DOCSLIB.ORG

Improvement in Waldenström's Macroglobulinemia After Successful

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Improvement in Waldenström's Macroglobulinemia After Successful 1072 Crespi M, et al. , 2018; 17 (6): 1072-1077 CASE REPORT November-December, Vol. 17 No. 6, 2018: 1072-1077 The Official Journal of the Mexican Association of Hepatology, the Latin-American Association for Study of the Liver and the Canadian Association for the Study of the Liver Improvement in Waldenström’s Macroglobulinemia after Successful Treatment of HCV with Direct-acting Antivirals Mattia Crespi,* Maria Giulia Demarzo,* Matteo Brunacci,* Gaia Pellegatta,* Fabio Ferrando,** Alberto Ballestrero,** Federica Grillo,*** Vincenzo Savarino,* Edoardo G. Giannini* * Gastroenterology Unit, Ospedale Policlinico San Martino, IRCCS per l’Oncologia, University of Genoa, Genoa, Italy. ** Internal Medicine and Oncology Unit, Department of Internal Medicine, Ospedale Policlinico San Martino, IRCCS per l’Oncologia, University of Genoa, Genoa, Italy. *** Pathology Unit, Department of Surgical Sciences, Ospedale Policlinico San Martino, IRCCS per l’Oncologia, University of Genoa, Genoa, Italy. ABSTRACT Chronic hepatitis C (HCV) virus infection may be associated with several non-hepatic manifestations, mainly driven by chronic im- mune stimulation, such as mixed cryoglobulinemia and Non-Hodgkin’s Lymphoma. This association has been proved by several meta-analyses and some interventional studies demonstrating that antiviral treatment may be effective in inducing HCV-associated lymphoma regression. The recent advent of direct acting antivirals (DAAs) in the therapeutic armamentarium of HCV infection made possible treatment of patients with advanced liver disease. Here we report on a rare association of a cirrhotic patient with HCV and Waldenström’s Macroglobulinemia with severe cryoglobulinemia, who had already failed an interferon-based antiviral regimen, whose haematologic disease was ameliorated by HCV eradication following treatment with sofosbuvir and simeprevir with ribavirin, and where successful treatment was accompanied also by consistent improvement in liver function and parameters of portal hyperten- sion. Key words. Cirrhosis. Portal hypertension. Outcome. Haematology. BACKGROUND HCV infection has several non-hepatic manifestations, mainly driven by chronic immune stimulation, such as Hepatitis C virus (HCV) infects more than 184 million mixed cryoglobulinemia and Non-Hodgkin’s Lymphoma people worldwide, and sequelae of chronic infection such (NHL).7 This association has been proved by several as chronic hepatitis, cirrhosis, and hepatocellular carcino- meta-analyses and some interventional studies demon- ma represent a major public health problem.1 The recent strating that antiviral treatment with pegylated-IFN or development of direct-acting antiviral agents (DAAs) for DAAs, in monotherapy or in combination with ribavirin, the treatment of chronic HCV infection in adults-in par- is effective in inducing HCV-associated lymphoma re- ticular second generation DAA that made possible inter- gression.7-9 As a result, the antiviral treatment has been feron (IFN)-free therapy – has revolutionized the proposed as first line therapy in asymptomatic patients treatment of HCV infection allowing for safe treatment of with HCV- related indolent NHL who do not need im- patients with advanced disease with unprecedented high mediate conventional treatment. Despite a potential addi- rates of sustained virological response (SVR).2 It is pro- tive effect inherent to its immune-modulatory properties, jected that by 2030 chronic HCV infection should theoret- IFN treatment has a low SVR rate in patients with cirrho- ically be confined, but even after few years from the sis and is burdened by several side effects, being not rec- introduction of DAAs the landscape