Continuous High Fever Research Articles

A Case of Dengue Co-infection with Microfilaria

Filariasis is one of the leading causes of long term and permanent disability worldwide. One of the main problem of the disease is that it remains dormant for years but the person is still capable of transmitting the infection to others. Over the past few years dengue has emerged as a rapidly growing and widespread public health problem, with more than half of the world’s population and countries at risk. Majority of cases are subclinical i.e., they are asymptomatic or present with mild flu-like symptoms which are often misdiagnosed as acute febrile illness leading to delay of treatment. Here, authors report a case of 20-year-old male, presented with continuous high grade fever for three days associated with severe headache and generalised body pain. On examination, patient was febrile and all vitals were normal. Laboratory results showed thrombocytopenia, increased haematocrit and peripheral smear findings showed leukopenia, thrombocytopenia and eosinophilia with microfilaria. Hence, this is a case of incidental finding of concurrent infection of dengue with microfilaria.

ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of adrenal insufficiency.

We provide guidance on prevention of adrenal crisis during the global COVID-19 crisis, a time with frequently restricted access to the usual level of healthcare. Patients with adrenal insufficiency are at an increased risk of infection, which may be complicated by developing an adrenal crisis; however, there is currently no evidence that adrenal insufficiency patients are more likely to develop a severe course of disease. We highlight the need for education (sick day rules, stringent social distancing rules), equipment (sufficient glucocorticoid supplies, steroid emergency self-injection kit) and empowerment (steroid emergency card, COVID-19 guidelines) to prevent adrenal crises. In patients with adrenal insufficiency developing an acute COVID-19 infection, which frequently presents with continuous high fever, we suggest oral stress dose cover with 20 mg hydrocortisone every 6 h. We also comment on suggested dosing for patients who usually take modified release hydrocortisone or prednisolone. In patients with adrenal insufficiency showing clinical deterioration during an acute COVID-19 infection, we advise immediate (self-)injection of 100 mg hydrocortisone intramuscularly, followed by continuous i.v. infusion of 200 mg hydrocortisone per 24 h, or until this can be established, and administration of 50 mg hydrocortisone every 6 h. We also advise on doses for infants and children.

A Case Report of Rickettsial Meningitis

Rickettsial diseases are a group of infections caused by the obligate intracellular bacteria Rickettsia. Rickettsial infections are common in southern Europe. The disease is usually characterized by the classical triad of fever, eschar and rash. Complications including neurological involvement are rarely described. We report an unusual case of meningitis in a 55 years old man presenting with high grade fever for 8 days associated with persistent headache. The patient was suspected to have enteric fever and treated with injection ceftriaxone. Forty-eight hours after admission, the presence of continued high grade fever, conjunctival congestion, headache, cough, low platelet and increased WBC count, and elevated transaminase raised the possibility of a different aetiology. Finally, Rickettsial meningitis was confirmed due to history of field visit, presence of eschar, neck rigidity, raised titre of WF OX-K antigen and the cerebrospinal fluid analysis revealed increased cellularity, hypoglycorrhachia, and hyper proteinorrhachia (106 mg/dL). Patient was treated with capsule doxycycline and other supportive therapy and became afebrile within 48 hours. This uncommon clinical scenario should be taken into account in the management of patients with high grade fever on admission.
 Delta Med Col J. Jul 2019 7(2): 100-103

Retroperitoneal abscess secondary to the perianal abscess: a surgical dilemma

Perianal abscess accounts for approximately two third of anorectal infection. Perianal abscess spreading retroperitoneally and forming extensive abscess is very rarely encountered. We are presenting a 33 year old newly diagnosed diabetic patient who presented initially with fever, pain in right loin region and burning micturition since 1 week. Patient also took care of pain during defecation. On DRE, boggy swelling was noted in right lateral wall. USG abdomen and pelvis was normal. Patient diagnosed to have perianal abscess and incision and drainage was done. Subsequently patient developed severe right loin pain and continuous high grade fever. CT abdomen pelvis was done which was suggestive of purulent content retroperitoneally extending to right loin for which incision and drainage was done. Antibiotics as per culture report administered and patient improved.

