RESUMO
The infections caused by Dipodascus capitatus are rare, and the treatment is difficult. We reported a case of a patient with acute myeloid leukemia. The fungus was first isolated from hemocultures, and the phenotypic identification was based on mycological methods. The genotyping was carried out by sequencing the region D1/D2 from 26 rDNA. The susceptibility tests were assayed by Etest® and by the microdilution technique. None of the antifungal treatments employed were effective. The patient died on day 17 after the mycological diagnosis. The authors discussed the emergence of such infections as well as the difficulty regarding the diagnosis and treatment.
Assuntos
Dipodascus/isolamento & purificação , Leucemia Mieloide Aguda/microbiologia , Micoses/microbiologia , Adolescente , DNA Fúngico/análise , DNA Ribossômico/análise , Dipodascus/genética , Evolução Fatal , Feminino , Genótipo , Humanos , Testes de Sensibilidade MicrobianaRESUMO
As infecções causadas por Dipodascus capitatus são raras e de difícil tratamento. Aqui se relata um caso em paciente com leucemia mielocítica aguda. O isolamento fúngico ocorreu a partir de hemocultura e a identificação fenotípica baseou-se em métodos micológicos clássicos; a identificação genotípica foi realizada através do sequenciamento da região D1/D2 do 26 rDNA. Os testes de suscetibilidade foram realizados através do Etest® e microdiluição em caldo. A antifungicoterapia foi ineficaz, registrando-se óbito da paciente no 17° dia após o diagnóstico. Os autores comparam o caso com relatos similares e discutem a emergência destas infecções bem como suas dificuldades diagnósticas e terapêuticas.
The infections caused by Dipodascus capitatus are rare, and the treatment is difficult. We reported a case of a patient with acute myeloid leukemia. The fungus was first isolated from hemocultures, and the phenotypic identification was based on mycological methods. The genotyping was carried out by sequencing the region D1/D2 from 26 rDNA. The susceptibility tests were assayed by Etest® and by the microdilution technique. None of the antifungal treatments employed were effective. The patient died on day 17 after the mycological diagnosis. The authors discussed the emergence of such infections as well as the difficulty regarding the diagnosis and treatment.
Assuntos
Adolescente , Feminino , Humanos , Dipodascus/isolamento & purificação , Leucemia Mieloide Aguda/microbiologia , Micoses/microbiologia , DNA Fúngico/análise , DNA Ribossômico/análise , Dipodascus/genética , Evolução Fatal , Genótipo , Testes de Sensibilidade MicrobianaRESUMO
Extramedullary involvement occurs infrequently in acute promyelocytic leukemia and is said to be more common after treatment with all-trans retinoic acid. We describe a 9-year-old girl who had an isolated external auditory canal and middle ear relapse after treatment with all-trans retinoic acid and chemotherapy. A patient with cytogenetically and molecularly confirmed acute promyelocytic leukemia developed isolated extramedullary relapse in the auditory canal and middle ear 4 years and 9 months after initial diagnosis, while in hematologic and molecular remission, successfully treated with arsenic trioxide alone.
Assuntos
Arsenicais/uso terapêutico , Meato Acústico Externo/patologia , Neoplasias da Orelha/diagnóstico , Orelha Média/patologia , Leucemia Promielocítica Aguda/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Óxidos/uso terapêutico , Trióxido de Arsênio , Criança , Meato Acústico Externo/efeitos dos fármacos , Neoplasias da Orelha/tratamento farmacológico , Orelha Média/efeitos dos fármacos , Feminino , Humanos , Leucemia Promielocítica Aguda/tratamento farmacológico , Resultado do TratamentoRESUMO
The presence of the t(12;21)(p13;q22) distinguishes a subset of children with acute lymphoblastic leukemia (ALL) that present a favorable prognosis. This is a cryptic translocation difficult to detect through conventional cytogenetics. In this study, bone marrow samples from 30 children with ALL from southern Brazil were evaluated by fluorescence in situ hybridization (FISH) for the t(12;21), using locus specific probes to detect the TEL/AML1 rearrangement. The selection criteria included: age (0-12 years old); FAB classification (L1 or L2), absence of specific clonal chromosomal aberrations; and adequate cellular integrity to perform FISH analysis. A frequency of 40% of the t(12;21) was observed, in addition to extra copies of the AML1 gene in 7.5% of patients. These findings were analyzed in relation to the patient's clinical parameters and compared with other pediatric populations.