of patients with HCV ommended in patients with advanced disease; therefore, infection and advanced disease has dramatically changed, DAAs therapy is the treatment of choice in these patients with a chance of delisting patients due to improved liver due to a better profile of safety and efficacy. function, and a decline in listing for liver transplantation Among B-cell NHL, the main subtypes associated with and occurrence of hepatocellular carcinoma.3-6 Moreover, HCV are marginal zone lymphoma, diffuse large B-cell Manuscript received: October 18, 2017. Manuscript accepted: December 28, 2017. DOI:10.5604/01.3001.0012.2124 HCV clearance and outcome of Waldenström’s Macroglobulinemia. , 2018; 17 (6): 1072-1077 1073 lymphoma, and lymphoplasmacytic lymphoma.10 Walden- lithiasis, and steroid-induced diabetes. The patient was re- ström’s Macroglobulinemia (WM) is a lymphoplasma- ferred to our Unit from the Haemato-Oncology Unit of cytic lymphoma characterised by the production of the Internal Medicine Department where, in 2009, she was monoclonal IgM involving bone marrow, and there is evi- diagnosed with WM (monoclonal component: 36-43 g/L) dence for an association between HCV infection and WM, by bone marrow biopsy (Figure 1). The haematologic ma- with a 3-fold higher risk of this lymphoproliferative disor- lignancy was associated with mixed cryoglobulinemia der in HCV-positive subjects as compared to controls.10,11 (cryocrite: 89%) and vasculitis. At diagnosis, due to the Although the evidence for this association is nevertheless presence of renal damage, the patient underwent kidney debated and data on optimal treatment of patients affected biopsy with evidence of membranoproliferative glomeru- by WM with concurrent HCV infection are limited, there lonephritis. At the same time, the patient complained of are reports of antiviral treatment in these patients.12 At the symptoms compatible with peripheral neuropathy (sensi- same time, however, the downstream consequences of tive and motor deficit). A first cycle of rituximab was ad- clinical features of WM such as cryoglobulinemia-in- ministered in November 2009, with a mild clinical duced renal damage, as well as the side effects of drugs response (improvement of vasculitis-related peripheral used to treat the underlying haematologic malignancy (e.g., neuropathy) but with no monoclonal component reduc- steroids, anti-CD 20), may hamper successful antiviral tion. When the patient was referred to our Unit, clinical treatment. and biochemical work-up was compatible with compen- This case reports on a middle-aged lady with chronic sated cirrhosis without clinically relevant portal hyperten- HCV infection, cirrhosis, and WM. In this case, the course sion, and a 48-week course of antiviral treatment with of disease was worsened by severe renal damage due to pegylated-IFN α2a (135 µg/weekly) with low-dose ribavi- cryoglobulinemia that required rituximab and steroids rin (200 mg/daily) due to reduced glomerular filtration treatment; the patient was unsuccessfully treated with an rate, was started. Antiviral treatment, besides being bur- IFN-based therapy in the pre-DAAs era, and was later re- dened by the common side effects of IFN and ribavirin treated with DAAs obtaining SVR and showing, besides (anaemia, fatigue, flu-like symptoms) and despite erythro- improvement in liver function, also a dramatic improve- poietin support, led to a worsening of peripheral neurop- ment in clinical and biochemical manifestations of WM. athy (need for crutches) that greatly affected the patient’s quality of life. This notwithstanding, the patient was able CASE PRESENTATION to complete the whole course of antiviral treatment, showing negativity of serum HCV RNA during therapy, A 50-year-old Caucasian lady was referred to our Gas- but with reappearance of viraemia at the end of treatment troenterology Unit