Chronic Myeloid Leukaemia Presented with Extreme Isolated Thrombocytosis

CML presenting with isolated extreme thrombocytosis is rare. We reported a 47 years old man who presented with history of right sided lower abdominal pain, vomiting, significant lethargy and chest tightness. Patient was mildly anaemic and abdominal examination revealed no organomegaly. On investigation, he was found to have extreme thrombocytosis (2050x109/L) and mild leucocytosis (31.7 x109/L) with mild anaemia. In view of extreme thrombocytosis, he was investigated for myeloproliferative disease especially essential thrombocythemia. He was found to be positive for BCR-ABL by reverse transcription PCR (RT-PCR) and negative for JAK2, CALR, MPL mutations. Ultimately, he was diagnosed as a case of CML with an atypical presentation. He received imatinib 400 mg/day and achieve complete haematological response at 15 days.

Rare Generalized Form of Fungal Dermatitis in a Horse: Case Report

A rare case of Geotrichum spp. dermatitis in a horse is presented. After unrelated, previous surgery and antibiotic treatment, a saddle horse showed well-circumscribed areas of non-pruritic alopecia. Suspecting allergic skin disease, the horse was treated with corticosteroids. The skin lesion spread, and a second veterinarian was consulted. At clinical examination, the horse was lethargic, pyretic and hair was shedding/easily epilated over the head, neck, shoulders, and legs and the hind legs were swollen. Blood analysis revealed mild leucocytosis and hyperglobulinemia. Hair, skin scraping, and skin biopsy ruled out parasites and bacteria; cytology identified yeast-like structures with hyphae or pseudohyphae. Geotrichum candidum was isolated on culture. Treatment consisted of stable disinfection, topical application of an antifungal solution, vitamins C and E supplementation and allowing the horse to graze in sunlight for at least 6 h/day. At 3-weeks follow-up, the horse had gained weight, alopecia was decreased, and all other clinical parameters were normal. Antifungal treatment was continued twice a week for three months. This study suggests Geotrichum candidum may cause skin lesions in horses after long-term use of corticosteroids or antibiotics. To avoid unnecessary and prolonged suffering in cases of dermatitis, veterinarians should be promptly consulted, appropriate diagnostic procedures conducted, so that a definitive diagnosis can be reached, and an appropriate treatment regimen implemented.

A case report of a rare omental extramedullary hematopoiesis in an adult: ‘an idiopathic finding’

This is a case of a 62-year-old female, known to have multiple medical problems, who presented to her primary care physician with an intermittent abdominal pain and discomfort for a few months. The initial work-up showed mild leucocytosis and a small mass in the omentum. Given that the most concerning differential diagnosis was malignancy, the patient was referred to oncology, where biopsy of the mass showed omentum extramedullary hematopoiesis. The differential diagnosis was wide; however, a repeat computed tomography (CT) scan of the abdomen and pelvis did show persistence of the omental mass. After ruling out any possible causes, including myelofibrosis, with a normal bone marrow, her extramedullary hematopoiesis was deemed of unknown origin and with no clear explanation. Therefore, the patient was diagnosed with a rare adult idiopathic omental extramedullary hematopoiesis that was stable over time.

Postpartum ovarian vein thrombosis and venous anatomical variation

A 34-year-old multipara presented 72 hours postpartum with acute right-sided abdominal pain. The investigation revealed mild leucocytosis with positive D-dimer and elevated C reactive protein. Abdominal ultrasound and abdominopelvic CT demonstrated an enlarged right ovarian vein with endoluminal thrombus, representing postpartum ovarian vein thrombosis. The patient became asymptomatic 48 hours after starting broad-spectrum antibiotic treatment and anticoagulant therapy. She completed the treatment in ambulatory regimen and control abdominopelvic CT imaging was performed and revealed a duplicated right ovarian vein and a small residual subacute thrombus in the lumen of the distal right ovarian vein. The patient remained asymptomatic in the clinical follow-up.

