rifampin and Myelodysplastic-Syndromes

Mycobacteruim kansasii occasionally causes disseminated infection with poor outcome in immunocompromised patients. We report the first case of disseminated M. kansasii infection associated with multiple skin lesions in a 48-yr-old male with myelodysplastic syndrome. The patient continuously had taken glucocorticoid during 21 months and had multiple skin lesions developed before 9 months without complete resolution until admission. Skin and mediastinoscopic paratracheal lymph node (LN) biopsies showed necrotizing granuloma with many acid-fast bacilli. M. kansasii was cultured from skin, sputum, and paratracheal LNs. The patient had been treated successfully with isoniazid, rifampin, ethmabutol, and clarithromycin, but died due to small bowel obstruction. Our case emphasizes that chronic skin lesions can lead to severe, disseminated M. kansasii infection in an immunocompromised patient. All available cases of disseminated M. kansasii infection in non HIV-infected patients reported since 1953 are comprehensively reviewed.

Topics: Antitubercular Agents; Clarithromycin; Glucocorticoids; Humans; Immunocompromised Host; Isoniazid; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Myelodysplastic Syndromes; Rifampin; Skin Diseases, Bacterial; Sputum; Sweet Syndrome

Myelodysplastic syndrome (MDS) was sorted out two types; primary type and secondary type caused by irradiation or several drugs. Clinical features and chromosomal analysis were investigated in two patients with secondary MDS, caused by cyclophosphamide (CPM) or rifampicin (RFP) respectively, and fourteen cases of primary MDS hospitalized from 1988 to 1993. Two cases of secondary MDS progressed refractory anemia with excess of blasts (RAEB), however two of 14 patients with primary MDS progressed to acute leukemia. Median survival was similar in two groups. In cytogenitic analysis, complex abnormalities including -5/5q- and/or -7/7q- have two cases of secondary MDS and nine out of 14 cases of primary MDS. Complex chromosomal abnormalities did not improve following chemotherapy. In this study, clinical features and cytogenetic analysis demonstrated no significant difference between primary and secondary MDS.

Topics: Aged; Anemia, Refractory, with Excess of Blasts; Antibiotics, Antitubercular; Chromosome Aberrations; Cyclophosphamide; Disease Progression; Humans; Immunosuppressive Agents; Male; Myelodysplastic Syndromes; Rifampin

Seventeen cases of infections due to Cunninghamella species have been reported worldwide in humans, and there have been only three survivors. We report a case of paranasal sinusitis due to Cunninghamella bertholletiae in an elderly patient who had diabetes mellitus and myelodysplasia. After receiving 7 weeks of therapy with deoxycholate amphotericin B (44 mg/kg or a total of 3 g) and rifampin, the patient was cured and did not have to undergo radical surgery.

Topics: Aged; Amphotericin B; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Ethmoid Sinusitis; Humans; Male; Maxillary Sinusitis; Mucorales; Mucormycosis; Myelodysplastic Syndromes; Paranasal Sinuses; Rifampin; Tomography, X-Ray Computed

Mycobacterium colombiense (M. colombiense) is a member of the Mycobacterium avium complex (MAC). To our knowledge, this is the third case report of an M. colombiense infection. An 80-year-old man, immunocompromised by myelodysplastic syndrome (MDS), developed a skin rash with exfoliation and eruption on his face and scalp. Mycobacteria were detected in pus samples. Broad-range polymerase chain reaction (PCR) revealed the mycobacteria to be M. colombiense. The lesions resolved after daily administration of rifampicin, ethambutol, and clarithromycin. In conclusion, broad-range PCR identified this rare mycobacterium, allowing for the administration of appropriate combination antibiotic therapy.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Clarithromycin; Ethambutol; Humans; Immunocompromised Host; Male; Middle Aged; Mycobacterium; Mycobacterium Infections; Myelodysplastic Syndromes; Rifampin; Treatment Outcome

We hypothesize that a large group of medical conditions of unknown etiology including leukemia, multiple myeloma, myelodysplastic and autoimmune disorders, may be associated with or caused by an obscure group of intracellular obligate parasitic bacteria named Ehrlichia/Anaplasma (EA). Ensconced in the stem cells of the bone marrow, EA may disrupt the normal development and function of many of the cells of immunity, manifesting itself as different syndromes. Recent studies of the activity of EA suggest direct effects on the immune system consistent with the manifestations of leukemia. We reference here three leukemia patients with direct or indirect evidence of EA infection. Moreover, EA have been shown to be most sensitive to rifamycins. Two moribund leukemia patients with levels of platelets and white cells incompatible with life were treated with therapeutic doses of Rifampin. Though they did not survive, their condition improved dramatically for a time, suggesting Rifampin provided some therapeutic benefit. We assert that these results warrant more extensive study.

Topics: Adolescent; Anti-Bacterial Agents; Autoimmune Diseases; Blood Platelets; Ehrlichia; Ehrlichiosis; Female; Humans; Immune System; Leukemia; Male; Middle Aged; Multiple Myeloma; Myelodysplastic Syndromes; Polycythemia Vera; Polymerase Chain Reaction; Rifampin

Topics: Antibiotics, Antitubercular; Antifungal Agents; Drug Interactions; Female; Hematopoietic Stem Cell Transplantation; Humans; Immunosuppressive Agents; Itraconazole; Middle Aged; Myelodysplastic Syndromes; Rifampin; Tacrolimus; Transplantation, Homologous