in 2010 for assessment of chronic HCV (relapse). In December 2012 the patient was admitted to infection (genotype 1b) and cirrhosis. hospital because of bilateral feet ischaemia, with instru- Medical history included hemicolectomy for congeni- mental evidence of severe peripheral vasoconstriction as tal megacolon at the age of 20, cholecystectomy for biliary the cause of symptoms, for which she was treated with in- Figure 1. Bone marrow biopsy showing focale intertrabecular infiltration of lymphoplasmacytic cells (yellow circle) with plasmocytoid features (see inset A) and expression of CD20 (see inset B). Haematoxylin and Eosin, x20 magnification, main figure; Haematoxylin and Eosin, x60 magnification, inset A; CD20, x60 magnification, inset B. 1074 Crespi M, et al. , 2018; 17 (6): 1072-1077 A. Monoclonal component (g/L). 70 DAA treatment 60 50 40 30 Rituximab treatment 20 10 Jul-11 Jul-12 Jul-13 Jul-14 Jul-15 Jul-16 Oct-11 Jan-12 Apr-12 Oct-12 Jan-13 Apr-13 Oct-13 Jan-14 Apr-14 Oct-14 Jan-15 Apr-15 Oct-15 Jan-16 Apr-16 Oct-16 Jan-17 Apr-17 B.B.P-IgM (g/L). 90 80 DAA treatment 70 60 50 40 30 Rituximab treatment 20 10 Jul-11 Jul-12 Jul-13 Jul-14 Jul-15 Jul-16 Oct-11 Jan-12 Apr-12 Oct-12 Jan-13 Apr-13 Oct-13 Jan-14 Apr-14 Oct-14 Jan-15 Apr-15 Oct-15 Jan-16 Apr-16 Oct-16 Jan-17 Apr-17 Figure 2. P-IgM (g/L). Monoclonal component (g/L). Modifications in monoclonal component (A) and plasmatic IgM (B) during the course of the disease. travenous iloprost and metilprednisolone. Moreover, due (nadir: 27.3 g/L, Figure 2A) and plasmatic IgM (41.5 g/L, to the absence of other therapeutic options for HCV infec- Figure 2B) that lingered on even after treatment cessation tion and the presence of symptoms, the patient underwent and during follow-up. Bence-Jones protein in urine be- three more cycles of rituximab until May 2015, although came negative. Moreover, we also observed consistently she experienced no significant haematologic and clinical satisfying haemoglobin levels despite
Load more

Recommended publications
  • Adult Congenital Megacolon with Acute Fecal Obstruction and Diabetic Nephropathy: a Case Report
    2726 EXPERIMENTAL AND THERAPEUTIC MEDICINE 18: 2726-2730, 2019 Adult congenital megacolon with acute fecal obstruction and diabetic nephropathy: A case report MINGYUAN ZHANG1,2 and KEFENG DING1 1Colorectal Surgery Department, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000; 2Department of Gastrointestinal Surgery, Yinzhou Peoples' Hospital, Ningbo, Zhejiang 315000, P.R. China Received November 27, 2018; Accepted June 20, 2019 DOI: 10.3892/etm.2019.7852 Abstract. Megacolon is a congenital disorder. Adult congen- sufficient amount of bowel should be removed, particularly the ital megacolon (ACM), also known as adult Hirschsprung's aganglionic segment (2). The present study reports on a case of disease, is rare and frequently manifests as constipation. ACM a 56-year-old patient with ACM, fecal impaction and diabetic is caused by the absence of ganglion cells in the submucosa nephropathy. or myenteric plexus of the bowel. Most patients undergo treat- ment of megacolon at a young age, but certain patients cannot Case report be treated until they develop bowel obstruction in adulthood. Bowel obstruction in adults always occurs in complex clinical A 56-year-old male patient with a history of chronic constipa- situations and it is frequently combined with comorbidities, tion presented to the emergency department of Yinzhou including bowel tumors, volvulus, hernias, hypertension or Peoples' Hospital (Ningbo, China) in February 2018. The diabetes mellitus. Surgical intervention is always required in patient had experienced vague abdominal distention for such cases. To avoid recurrence, a sufficient amount of bowel several days. Prior to admission, chronic bowel obstruction should be removed, particularly the aganglionic segment.
