phenylephrine-hydrochloride and Leukemia--Myeloid--Acute

A 42-year-old woman with a history of acute myeloid leukaemia status postallogeneic stem cell transplant presented with fevers, altered mental status, pulmonary infiltrates and septic shock that further progressed to thrombocytopenia and purpura fulminans. Laboratory studies were consistent with a diagnosis of thrombotic thrombocytopenic purpura (TTP). Blood cultures grew

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Diagnosis, Differential; Female; Fibrinolytic Agents; Fingers; Gangrene; Glucocorticoids; Graft vs Host Disease; Humans; Immunologic Factors; Leukemia, Myeloid, Acute; Nose; Plasma Exchange; Pneumococcal Infections; Purpura Fulminans; Purpura, Thrombotic Thrombocytopenic; Rituximab; Shock, Septic; Single-Domain Antibodies; Stem Cell Transplantation; Toes

Staphylococcus aureus frequently causes infections in outpatient and hospital settings and can present as a highly variable entity. Typical manifestations are endocarditis, osteoarticular infections or infection of implanted prostheses, intravascular devices or foreign bodies. A thorough diagnostic evaluation with early focus identification is mandatory to improve patient outcome.. We report a case of a 68-year old patient with a history of double allogeneic stem cell transplant for acute myeloid leukemia who developed a S. aureus bacteremia with dissemination, severe sepsis and lethal outcome due to nasal handkerchief packing after nose bleeding.. A thorough medical examination with further diagnostic work-up is most important in S. aureus blood stream infection to identify and eradicate the portal(s) of entry, to rule out endocarditis, to search for spinal abscesses, osteomyelitis or spondylodiscitis. Adherence to management guides for clinicians must be of major importance to achieve optimal quality of clinical care, and thus improve patient outcome.

Topics: Aged; Bacteremia; Cross Infection; Diagnosis, Differential; Fatal Outcome; Germany; Humans; Leukemia, Myeloid, Acute; Male; Nose; Staphylococcal Infections; Staphylococcus aureus; Stem Cell Transplantation; Transplantation, Homologous

Intensive chemotherapy for pediatric acute myeloid leukemia incurs the risk of infectious complications, but the benefits of antibiotic prophylaxis remain unclear.. In the current study, among 103 children treated on the AML02 protocol between October 2002 and October 2008 at St. Jude Children's Research Hospital, the authors retrospectively assessed the effect of antibiotic prophylaxis on the frequency of febrile neutropenia, clinically or microbiologically confirmed infections (including bacteremia), and antibiotic resistance, as well as on the results of nasal and rectal surveillance cultures. Initially, patients received no prophylaxis or oral cephalosporin (group A). The protocol was then amended to administer intravenous cefepime alone or intravenous vancomycin plus either oral cephalosporin, oral ciprofloxacin, or intravenous cefepime (group B).. There were 334 infectious episodes. Patients in group A had a significantly greater frequency of documented infections and bacteremia (both P < .0001) (including gram-positive and gram-negative bacteremia; P = .0003 and .001, respectively) compared with patients in group B, especially viridans streptococcal bacteremia (P = .001). The incidence of febrile neutropenia without documented infection was not found to be different between the 2 groups. Five cases of bacteremia with vancomycin-resistant enterococci (VRE) occurred in group B (vs none in group A), without related mortality. Two of these cases were preceded by positive VRE rectal surveillance cultures.. Outpatient intravenous antibiotic prophylaxis is feasible in children with acute myeloid leukemia and reduces the frequency of documented infection but not of febrile neutropenia. Despite the emergence of VRE bacteremia, the benefits favor antibiotic prophylaxis. Creative approaches to shorten the duration of prophylaxis and thereby minimize resistance should be explored.

