M. Hosein Zarrabi

Babesiosis in splenectomized adults: Review of 22 reported cases

Since 1957, there have been 22 reported cases of human babesiosis in splenectomized persons, representing about one third of all clinical human babesiosis. Splenectomy had been performed one month to 36 years (mean 8.7 years, median 6.0 years) earlier for a variety of reasons. Four of the seven European cases were from Babesia divergens whereas 12 of the 15 United States cases were from B. microti. Most of the 22 patients had moderate to severe clinical disease including hemolytic anemia, yet all but six recovered. Three patients had transfusion-acquired babesiosis. Treatments employed included the use of chloroquine, quinine, pyrimethamine, pentamidine, clindamycin, dialysis, and exchange transfusion. Splenectomized and/or otherwise immunocompromised hosts should be advised to avoid visiting endemic areas for babesiosis such as Nantucket Island or Marthas Vineyard in Massachusetts and Shelter Island and other parts of Long Island, New York. Babesiosis must be considered as one of the not uncommon organisms responsible for the postsplenectomy sepsis syndrome and one for which there is no current prophylaxis.

Second neoplasms in acute lymphoblastic leukemia

The authors reviewed 61 reported cases of second neoplasms in acute lymphoblastic leukemia (ALL), including 17 patients with ALL followed by another type of acute leukemia, 12 patients with ALL followed by chronic myelocytic leukemia, 19 patients with ALL followed by lymphoma, and 13 patients with ALL followed by other solid tumors. From a review of the literature, it is believed that there is no firm evidence yet that patients with ALL, intensively treated with chemotherapy and/or radiotherapy, are at increased risk of developing therapy‐related second neoplasms. Because the number of cases reported is small, there is even insufficient data to firmly suggest that acute myeloblastic leukemia, following intensive therapy for ALL, occurs in a higher‐than‐expected frequency.

Pseudopulmonary embolism: Acute respiratory distress in the syndrome of heparin-induced thrombocytopenia

A 73-year-old man with myasthenia gravis was treated with daily plasmapheresis. During the course of treatment, the patient developed progressive thrombocytopenia and an episode of severe acute respiratory distress suggesting pulmonary embolism. The thrombocytopenia and respiratory impairment improved after discontinuation of heparin, and both recurred on heparin rechallenge. The presence of heparin-specific antibodies was confirmed by in vitro assay. The time frame of clinical events suggests a heparin-mediated mechanism for both the thrombocytopenia and respiratory compromise. We conclude that acute respiratory distress may be the presenting manifestation of the syndrome of heparin-associated thrombocytopenia in patients treated with dialysis or apheresis.

Acute Nonlymphocytic Leukemia After Thiotepa Instillation Into the Bladder: Report of 2 Cases and Review of the Literature

We report 2 cases of acute nonlymphocytic leukemia after thiotepa instillation into the bladder for superficial bladder carcinoma and review 4 additional cases from the literature. Intravesical thiotepa is absorbed systemically in patients with bladder carcinoma and such treatment may be associated with the rare occurrence of acute nonlymphocytic leukemia and/or the myelodysplastic syndrome.

Acute leukemia as a complication of cytotoxic chemotherapy

Abstract Acute leukemia occurring after intensive cytotoxic chemotherapy and/or radiotherapy has been reported in 122 patients with multiple myeloma, in 93 patients with Hodgkins disease, in 78 patients with breast cancer, in 45 patients with non-Hodgkins lymphoma, in 41 patients with chronic lymphotic leukemia and in 61 patients receiving immunosuppressive chemotherapy for a variety of non-neoplastic diseases. Although risk estimates have been calculated for several large series of patients (approximately 1% to 3% in several series), the precise carcinogenic or leukemogenic potential of cancer chemotherapeutic agents singly and in combinations is not known.