompromised Hosts

Invasive fungal disease (IFD) leads to increased mortality, morbidity, and costs of treatment in patients with immunosuppressive conditions. The definitive diagnosis of IFD relies on the isolation of the causative fungal agents through microscopy, culture, or nucleic acid testing in tissue samples obtained from the sites of the disease. Biopsy is not always feasible or safe to be undertaken in immunocompromised hosts at risk of IFD. Noninvasive diagnostic techniques are, therefore, needed for the diagnosis and treatment response assessment of IFD. The available techniques that identify fungal-specific antigens in biological samples for diagnosing IFD have variable sensitivity and specificity. They also have limited utility in response assessment. Imaging has, therefore, been applied for the noninvasive detection of IFD. Morphologic imaging with computed tomography (CT) and magnetic resonance imaging (MRI) is the most applied technique. These techniques are neither sufficiently sensitive nor specific for the early diagnosis of IFD. Morphologic changes evaluated by CT and MRI occur later in the disease course and during recovery after successful treatment. These modalities may, therefore, not be ideal for early diagnosis and early response to therapy determination. Radionuclide imaging allows for targeting the host response to pathogenic fungi or specific structures of the pathogen itself. This makes radionuclide imaging techniques suitable for the early diagnosis and treatment response assessment of IFD. In this review, we aimed to discuss the interplay of host immunity, immunosuppression, and the occurrence of IFD. We also discuss the currently available radionuclide probes that have been evaluated in preclinical and clinical studies for their ability to detect IFD.