Topics: Administration, Oral; Adolescent; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteremia; Bacterial Infections; Candidiasis; Cefepime; Cephalosporins; Chemotherapy-Induced Febrile Neutropenia; Child; Child, Preschool; Ciprofloxacin; Consolidation Chemotherapy; Drug Therapy, Combination; Feasibility Studies; Female; Humans; Incidence; Induction Chemotherapy; Infant; Infusions, Intravenous; Leukemia, Myeloid, Acute; Male; Neoplasm Staging; Nose; Outpatients; Rectum; Retrospective Studies; Treatment Outcome; Vancomycin; Young Adult

Topics: Hematopoietic Stem Cell Transplantation; Hemorrhage; Humans; Leukemia, Myeloid, Acute; Male; Nose

Topics: Acyclovir; Female; Herpes Simplex; Humans; Leukemia, Myeloid, Acute; Middle Aged; Mupirocin; Nose; Nose Diseases; Simplexvirus

To determine if simultaneous, bilateral lateral rhinotomies for medial maxillectomies would result in central skin or bone loss in pediatric patients with invasive fungal disease.. Retrospective chart review.. Tertiary care children's hospital.. Three children underwent surgery between April 1996 and June 1998. Ages at treatment ranged from 11 to 14 years. All had bilateral, biopsy-proven invasive fungal disease of the lateral walls of the nose. All were undergoing chemotherapy for acute lymphocytic leukemia (ALL) or acute myelocytic leukemia (AML).. Bilateral lateral rhinotomies for medial maxillectomy. Two of 3 also had simultaneous total septectomy.. Skin survival and patient survival.. All three patients had bilateral simultaneous medial maxillectomy for invasive fungal disease in the presence of profound pancytopenia secondary to treatment of leukemia. One patient had minor nasal edema postoperatively, but none showed any loss of the central nasal skin or facial skeleton. All patients survived the invasive fungal disease with follow-up of at least 24 months. All patients underwent multiple debridements after the original surgery, and 3 of 6 eyes had permanent epiphora requiring dacryocystorhinostomies.. Bilateral simultaneous lateral rhinotomies are safe in children and did not result in any central skin loss. Aggressive bilateral surgery for invasive fungal disease is compatible with a good esthetic outcome and long-term survival.

Topics: Adolescent; Child; Female; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Male; Maxillary Sinus; Maxillary Sinusitis; Mycoses; Nose; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies

Topics: Acremonium; Ankle; Antineoplastic Combined Chemotherapy Protocols; Child, Preschool; Colony Count, Microbial; Dermatomycoses; Facial Dermatoses; Fusarium; Humans; Immunocompromised Host; Leg Dermatoses; Leukemia, Myeloid, Acute; Male; Nose; Opportunistic Infections

Topics: Child; Ecthyma; Female; Gangrene; Humans; Leukemia, Myeloid, Acute; Necrosis; Nose; Opportunistic Infections; Osteonecrosis; Pseudomonas Infections; Skin

Granulocytic sarcoma of the skin is only rarely the initial manifestation of acute granulocytic leukemia. In the absence of systemic signs and symptoms of leukemia, routine histologic examination of granulocytic sarcoma may result in misdiagnosis. A case of granulocytic sarcoma preceding overt leukemia is reported in which the biopsy specimen was initially interpreted as granuloma faciale.

Topics: Aged; Diagnosis, Differential; Granuloma; Humans; Leukemia, Myeloid, Acute; Male; Nose; Nose Neoplasms; Skin Neoplasms

A patient developed a cutaneous deposit of leukaemic cells within a squamous cell carcinoma as the first presentation of acute myeloblastic leukaemia.

Topics: Aged; Carcinoma, Squamous Cell; Facial Neoplasms; Humans; Leukemia, Myeloid, Acute; Male; Neoplasms, Multiple Primary; Nose; Skin; Skin Neoplasms

Topics: Acute Disease; Adult; Amphotericin B; Blood Cell Count; Blood Platelets; Candida; Candidiasis; Cytarabine; Feces; Fever; Humans; Hypersplenism; Leukemia; Leukemia, Myeloid, Acute; Leukocyte Count; Male; Nose; Pharynx; Prednisone; Skin; Spleen