BJH - volume 12, issue 3, may 2021
A-S. Vander Mijnsbrugge MD, D. Wijsmans MD, V. Maertens MD
Ibrutinib is an inhibitor of Bruton’s tyrosine kinase used in the treatment of different B-cell malignancies. We describe a case of an 82-year-old woman with known chronic lymphocytic leukaemia (CLL) treated with ibrutinib who presented to the medical department with a symptomatic pericardial and pleural effusion. Extensive investigations were performed to rule out the most common aetiologies. Diagnosis of pleuro-pericardial effusion as an infrequently reported adverse effect of ibrutinib was made. Signs, symptoms, echocardiographic and radiographic abnormalities resolved steadily with anti-inflammatory therapy, pericardiocentesis, various thoracenteses and eventually surgical pleurodesis. Therapy with ibrutinib was definitively interrupted. A similar case of an 88-year-old male patient with stage IV mantle cell lymphoma was seen a few months later. These two cases suggest a causal relationship between therapy with ibrutinib and the onset of a symptomatic pleuropericardial effusion.
(BELG J HEMATOL 2020;12(3):132-7)
Read moreBJH - 2021, issue 2, march 2021
S. Kluijfhout MD, P. Stordeur PhD, M. van den Akker MD, S. Ryckx MD, J. van der Werff ten Bosch MD, PhD
We describe two young children with pneumococcal meningitis, one of them with a complement deficiency. Our aim is to illustrate the importance of testing the complement system in young patients with severe bacterial infections and to stress the importance to respect pre-analytical conditions. We found in a child of consanguineous parents a complement factor I deficiency, which is associated with severe recurrent pyogenic infections mainly caused by Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae. We conclude that complement deficiencies are rare but immunological workup should be done in case of recurrent bacterial infections. Patients need follow up, antibiotic prophylaxis and additional vaccinations.
(BELG J HEMATOL 2020;12(2):85-9)
Read moreBJH - volume 11, issue 7, november 2020
D. Papazoglou MD, A. Salaroli MD, P. Heimann MD, PhD, P. Lewalle MD, PhD, D. Bron MD, PhD
A 47-year-old patient was diagnosed with FIP1L1-PDGFRA-positive myeloid/lymphoid neoplasm with eosinophilia (F/P+ MLN-eo) and was successfully treated with Imatinib, achieving a sustained molecular treatment free remission (TFR) persisting three years after discontinuation.
(BELG J HEMATOL 2020;11(7):320-4)
Read moreBJH - volume 11, issue 7, november 2020
J. Deuson MD, C. Motet MD, L. Delval MD, A-L. Trepant MD, J. Brauner MD
A 65-year-old woman presented with thrombocytopenia. A bone marrow biopsy was done and showed a cellular bone marrow infiltration by 94% of blast-like cells making the diagnosis of acute leukaemia. However, flow cytometry excluded hematological malignancy. After an extensive panel of immunohistochemical stains and genetic analysis, the diagnosis of metastatic alveolar rhabdomyosarcoma was made.
(BELG J HEMATOL 2020;11(7):317-9)
Read moreBJH - volume 11, issue 6, october 2020
E. Damen MD, M. van den Akker MD, S. Diallo MD, S. Uyttebroeck MD, B. Hauser MD, PhD, J. van der Werff ten Bosch MD, PhD
DNAJC21 mutations have recently been discovered as the rare cause of a Swachmann Diamond-like syndrome. So far, fifteen children have been reported in literature. We here describe two new patients from two different families, both harbouring previously undescribed mutations. Our patients had different mutations, but looked phenotypically alike and both presented with oral aversion. One patient presented with amegakaryocytosis only, which is not described as such in literature. The other patient presented with low platelets and only a mild decrease in neutrophils and haemoglobin, had only amegakaryocytosis in the bone marrow and developed pancytopenia soon afterwards. Finally, both patients had low elastase in stool, although they had no clinical signs of pancreatic insufficiency, hinting that this easy test should not be forgotten in the work up of patients with congenital amegakaryocytosis or bone marrow failure syndrome.
(BELG J HEMATOL 2020;11(6):268-71)
Read moreBJH - volume 11, issue 3, may 2020
J. Loos MD, D. Dierickx MD, PhD
Oxaliplatin-based chemotherapy is commonly used to treat colorectal cancer. After prolonged administration it can rarely lead to hypersensitivity reactions such as immune mediated haemolytic anaemia and thrombocytopenia. We present the case of a 50-year old patient admitted with acute onset of fever, dark urine and back pain during the ninth infusion of oxaliplatin. Two weeks before the current event he experienced similar though less severe symptoms. Laboratory signs were compatible with severe Coombs positive haemolytic anaemia, thrombocytopenia and acute kidney injury. Signs of haemolysis abated quickly, however, the patient developed anuria and required dialysis for thirty days. Immune mediated haemolytic anaemia is a rare but potentially life-threatening complication of prolonged oxaliplatin therapy, especially when kidney failure develops. A careful history and high index of suspicion may identify warning signs leading to increased vigilance and possible prevention of such events.
(BELG J HEMATOL 2020;11(3):128–32)
Read moreBJH - volume 11, issue 2, march 2020
N.C. Granacher MD, T. Eyckmans MD
The chimeric monoclonal IgG1 antibody directed to CD20 Rituximab is used to treat various haematological malignancies and auto-immune diseases. Serum sickness is a type III hypersensitivity reaction leading to the formation and tissue deposition of immune antibody-antigen complexes. It has been described as a very rare complication of Rituximab treatment, mainly seen in patients treated for auto-immune diseases. We report the case of a patient with Waldenstrom’s macroglobulinaemia whose Rituximab treatment was complicated by documented immune complex deposition or serum sickness. We successfully applied a Rituximab desensitisation protocol, which allowed us to complete treatment.
(BELG J HEMATOL 2020;11(2):75–8)
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