Brucellosis is one of the most common zoonotic infections worldwide caused by gram negative bacilli of the genus Brucella. It is transmitted to humans by contact with infected animals or derived food products such as unpasteurized milk. Brucellosis' clinical presentation varies widely from multi-systemic involvement to asymptomatic infection. We present the case of a 52-year-old Lebanese male who was admitted to our hospital with a 3-week history of fever (up to 40 °C), chills, night sweats and abdominal pain. Abdominal CT scan revealed the presence of several mesenteric lymphadenopathies and some retroperitoneal lymphadenopathies. Blood cultures came back positive for Brucella melitensis, and a follow-up CT of the abdomen done after treatment revealed complete resolution of the lymphadenopathies. To our knowledge, this is the first case in the literature of brucellosis presenting as retroperitoneal and mesenteric lymphadenopathies. In endemic areas, the diagnosis of brucellosis should always be raised in front of any long duration fever even in the absence of a typical clinical presentation.

We retrospectively reviewed 105 cases of primary mediastinal large B-cell lymphoma (PMLBL). Patients were treated with dose-intensified chemotherapy according to the GELA protocols without planned radiotherapy. Radiotherapy was delivered to patients with a lymphoma proven sensitive to CHOP who could receive irradiation for localised disease. Seventy-six patients achieved a complete remission (24%) or unconfirmed CR (49%), and 15 (14%), a partial remission. Patients treated with intensified induction therapy had a better FFP rate than patients treated with CHOP chemotherapy even when radiotherapy was restricted to partial responders to the dose-intensified chemotherapy regimen (p = 0.01). In the multivariate analysis for overall survival, a poor performance status and CHOP chemotherapy remained associated with a poor outcome (p = 0.02 and 0.02, respectively). Radiotherapy might not be necessary in PMLBL when a CR or a Cru is achieved with dose-intensified chemotherapy. CHOP chemotherapy yield inferior results compared to dose-intensified chemotherapy with more frequent progression on therapy.

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