Coccidioidomycosis involving the lung is common in endemic areas. However, it is unusual for it to present as a solitary bone lesion.Two cases of Coccidioides immitis osteomyelitis clinically and radiographically mimicked a primary bone tumor. Fine needle aspiration (FNA) biopsy of these lytic bone lesions yielded diagnostic material. Aspirated material in 1 case showed a suppurative, granulomatous inflammation and scattered spherules with refractile walls, some containing endospores consistent with coccidioidomycosis. Smears in the other case showed acute inflammation and necrosis, and rare spherules were identified with the Gomori-mathenamine-silver stain. C immitis infection was confirmed by culture in both cases.Although rare, coccidioidomycosis can involve the bone and mimic a primary bone tumor. FNA biopsy is helpful in differentiating between inflammatory and neoplastic processes involving bone by acquiring material for cytologic studies and cultures.
Cytomegalovirus (CMV) pneumonia is reportedly unusual among adults with leukemia who have not undergone transplantation. To assess the frequency of CMV pneumonia and its outcome during the present time, we reviewed the experience of 2136 hospitalized adults with leukemia. Sixty-one patients (2.9%) had CMV pneumonia diagnosed. The frequency doubled from 1.4% in 1992--1994 to 2.8% in 1995--1997 (P<.05). Fifty-four patients (89%) had received treatment with an immunosuppressive chemotherapeutic regimen that contained fludarabine (n=37), high-dose cytoxan (n=17), or both (n=10), and 15 patients (25%) had received granulocyte transfusions that were stimulated with hematopoietic growth factors from unscreened donors. The overall CMV pneumonia--associated mortality rate was 57%. Among autopsied patients who had leukemia, the frequency of CMV pneumonia increased from 0%, 2.3%, and 0% in 1992, 1993, and 1994, respectively, to 4.6%, 6.5%, and 16% in 1995, 1996, and 1997, respectively (P<.05). CMV has emerged as an important cause of life-threatening pneumonia in adults with leukemia who have received potent immunosuppressive therapies and stimulated granulocyte transfusions from unscreened donors.
Abstract Background Cat scratch disease (CSD) mimicking malignancy has been the subject of scattered case reports. To that end, we reviewed patients (pts) with CSD at MD Anderson Cancer Center (MDACC), focusing on the clinical overlap of CSD presentation with that of malignancy. Methods We retrospectively reviewed all pts diagnosed with CSD at MDACC (11/2015-1/2020). CSD was diagnosed based on Bartonella henselae serology, animal exposure and biopsy findings consistent with the diagnosis. We collected data on CSD epidemiology, signs, symptoms, laboratory findings, histopathology, radiological studies, treatment used, outcome and the malignancy mimicked. We also reviewed the published cases of CSD mimicking malignancy (1952-2020). Results We identified 11 such pts; 1 (9%) was male and 5(45%) were ≤ 18 years old. No pt had a prior history of malignancy. All but 1 pt reported an exposure to cats. Only 2/11 (18%) had fever, and none of the pts had skin lesions or hepatosplenomegaly. All pts had lymphadenopathy; 2/11 (18%) had only inguinal lymphadenopathy. PET scan was performed for 3 pts and revealed only enlarged lymph nodes. Several malignancies were considered as initial diagnostic impressions, including sarcoma (n=3), lymphoma (n=2), breast cancer (n=2). Serum Bartonella IgG titer was ≥ 1:512 in 9/11(82%) pts with 3 pts (28%) positive for IgM. 8 pts had a biopsy and non-necrotizing granuloma was the most common finding, present in 4. Azithromycin was used in all 8 pts that were treated. Nearly all pts improved or had resolution of symptoms with one pt having persistent fever and lymphadenopathy. Literature search identified 33 cases of CSD that mimicked malignancy (10 for breast cancer, 10 for lymphoma, 6 for sarcoma with 1 each for lung, pancreatic, parotid and 4 others). Conclusion Although there was a probable referral bias in the CSD pts at MDACC, CSD should be included in the differential diagnosis of malignancy. Although publication biases are probable, literature review also supports the notion that atypical CSD rarely can simulate a variety of malignancies. Disclosures Dimitrios P. Kontoyiannis, MD, Amplyx Pharmaceuticals (Consultant)Astellas Pharma (Consultant)Ciadara Therapeutics (Consultant)Gilead Sciences (Other Financial or Material Support, Honoraria)Mayne Pharma (Consultant)Merck & Co (Consultant, Honoraria)Pharma (Consultant)United Medical (Other Financial or Material Support, Honoraria)
Herbaspirillum species are capable of causing systemic infections in immunocompromised patients. It may present as a nosocomial common-source cluster or sporadic hospital or community-onset infection and is most often misidentified as Burkholderia cepacia. Background. Herbaspirillum species are gram-negative Betaproteobacteria that inhabit the rhizosphere. We investigated a potential cluster of hospital-based Herbaspirillum species infections. Methods. Cases were defined as Herbaspirillum species isolated from a patient in our comprehensive cancer center between 1 January 2006 and 15 October 2013. Case finding was performed by reviewing isolates initially identified as Burkholderia cepacia susceptible to all antibiotics tested, and 16S ribosomal DNA sequencing of available isolates to confirm their identity. Pulsed-field gel electrophoresis (PFGE) was performed to test genetic relatedness. Facility observations, infection prevention assessments, and environmental sampling were performed to investigate potential sources of Herbaspirillum species. Results. Eight cases of Herbaspirillum species were identified. Isolates from the first 5 clustered cases were initially misidentified as B. cepacia, and available isolates from 4 of these cases were indistinguishable. The 3 subsequent cases were identified by prospective surveillance and had different PFGE patterns. All but 1 case-patient had bloodstream infections, and 6 presented with sepsis. Underlying diagnoses included solid tumors (3), leukemia (3), lymphoma (1), and aplastic anemia (1). Herbaspirillum species infections were hospital-onset in 5 patients and community-onset in 3. All symptomatic patients were treated with intravenous antibiotics, and their infections resolved. No environmental source or common mechanism of acquisition was identified. Conclusions. This is the first report of a hospital-based cluster of Herbaspirillum species infections. Herbaspirillum species are capable of causing bacteremia and sepsis in immunocompromised patients. Herbaspirillum species can be misidentified as Burkholderia cepacia by commercially available microbial identification systems.