    [Show full text]
  • Up-Date on Solitary Plasmacytoma and Its Main Differences with Multiple Myeloma P
    Experimental Oncology 27, 7-12, 2005 (March) 7 Exp Oncol 2005 27, 1, 7-12 UP-DATE ON SOLITARY PLASMACYTOMA AND ITS MAIN DIFFERENCES WITH MULTIPLE MYELOMA P. Di Micco1,*, B. Di Micco2 1Thrombosis center, Instituto Clinico Humanitas, Milan, Italy 2Clinical Chemistry, University of Sannio, Benevento, Italy Solitary plasmacytoma is plasma cell neoplasm. It is a localized bone disease and for this reason it is different from multiple myeloma (systemic plasma cell neoplasm). Sometimes, solitary plasmacytoma precedes a following multi- ple myeloma. Clinical findings of solitary plasmacytoma are related to the univocal localization on damaged bone, while laboratory findings could be similar to multiple myeloma (i.e. M component, kidney dysfunction, blood calcium alterations, increased β-2-microglobulin). However, during a solitary plasmacytoma, laboratory findings could not be present contemporaneously such clinical complications (i.e. kidney failure, immunological disorders with a trend toward infectious disease and/or autoimmunity, neurological disorders, haematological disorders, amyloidosis, POEMS syndrome). These raise the reason because solitary plasmacytoma has better prognosis compared to multiple myeloma. Key Words: solitary plasmacytoma, multiple myeloma. General information damages are principally related to light chains and are Plasmacytoma, a clonal neoplastic disorder of bone quickly eliminated representing the Beence-Jones pro- marrow that originates from plasma cells, the last mat- tein in the urine [9, 10]. Moreover, immunoglobulin pro- uration stage of B lymphocytes [1-2], may appear as duced by plasmacytoma may be insoluble if cold tem- three different diseases: multiple myeloma (systemic perature is present, so causing a cryoglobulinemia [5, disease), extramedullary plasmacytoma and solitary 11], in particular if a chronic C viral hepatitis is associ- plasmacytoma (localized bone disease) [3].
    [Show full text]
  • Etiology and Management of Toxic Megacolon with Human
    GASTROENTEROLOGY 1994;107:898-883 Etiology and Management of Toxic Megacolon in Patients With Human lmmunodeficiency Virus Infection LAURENT BEAUGERIE,* YANN NG&* FRANCOIS GOUJARD,’ SHAHIN GHARAKHANIAN,§ FRANCK CARBONNEL,* JACQUELINE LUBOINSKI, ” MICHEL MALAFOSSE,’ WILLY ROZENBAUM,§ and YVES LE QUINTREC* Departments of *Gastroenterology, ‘Surgery, %fectious Diseases, and llPathology, Hdpital Rothschild, Paris, France We report six cases of toxic megacolon in patients with megacolon, we opted for nonsurgical treatment of colonic human immunodeficiency virus (HIV). One case, at an decompression and anti-CMV treatment with a favorable early stage of HIV infection, mimicked a severe attack short-term outcome. of Crohn’s disease, with a negative search for infec- tious agents. Subtotal colectomy was successfully per- Case Report formed with an uneventful postoperative course. The All of the cases of toxic megacolon in patients with five other cases concerned patients with acquired im- HIV seen at Rothschild Hospital between 1988 and 1992 were munodeficiency syndrome at a late stage of immunode- reviewed. During this period, 2430 patients were seen in the ficiency. They were related to Clostridium ditTcile or hospital for HIV infection. Diagnostic criteria for toxic mega- cytomegalovirus (CMV) intestinal infection in two and colon were defined as follows: (1) histologically proven colitis; three patients, respectively. One case of CMV colitis (2) radiological dilatation of the transverse colon on x-ray film presented macroscopically and histologically as pseu- of the abdomen with a colonic diameter above 6 cm at the domembranous colitis. Emergency subtotal colectomy, point of maximum dilatation’*; and (3) evidence of at least performed in the first four patients with acquired immu- two of these following signs’: tachycardia greater than 100 nodeficiency syndrome was followed by a fatal postop beats per minute, body temperature >38.6”C, leukocytosis erative outcome.
