Orbital non-HIV immune reconstitution inflammatory syndrome after cytapheresis

The immune reconstitution inflammatory syndrome is a phenomenon typically described in HIV patient during the restoration of CD4 count after highly active antiretroviral therapy. Non-HIV immune reconstitution inflammatory syndrome has also been described after organ transplantation or immune recovery in neutropenic patients. We report the case of a 50-year-old man who presented to our department with left painful proptosis and ophthalmoplegia 2 days after having performed cytapheresis for a mantel cell lymphoma. Systemic work up and biopsy were performed and symptoms were relieved with intravenous steroids therapy. To our knowledge, this is the first case of orbital non-HIV immune reconstitution inflammatory syndrome described in the literature.

Staphylococcus warneri meningitis in a patient with Strongyloides stercoralis hyperinfection and lymphoma: first report of a case

A case of meningitis due to Staphylococcus warneri in a patient with a hyperinfection with Strongyloides stercoralis possibly associated with rituximab treatment for mantel cell lymphoma is reported for the first time in the literature. The patient was a 59-year-old woman, with a 3-year history of an apparently well controlled lymphoma after treatment with chemotherapy-immunotherapy and then immunotherapy alone, and diagnosis of strongyloidiasis. Meningitis was diagnosed by cerebrospinal fluid culture and tested with an automated plate system. The patient was successfully treated with vancomycin; although fever and productive cough persisted. Severe gastrointestinal symptoms and pneumonia developed three weeks later. Hyperinfection syndrome by S. stercoralis was diagnosed, with abundant larvae in feces and expectoration.

Long Term Results for Cladribine Induction and Interferon Maintenance Treatment in Previous Untreated Indolent Lymphoma.

Indolent lymphoma in advanced stage is an incurable disease. The main treatment goal is palliation with low treatment related toxicity. In a multicenter setting we prospectively treated 91 previous untreated indolent lymphomas with intravenous cladribine 0.12 mg/kg body weight for 4 or 5 consecutive days every 4 weeks for 4 cycles. Following the cladribine induction treatment an interferon-2c maintenance therapy was started until progression. Median age was 59 years (range 25–79). All patients had stage 3 or 4 disease. Overall remission rate was 70% with 23% complete remissions. We found no significant difference in remission rate between the 4 or 5 day regimen. The remission rate was not different between follicular lymphoma, mantel-cell lymphoma, or Waldenstrom’s disease. Neither did the international prognostic index influence the rate of remission. Median observation was 60 months for living patients. Median time to progression and survival was 22 and 69 months respectively. At 5 years 23% and 57% were progression free and alive respectively. Transformation in a high-grade lymphoma occurred in 11/91 patients. A secondary cancer was observed in 4/91 patients. Toxicity was mainly hematologic for cladribine. Interferon maintenance was poorly tolerated, 27% of patients did not complete the therapy. Four months of cladribine seems to have similar results as conventional therapy with chlorambucil for 6 to 12 months.