scholarly journals Cryptococcal Meningoencephalitis in an Immunosuppressed Patient with Chronic Lymphocytic Leukemia

2021 ◽  
Vol 16 (2) ◽  
pp. 87-89
Author(s):  
Md Monirul Hoque ◽  
Sonia Chakraborty ◽  
Arif Ahmed Khan
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Antifungal Agents ◽  
Immunosuppressive Drugs ◽  
Rapid Diagnosis ◽  
Lymphocytic Leukemia ◽  
Cell Mediated Immunity ◽  
Immunosuppressed Patient ◽  
Cryptococcal Meningoencephalitis ◽  
India Ink ◽  
Cryptococcal Disease

Cryptococcal meningoencephalitis, an invasive fungal infection caused by an encapsulated fungus Cryptococcus neoformans should be suspected in immune compromised individuals with defective cell-mediated immunity and patients on immunosuppressive drugs with recent development of fever, confusion and loss of consciousness. A rapid diagnosis is fundamental for decreasing morbidity and mortality from cryptococcal disease. Cerebrospinal fluid (CSF) study and simple stain like India Ink Stain can be performed for diagnosis of cryptococcal meningoencephalitis. Here, we report a case of cryptococcal meningoencephalitis in chronic lymphocytic leukemia (CLL) patient on immunosuppressive drugs diagnosed by CSF study and India ink stain which responded dramatically with antifungal agents after diagnosis. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 87-89

scholarly journals Disseminated Cryptococcal Disease in a Patient with Chronic Lymphocytic Leukemia on Ibrutinib

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Koh Okamoto ◽  
Laurie A. Proia ◽  
Patricia L. Demarais
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Tyrosine Kinase ◽  
B Cell ◽  
Lymphocytic Leukemia ◽  
Biologic Agent ◽  
Cell Mediated Immunity ◽  
Bruton’S Tyrosine Kinase ◽  
Bruton's Tyrosine Kinase ◽  
First Case ◽  
Cryptococcal Disease

Cryptococcusis a unique environmental fungus that can cause disease most often in immunocompromised individuals with defective cell-mediated immunity. Chronic lymphocytic leukemia (CLL) is not known to be a risk factor for cryptococcal disease although cases have been described mainly in patients treated with agents that suppress cell-mediated immunity. Ibrutinib is a new biologic agent used for treatment of CLL, mantle cell lymphoma, and Waldenstrom’s macroglobulinemia. It acts by inhibiting Bruton’s tyrosine kinase, a kinase downstream of the B-cell receptor critical for B-cell survival and proliferation. Ibrutinib use has not been associated previously with cryptococcal disease. However, recent evidence suggested that treatments aimed at blocking the function of Bruton’s tyrosine kinase could pose a higher risk for cryptococcal infection in a mice model. Here, we report the first case of disseminated cryptococcal disease in a patient with CLL treated with ibrutinib. When evaluating possible infection in CLL patients receiving ibrutinib, cryptococcal disease, which could be life threatening if overlooked, could be considered.

Cryptococcal infections in two patients receiving ibrutinib therapy for chronic lymphocytic leukemia

2018 ◽  
Vol 25 (3) ◽  
pp. 710-714 ◽  
Author(s):  
Matthew Stankowicz ◽  
Megan Banaszynski ◽  
Russell Crawford
Keyword(s):  
Health Care ◽  
Chronic Lymphocytic Leukemia ◽  
Kinase Inhibitors ◽  
Acute Illness ◽  
Lymphocytic Leukemia ◽  
High Dose ◽  
Cryptococcal Antigen ◽  
Cryptococcal Meningoencephalitis ◽  
Health Care Associated Pneumonia ◽  
Antigen Testing

Cryptococcal infections are responsible for significant morbidity and mortality in immunocompromised patients. Reports of these infections in patients on small molecular kinase inhibitors have not been widely reported in clinical trials. We describe one case of cryptococcal meningoencephalitis and one case of cryptococcal pneumonia in two patients who were receiving ibrutinib for chronic lymphocytic leukemia. Despite different sites of cryptococcal infection, both patients had similar presentations of acute illness. Patient 1 was worked up for health care–associated pneumonia, as well as acute sinusitis prior to the diagnosis of cryptococcal meningoencephalitis. He also had a more complex past medical history than patient 2. Patient 2 developed atrial fibrillation from ibrutinib prior to admission for presumed health care–associated pneumonia. Cryptococcal antigen testing was done sooner in this patient due to patient receiving high-dose steroids for the treatment of underlying hemolytic anemia. We conclude that patients who develop acute illness while receiving ibrutinib should be considered for cryptococcal antigen testing.

