Patients with hereditary retinoblastoma have a heightened risk of developing subsequent bone and soft tissue sarcomas, exacerbated by radiation and alkylating chemotherapy. Secondary leiomyosarcomas are rare. A 29-year-old patient with bilateral retinoblastoma history presented with concurrent, independent malignancies found to be Rb-suppressed uterine and Rb-positive bladder leiomyosarcomas. She had undergone both ifosfamide chemotherapy and radiation therapy but demonstrated rare simultaneous primary leiomyosarcomas not previously described in association with ifosfamide. This rare case underlines the protean genetic predisposition to malignancy in this patient population, heightening awareness of lifelong malignancy potential, and the necessity for continuous periodic screening.
Fever in a kidney transplant recipient can be due to a variety of infections in the post-transplant period. Infection in the first month after solid organ transplant is primarily due to nosocomial bacterial or candidal infections and donor-derived infections. Opportunistic infections including viruses (Epstein-Barr virus [EBV], cytomegalovirus [CMV], and parvovirus), fungi, and Pneumocystis jiroveci are more common after the first post-transplant month. 1 Zoonotic infections, such as ehrlichiosis, are an uncommon cause of acute febrile illness in the immediate post-transplant period. Ehrlichiosis is a tick-borne illness caused by three genera: Ehrlichia, Anaplasma, and Neoehrlichia. 2,3 Ehrlichia chaffeensis is an obligate intracellular bacterium that infects monocytes and causes human monocytotropic ehrlichiosis (HME) and is transmitted by the bite of the lone star tick (Amblyomma americanum). HME occurs predominantly in the southcentral and southeastern United States 3 and demonstrates seasonal variability, with the majority of cases
BackgroundIn immunocompromised patients, high mortality and morbidity of invasive mucormycosis (IM) remain significant healthcare issues due in part to confusion of IM with invasive aspergillosis (IA) and failure to initiate appropriate therapy. A validated Mucorales (MUC) PCR detects the causative agents of IM with good sensitivity and specificity, as reported previously (M-227, ICAAC 2013). Published studies have not definitively determined the frequency of patients for whom pulmonary IA is suspected but IM is present. We aimed to (1) estimate the frequency of MUC PCR positivity in bronchoalveolar lavage (BAL) samples submitted for Aspergillus (ASP) PCR panel testing.MethodsWe identified 1,067 clinical BAL specimens originally submitted to a reference laboratory for ASP PCR panel testing. Eluates from DNA extraction were tested by MUC PCR, which detects known pathogens from seven Mucorales genera (Apophysomyces, Cunninghamella, Lichtheimia [previously Absidia], Mucor, Rhizomucor, Rhizopus and Saksenaea).ResultsThe proportions of MUC PCR and ASP PCR positive BAL specimens were 1.5% (16) and 6.9% (74), respectively. 87.5% (14/16) of the MUC positive (POS) were ASP negative (NEG). One patient had two MUC PCR POS BAL samples within the testing period. The MUC quantification averaged 20,000 copies per mL BAL (range 24–266,000), which is >1,000-fold above the assay the 20 copies/mL limit of detection (LOD). Two of the ASP POS’s were MUC POS (~400 and 20-fold above LOD). For patients with MUC POS BALs, physicians requested on average 6.3 pneumonia-related tests (e.g., ASP PCR, Galactomannan, Legionella PCR, etc.) within 2 weeks of the tested BAL. In total 94.0% (85/91) of these orders yielded NEG results. The MUC PCR was physician-ordered in only one (6.25%) of the MUC POS BALs.ConclusionIn BAL samples submitted for IA testing, 16 cases (1.5%) had POS MUC PCR. The observed 5:1 (ASP:MUC) ratio approximates published literature on invasive mould incidence. MUC POS concurrent with NEG results for other pathogens suggest potential missed opportunities for MUC early diagnosis and treatment in cases of suspected invasive mould.Disclosures K. Wilgers, Viracor Eurofins Clinical Diagnostics: Employee, Salary. J. Waddell, Viracor-Eurofins: Collaborator, No financial benefit. A. Tyler, Viracor Eurofins Clinical Diagnostics: Employee, Salary. M. Altrich, Viracor Eurofins Clinical Diagnostics: Employee, Salary. S. Kleiboeker, Viracor Eurofins Clinical Diagnostics: Employee, Salary. D. Yin, Viracor-Eurofins: Collaborator, No financial benefit. ; Marion Merrell Dow Fund: Grant Investigator, Research grant. ; Astellas: Investigator, Research grant. ; Merck: Investigator, Research grant. M. Wissel, Viracor Eurofins Clinical Diagnostics: Employee, Salary.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.