Chimeric antigen receptors T cells for treatment of 48 relapsed or refractory acute lymphoblastic leukemia children: long term follow-up outcomes

目的评价嵌合抗原受体（CAR）T细胞技术治疗复发、难治儿童急性B淋巴细胞白血病（B-ALL）的疗效，探讨影响预后的因素。方法2014年9月至2017年8月应用第四代CD19特异性CAR-T细胞治疗复发、难治CD19阳性B-ALL/B淋巴母细胞性淋巴瘤患儿48例，其中男29例，女19例，中位年龄8（3~17）岁。48例患儿共接受61次CAR-T细胞输注，观察输注后的不良反应，治疗前后应用流式细胞术或实时定量聚合酶链反应方法监测白血病微小残留病（MRD）水平。中位随访时间406（16~1 259）d。结果61例次CAR-T细胞输注过程中均无不良反应。CAR-T细胞输注后最常见的不良反应为细胞因子释放综合征（CRS）。仅2例患儿出现3级CRS表现，包括持续高热、惊厥、谵妄、浆膜腔积液、血压下降等，1例经对症治疗后好转，另1例应用妥珠单抗治疗后缓解。无一例患者发生CAR-T细胞治疗相关死亡。CAR-T细胞治疗反应率为77.1%，反应出现的时间为输注后第7~28天，CAR-T细胞输注前肿瘤负荷<5%组与≥5%组的反应率分别为87.1%和58.8%（χ2=4.968，P=0.036）。对于有治疗反应的37例患儿，2年总生存率和年龄、疾病状态及CAR-T细胞输注前的肿瘤负荷相关（P<0.05）；而CAR-T细胞输注前的肿瘤负荷≥5%[RR=3.433（95%CI 1.333~8.844），P=0.011]及未桥接造血干细胞移植（HSCT）[RR=4.996（95%CI 1.852~13.474），P=0.001]是影响患儿无事件生存的独立危险因素。结论抗CD19的CAR-T细胞技术治疗儿童复发、难治B-ALL安全有效。通过有效的预处理手段，尽可能降低CAR-T细胞输注前的肿瘤负荷有利于提高CAR-T细胞治疗的反应率。对于难治性白血病或仅分子水平复发的患儿进行CAR-T细胞治疗后桥接HSCT可能是更优的治疗策略。

Role of granulocyte transfusions in combating life-threatening infections in patients with severe neutropenia: Experience from a tertiary care centre in North India.

Bacterial and fungal infections still remain an important cause of mortality in patients with hematological malignancies and in recipients of hematopoietic stem cell transplants (HSCT) especially in developing countries like India. Granulocyte transfusions (GTX) from healthy donors may lead to early clearance of index infection and thus prevent mortality. The aim of the present study was to evaluate the efficacy of GTX in combating life-threatening infections and preventing mortality in patients of hematological disorders/recipients of HSCT with severe neutropenia. This study was a prospective, observational analysis of patients with different hematological disorders/recipients of HSCT, who received GTX from January 2014 to December 2017. All patients had an Absolute neutrophil Count (ANC) < 0.5 x 109/L and a life threatening sepsis defined by presence of hemodynamic instability/ impending septic shock/ continuous high fever despite the use of the highest line of antimicrobials. A total of 143 granulocyte collections were done for 66 infectious episodes (IEs) in 60 patients. Multidrug resistant organisms (MDROs) were observed in 47/66 IEs (71.2%) and fungal infections were seen in 9/66 IEs (13.6%). Resolution of index infection after GTX was seen in 45/66 IEs (68.2%), and the 30 day overall survival (OS) was 67.7%. OS was significantly higher in patients who received GTX within 7 days of neutropenic sepsis (p = 0.01). Patients with MDROs who received early GTX therapy had a better OS as compared to those who received late GTX (p = 0.02). GTX were well tolerated and only 6 patients’ developed mild features of transfusion related acute lung injury (TRALI) which was managed conservatively, and 1 patient demonstrated hypocalcemic tetany. GTX may be of particular relevance in countries like India, where the incidence of infections is very high in neutropenic patients and there is an increasing emergence of MDROs.

