HEMATOCASE

Clinical case: High grade “triple hit” Lymphoma

SUMMARY

We report the case of a 64-year-old patient, known for follicular lymphoma, admitted with facial paralysis accompanied by acute cervicobrachialgia. A lumbar puncture revealed the presence of centroblastic lymphoma cells whose clonal nature was confirmed by immunophenotyping. The histological examination of a lymph node biopsy was consistent with Burkitt-like high-grade lymphoma. Cytogenetic analysis showed the concomitant presence of a rearrangement of MYC as well as of BCL2 and BCL6. A final diagnosis of “triple-hit” high-grade B cell lymphoma (HGBL) was thus made. This entity belongs to the HGBL category of the WHO 2016 classification and shares characteristics with diffuse large B-cell lymphoma and Burkitt lymphoma. The diagnosis of this entity can be complex, in particular in view of a significant morphological variability. The cytogenetic work-up is thus essential for the differential diagnosis.

(BELG J HEMATOL 2021;12(7):318–22)

Recurrent deep venous thrombo-embolism in an obese anticoagulated patient

SUMMARY

Deep venous thrombosis (DVT) is a medical emergency requiring immediate anticoagulant treatment to prevent further clot formation and pulmonary thrombo-embolism. We present here the case of a patient affected by class I obesity who suffered from recurrent DVT despite anticoagulation with rivaroxaban.¹ After a switch to VKA, it appeared that the patient also presented resistance to vitamin K antagonists (VKA). Through this case, we would like to highlight the factors that must be taken into account when initiating and monitoring an anticoagulation therapy, including obesity and VKA resistance.

(BELG J HEMATOL 2021;12(7):323–6)

EBV-induced double hit transformation of splenic (marginal zone) lymphoma, in a patient with a chronic Hepatitis B virus hepatitis

SUMMARY

We report a case of an EBV-induced large-cell transformation of a splenic marginal zone lymphoma in an 81-year-old female with a simultaneous finding of hepatitis B viral infection.

(BELG J HEMATOL 2021;12(6):275-9)

Coombs-negative haemolysis in hepatosplenic T-cell lymphoma

SUMMARY

We present to you a Coombs-negative haemolytic anaemia in a patient with a hepatosplenic T-cell lymphoma (HSTL). The underlying mechanism was considered to be due to the massive hypersplenism or a Coombs negative immune-mediated direct cytotoxic mechanism, which has been previously described in patients with HSTL. Our patient was treated with cytostatic therapy consisting of dexamethasone, cytarabin and cisplatin (DHAP), followed by allogenic stem cell transplantation, after which complete remission was achieved.

(BELG J HEMATOL 2022;13(8):316–20)

Hepatosplenic Candidiasis (Chronic Disseminated Candidiasis) in a patient with acute myeloid leukaemia: A case report

SUMMARY

This case report describes the diagnosis and treatment of hepatosplenic candidasis (or chronic disseminated candidiasis) in a young man with acute myeloid leukaemia (AML). The disease is characterized by persisting fever during treatment with broad-spectrum antibiotics after neutropenia. Sometimes the preceded candidemia is detected. The diagnosis can be made, using radiographic imaging (CT scan/PET scan), supported by histologic examination of a (liver) biopsy. Cultures can be negative. The β-D-glucan test and PCR assays might be of supportive value. Long-term antifungal medication (several months) is necessary. In some cases, fever only disappears after the start of corticosteroids.

(BELG J HEMATOL 2022;13(8):321–4)

Complete response of Sweet syndrome associated with myelodysplastic syndrome to 5-azacytidine

SUMMARY

Sweet syndrome (SS), known as acute febrile neutrophilic dermatosis, is an inflammatory disorder characterised by the abrupt appearance of painful, oedematous and erythematous skin lesions. It is a relatively rare phenomenon, with unknown pathogenesis but is often associated with haematological malignancies. We present the case of a 74-year old patient with low risk myelodysplastic syndrome (MDS) (IPSS-R of three) who suffered from Sweet syndrome complicated by inflammatory ischemic events and weight loss. The patient was treated for his underlying MDS with 5-azacytidine (Vidaza) (samples obtained from Celgene) after failure of other commercially available therapies for SS. His signs and symptoms resolved in a few months and his quality of life significantly improved over time.

(BELG J HEMATOL 2021;12(4):169-72)

Intracranial myeloid sarcoma as rare presentation of BCR-ABL-positive acute myeloid leukaemia: A case report

SUMMARY

Introduction: BCR-ABL positive acute myeloid leukaemia is recognised as a provisional entity in the WHO 2016 classification for AML and related precursor neoplasms. Myeloid sarcoma is an extramedullary accumulation of immature myeloid cells, intracranial occurrence is rare.

Case report: A 40-year old male presented with an intracranial mass and peripheral blood blastosis of 65%. A diagnosis of acute myeloid leukaemia with intracranial myeloid sarcoma was presumed, requiring urgent cranial decompression. The patient received standard AML induction therapy with daunorubicine and cytarabine. Molecular analysis surprisingly revealed BCR-ABL positivity.

Discussion: BCR-ABL positive AML is a rare entity and needs to be differentiated from CML in blast crisis because of therapeutic consequences. In our case, clinical and molecular features suggested a diagnosis of AML.

Conclusion: To the best of our knowledge, this is the first case of intracranial myeloid sarcoma as a concurrent presentation of BCR-ABL-positive acute myeloid leukaemia.

(BELG J HEMATOL 2021;12(4):165-8)