Samira Mhamdi

Second lung malignancy and Richter syndrome in chronic lymphocytic leukemia: case report and literature review

BackgroundChronic lymphocytic leukemia (CLL) is the most frequent lymphoproliferative disease. Transformation into Richter disease and occurrence of second malignancies involving the lungs are rare complications. The hallmarks of any thoracic involvement are still unknown.Case presentationWe report a case of a 56-year-old male patient, with history of tobacco smoking, who presented with recurrent hemoptysis, fatigue and weight loss. Physical examination was normal except a slightly enlarged supraclavicular lymph node. Chest x-ray revealed a mediastinal widening due to enlarged paratracheal nodes and a left parahilar infiltrate. Blood tests showed a hyperlymphocytosis and a biological inflammatory syndrome. CT scan showed bilateral mediastinal and axillary lymphadenopathy, as well as left supraclavicular lymphadenopathy, with a left upper lobe alveolar attenuation and a solitary contralateral pulmonary nodule. Examination of Virchow’s node and bone marrow biopsies confirmed metastasis of a pulmonary adenocarcinoma, as well as chronic lymphocytic leukemia with Richter’s transformation. The clinical course was unfavorable since the first days of therapy as the patient passed away in a matter of a few days.ConclusionsSteady surveillance of CLL patients and systematic screening for second solid tumors, particularly lung cancer, and Richter’s transformation seem to be relevant more than ever. Early diagnosis might help us understand the pathways leading to these complications and adapt therapy.

Ultra-rush sublingual immunotherapy: Safety of use for patients with various allergic manifestations

Immunotherapy is the only treatment improving durably allergic patients. Disadvantages of sub-cutaneous route were side effects and non-adherence to therapy. Studies are coming up with new enhanced protocols and safe routes of administration. The aim of the study is to prove the safety and tolerance of the Ultra-Rush protocol shortening the inducting phase of the sub-lingual immunotherapy (SLIT) to less than 2 hours. It9s a retrospective study gathering all patients put on the Ultra-Rush protocol of SLIT from January 2013 to December 2014. We found 106 patients, including 64 males and 42 females. The mean age was 15.8 years. 46 patients (43.4%) had family history of atopy. The onset of allergic signs was 1 month to 30 years before the SLIT. Allergic rhinitis is the most frequent allergic manifestation (77.36% of patients). Asthma was found in 58.5% and allergic conjunctivitis in 48.1% of all patients. 104 patients were sensitive to house dust mites, among them, 28 patients were sensitive to several agents. 2 patients were sensitive to grass. In the inducting phase, systemic side effects were seen in 16 patients (15%), and were always benign such as a mild asthma attack, rhinitis, pruritus, eye itching. Local side effects were seen in 18 patients (17%) such as lingual edema or tingling, labial edema, nausea. Side effects during maintenance phase were rare (3 patients), benign and temporary. Adherence to therapy was perfect in 101 patients (95.3%). Ultra-Rush protocol of SLIT is safe, tolerated by patients. It allows us to achieve the inducting phase under medical supervision.