Prolonged voriconazole treatment in a patient with chronic lymphocytic leukemia resulting in a litany of chronic overlapping toxicities

2018 ◽  
Vol 25 (3) ◽  
pp. 747-753 ◽  
Author(s):  
Caitlin R Rausch ◽  
Dimitrios P Kontoyiannis
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Lymphocytic Leukemia ◽  
Suppressive Therapy ◽  
Prolonged Treatment ◽  
High Morbidity ◽  
Limited Experience ◽  
Continuous Use ◽  
Visual Disturbances

Voriconazole is a triazole antifungal with activity against a number of yeast and mold species including Candida, Aspergillosis, Fusarium, and Coccidioides. Invasive fungal infections are associated with high morbidity and mortality, prolonged treatment courses, and occasionally lifelong suppressive therapy. Voriconazole therapy can result in a number of acute toxicities that clinicians are frequently aware of including hepatotoxicity, visual disturbances, and hallucinations; however, there is limited experience with extended durations of voriconazole therapy. We describe the case of a 62-year-old man who developed Coccidioides meningitis as a result of prolonged neutropenia from treatment for chronic lymphocytic leukemia. He was initially treated with a number of different antifungal agents including voriconazole, liposomal amphotericin B, fluconazole, and itraconazole; however, he developed acute toxicity due to those agents. He was successfully re-challenged with voriconazole, and maintained therapeutic serum concentrations throughout treatment. As a result of prolonged voriconazole exposure of over 14 years, he has suffered a number of toxicities, most significantly including actinic keratosis, squamous cell carcinoma, and skeletal fluorosis. To our knowledge, this is the longest continuous use of voriconazole therapy currently in the literature.

scholarly journals Idelalisib impairs T-cell-mediated immunity in chronic lymphocytic leukemia

Haematologica ◽  
2018 ◽  
Vol 103 (12) ◽  
pp. e598-e601 ◽  
Author(s):  
Silvia Martinelli ◽  
Rossana Maffei ◽  
Stefania Fiorcari ◽  
Chiara Quadrelli ◽  
Patrizia Zucchini ◽  
...  
Keyword(s):  
T Cell ◽  
Chronic Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Cell Mediated Immunity

Evaluation and identification of protocols for safe and efficacious institutional administration of intravenous immune globulin in hypogammaglobulinemia associated with chronic lymphocytic leukemia, non-Hodgkin lymphoma, and multiple myeloma.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 250-250
Author(s):  
Doron Feinsilber ◽  
Cole McCoy ◽  
Parameswaran Hari ◽  
Patrick C. Foy ◽  
Ravi Narra ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Chronic Lymphocytic Leukemia ◽  
Hematologic Malignancies ◽  
Iga Deficiency ◽  
Lymphocytic Leukemia ◽  
Data Capture ◽  
Cell Mediated Immunity ◽  
Nccn Guidelines ◽  
Quality Reporting ◽  
Non Hodgkin Lymphoma

