[Plasmablastic lymphoma presenting with plasmacytosis and polyclonal hypergammopathy]

A 72-year-old woman presented with generalized lymphadenopathies and plasmacytosis accompanied by polyclonal hypergammopathy. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) showed FDG accumulation in the systemic lymph nodes, spleen, and multiple bones. Human immunodeficiency virus antibody was negative. Lymph node histologic findings showed a monotonous population of plasma cells with a starry-sky appearance. The cells were positive for CD19, λ, and Epstein-Barr virus-encoded RNA, and negative for CD20 and CD56. The MIB-1 index was 80%. A diagnosis of plasmablastic lymphoma with plasmacytosis and polyclonal hypergammopathy was made, and complete metabolic response was achieved after six cycles of dose-adjusted-EPOCH therapy (etoposide, prednisolone, vincristine, cyclophosphamide, and doxorubicin).

A variant of KSHV-associated inflammatory cytokine syndrome in elderly men of Mediterranean descent

The spectrum of HHV-8-associated disorders includes Kaposi's sarcoma, primary effusion lymphoma, multicentric Castleman's disease, and the recently described KSHV inflammatory cytokine syndrome (KICS), a life-threatening disorder complicating HIV infection. There have been no reports in the literature concerning non-immunosuppressed individuals affected with KICS. We report here a KICS-like illness occurring in two elderly Greek men without HIV infection or other recognizable cause of immunosuppression.

Bulbar Palsy as the Initial Manifestation of Multiple Myeloma: A Case Report

Multiple Myeloma (MM) is a neoplastic disorder derived from the malignant proliferation of monoclonal plasma cells. It is characterized by the overproduction of immunoglobulins (Ig). We report a rare case in which bulbar palsy was the initial manifestation of IgG-MM. A 66-year-old woman initially presented with progressive dysphagia and dysarthria for half a year. Physical examination demonstrated a deviation of the uvula, difficulty in protruding tongue, and bilateral tongue atrophy. Laboratory assessments revealed anemia and prominent monoclonal elevation of IgG levels both in serum and cerebrospinal fluid (CSF). The diagnosis of IgG-MM was confirmed by the identification of plasmacytosis in bone marrow aspiration and biopsy and elevation of γ-M protein in serum protein electrophoresis (SPEP). Therefore, the patient began to receive the chemotherapy with PAD (bortezomib-doxorubicin-dexamethasone) regimen. Her condition had been under control. MM as a hematological malignancy can affect cranial nerves and present as chronic progressive bulbar palsy.

Myalgia caused by chronic myositis associated with plasmacytosis: a case report

Background

Cutaneous and systemic plasmacytosis are skin disorders characterized by cutaneous polyclonal plasma cell infiltration accompanied by polyclonal hypergammaglobulinemia. Cutaneous plasmacytosis involvement is limited to the skin, mainly on the face and trunk, while systemic plasmacytosis also involves 2 or more organ systems. However, there have been no reports of inflammatory myositis due to plasmacytosis. Here, we report a patient with plasmacytosis who developed myalgia and easy fatigability due to inflammatory myositis.

Case presentation

A 54-year-old man with cutaneous plasmacytosis on the face, chest, and back complained of a history of atypical facial and lower leg pain and easy fatigability since the age of 45 years. Muscle-strength tests revealed bilateral trivial gastrocnemius weakness with myalgia. The results of routine blood analysis, including creatine kinase and thyroid function, were normal, but levels of several inflammation markers and autoantibodies were elevated. Additionally, lower leg magnetic resonance imaging and gastrocnemius muscle biopsy revealed inflammatory myositis mimicking polymyositis. His plasmacytosis, myalgia, and lower leg weakness were ameliorated by prednisolone.

Conclusion

The patient was diagnosed with inflammatory myositis due to plasmacytosis. Given that plasmacytosis has previously been reported to disrupt the immune status, myositis in this patient might have been associated with abnormal autoimmune inflammation. Neurologists and physicians should thus be aware that plasmacytosis might be associated with inflammatory myositis accompanied by myalgia.

Outbreak tracking of Aleutian mink disease virus (AMDV) using partial NS1 gene sequencing

Background

Aleutian Mink Disease (AMD) is an infectious disease of mink (Neovison vison) and globally a major cause of economic losses in mink farming. The disease is caused by Aleutian Mink Disease Virus (AMDV) that belongs to the genus Amdoparvovirus within the Parvoviridae family. Several strains have been described with varying virulence and the severity of infection also depends on the host’s genotype and immune status. Clinical signs include respiratory distress in kits and unthriftiness and low quality of the pelts. The infection can also be subclinical.

Systematic control of AMDV in Danish mink farms was voluntarily initiated in 1976. Over recent decades the disease was mainly restricted to the very northern part of the country (Northern Jutland), with only sporadic outbreaks outside this region. Most of the viruses from this region have remained very closely related at the nucleotide level for decades. However, in 2015, several outbreaks of AMDV occurred at mink farms throughout Denmark, and the sources of these outbreaks were not known.

Methods

Partial NS1 gene sequencing, phylogenetic analyses data were utilized along with epidemiological to determine the origin of the outbreaks.

Results

The phylogenetic analyses of partial NS1 gene sequences revealed that the outbreaks were caused by two different clusters of viruses that were clearly different from the strains found in Northern Jutland. These clusters had restricted geographical distribution, and the variation within the clusters was remarkably low. The outbreaks on Zealand were epidemiologically linked and a close sequence match was found to two virus sequences from Sweden. The other cluster of outbreaks restricted to Jutland and Funen were linked to three feed producers (FP) but secondary transmissions between farms in the same geographical area could not be excluded.

