Immunodeficiency Virus-negative Women Research Articles

Primary effusion lymphoma in a human immunodeficiency virus-negative patient with unexpected unusual complications: a case report

BackgroundPrimary effusion lymphoma is a rare, high-grade non-Hodgkin’s lymphoma that usually occurs in immunosuppressed or human immunodeficiency virus-positive individuals in advanced stages of the disease. However, primary effusion lymphoma occasionally affects immunocompetent patients who are infected with human herpes virus type 8 or Epstein-Barr virus. This disease manifests with liquid collections in cavities, producing constitutional symptoms; fever; weight loss; and symptoms related to extrinsic compression, such as dyspnea or abdominal discomfort. Diagnosis is confirmed with cytological or tissue evaluation showing large, multinucleated lymphoid cells with positive specific markers for the disease, such as CD45 and markers related to viral infections, when present. There is no standard treatment for primary effusion lymphoma, but several chemotherapy protocols are recommended, usually with poor results.Case presentationWe present a case of an adult human immunodeficiency virus-negative Hispanic origin woman with primary effusion lymphoma with pleuritic, pericardial, and peritoneal compromise who also had unusual complications during a diagnostic procedure: the accidental rupture of the left ventricle and the development of a secondary left ventricular pseudoaneurysm. We describe the clinical, radiological, and laboratory characteristics as well as the outcome of this case.ConclusionsPrimary effusion lymphoma is a very rare entity that represents 4% of non-Hodgkin’s lymphoma cases associated with human immunodeficiency virus and 0.1% to 1% of all lymphomas in patients with another type of immunodeficiency in regions where human herpes virus type 8 is not endemic. This reported case is an unusual presentation of primary effusion lymphoma because it occurred in an immunocompetent human immunodeficiency virus-negative adult woman without the presence of Kaposi’s sarcoma or Castleman’s disease and for whom the clinical course after chemotherapy was successful. However, the rupture of the free wall of the left ventricle is a very rare catastrophic event that usually occurs after myocardial infarction. Left ventricle free wall rupture rarely goes unnoticed, but when it occurs, it leads to the development of a ventricular pseudoaneurysm in which the rupture is contained by the pericardium with an organized thrombus and an adjacent hematoma.

Evaluation of See-and-Treat Cervical Cancer Screening in Human Immunodeficiency Virus–Positive and Human Immunodeficiency Virus–Negative Women in Cameroon [332

Evaluation of See-and-Treat Cervical Cancer Screening in Human Immunodeficiency Virus–Positive and Human Immunodeficiency Virus–Negative Women in Cameroon [332

Delayed Diagnosis of Disseminated Mycobacterium genavense Infection in a Human Immunodeficiency Virus-Negative Young Woman

Delayed Diagnosis of Disseminated Mycobacterium genavense Infection in a Human Immunodeficiency Virus-Negative Young Woman

A newborn with complete heart block and structural cardiac defects

HISTORY OF PRESENT ILLNESS A 3,200-g girl was born to a 37-year-old human immunodeficiency virus–negative woman at 36 weeks’ gestation. The pregnancy was complicated by maternal type 2 diabetes mellitus (requiring insulin therapy during pregnancy) and by hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome.1 The baby was delivered by emergency cesarean section for maternal preeclampsia. Apgar scores were 8 at 1 minute of life and 9 at 5 minutes of life. Complex congenital heart disease had been diagnosed in utero by fetal ultrasound. The infant was promptly administered prostaglandin E2 shortly after birth and then was transferred to the neonatal intensive care unit. A chest radiograph (Fig 1) revealed a boot-shaped heart secondary to right ventricular hypertrophy and an abnormal main pulmonary artery segment. Also notable is the absence of a thymic shadow. Echocardiography revealed complete atrioventricular heart block, pulmonary atresia, and an unbalanced atrioventricular canal. Laboratory evaluation revealed a white blood cell count of 15,700/ L (reference range, 5,000–20,000/ L), a hemoglobin level of 17.3 g/dL (reference range, 13.5–20.5 g/dL), a platelet count of 151,000/ L (reference range, 140,000– 440,000/ L), an absolute lymphocyte count of 1,300/ L (reference range, 2,000–17,000/ L), and an absolute neutrophil count of 12,500/ L (reference range, 1,000–9,500/ L). Serum electrolyte values were normal except for a total calcium level of 7.5 mg/dL (reference range, 8.8–10.0 mg/ dL) and an ionized calcium level of 0.83 mmol/ L (reference range, 1.03–1.23 mmol/ L). The infant began peripheral hyperalimentation and underwent a Blalock-Taussig shunt and placement of an epicardial pacing system. Unifocalization of the pulmonary artery, a surgical technique to connect all pulmonary segments to convergent central pulmonary arteries, was performed on day 4 of life. It was confirmed at surgery that the thymus was absent. The infant began to have increasing calcium requirements, and at 1 week of age she was diagnosed as having hypoparathyroidism, with a parathyroid hormone level of 1 pg/mL (reference range,12–72 pg/mL).