HEMATOCASE

Rituximab induced serum sickness or immune complex deposition disease: case report and desensitisation protocol

SUMMARY

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)

Severe neutropenia in an infant after treatment with infliximab during pregnancy

SUMMARY

We describe a 7-month-old girl with severe neutropenia born to a mother treated for ulcerative colitis with infliximab until the 24^th week of pregnancy. Despite the recommendation of using Tumour Necrosis Factor inhibitors (TNFi) only in the first and second trimester of pregnancy, significant levels of TNFi in offspring are possible. Hence, drug-induced neutropenia should be considered in the differential diagnosis of infants with severe neutropenia if these were exposed to TNFi in utero. Moreover, additional information is given on the risk of infection and dysfunctional immune development in these new-borns.

(BELG J HEMATOL 2019;10(7):285–9)

Spuriously high MCV in a patient with diabetic ketoacidosis

SUMMARY

We report a case of a falsely increased mean corpuscular volume (MCV) due to severe hyperglycaemia in a patient with diabetic ketoacidosis. This phenomenon results from in vitro swelling of hyperosmolar red blood cell size when diluted in an iso-osmolar buffer of a haematology analyser, and does not reflect a true macrocytosis in vivo. The magnitude of this effect is dependent on the glucose concentration of the sample and time of incubation prior to analysis. Haematology analysers from three different manufacturers were found equally sensitive to this phenomenon. Therefore, it is suggested to use reluctance when reporting and interpreting MCV results in the case of severe hyperglycaemia to avoid unnecessary additional investigation.

(BELG J HEMATOL 2019;10(6):250–4)

The complex diagnosis of post-transfusion purpura: a case report

Post-transfusion purpura (PTP) is a rare but potential lethal transfusion complication. This immune-mediated transfusion reaction can occur three to ten days after a transfusion of a product containing platelets or platelet antigens. Antibodies against human platelet antigen (HPA)-1a are most frequently identified as causal, although antibodies against other HPA antigens have been demonstrated. The rarity of PTP and its manifestation under complex clinical conditions associated with thrombocytopenia often delays the clinical and laboratory suspicion to include PTP in the differential diagnosis. The treatment mainly consists of suppression of the platelet destruction. We present a patient illustrating the typical complexity of the clinical manifestation, diagnosis and treatment of PTP.

(BELG J HEMATOL 2019;10(4):177–82)

An unusual mononucleosis infectiosa-like illness caused by toxoplasmosis in a B-cell chronic lymphocytic leukaemia patient

The differential diagnosis of mononucleosis infectiosa (Ml)-like illness can be challenging since several infectious causes have been identified to date. The most common associated pathogen is Epstein-Barr virus, followed by cytomegalovirus, human immunodeficiency virus type 1 and human herpesvirus-6. Ml-like illness is rather rarely caused by Toxoplasma gondii, a parasite that is transmitted through consumption of undercooked food or contact with faeces from infected cats. In this case report, we discuss a B-cell chronic lymphocytic leukaemia patient with a Ml-like illness caused by toxoplasmosis.

(BELG J HEMATOL 2019;10(3):122–6)

When winter is coming, you better keep warm

A 75-year-old patient presented with fluctuating swelling around the eyes, vasculitis at the lower legs and back of the upper legs and an extreme hypogammaglobulinaemia. An extensive work-up revealed the presence of secondary immunoglobulin M cryoglobulinaemia related to a monoclonal B-cell lymphocytosis. Precipitation of proteins also resulted in a decreased C1-esterase inhibitor causing angioedema. She was treated with an elderly chronic lymphocytic leukaemia regimen consisting of obinutuzumab and chlorambucil with a subsequent clinical and haematological remission.

(BELG J HEMATOL 2019;10(2):85–8)

Management of extended breast implant-associated anaplastic large cell lymphoma

SUMMARY

We report the case of a 69-year-old woman who presented an aggressive breast implant-associated anaplastic large cell lymphoma with supra- and infradiaphragmatic disease. The diagnosis was made 17 years after her first prosthesis, following a right breast carcinoma, and three years after the replacement of this first prosthesis. Breast implant-associated anaplastic large cell lymphoma is a rare form of non-Hodgkin lymphoma caused by a breast implant. Unique features of this case include the fast clinical extension of a lymphoma that is indolent in the vast majority of the cases. Indeed, less than two months after the first symptoms on the breast, cutaneous metastasis appeared on the right arm. The key diagnosis exams are histology and immunohistochemistry including CD30 and cytotoxic markers and a PET-scan to evaluate the extension of the disease. The treatment should include removal of the prosthesis and any associated mass. Local residual or unresectable disease may benefit from radiation therapy to the chest wall. For regional lymph node involvement or confirmed extended disease, adjuvant chemotherapy more in line with systemic anaplastic large cell lymphoma anaplastic lymphoma kinase-negative treatments is recommended. Finally, brentuximab vedotin, an anti-CD30 monoclonal antibody, showed encouraging results in refractory disease but still needs more prospective trials.

(BELG J HEMATOL 2018;9(7):279–84)