    [Show full text]
  • Toxic Megacolon with Colonic Ischemia Masquerading As Diabetic Ketoacidosis: a Case Report F
    Saudi Journal of Medical and Pharmaceutical Sciences Abbreviated Key Title: Saudi J Med Pharm Sci ISSN 2413-4929 (Print) |ISSN 2413-4910 (Online) Scholars Middle East Publishers, Dubai, United Arab Emirates Journal homepage: https://saudijournals.com/sjmps Case Report Toxic Megacolon with Colonic Ischemia Masquerading as Diabetic Ketoacidosis: A Case Report F. Mansouri* Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia DOI: 10.36348/sjmps.2020.v06i01.010 | Received: 03.01.2020 | Accepted: 15.01.2020 | Published: 22.01.2020 *Corresponding author: Mansouri F Abstract A previously healthy 12-year-old boy presented with abdominal pain and clinical and laboratory features highly suggestive of diabetic ketoacidosis. When his blood glucose plummeted and his urinary ketones disappeared within the first hour of insulin therapy, while his abdominal pain, acidosis and hemodynamic status failed to improve despite vigorous fluid resuscitation, the diagnosis of diabetic ketoacidosis was questioned. At laparotomy, gangrenous, hugely dilated large bowel was found, requiring a subtotal colectomy from the cecum to the sigmoid colon; leaving the patient with an ileostomy. The child survived a complicated postoperative course and is currently doing well. Keywords: Ischemic bowel, toxic megacolon, diabetic ketoacidosis. Copyright @ 2020: This is an open-access article distributed under the terms of the Creative Commons Attribution license which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use (NonCommercial, or CC-BY-NC) provided the original author and source are credited. NTRODUCTION never been on any treatment and had been incompliant I with dietary modifications. 4 days prior to presentation, Twenty percent to 40% of children with newly he had progressively worsening episodes of abdominal diagnosed insulin-dependent (type-I) diabetes mellitus pain, mainly in his right lower quadrant (RLQ).
    [Show full text]
  • Megacolon Toxic of Idiophatic Origin: Case Report
    DOI: http://dx.doi.org/10.22516/25007440.256 Case report Megacolon toxic of idiophatic origin: case report Sergio Andrés Siado,1 Héctor Conrado Jiménez,2 Carlos Mauricio Martínez Montalvo.3 1 General Surgeon at Clinica Belo Horizonte and Abstract Clinica Medilaser in Neiva, Huila, Colombia 2 Epidemiologist and second year resident in general Toxic megacolon is a pathology whose mortality rate is over 80%. A progressive inflammatory process com- surgery at Universidad Surcolombiana and the promises the colon wall, and secondary dilation of the intestinal lumen occurs due to inflammatory or in- Hospital Universitario Hernando Moncaleano fectious processes. Its clinical presentation is bizarre. but the basic pillars for management are opportune Perdomo in Neiva, Huila, Colombia 3 General Practitioner at the Universidad diagnosis and adequate medical management with antibiotics, water resuscitation, and metabolic correction. Surcolombiana in Neiva, Huila, Colombia If necessary, effective surgical management can prevent the development of complications that worsen the disease and the prognosis of a patient. In this article we present the case of a patient who died after deve- Corresponding author: Carlos Mauricio Martinez Montalvo. [email protected] loping septic shock secondary to toxic megacolon. Cholangitis grade III was suspected, but discarded after ultrasonography, and this resulted in generated distortions in approach and initial management. Due to clinical ......................................... deterioration and abdominal distension, the patient underwent diagnostic laparoscopy which revealed severe Received: 08-08-17 Accepted: 13-04-18 ischemic compromise of the entire colon but without involvement of the small intestine. For this reason, a total colectomy was performed. The pathology report and clinical history ruled out ulcerative colitis or Crohn’s disease which confirmed the diagnosis of toxic megacolon.
