rifampin and Hodgkin-Disease

Tuberculosis (TB) is the most common cause of cervical lymphadenopathy in the TB-endemic zone, like India but it can also mimic other diseases. Four cases of cervical lymphadenopathy presented to us as initial treatment failure after completion of six months of antitubercular drugs (ATD), including rifampicin, isoniazid, pyrazinamide, and ethambutol. All were diagnosed as having tuberculosis either by fine needle aspiration cytology or clinically from outside our institution. In one case, tuberculosis was the final diagnosis but, unfortunately, it was multidrug-resistant. In other three cases, Hodgkin disease, Non-Hodgkin lymphoma, and Kikuchi's disease were the diagnoses. In resource-poor countries, like India, which is also a TB-endemic zone, TB should be the first diagnosis in all cases of chronic cervical lymphadenopathy, based on clinical and/or cytological evidences. So, they were correctly advised antitubercular therapy (ATT) initially. Sometimes, TB mimics other aetiologies where apparent initial improvement with ATT finally results in treatment failure. Hence, investigations for microbiological and histopathological diagnosis are warranted, depending on the resources and feasibility. If these tests are not routinely available, the patients should be under close monitoring so that lymphoma, drug-resistant TB, or other aetiologies of cervical lymphadenopathy are not missed. Patients with cervical lymphadenopathy rarely presents acutely; so, a physician can take the opportunity of histopathological study of lymphnode tissue.

Topics: Adolescent; Adult; Antitubercular Agents; Biopsy; Diagnostic Errors; Ethambutol; Female; Histiocytic Necrotizing Lymphadenitis; Hodgkin Disease; Humans; India; Isoniazid; Lymphoma, Non-Hodgkin; Male; Middle Aged; Pyrazinamide; Rifampin; Tuberculosis; Tuberculosis, Multidrug-Resistant; Young Adult

Brain abscesses are a rare but potentially lethal neurological lesions, generally occurring after septic episodes in immunodeficient patients or complicating neurosurgical procedures. Even though they are known complications of surgically treated intracerebral haemorrhages (ICH), the presence of a brain abscess at the site of an untreated ICH is a rare event. Such cases may result from haematogenous spread from distant foci or contiguous sites and are often preceded by episodes of sepsis and local infection. Immunodeficiency, AIDS, age, diabetes mellitus and vitamin-K deficiency are predisposing factors. Abscess formation should be considered in case of clinical deterioration, headache, and any neurological deficit after febrile episodes. Early diagnosis with neuroradiological imaging, infection blood markers and microbiological identification of the causative pathogen is crucial for treatment with surgical drainage or excision and specific antibiotic therapy, which guarantee good outcome and long-term survival. In fact, while prompt diagnosis and treatment guarantee good outcome and long-term survival, morbidity and mortality are very high in case of misdiagnosis. We report a case of a 49-year old man presenting with a brain abscess 13 weeks after a spontaneous ICH, without previous episodes of sepsis and with a suspected septic arthritis 2 weeks after abscess drainage.

Topics: Anti-Bacterial Agents; Brain Abscess; Cerebral Hemorrhage; Chemoradiotherapy; Drainage; Dysarthria; Headache; Hodgkin Disease; Humans; Hypertension; Levofloxacin; Magnetic Resonance Imaging; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nervous System Diseases; Oxacillin; Rifampin; Spine; Tomography, X-Ray Computed; Treatment Outcome

To analyse the impact of intensified prophylaxis with ofloxacin plus rifampin (O+R) in neutropenic patients we used this combination in 40 consecutive cycles of ifosfamide, cytarabine, prednisolone and etoposide (IAPVP-16). This salvage chemotherapy regimen for lymphoma usually produces four to six days of severe neutropenia without significant extrahematologic toxicities. We compared the infectious morbidity during neutropenia under O+R with 58 consecutives cycles using either norfloxacin or no prophylaxis (control group). Fifty-three percent of control group patients and 20% of the O+R group developed febrile neutropenia that required hospital admission (p<0.001, 95% CI for the difference between both proportions of 16% to 51%). Bacteremia was documented in two patients in the O+R group and six in the control group (p=0.08). Gram-positive cocci (GPC) accounted for all six bacteremias in the control group, while both cases in O+R group were due to a quinolone-resistant gram-negative bacteria (GNB) (p<0.01 for GPC). Five patients (13%) who received O+R and 23 (40%) in control group developed fever of unknown origin, p<0.001, while the total duration of hospitalization due to febril neutropenia was 42 days and 158 days, respectively (p<0.001). In conclusion, intensified prophylaxis with O+R appears to reduce the rate of febrile neutropenia and GPC bacteremia in patients with short and severe neutropenia, which translates into a reduction in the need for hospitalization.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Bacteremia; Carmustine; Cyclophosphamide; Etoposide; Female; Fever; Hodgkin Disease; Humans; Length of Stay; Lymphoma; Male; Middle Aged; Neutropenia; Ofloxacin; Opportunistic Infections; Rifampin; Salvage Therapy

Topics: Hodgkin Disease; Humans; Mycoplasma; Rifampin

A patient with Hodgkin's disease (HD) underwent autologous bone marrow transplantation (ABMT). Six months later while receiving interleukin (IL)-2 and alpha-interferon immunotherapy, he developed a painful lesion in his oral cavity with a fistula in the buccal area. Excision biopsy disclosed necrotizing granulomatous inflammation with acid-fast bacillus. The patient received a 9-month course of isoniazide, rifampin and pyrazinamide, and recovered. The possible pathophysiological mechanism is discussed.

Topics: Adjuvants, Immunologic; Adult; Anti-Bacterial Agents; Antitubercular Agents; Bone Marrow Transplantation; Combined Modality Therapy; Disease Susceptibility; Drug Therapy, Combination; Fistula; Hodgkin Disease; Humans; Immunocompromised Host; Interferon-alpha; Interleukin-2; Isoniazid; Male; Opportunistic Infections; Oral Ulcer; Pyrazinamide; Recombinant Proteins; Rifampin; Risk Factors; Transplantation Conditioning; Transplantation, Autologous; Tuberculosis, Oral

Topics: Adult; Erythromycin; Hodgkin Disease; Humans; Legionnaires' Disease; Male; Rifampin

Topics: Adult; Aged; Female; Hodgkin Disease; Humans; Lung Neoplasms; Middle Aged; Remission, Spontaneous; Rifampin; Time Factors

A white child with a long history of illness from the age of six was thought at first to have Hodgkin's disease. There followed an acute illness with lesions involving glands, lungs, bone and skin. Mycobacterium avium-intracellulare group (Battey) was isolated from various lesions at the age of thirteen. After six years of continuous treatment the patient, now eighteen, is living a normal life.

Topics: Adolescent; Bone Diseases; Bone Neoplasms; Child; Diagnosis, Differential; Ethambutol; Hodgkin Disease; Humans; Isoniazid; Kanamycin; Male; Mycobacterium; Mycobacterium avium; Mycobacterium Infections; Radiography; Rifampin; Time Factors

Topics: Female; Herpes Simplex; Hodgkin Disease; Humans; Leukemia, Lymphoid; Male; Recurrence; Rifampin; Rifamycins; Time Factors