250 Background: Hematologic malignancies effect both humoral and cell-mediated immunity. We hypothesize that for patients with Chronic Lymphocytic Leukemia (CLL), Non-Hodgkins Lymphoma (NHL), and Multiple Myeloma (MM) outcomes improve with adherence to National Comprehensive Cancer Network (NCCN) guidelines for intravenous immunoglobulin (IVIG).Our objective is to understand resource allocation and implementation of IVIG in outpatient and inpatient settings. We identified a cohort of patients with hypogammaglobulinemia for assessing incidence of sepsis, outcomes, and resource use. We initiated this project by undertaking a large descriptive study of current IVIG use. Methods: A retrospective Institutional Review Board (IRB) approved data capture was conducted covering 2016-2018. Inclusion criteria involved those on an active chemotherapy plan, age > 18 years and diagnosis of CLL, NHL, or MM. IgA deficiency, anaphylaxis to IVIG, planned chemotherapy, inherited immunodeficiency, and thymic deficiency were excluded. We considered patients to be suitable for IVIG if IgG was < 500 mg/dL for CLL and MM and < 400 mg/dL in NHL. Outcomes, number of admissions, sepsis, ICU care, infectious etiology, and monthly IgG levels were examined. Results: A preliminary i2b2 data capture identified a cohort of 563 patients that yielded 12% with bacteremia, 21% with sepsis, and 23% with pneumonia of which 87% were admitted. 28% received IVIG during the 2-year period. Of the 563, 77% were hospitalized and 21% required ICU care. 54% of ICU patients received inpatient IVIG. All influenza and parainfluenza cases were inpatient. Final data analysis will yield greater detail in comparing inpatient to outpatient IVIG use. Conclusions: Large academic institutions appear to have significant variability in use of IVIG in patients with lymphopenia and hematologic malignancies. With this data, we plan to assess for patient-level outcomes based on adherence to NCCN guidelines as a way to enhance Physician Quality Reporting System (PQRS) standards by prioritizing outpatient use of IVIG.

Thromboembolic Complications of Intravenous Immunoglobulin (IVIG) in Hypogammaglobulinemic Patients with Chronic Lymphocytic Leukemia (CLL).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4416-4416
Author(s):  
Cannon Milani ◽  
Samir Dalia ◽  
Gerald A. Colvin
Keyword(s):  
High Risk ◽  
Chronic Lymphocytic Leukemia ◽  
Intravenous Immunoglobulin ◽  
Conflicts Of Interest ◽  
High Risk Patient ◽  
Lymphocytic Leukemia ◽  
Ivig Treatment ◽  
Cell Mediated Immunity ◽  
Thromboembolic Complications ◽  
Rapid Infusion

Abstract Abstract 4416 Infectious complications represent a major cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL). The etiology is postulated to be secondary to aberrations in cell-mediated immunity, as well as to therapy-related immunosuppression. Hypogammaglobulinemia, which occurs in virtually all patients with CLL, may beprofound and correlates with disease duration and stage. In 1981 during treatment of two children with hypogammaglobulinemia and coincidental idiopathic thrombocytopenic purpura (ITP), physicians in Switzerland observed a reproducible increase in the platelet count following IVIG treatment. This clinical observation and follow up systemic investigations further intensified the widespread clinical use of IVIG as a potential immune modulatory agent. Intravenous immunoglobulin (IVIG) therapy has been used successfully to prevent and treat infections in this cohort of patients. Today, Intravenous immunoglobulin (IVIG) is used in a broad spectrum of autoimmune, inflammatory, and primary and secondary immunodeficiencies. The efficacy has been demonstrated in several control studies. IVIG is a blood product prepared from the serum of between 1,000 and 15,000 donors per batch. The mechanism of action validated by in-vitro models is exerted by a combined effect on autoantibodies, complement activation, cytokines, and saturation of Fc receptors on tissue macrophages. However IVIG administration and treatment is not benign and should be used with caution given the potential manifestations of thromboembolic complications. High concentration and rapid infusion rate of the IVIG, as well as increased dose and osmolarity of the solution are thought to predispose to thrombotic events. Serum viscosity is the implicated mechanism for compromised blood flow and predisposition of high-risk patients to cardiovascular or cerebrovascular infarction. In this retrospective review, we detail IVIG related thromboembolic manifestations in CLL patients, to highlight the importance of risk stratifying patients prior to treatment administration. The current consensus surrounding IVIG is that of a relatively safe treatment, with minor adverse effects such as hypertension, fever and chills, nausea, myalgias, or headache. However our report highlights the importance of proceeding with caution in the application of this therapy, as it's proclivity for thrombotic complications has not been fully elucidated in patients with underlying malignancies. Pre-existing thrombogenic risk factors should be carefully evaluated in patients undergoing treatment with IVIG. Clinical evaluation, with careful attention to vascular history and underlying co-morbidities can potentially unmask the high-risk patient where IVIG could be lethal. Disclosures: No relevant conflicts of interest to declare.

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