Urias Almagro

Refractory acute kidney transplant rejection with CD20 graft infiltrates and successful therapy with rituximab.

Abstract:  Acute rejection is an expected event after transplantation and has been associated with poor long‐term kidney transplant outcome. The presence of B cells in the kidney graft with acute rejection is thought to be an omnious sign, as it has been associated with poor graft outcome. There is no definitive treatment for acute rejection with B cells in the graft. Rituximab, a humanized monoclonal antibody against CD20, has been used in the treatment of B cell lymphoma. We present the case of a 49‐yr‐old Caucasian male with early acute kidney allograft rejection that was refractory to high doses of steroids and rabbit anti‐thymocyte globulin (thymoglobulin). Repeat renal biopsy revealed T cell and B cells in the kidney graft and responded to the combination of rituximab and muromonab (a mouse monoclonal antibody to CD3 receptor). Over 9 months post‐transplant, the patient remains rejection free with a serum creatinine of 1.7 mg/dL.

Cardiovascular Ochronosis: A Case Report and Review of the Medical Literature

Ochronosis is a rare disorder of tyrosine metabolism due to a deficiency of the enzyme homogentisic acid oxidase. The most common clinical manifestations include alkaptonuria, spondyloarthropathy, large joint arthritides and pigmentation of cartilage. Cardiac involvement may occur due to the deposition of polymerized homogentisic acid in the aortic, mitral and pulmonic valves. Usually, this leads to increasing rigidity and calcification. The only functionally significant valve lesion reported appears to be aortic stenosis. A possible link between ochronosis and coronary artery disease has been postulated. Further, a link between peripheral vascular disease and ochronosis may be present. We describe a case of ochronotic cardiovascular disease and review the literature on the subject.

The association of adult respiratory distress syndrome (ARDS) with thoracic irradiation (RT)

The authors report two cases of apparent adult respiratory distress syndrome (ARDS) following limited thoracic irradiation for lung cancer. Respiratory failure followed rapidly after irradiation with diffuse bilateral infiltrates, both in and out of the irradiated volume along with progressive hypoxemia unresponsive to oxygen management. Other potential causes of lung injury such as lymphangitic tumor, cardiac failure, and infections were excluded by both premortem and postmortem examination. Autopsy findings in both irradiated and unirradiated volumes of lung were consistent with hyaline membrane changes. The possible relationship between radiation therapy to limited lung volumes and the development of adult respiratory distress syndrome is discussed.

Spinal cord metastasis in small cell carcinoma of the lung

Among 50 patients with small cell bronchogenic carcinoma who were placed on a protocol of combined chemotherapy and radiation therapy, seven patients developed recurrence in the spinal cord. Five cases terminated in paraplegia and death. One patient with pontine recurrence recovered with local radiation therapy. One patient, diagnosed early, responded to local radiation therapy and is ambulatory. Methods of diagnosis were myelogram, computerized axial tomography, cerebro spinal fluid, chemistry and cytologies. The poor prognosis and the difficulty of diagnosis suggest that we should evaluate prophylactic therapy of the entire cranio-spinal axis.

Annular constriction of the rectum secondary to transitional cell carcinoma of the bladder

Recurrent transitional cell carcinoma of the bladder is often a locally progressive disease. Regional lymph node metastasis is a frequent finding and may be the first sign of recurrence. Involvement of the gastrointestinal tract is rare, but metastasis to the colon, small intestine, and stomach have been reported. Herein, we present a case of recurrent transitional cell carcinoma of the bladder manifesting as an annular constricting mass of the rectum, and review the literature regarding this unusual lesion.

Left Ventricular Thrombus in Agnogenic Myeloid Metaplasia

A 40-year-old white male with agnogenic myeloid metaplasia presented to our institution with symptoms of fever, rash and pleuropericardial pain. A two-dimensional echocardiogram revealed a pedunculated left ventricular mass which simulated a left ventricular myxoma. Left ventricular wall motion and coronary arteries were normal on preoperative angiography. The mass was surgically removed and found to be fibrin thrombus. A mild chronic inflammatory infiltrate was present in the base of the thrombus. The formation of thrombus in the left ventricle was ascribed to spontaneous aggregation of platelets and myocarditis of unknown cause.