Case Report of Scrub Typhus

Scrub typhus is an acute, febrile, infectious illness that is caused by Orientia tsutsugamushi. Scrub and murine endemic typhus infections are under-diagnosed causes of febrile illness across the tropics, and it is not known how common they are in Bangladesh. Here reporting a case who presented with high grade fever for 7 days associated with headache, abdominal discomfort, cough and receiving inj ceftriaxone for 2 days considering as a case of enteric fever. Forty-eight hours after admission, the presence of continued high grade fever, conjunctival congestion, headache, loose motion, cough, low platelet, elevated transaminase raised the possibility of a different aetiology. The two most likely differentials being dengue and malaria. Finally, typhus was discovered due to history of field visit, presence of eschar and raised titre of WF OXK antigen. All other causes of fever were ruled out by history, clinical examination and relevant investigations. Patient was treated with capsule doxycycline and other supportive therapy and become afebrile within 48 hours. This uncommon clinical scenario should be taken into account in the management of patients with high fever on admission.J Bangladesh Coll Phys Surg 2018; 36(3): 123-127

IUse of Mean platelet Volume as an initial diagnostic marker in evaluation of dengue fever

Background: Dengue fever is the most rapidly spreading mosquito-borne viral disease. Four main characteristic manifestations of dengue illness are (i) continuous high fever lasting 2-7 days; (ii) haemorrhagic tendency as shown by a positive tourniquet test, petechiae or epistaxis; (iii) thrombocytopoenia (platelet count <100×109/l); and (iv) evidence of plasma leakage manifested by haemoconcentration (an increase in haematocrit 20% above average for age, sex and population), pleural effusion and ascites, etc. Recently, novel platelet indices such as MPV, PDW, and P-LCR have been investigated as prospective platelet activation markers .Platelet volume, a marker of platelet function and activity is measured as mean platelet volume (MPV) by hematology analyzer. Method: The study was done with the aim to assess whether mean platelet volume has any diagnostic importance in the initial evaluation of dengue fever . 45 adult patients were diagnosed with Dengue NS1 antigen positivity and underwent routine complete blood counts on automated hematology analyser HORIBA Pentra ES60. Result: A total of 76 cases ranging from 6 months to 50 years of age were reported as antigenically positive for dengue indicating acute infection, out of which 45 were adults ranging from 12 to 50 years of age. 34 were male and 11 were female. Infants and children below 12 years of age were not included in this study. 55 controls were studied which included 31 males and 24 females. The mean platelet volume was found to be significantly higher in dengue cases when compared to controls. MPV was also noted to be significantly higher in patients with platelet count below the normal biological reference range of 1.5 lakhs ,when compared to dengue patients with normal platelet counts. Conclusion: To conclude, high MPV indicates platelet activation and may be used as an initial marker to suspect dengue fever in a case of thrombocytopenia.

Flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants

We evaluated the clinical value of flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants. Fifty-five infants with upper urinary tract calculi were included in this study: 41 males and 14 females. Retrograde intrarenal surgery was performed by an 8 Fr/30 cm flexible ureterorenoscope (POLY®) combined with a holmium laser. CT scanning or radiography of the kidneys, ureters, and bladder region was performed one month after the operation to confirm the clearance of calculi. All the 55 infants with calculi in 74 sides underwent 66 flexible ureteroscopic lithotripsy procedures. The median operation time was 30 min. The median amount of flushing fluid was 500 mL. The stone-free rate after a single session treatment was 94.6%, within which 10 infants underwent simultaneous bilateral flexible ureteroscopy lithotripsy. Catheters were retained in 45 infants for 24-48 h after the operation. Continuous high fever due to reflux was present in two cases. Flushing fluid extravasation was found in one infant. Some patients with minor complications, such as mild hematuria, irritation symptoms, and low fever, recovered without treatment. The duration of hospitalization time after the operation was approximately 1-5 days. Flexible ureteroscopic lithotripsy is a safe, highly efficient, minimally invasive, and reproducible operation for removal of upper urinary tract calculi in infants. This technique is a convenient method for postoperative management of patients that enhances their rapid recovery. It is a promising option for therapy of infants ineffectively treated by extracorporeal shockwave lithotripsy.

Mucha-Habermann disease

A case of Mucha-Habermann disease (MHD), possibly associated with macrophage activation syndrome (MAS), is reported. The purpose of this paper was to describe the rare MHD (also known as pityriasis lichenoides et varioliformis acuta – PLEVA) in a 28-year-old male, who presented with generalized ulceronecrotic lesions on the skin and mucosae, gastrointestinal involvement, and heart andliver failure, associated with continuous high fever. The patient might have progressed to MAS and eventually died. The MHD is rare, potentially fatal and has severe systemic complications. The importance of early diagnosis and aggressive treatment is emphasized.