Background: BK virus infection is highly prevalent in humans, and has been associated with development of HC after UD HSCT. Previously we determined that UD HSCT is independently associated with higher prevalence of HC (El-Zimaity et al. Blood 2004). In order to further investigate the association of BK with HC, we hypothesized that the presence of BK virus in the urine as determined by a PCR assay before UD transplant would be associated with a higher incidence of HC. Methods: We studied prospectively 209 consecutive patients transplanted from 09/05 to 08/07. Preparative regimens were ablative (n = 118) and reduced intensity (n = 91); 38 patients (18%) received cyclophosphamide-containing regimens. GVHD prophylaxis was tacrolimus and mini-methotrexate. Stem cell source was bone marrow (n = 78), peripheral blood (n = 108) and umbilical cord (n = 23). BK virus quantitative PCR was performed on urine samples collected at admission for transplant and on days 15, 30, 45 and 60 after transplant. Results: Median age was 49 years (range, 19–71). Diagnoses were Leukemias (n = 161), Multiple Myeloma (n = 6), Hodgkin's disease (n = 7), Non-Hodgkin's Lymphomas (n = 32), and other(n = 3). Median follow-up is 246 days (range 7–848). BK PCR was positive in 96 patients(46%). Number of viral copies ranged from 200 to >200 million copies. Twenty-eight patients (13.4%) developed HC, at a median of 59 days (range 8–225) after HSCT. The 100-day cumulative incidence (using death as a competing risk) of HC in the PCR positive and negative groups was 13% versus 6% (HR 2.6; 95% CI, 1–6.9; P = 0.05). The one-year cumulative incidence of HC in the PCR positive and negative groups was 16% versus 10% (HR 2; 95% CI, 0.9–4.6; P = 0.09). Incidence of HC (table) was not statistically significantly increased among recipients of cyclophosphamide-containing regimens or among patients with grade II-IV acute GVHD. Conclusion: BK viruria pre-HSCT may increase the risk of developing HC.Tabled 1Incidence of HCHC Yes (n)%non CTX regimen2011CTX regimen410GVHD II-IV812non GVHD910Ablative regimen1815non-Ablative regimen66Stem Cell Source PBSC1312 BM67 CB521 BK PCR > 200 million copies225 BK PCR < 200 million copies1315HC: Hemorrhagic Cystitis; CTX: Cyclophosphamide; PBSC: Peripheral Blood Stem Cell; BM Bone Marrow; CB: Cord Blood. Open table in a new tab HC: Hemorrhagic Cystitis; CTX: Cyclophosphamide; PBSC: Peripheral Blood Stem Cell; BM Bone Marrow; CB: Cord Blood.
Respiratory syncytial virus (RSV) has been demonstrated to be an important cause of life-threatening pneumonia in adult bone marrow transplant recipients; however, its role in other immunocom-promised adults has not been defined. We prospectively studied all adult patients with leukemia who were hospitalized at M. D. Anderson Cancer Center (Houston) during a 1-year period (November 1993 through October 1994). During a 19-week period when RSV was prevalent in the community, it was isolated from 9 (10%) of 87 patients with leukemia who developed an acute respiratory illness. In 6 (75%) of 8 patients with profound chemotherapy-induced myelosuppression, the RSV infection was complicated by pneumonia, with an 83% mortality rate. RSV appears to be an important cause of severe and often fatal pneumonia in myelosuppressed patients with leukemia.
For patients who had cancer and autopsy-proven pneumonia, we evaluated whether cultures of respiratory secretions (sputum and/or bronchoalveolar lavage) performed < or =4 weeks before autopsy were a reliable basis for the diagnosis of pulmonary candidiasis. Pulmonary candidiasis was identified at autopsy in 36 patients, but common clinical predictors were insensitive for this diagnosis. For sputum culture, the sensitivity, specificity, and the positive and negative predictive values were 85%, 60%, 42%, and 93%, respectively; for bronchoalveolar lavage culture, these values were 71%, 57%, 29%, and 89%, respectively.
