Hepatitis C and double-hit B cell lymphoma successfully treated by antiviral therapy

B cells lymphoma is one of the most challenging extrahepatic manifestations of hepatitis C virus(HCV). Recently, a new kind of B-cell lymphoma, named doublehit B(DHL), was characterized with an aggressive clinical course whereas a potential association with HCV was not investigated. The new antiviral direct agents(DAAs) against HCV are effective and curative in the majority of HCV infections. We report the first case, to our knowledge, of DHL and HCV-infection successfully treated by new DAAs. According to our experience, a DHL must be suspected in case of HCV-related lymphoma, and an early diagnosis could direct towards a different hematological management because a worse prognosis might be expected. A possible effect of DAAs on DHL regression should be investigated, but eradicating HCV would avoid life-threatening reactivation of viral hepatitis during pharmacological immunosuppression in oncohaematological diseases.

Detection of anti-aquaporin-4 autoantibodies in the sera of Chinese neuromyelitis optica patients

In this study, we recruited 10 neuromyelitis optica patients, two multiple sclerosis patients and two myelitis patients. Chinese hamster lung fibroblast （V79） cells transfected with a human aquaporin-4-mCherry fusion protein gene were used to detect anti-aquaporin-4 antibody in neuromyelitis optica patient sera by immunofluorescence. Anti-aquaporin-4 autoantibody was stably detected by immunofluorescence in neuromyelitis optica patient sera exclusively. The sensitivity of the assay for neuromyelitis optica was 90% and the specificity for neuromyelitis optica was 100%. The anti-aquaporin-4 antibody titers in sera were tested with serial dilutions until the signal disappeared. A positive correlation was detected between Expanded Disability Status Scale scores and serum anti-aquaporin-4 antibody titers. The anti-aquaporin-4 antibody assay is highly sensitive and specific in the sera of Chinese neuromyelitis optica patients. Detection of aquaporin-4 autoantibody is important for the diagnosis and treatment of neuromyelitis optica.

Cytomegalovirus reactivation after autologous stem cell transplantation in myeloma and lymphoma patients:A single-center study

AIM: To determine the incidence of and the risk factors for cytomegalovirus(CMV) symptomatic infection and end-organ disease after autologous stem cell transplantation(ASCT).METHODS: A total of 327 consecutive non CD34+ selected autografts performed from the Hematology and Stem Cell Transplantation Unit of Regina Elena National Cancer Institute of Rome(Italy) in the period comprised between January 2003 to January 2015, were reviewed. Over the 327 autografts, 201 were performed in patients with multiple myeloma, whereas the remaining 126 in patients affected by non-Hodgkin's lymphoma and Hodgkin's lymphoma. The patients who underwent an ASCT for an acute leukemia(n = 20) in the sameperiod were excluded from this analysis. CMV DNA load in the blood has been determined by polymerasechain reaction in the case of a clinical suspicion of reactivation, therefore, no routine monitoring strategy was adopted. In the presence of signs and symptoms of CMV reactivation an antiviral treatment was performed.RESULTS: Overall, 36 patients(11%) required a specific antiviral treatment for a symptomatic CMV reactivation(n = 32) or an end-organ disease(n = 4). We observed 20 and 16 cases of CMV reactivation among lymphoma(16%) and myeloma patients(8%), respectively. Among cases of end-organ disease, 3 were diagnosed as interstitial pneumonia and one remaining case as hemorrhagic enteritis. All cases of CMV reactivation were observed in Ig G seropositive patients, with no documented cases of primary CMV infection. All patients were treated with a specific antiviral therapy, with a global rate of hospitalization of 55%; four patients received intravenous immunoglobulins. Transplantrelated mortality was significantly higher in patients who experienced a CMV reactivation(8.4% ± 4.7% vs 1.7% ± 0.8%; P = 0.047). In univariate analysis, a pretransplant HBc Ig G seropositivity, a diagnosis of T-cell non-Hodgkin's lymphoma and higher median age at transplant were significantly associated with the risk of developing a clinically relevant CMV infection requiring specific antiviral therapy(P < 0.001, P = 0.042 and P = 0.004, respectively). In multivariate analysis, only a pretransplant HBc Ig G seropositivity(OR = 8.928, 95%CI: 1.991-33.321; P = 0.023) and a diagnosis of T-cell nonHodgkin's lymphoma(OR = 4.739, 95%CI: 1.511-11.112; P = 0.042) proved to be independent predictors of a post-transplant clinically relevant CMV reactivation. CONCLUSION: A symptomatic CMV infection can occur in about 11% of adult patients with lymphoma or myeloma undergoing ASCT. A pre-transplant HBc Ig G seropositivity and a diagnosis of T-cell non-Hodgkin's lymphoma should be considered as independent predictor factors of CMV reactivation.

Acute symptomatic seizures in newborns:a narrative review

Acute symptomatic seizures are the main sign of neurological dysfunction in newborns.This is linked to the unique characteristics of the neonatal brain,making it hyperexcitable compared to older ages,and to the common occurrence of some forms of acquired brain injury,namely hypoxic-ischemic encephalopathy.In this narrative review we will provide an overview of neonatal seizures definition,their main underlying etiologies,diagnostic work-up and differential diagnoses,and will discuss about therapeutic options and prognostic outlook.The latest publications from the ILAE Task Force on Neonatal Seizures will be presented and discussed.Of note,they highlight the current lack of robust evidence in this field of clinical neurology.We will also report on specificities pertaining to low-and-middle income countries in terms of incidence,main etiologies and diagnosis.The possibilities offered by telemedicine and automated seizures detection will also be summarized in order to provide a framework for future directions in seizures diagnosis and management with a global perspective.Many challenges and opportunities for improving identification,monitoring and treatment of acute symptomatic seizures in newborns exist.All current caveats potentially represent different lines of research with the aim to provide better care and reach a deeper understanding of this important topic of neonatal neurology.