Doença de Mucha-Habermann

A case of Mucha-Habermann disease (MHD), possibly associated with macrophage activation syndrome (MAS), is reported. The purpose of this paper was to describe the rare MHD (also known as pityriasis lichenoides et varioliformis acuta – PLEVA) in a 28-year-old male, who presented with generalized ulceronecrotic lesions on the skin and mucosae, gastrointestinal involvement, and heart andliver failure, associated with continuous high fever. The patient might have progressed to MAS and eventually died. The MHD is rare, potentially fatal and has severe systemic complications. The importance of early diagnosis and aggressive treatment is emphasized.

P2-127 - Pneumocystis Pneumonia in Patients with Solid Tumors during Chemotherapy

ABSTRACT Background Pneumocystis pneumonia (PCP) is an opportunistic infection well recognized in patients with profound T cell immunodeficiency, especially in patients with AIDS. This infection is also a life-threatening complication seen during immunosuppressive chemotherapy for cancer or organ transplantation, so it is important to make an early diagnosis and start treatment. We present three cases of PCP developing during chemotherapy for solid malignancies. Case reports Case 1: A 50-year-old female received a first-line chemotherapy of gemcitabine–docetaxel (GT therapy) for leiomyosarcoma. After three cycles of GT therapy, she was admitted for a non-productive cough and high fever. Her chest radiograph and CT showed diffuse ground-glass bilateral opacities. SpO2 was 90% (room air). Serum b- d -glucan was 66.7 pg/ml. PCR of PCP by using BAL specimens was positive. We diagnosed PCP infection. Case 2: A 70-year-old female received gemcitabine (GEM) monotherapy as a first-line treatment of a pancreas cancer. After two cycles of GEM therapy, she developed dyspnea and a fever of 38°C. Her chest radiograph and CT showed diffuse ground-glass bilateral opacities. SpO2 was 92% (room air). Serum b- d -glucan was 40.8 pg/ml. We diagnosed PCP infection on the basis of these findings. Case 3: A 64-year-old female received neo-adjuvant chemotherapy with 5-fluoropyrimidine, epirubicin and cyclophosphamide (FEC therapy) for a breast cancer. After two cycles of FEC therapy, she was admitted for febrile neutropenia. Although neutropenia was recovered, she developed exertional dyspnea and a non-productive cough with continuous high fever. Her chest CT showed diffuse ground-glass bilateral opacities. SpO2 was 90% (room air). Serum b- d -glucan was 39.5 pg/ml. We diagnosed PCP infection on the basis of these findings. These patients were immediately treated with trimethoprim–sulfamethoxazole (ST) and corticosteroid. The infiltrations and diffuse ground-glass opacities on their chest radiographs improved and they got well. Conclusion We should be careful of not only drug-induced interstitial pneumonia and febrile neutropenia but also PCP during chemotherapy for solid malignancies.

Efficacy of X-ray localization in ESWL (report of 15 019 cases in 23 years)

Objective To summarize the experience of management of upper urinary tract calculi by Extracorporeal Shock Wave Lithotripsy (ESWL) in our department in order to improve the gravel success rate and decrease the incidence of complications.Methods 15 019 patients with upper urinary calculi from October 1988 to September 2011 treated by ESWL with X-ray localization were analyzed retrospectively.The maximum diameter of the stones ranged from 0.8 cm to 3.2 cm,with 1 3 794 cases with maximum stone diameter less than 2 cm (guoup A),and with 1225 cases with maximum stone diameter more than 2 cm (guoup B).All patients had normal or nearly normal renal function,and 56.0％ patients (8 410/15 019)had varying degrees of hydronephrosis.Results The effective rate of first ESWL was 84.5％ ( 12 691/15 019) and the effective rate of second ESWL was 12.0％ (1 802/15 019),and 313 cases need a third ESWL.The clearance rate in group A was 90.2％ ( 12 443/13 794 ),in group B was 50.9％ (623/1225),and the overall stone clearance rate within three months was 87.0％ ( 13 066/15 019).The majority of patients ( about 93％ ) had postoperative gross hematuria,which disappeared after drinking lots of water.46cases (0.3％) of patients had postoperative fever,which returned to normal after usage of antibiotics.There were no serious complications such as kidney hematoma,continuous high fever,continuous hematuria,ureteral stones jams.Conclusions ESWL.with X-ray localization had the advantage of low energy,minor injury,easy localization,uniform stone fragment,because of which it could reduce the complications such as continuity fever,ureter stone james,continuious hematuria.ESWL with X-ray localization could be preferred treatment for upper urinary calculi with diameters between 10 to 20 mm. Key words: X-ray; Extracorporeal shock wave lithotripsy; Upper urinary calculus