    [Show full text]
  • Initial Evaluation of the Patient with Waldenstro¨ M Macroglobulinemia Can Be Challenging
    Initial Evaluation of the Patient with Waldenstro¨m Macroglobulinemia Jorge J. Castillo, MD*, Steven P. Treon, MD, PhD KEYWORDS Waldenstro¨ m macroglobulinemia Bone marrow aspiration Anemia Hyperviscosity Cryoglobulinemia Peripheral neuropathy Bing-Neel syndrome Amyloidosis KEY POINTS The initial evaluation of the patient with Waldenstro¨ m macroglobulinemia can be challenging. Not only is Waldenstro¨ m macroglobulinemia a rare disease, but the clinical features of pa- tients with Waldenstro¨ m macroglobulinemia can vary greatly from patient to patient. The authors provide concise and practical recommendations for the initial evaluation of patients with Waldenstro¨ m macroglobulinemia, specifically regarding history taking, physical examination, laboratory testing, bone marrow aspiration and biopsy evaluation, and imaging studies. The authors review the most common special clinical situations seen in patients with Wal- denstro¨ m macroglobulinemia, especially anemia, hyperviscosity, cryoglobulinemia, pe- ripheral neuropathy, extramedullary disease, Bing-Neel syndrome, and amyloidosis. INTRODUCTION Given its rarity and a highly variable clinical presentation, the initial evaluation of the patient with a clinicopathologic diagnosis of Waldenstro¨ m macroglobulinemia (WM) can be challenging. The clinical manifestations of WM can be associated with infiltra- tion of the bone marrow and other organs by malignant lymphoplasmacytic cells and/ or the properties of the monoclonal IgM paraproteinemia, and include anemia, hyper- viscosity,
    [Show full text]
  • Cryoglobulinemia in Sjögren Syndrome: a Disease Subset That
    The Journal of Rheumatology Cryoglobulinemia in Sjögren Syndrome: A Disease Subset that Links Higher Systemic Disease Activity, Autoimmunity, and Local B Cell Proliferation in Mucosa-associated Lymphoid Tissue Luca Quartuccio, Chiara Baldini, Roberta Priori, Elena Bartoloni, Francesco Carubbi, Alessia Alunno, Saviana Gandolfo, Serena Colafrancesco, Roberto Giacomelli, Roberto Gerli, Guido Valesini, Stefano Bombardieri, Salvatore De Vita and the GRISS Group DOI: 10.3899/jrheum.161465 http://www.jrheum.org/content/early/2017/05/09/jrheum.161465 1. Sign up for TOCs and other alerts http://www.jrheum.org/alerts 2. Information on Subscriptions http://jrheum.com/faq 3. Information on permissions/orders of reprints http://jrheum.com/reprints_permissions The Journal of Rheumatology is a monthly international serial edited by Earl D. Silverman featuring research articles on clinical subjects from scientists working in rheumatology and related fields. Downloaded from www.jrheum.org on July 31, 2017 - Published by The Journal of Rheumatology Cryoglobulinemia in Sjögren Syndrome: A Disease Subset that Links Higher Systemic Disease Activity, Autoimmunity, and Local B Cell Proliferation in Mucosa-associated Lymphoid Tissue Luca Quartuccio, Chiara Baldini, Roberta Priori, Elena Bartoloni, Francesco Carubbi, Alessia Alunno, Saviana Gandolfo, Serena Colafrancesco, Roberto Giacomelli, Roberto Gerli, Guido Valesini, Stefano Bombardieri, and Salvatore De Vita, the GRISS Group ABSTRACT. Objective. To compare systemic disease activity by validated tools, i.e., the European League Against Rheumatism Sjögren Syndrome Disease Activity Index (ESSDAI) and the Clinical ESSDAI (ClinESSDAI) scores, between primary Sjögren syndrome (pSS) with positive serum cryoglobulins and pSS without serum cryoglobulins. Methods. There were 825 consecutive patients with pSS who were retrospectively evaluated.
