Since the late 1990s, Stenotrophomonas maltophilia (S. maltophilia) has become one of the most common nonfermenting Gram-negative bacilli that cause opportunistic infection. Patients with hematologic diseases are the most risky candidate for S. maltophilia pneumonia or sepsis because of chemotherapy-induced neutropenia or immunodeficiency. Frequent exposure to broad-spectrum antibiotics and prolonged insertion of central venous catheter further enhance the risk of S. maltophilia infection. One of the most severe S. maltophilia infections is hemorrhagic pneumonia. This type of infection is mostly fatal because of pulmonary alveolar hemorrhage that leads to acute respiratory failure. Furthermore, S. maltophilia exhibits a high-level intrinsic resistance to conventional antibiotics such as β-lactams and aminoglycosides and, more recently, the increasing acquired resistance to co-trimoxazole and quinolones. According to our experienced and previously reported cases, all of the patients with hemorrhagic pneumonia caused by S. maltophilia had a fatal course within a few days after the onset of the pneumonia. In this article, we perform a systematic review on a total 30 cases of hemorrhagic pneumonia induced by S. maltophilia from our institutions and the literature, and we describe its early diagnosis, prophylaxis, and recommended therapeutic strategy for the infection in the treatment of hematologic disease.

Objective While unexplained liver dysfunction is common, it is sometimes difficult to identify its exact cause. One cause is viral infections. The identification of viruses other than hepatitis B and C that cause liver dysfunction is difficult because no methods to simultaneously identify these viruses have been established. The aim of this study was to quickly and simultaneously identify multiple virus species. Methods A total of 49 patients with unexplained liver dysfunction and undetermined inflammation were examined. The majority of patients had hematologic malignancies, and some had undergone bone marrow transplantation. Qualitative polymerase chain reactions (PCR) were performed to detect 12 species of DNA virus in whole blood. Quantitative real-time PCR was performed when a specific virus was amplified. In addition, 6 RNA hepatitis viruses were directly assayed by real-time PCR. These 2 PCR steps were completed within 1 hour. Results The most frequently detected virus in 37 patients with liver dysfunction, was transfusion transmitted virus (38%), which was followed by human herpes virus (HHV) type 6 (35%), Epstein-Barr virus (14%), cytomegalovirus (8%), and rarely hepatitis G virus and HHV-7 (3%). Similar viremia was observed in 12 patients with mild liver dysfunction. The results of the PCR assay were mostly consistent with those of routine virus serological tests. Conclusion A multiplex viral PCR assay was a useful tool for quickly identifying viruses that possibly cause liver dysfunction. It was also important that liver dysfunction acted as a proband that led to the discovery of serious viremia.

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A 78-year-old woman with multiple tumors in the liver and spleen was diagnosed with follicular dendritic cell (FDC) sarcoma based on the histological picture of splenectomized specimen and its expression of CD21 and CD 23. As a paraneoplastic immune disorder, Coombs' test was positive although hemolysis was not obvious. Since systemic chemotherapies were ineffective for residual liver tumors, transcatheter arterial chemoembolization (TACE) was performed with subsequent tumor reduction. Currently, the patient is alive 27 months after the diagnosis with residual hepatic tumors favorably controlled by repeated TACE. Our experience suggests that TACE is useful for the management of hepatic FDC sarcoma.

Transplant-associated thrombotic microangiopathy (TA-TMA) is a fatal complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, so far, no large cohort study determined the risk factors and the most effective therapeutic strategies for TA-TMA. Thus, the present study aimed to clarify these clinical aspects based on a large multicenter cohort. This retrospective cohort study was performed by the Kyoto Stem Cell Transplantation Group (KSCTG). A total of 2425 patients were enrolled from 14 institutions. All patients were aged ≥16 years, presented with hematological diseases, and received allo-HSCT after the year 2000. TA-TMA was observed in 121 patients (5.0%) on day 35 (median) and was clearly correlated with inferior overall survival (OS) (hazard ratio [HR], 4.93). Pre- and post-HSCT statistically significant risk factors identified by multivariate analyses included poorer performance status (HR, 1.69), HLA mismatch (HR, 2.17), acute graft-versus-host disease (aGVHD; grades 3-4) (HR, 4.02), Aspergillus infection (HR, 2.29), and veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS; HR, 4.47). The response rate and OS significantly better with the continuation or careful reduction of calcineurin inhibitors (CNI) than the conventional treatment strategy of switching from CNI to corticosteroids (response rate, 64.7% vs 20.0%). In summary, we identified the risk factors and the most appropriate therapeutic strategies for TA-TMA. The described treatment strategy could improve the outcomes of patients with TA-TMA in the future.