耳鼻咽喉科領域の病変を初期症状とした膠原病症例の分析

We investigated 33 patients with collagen disease and related diseases following complaints of otorhinolaryngological symptoms. These 33 patients initially, complained of otorhinolaryngological symptoms, that were later found to be symptoms of collagen disease and related diseases. Twelve collagen diseases and related diseases were diagnosed. Primary Sjögren’s syndrome was definitively diagnosed in 19 patients. Two patients had Sjögren’s syndrome and rheumatoid arthritis, 1 had Sjögren’s syndrome and systemic sclerosis, and 2 had relapsing polychondritis. Temporal arteritis, atypical Cogan syndrome, adult-onset Still’s disease, Wegener’s granulomatosis, Behçet’s disease, systemic sclerosis only, systemic lupus erythematosus, sarcoidosis, and mixed connective tissue disease were diagnosed in 1 patient each. An average of 4.1 patients were diagnosed annually as having collagen disease and related diseases. The proportion of these patients diagnosed with collagen disease and related diseases following complaints of otorhinolaryngological symptoms was 0.3% annually in new outpatients. The most frequent clinical symptom was xerostomia, found in 17 of the 33 patients. All 17 of these patients with xerostomia were diagnosed as having Sjögren’s syndrome, suggesting that the otolaryngologist should carefully examine patients with xerostomia. When a patient was diagnosed as having Sjögren’s syndrome, the otolaryngologist consulted with a collagen disease specialist. Although the patients with temporal arteritis, atypical Cogan syndrome, or adult-onset Still’s disease, presented with high fever and severe otorhinolaryngological symptoms, the actual local otorhinolaryngological findings were mild. Therefore, patients with continuous high fever and severe otorhinolaryngological symptoms in spite of slight local abnormal otorhinolaryngological findings should be considered to have collagen disease or related diseases. Otolaryngologists should be familiar with otorhinolaryngological disturbances associated with collagen disease and related diseases.

Epidemiology and Evolutionary Characteristics of the Porcine Reproductive and Respiratory Syndrome Virus in China between 2006 and 2010

In 2006, an emerging highly pathogenic strain of porcine reproductive and respiratory syndrome virus (PRRSV), which causes continuous high fever and a high proportion of deaths in vaccinated pigs of all ages, broke out in mainland China and spread rapidly to neighboring countries. To examine the epidemiology and evolutionary characteristics of Chinese PRRSV after the 2006 outbreak, we tested 2,981 clinical samples collected from 2006 to 2010 in China, determined 153 Nsp2 sequences and 249 ORF5 sequences, and analyzed the epidemiology and genetic diversity of Chinese PRRSV. Our results showed that the percentage of PRRSV-positive specimens collected from sick pigs averaged 60.85% in the past 5 years and that the highly pathogenic PRRSV has become the dominant strain in China. Furthermore, a reemerging strain which apparently evolved from the highly pathogenic PRRSV strain in 2006 appeared to be widely prevalent in China from 2009 onwards. Sequence analyses revealed that the hypervariable region of Nsp2 in most of the isolates contained a discontinuous deletion equivalent to 30 amino acids, along with other types of deletions. Extensive amino acid substitutions in the GP5 sequence translated from ORF5 were found, particularly in the potential neutralization epitope and the N-glycosylation sites. Our results suggest that Chinese PRRSV has undergone rapid evolution and can circumvent immune responses induced by currently used vaccines. Information from this study will help in understanding the evolutionary characteristics of Chinese PRRSV and assist ongoing efforts to develop and use PRRSV vaccines in the future.

A CASE OF MILIARY TUBERCULOSIS WITH INTERSTITIAL NEPHRITIS DUE TO RE-ADMINISTRATION OF RIFAMPICIN TREATED SUCCESSFULLY WITH S T E ROID

A 26-year-old man was admitted to a hospital complaing of continuous high fever and abdominal swelling. As his sputum and ascites culture was positive for acid-fast bacilli and PCR-TB, he was diagnosed as miliary tuberculosis, tuberculous with pleuritis and peritonitis, and transferrd to our hospital. After initiation of treatment with isoniazid, rifampicin (RFP), ethambutol, and pyrazinamide, RFP was suspended because of direct-reacting hyperbilirubinemia. As the liver function recovered after discontinuation of RFP, low dose of RFP was re-administrated and renal dysfunction was observed. The renal dysfunction continued after discontinuation of suspicious drugs including RFP. As renal biopsy revealed interstitial nephritis, prednisolon 20 mg/day was started and renal function recovered quickly. From the clinical course and examination, we considered interstitial nephritis was due to re-administration of RFP and steroid therapy was effective.