    [Show full text]
  • Understanding the Cryoglobulinemias
    Current Rheumatology Reports (2019) 21:60 https://doi.org/10.1007/s11926-019-0859-0 VASCULITIS (L ESPINOZA, SECTION EDITOR) Understanding the Cryoglobulinemias Alejandro Fuentes1 & Claudia Mardones1 & Paula I. Burgos1 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Purpose of the Review Cryoglobulins are immunoglobulins with the ability to precipitate at temperatures <37 °C. They are related to hematological disorders, infections [especially hepatitis C virus (HCV)], and autoimmune diseases. In this article, the state of the art on Cryoglobulinemic Vasculitis (CV), in a helpful and schematic way, with a special focus on HCV related Mixed Cryoglobulinemia treatment are reviewed. Recent Findings Direct – acting antivirals (DAA) against HCV have emerged as an important key in HCV treatment to related Cryoglobulinemic Vasculitis, and should be kept in mind as the initial treatment in non–severe manifestations. On the other hand, a recent consensus panel has published their recommendations for treatment in severe and life threatening manifestations of Mixed Cryoglobulinemias. Summary HCV-Cryoglobulinemic vasculitis is the most frequent form of CV. There are new treatment options in HCV-CV with DAA, with an important number of patients achieving complete response and sustained virologic response (SVR). In cases of severe forms of CV, treatment with Rituximab and PLEX are options. The lack of data on maintenance therapy could impulse future studies in this setting. Keywords HCV . Mixed Cryoglobulinemia . Type I Cryoglobulinemia . gC1qR . Direct-acting antivirals . Rituximab Introduction and Definitions tion of the total pool of cryoprecipitable immunocomplexes in targeted vessels and due to false negative results owing to im- Cryoglobulins are immunoglobulins (Ig) that precipitate in vitro proper blood sampling or inadequate laboratory processes [4].
    [Show full text]
  • MEGACOLON Parry R Photo: by Nadene Stapleton, Veterinary Surgeon
    HEALTH RMS is more commonly observed in older rabbits MEGACOLON Parry R Photo: By Nadene Stapleton, Veterinary Surgeon aving owned many species of pets over the years caecum and the colon that food is separated into two fractions. Material I am constantly in awe of my rabbits’ relationship high in indigestible fibre passes from the small intestine to the colon and Hwith food. I don’t believe I have come across out in the form of normal (copious) round poo particles which we know all another pet as food motivated as they are (it is as too well! though we are kindred spirits!). I often joke with other rabbit owners that my rabbits are just a ‘stomach Smaller, highly digestible particulate matter moves backwards from the covered in fluff’ personality-wise, but the same can be colon into the caecum where it is fermented to form caecotrophs which said for them anatomically as well. are then eaten by the rabbit from the rectum. The passage of material through the gut is helped by a wave of contractions of the wall of the The digestive system intestine known as peristalsis. It is a reduction in this normal movement of the gut wall that veterinarians refer to as ‘gut stasis’. There is a reason why descriptions of the digestive system of rabbits and gastrointestinal diseases affecting There is a very important and very complex area of the colon which is them make up such a large part of the rabbit veterinary rich in blood vessels and nerves called the ‘fusus coli’ (figure 1).
    [Show full text]
  • Progression of a Solitary, Malignant Cutaneous Plasma-Cell Tumour to Multiple Myeloma in a Cat
    Case Report Progression of a solitary, malignant cutaneous plasma-cell tumour to multiple myeloma in a cat A. Radhakrishnan1, R. E. Risbon1, R. T. Patel1, B. Ruiz2 and C. A. Clifford3 1 Mathew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA, USA 2 Antech Diagnostics, Farmingdale, NY, USA 3 Red Bank Veterinary Hospital, Red Bank, NJ, USA Abstract An 11-year-old male domestic shorthair cat was examined because of a soft-tissue mass on the left tarsus previously diagnosed as a malignant extramedullary plasmacytoma. Findings of further diagnostic tests carried out to evaluate the patient for multiple myeloma were negative. Five Keywords hyperproteinaemia, months later, the cat developed clinical evidence of multiple myeloma based on positive Bence monoclonal gammopathy, Jones proteinuria, monoclonal gammopathy and circulating atypical plasma cells. This case multiple myeloma, pancytopenia, represents an unusual presentation for this disease and documents progression of an plasmacytoma extramedullary plasmacytoma to multiple myeloma in the cat. Introduction naemia, although it also can occur with IgG or IgA Plasma-cell neoplasms are rare in companion ani- hypersecretion (Matus & Leifer, 1985; Dorfman & mals. They represent less than 1% of all tumours in Dimski, 1992). Clinical signs of hyperviscosity dogs and are even less common in cats (Weber & include coagulopathy, neurologic signs (dementia Tebeau, 1998). Diseases represented in this category and ataxia), dilated retinal vessels, retinal haemor- of neoplasia include multiple myeloma (MM), rhage or detachment, and cardiomyopathy immunoglobulin M (IgM) macroglobulinaemia (Dorfman & Dimski, 1992; Forrester et al., 1992). and solitary plasmacytoma (Vail, 2001). These con- Coagulopathy can result from the M-component ditions can result in an excess secretion of Igs interfering with the normal function of platelets or (paraproteins or M-component) which produce a clotting factors.
