We report the pulmonary computed tomography (CT) findings in three patients with acute promyelocytic leukaemia who developed the retinoic acid syndrome following all-trans retinoic acid (ATRA) therapy. The most consistent CT findings were small, irregular peripheral nodules in the lung fields and pleural effusions. Two of the patients also showed evidence of reticular and ground glass shadowing as well as abnormal anterior mediastinal soft tissue. We report for the first time an association between ATRA and pneumothorax. We conclude that routine CT scanning may provide a sensitive means of early detection or monitoring of the syndrome and thereby may facilitate its management.
There is currently limited knowledge about the transmission risks of the SARS-CoV-2 virus and its associated disease COVID-19 from routine clinical specimens. The first study to be published on the initial 41 cases of COVID-19 infections admitted in Wuhan detected SARS-CoV-2 RNA in the blood of 6/41 (15%) of patients. 1 However, another study conducted on 1 070 clinical specimens collected from confirmed COVID-19 patients in China showed the highest positive rates of SARS-CoV-2 from real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) testing of respiratory specimens such as bronchoalveolar lavage, sputum and nasopharyngeal swabs (32%-93%). In contrast, only 1% of blood specimens and none of the urine specimens tested positive. 2 Although the rates of viraemia appear to be low, it nonetheless poses a risk of potential respiratory transmission to laboratory staff via aerosolization of blood specimens during specimen processing steps such as centrifugation and vortexing. Paediatric specimens pose a particular challenge as automated analysers cannot handle small-volume samples from paediatric-sized tubes, necessitating manual handling of specimens.
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