A Case of Pyogenic Liver Abscess Infected with Fusobacterium necrophorum Depicted by Microscopy and Confirmed by Tissue Culture

A 40-year-old man was admitted with a continuous high grade fever accompanying a relatively large solitary liver abscess with septations. A puncture of the abscess revealed gram-negative rods that could be identified histologically as Fusobacterium necrophorum, which was later confirmed by tissue culture. The patient was switched to meropenem and penicillin, and cured of the infection. Fusobacterium necrophorum is a rare bacterium causing potentially fatal liver abscesses in humans. Clinicians should bear Fusobacterium necrophorum in mind when treating patients with an enlarged solitary liver abscess.

BCG膀胱内注入療法を契機に肝障害を伴う間質性肺炎を発症した1例

A 49-year man, with past history of right total nephroureterectomy due to urothelial carcinoma of the right renal pelvis in September 2006 and left partial ureterectomy due to contralateral ureteral recurrence in October 2007, underwent TUR-BT due to superficial high-grade recurrent bladder cancer. After TUR-Bt, he was treated with intravesical Bacillus Calmette-Guérin (BCG) instillation at weekly intervals. Just after 5th instillation, he suffered a continuous high fever up to 38 degrees C and complained of general fatigue. Chest CT showed diffuse micronodular shadows in both lungs, and serum liver enzyme was markedly elevated. All cultures from his sputum and urine were negative for mycobacterium tuberculosis. TB-PCR test and quantiferon were also negative. These findings together with no improvement of the symptoms with anti-tuberculous treatment finally made us to judge that this was due to a hypersensitivity reaction to BCG. Soon after pulse steroid therapy, body temperature was normalized and the abnormal findings of the lung and liver disappeared.

Differenzialdiagnose: Kawasaki-Syndrom

Das Kawasaki-Syndrom, erstbeschrieben durch Tomisaku Kawasaki 1967, ist eine hochfieberhafte Systemerkrankung in Form einer Vaskulitis, die zwar zahlreiche Gefäßregionen betreffen kann, insbesondere aber durch aneurysmatische Veränderungen der Koronargefäße als schwerwiegende Verlaufskomplikation gekennzeichnet ist. Klinisch imponieren die Kinder – Prädilektionsalter 2 – 5 Jahre – durch anhaltend (> 5 Tage) hohes, antibiotikaresistentes Fieber, eine ausgeprägte, auch hämorrhagische Konjunktivitis, ausgedehnte, nicht eitrige zervikale Lymphknotenschwellungen, eine Himbeerzunge, düsterrote Lacklippen, ein morbilliformes Exanthem und ein variabel deutlich ausgeprägtes Palmar- und Plantarerythem, dem eine akral betonte, aber auch die gesamten Handflächen und Fußssohlen betreffende Hautabschilferung folgt. Je nach Betonung der Symptomatik werden die Kinder ggf. auch dem Dermatologen oder Augenarzt vorgestellt, denen dieses Krankheitsbild daher bekannt sein sollte. Eine umgehend eingeleitete Therapie mit Immunglobulinen und Azetylsalizylsäure trägt signifikant zu einer Reduktion der z. T. schwerwiegenden vaskulären Komplikationen bei. Bei Überstehen der akuten Krankheitsphase ist die Prognose in Abhängigkeit von der Koronarbeteiligung mit restloser Rückbildung der vaskulitischen Veränderungen im Allgemeinen gut.

Ex vivo‐expanded donor CD4+ lymphocyte infusion against relapsing neuroblastoma: A transient graft‐versus‐tumor effect

High-risk neuroblastoma has a poor prognosis despite multimodal treatment including high-dose chemotherapy. A 7-year-old male with neuroblastoma received ex vivo-expanded donor CD4(+) T lymphocyte infusion (CD4(+) DLI) after recurrence in the bone marrow following allogeneic hematopoietic stem cell transplantation from his HLA-identical mother. The disease transiently responded to CD4(+) DLI with reduction of tumor cells and a decrease of serum neuron-specific enolase. The response was associated with development of continued high fever and an increase of cytotoxic T lymphocytes in peripheral blood. This case suggests a possibility of a graft-versus-tumor effect against neuroblastoma.