    [Show full text]
  • Significance of Antiphospholipid Antibodies in Essential Cryoglobulin- Emia: a Case Report and Review of Literature Rama Atluri and Mian Muhammad Rizwan*
    Atluri and Rizwan. Clin Med Rev Case Rep 2017, 4:151 Volume 4 | Issue 1 Clinical Medical Reviews ISSN: 2378-3656 and Case Reports Case Report: Open Access Significance of Antiphospholipid Antibodies in Essential Cryoglobulin- emia: A Case Report and Review of Literature Rama Atluri and Mian Muhammad Rizwan* Division of Rheumatology, Saint Louis University, St Louis, USA *Corresponding author: Mian Muhammad Rizwan, Fellow Rheumatology, Division of Rheumatology, 1402 South Grand Boulevard, Doisy Hall, Room 203, St Louis, MO 63104, USA, Tel: 314-977-8832, Fax: 314-977-8818, E-mail: [email protected] monoclonal cryoglobulins. In 1990s it was established that most Abstract of these essential MC are associated with chronic hepatitis C virus Cryoglobulinemia is a rare immune-complex-mediated small vessel (HCV) infection [2,3]. We now know that MC is associated with vasculitis that has a smoldering clinical course and can potentially clinical situations that generate large amounts of IgG and immune involve multiple organ systems. The discovery of its relationship complexes, including chronic autoimmune diseases such as systemic with hepatitis C infection shows the striking association between lupus erythematosus, Sjögren’s syndrome [4] or infections such as a viral infection, an autoimmune disease and lymphoproliferative HCV and HIV infections. MC not associated with those disorders disorders. It is estimated that hepatitis C negative cryoglobulinemia accounts for about 5% to 10% of cases. There have been sporadic has been defined as essential (primary) MC. The clinical features, reports of association between cryoglobulins and antiphospholipid etiologies, and treatment of MC not associated with HCV infection antibody leading to the suspicion that they participate in the have been poorly described.
    [Show full text]
  • Introducing Hill's Prescription Diet Gastrointestinal
    NEW INGREDIENT TECHNOLOGY SEE GI ISSUES IN A NEW LIGHT WITH MICROBIOME SCIENCE NEW HILL’S PRESCRIPTION DIET GASTROINTESTINAL BIOME revolutionises the way you tackle fibre-responsive GI issues. DRY DRY STEW FIBRE-RESPONSIVE GI ISSUES ARE DISRUPTIVE TO THE PET, YOUR CLIENT AND YOU Fibre-Responsive Enteropathies Antibiotic-Responsive Diarrhoea Diarrhoea Constipation Colitis Megacolon* *responsive to fibre No matter the cause, GI issues can be stressful and emotions often run high. A new approach to GI care: The microbiome “ I was always worried about a flare-up • Traditional fibre foods primarily or worried about having to wake up work by affecting water balance to and clean diarrhoea off the floor.” help manage clinical signs “ My cat seemed frail before. • Groundbreaking new science and CAROLINE K., I grew incredibly concerned OWNER OF PIPER, research highlights the critical role 9-YEAR-OLD about his constipation problems.” a dog’s or cat’s gut microbiome can JACK RUSSELL MIX play in not only their response to GI RICKY E., OWNER OF COUNT RUGAN, issues, but also in determining their 11-YEAR-OLD GREY TABBY overall well-being What is the gut microbiome? Billions of various microorganisms, with a dynamic interaction between desirable and undesirable bacteria, which is unique to each pet. Microbiome balance influences the transition between health, and acute or chronic GI disease. FINALLY — NUTRITION THAT USES THE POWER OF THE PET’S OWN MICROBIOME Introducing Hill’s Prescription Diet Gastrointestinal Biome — a first-of-its-kind, great-tasting
    [Show full text]