A Case with Mega Cisterna Magna Renal and Ear Anomalies: Is This a New Syndrome?

Background. Extrarenal pathologies may be associated with renal position and fusion anomalies. According to the literature, our patient is the first horseshoe kidney case that had mega cisterna magna, arachnodactyly, and mild mental retardation.Case Report. A 9-year-old boy admitted because of the myoclonic jerks. He had a dysmorphic face, low-set and cup-shaped ears, arachnodactyly, and mild mental retardation. The patient’s laboratory findings were normal except for a mild leucocytosis and hypochromic microcytic anemia. His cerebrospinal fluid was cytologically and biochemically normal. Cranial MRI revealed 1.5 cm diametered mega cisterna magna in the retrocerebellar region. Although there were no significant epileptical discharges in the electroencephalography, there were slow wave discharges arising from the anterior regions of both hemispheres. Because he had stomachache, abdominal ultrasonography was performed, and horseshoe kidney was determined. Abdominal CT did not reveal any abnormalities except the horseshoe kidney. There were not any cardiac pathologies in echocardiography. He had normal 46XY karyotype and there were no repeated chromosomal derangements, but we could not evaluate for molecular and submicroscopic somatic changes. He was treated with valproic acid and myoclonic jerks did not repeat.Conclusion. We suggest that the presence of these novel findings may represent a newly recognized, separate syndrome.

Smoking as a Cause for Mild Chronic Neutrophilia.

Mild chronic neutrofilia is a frequent reason for hematologic consultation and in 70% of the cases there is no identifiable cause. Objective: to determine if smoking habit could be the etiology for leucocytosis with neutrophilia in smokers with no other pulmonary associated disease. Materials and Methods: We questioned 300 consecutive blood donors from our institution, elaborating a complete record of smoking habit. Immediately before blood donation an automated complete blood count was performed. Leucocytosis was defined as a white cell count above 11 x 109/L, and neutrophilia as a neutrophil count over 7.7 x 109/L. All data is stated as mean value ± 1 SD. Results: we studied 195 (65%) men and 105 (35%) women (n=300). Mean age was 36.5 y.o. (18–69). Fifty-five percent (165/300) smoke or were previous smokers; 8.4% (14/165) of these, did not smoke at the time of this investigation, and only two have quit smoking a year prior to questioning. Mean time of duration of smoking habit was 16.4 years ± 10.6 and the average amount of cigarettes smoked through life (estimated from data referred along different phases of each subject’s history) was 1.26 x 105 ± 1.21 x 105. In the following table results from smokers (previous or actual) vs. non-smokers are compared. Leucocytosis was present in 37/165 (22.4%) of smokers and in 3/135 (2.2%) of non-smokers (p<0.001) and neutrophilia was noted in 19/165 (11.5%) of smokers and in 2/135 (1.5%) of non-smokers (p<0.001). None of the volunteers had a WBC count over 20 x 109/L. A direct association was established for the number of cigarettes smoked and the WBC count and neutrophil count. Discussion: smoking habit affects ciliar movement, inhibits alveolar macrophage function and produces hyperplasia on mucous glands within bronquial walls. These alterations result in entrapment of mucous secretions that will ultimately lead to bacterial colonization. The neutrophilia observed in smokers would be the result of a normal physiologic response to a potential infectious focus. In conclusion, is our understanding that the smoking habit should be considered as a common etiology for mild leucocytosis and neutrophilia. Smokers (n:165) Non-smokers (n:135) p (t-test) WBC x 109/L 9.6 ± 2.1 6.8 ± 1.3 < 0.001 Neutrophils x 109/L 5.7 ± 1.6 3.9 ± 1.0 < 0.001 Hct % 45.9 ± 3.7 45.2 ± 3.6 NS Platelets 207 ± 48.7 206.4 ± 45.8 NS