Saprophytic fungi are being increasingly recognized as etiologic agents of mycoses in immunosuppressed patients. We report a case of subcutaneous infi ltration by Aureobasidium pullulans, likely due to traumatic inoculation, in a neutropenic patient during chemotherapy for chronic lymphocytic leukemia. The patient was treated with amphotericin B deoxycholate but was subsequently switched to itraconazole, which improved the lesion. This case highlights the importance of considering unusual fungal infections in critically ill patients such as those who are immunosuppressed due to chemotherapy. Diagnostic techniques and effective antifungal therapy have improved the prognosis of these cases.
Myeloid sarcomas are extramedullary solid tumors composed of immature granulocytic precursor cells. In association with acute myeloid leukemia and other myeloproliferative disorders, they may arise concurrently with compromised bone marrow related to acute myeloid leukemia, as a relapsed presentation, or occur as the first manifestation. The testicles are considered to be an uncommon site for myeloid sarcomas. No therapeutic strategy has been defined as best but may include chemotherapy, radiotherapy and/or hematopoietic stem cell transplantation. This study reports the evolution of a patient with testicular myeloid sarcoma as the first manifestation of acute myeloid leukemia. The patient initially refused medical treatment and died five months after the clinical condition started.
Aplastic anemia is a bone marrow failure syndrome characterized by peripheral
cytopenias and hypocellular bone marrow. Although aplastic anemia is idiopathic in
most cases, rheumatic diseases such as systemic lupus erythematosus are recognized as
causes of aplastic anemia, with their possible etiological mechanisms being T and B
lymphocyte dysfunction and pro-inflammatory cytokines and autoantibody production
directed against bone marrow components. In the course of the human immunodeficiency
virus infection/acquired immunodeficiency syndrome, the identification of
autoantibodies and the occurrence of rheumatic events, in addition to the natural
course of systemic lupus erythematosus which is modified by immune changes that are
characteristic of human immunodeficiency virus infection/acquired immunodeficiency
syndrome, make the diagnosis of systemic lupus erythematosus challenging. This study
reports the case of a woman with acquired immunodeficiency syndrome treated with a
highly active antiretroviral therapy, who had prolonged cytopenias and hypocellular
bone marrow consistent with aplastic anemia. The clinical picture, high
autoantibodies titers, and sustained remission of the patient's hematological status
through immunosuppression supported the diagnosis of systemic lupus
erythematosus-associated aplastic anemia. This is the first report of aplastic anemia
concurrent with systemic lupus erythematosus and acquired immunodeficiency syndrome,
providing additional evidence that immune dysfunction is a key part of the
pathophysiological mechanism of aplastic anemia.
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