Conclusion

This study confirmed that partial NS1 sequencing can be used in outbreak tracking to determine major viral clusters of AMDV. Using this method, two new distinct AMDV clusters with low intra-cluster sequence diversity were identified, and epidemiological data helped to reveal possible ways of viral introduction into the affected herds.

Electronic supplementary material

The online version of this article (doi:10.1186/s12985-017-0786-5) contains supplementary material, which is available to authorized users.

Synchronous Plasma Cell Myeloma and Acute Myeloid Leukemia in a Therapy-Naïve Patient: A Rare Occurrence

Plasma cell proliferations in patients with acute myeloid leukemia (AML) are rare, whether at presentation or during or after therapy. Interpretation requires correlation with the clinical background, drug history as well as inputs from tests for monoclonal gammopathy and end-organ damage. The major diagnostic issues stem from excluding myeloma alone with a plasmablastic morphology that mimics AML as well as reactive or polyclonal plasmacytosis occurring in a bonafide case of AML alone before rendering a rare diagnosis of true dual pathologies. We report a rare case of concurrent AML and plasma cell myeloma in a 55-year-old lady that posed a significant diagnostic challenge. The patient had significant co-morbidities complicating the clinical picture and was treatment-naïve at the time of diagnosis. Our approach to confirming the diagnosis, as well the challenges faced in flow cytometric analyses are highlighted. The pathogenesis of such dual pathologies remains unresolved, although various conjectures and theories have been propounded in literature.

IL-10 mediates plasmacytosis-associated immunodeficiency by inhibiting complement-mediated neutrophil migration

BACKGROUND

Plasmacytosis (ie, an expansion of plasma cell populations to much greater than the homeostatic level) occurs in the context of various immune disorders and plasma cell neoplasia. This condition is often associated with immunodeficiency that causes increased susceptibility to severe infections. Yet a causative link between plasmacytosis and immunodeficiency has not been established.

OBJECTIVE

Because recent studies have identified plasma cells as a relevant source of the immunosuppressive cytokine IL-10, we sought to investigate the role of IL-10 during conditions of polyclonal and neoplastic plasmacytosis for the regulation of immunity and its effect on inflammation and immunodeficiency.

METHODS

We used flow cytometry, IL-10 reporter (Vert-X) and B cell-specific IL-10 knockout mice, migration assays, and antibody-mediated IL-10 receptor blockade to study plasmacytosis-associated IL-10 expression and its effect on inflammation and Streptococcus pneumoniae infection in mice. ELISA was used to quantify IL-10 levels in patients with myeloma.

RESULTS

IL-10 production was a common feature of normal and neoplastic plasma cells in mice, and IL-10 levels increased with myeloma progression in patients. IL-10 directly inhibited neutrophil migration toward the anaphylatoxin C5a and suppressed neutrophil-dependent inflammation in a murine model of autoimmune disease. MOPC.315.BM murine myeloma leads to an increased incidence of bacterial infection in the airways, which was reversed after IL-10 receptor blockade.

CONCLUSION

We provide evidence that plasmacytosis-associated overexpression of IL-10 inhibits neutrophil migration and neutrophil-mediated inflammation but also promotes immunodeficiency.

Orofacial plasmacytosis: a management conundrum

Plasmacytosis of the mucous membrane is a rare, benign, inflammatory condition of poorly understood aetiology that affects the mucous membranes. Most reported cases involve the gingival tissues, larynx, and occasionally the lips. We describe an interesting case of orofacial plasmacytosis that affected the lower lip, mandibular gingiva, and buccal mucosa. It mimicked an oral squamous cell carcinoma and presented a management dilemma.

Massive plasmacytosis with severe marrow suppression induced by methimazole in Graves' disease patients: case report and literature review

Antithyroid drugs (ATDs) induced leukopenia is commonly seen, but life-threatening agranulocytosis is a rare occurrence. Interestingly, agranulocytosis accompanied with plasmacytosis in bone marrow (BM) is rarer. In this study, we admitted a patient with Graves' disease who had been treated with 15 mg/d methimazole (MMI) for 42 days. She presented with agranulocytosis and plasmacytosis in bone marrow (BM). The patient withdrew taking MMI and was treated with broad-spectrum antibiotics and G-CSF. After two weeks, the patient's peripheral blood improvement was achieved and BM nearly returned to normal level. The case provides evidence that the elder patients with a high dose of MMI treatment are prone to develop agranulocytosis, especially the duration of treatment is longer than three months. We summary the literatures, and propose our new viewpoint on the mechanism of plasmacytosis in ATDs-induced agranulocytosis patients.

Transient Plasmacytosis With Trisomy of Chromosome 8 in a Patient With Multiple Myeloma: A Case Report

A 96-year-old woman with a 5-year history of multiple myeloma was admitted to our hospital because of increasing fatigue and fever. Bone marrow plasma cell analysis showed t(11;14), del(13q), and del(17p13). Her condition deteriorated, and she developed plasmacytosis resembling plasma cell leukemia. Chromosome analysis showed trisomy of chromosome 8 in the circulating plasma cells. The plasmacytosis resolved spontaneously without chemotherapy after about 5 weeks, and the trisomy became undetectable. The findings suggest that trisomy 8 might have contributed to the transient plasmacytosis, and that chromosome 8 carries genes associated with plasma cell proliferation, maturation, and apoptosis.