Case Reports

CNS Relapse in Acute Promyelocytic Leukemia: A Rare Occurrence

ABSTRACT: Acute Promyelocytic leukemia with central nervous system involvement is one of the rarest occurrences. A 25 year old lady, admitted at Shifa International Hospital Islamabad, with complaints of menorrhagia, bruises, petechiae, headache and vomiting. Her laboratory investigation showed patient being in disseminated intravascular coagulation. Complete blood counts and Bone marrow examination showed significant promyelocytes and blasts with flow cytometric analysis consistent with acute promyelocytic leukemia (APL). PCR for PML-RARα detected, CSF examination and its cytology revealed promyelocytes. CT scan of brain showed slight leptomeningeal enhancement. CNS involvement was diagnosed based on the appearance of APL blasts in cerebrospinal fluid (CSF). After treated with all-trans retinoic acid (ATRA), idarubicin, cytarabine and intrathecal methotrexate, she achieved morphological, molecular, and CNS remission. Patient was readmitted, 02 years later with complaints of headache, vomiting, right sided weakness and difficulty in speaking with suspicion of relapse. Lumber puncture was performed which showed many promyelocytes with Auer rods and diagnosis of CNS relapse of APL was made.

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Bortezomib-Induced Cardiac Dysfunction in a Patient with Plasma Cell Leukemia–A Remote Complication

ABSTRACT: Bortezomib is an important proteasome inhibitor widely used in plasma cell neoplasms. An acute cardiac dysfunction is not a frequent side effect of bortezomib, but it is mentioned in literature search via multiple case reports. We have discussed here, another case of a young male diagnosed with plasma cell leukemia on treatment, presenting with sudden onset dyspnea due to an acute myocardial toxicity which subsequently upon thorough evaluation turned out to be an association with cyclical bortezomib administration.

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Intestinal Obstruction Caused by Retained Surgical Swab

ABSTRACT: Retained surgical swab (RSS) is an infrequent and avoidable complication after any type of abdomino-pelvic surgeries which leads to increased morbidity of patient as well as the cost of treatment. We report one such case of a 32 years old female patient who presented with signs and symptoms of acute intestinal obstruction, 1 year after a cesarean section. On exploration a mass was found in the region of terminal ileum which was resected followed by end to end anastomosis. Upon dissection of the mass, a large surgical swab was found inside the lumen of the gut. The mass which is formed around a retained surgical swab is known as Gossypiboma. Complete intra-luminal migration is very rare and a delayed complication of RSS and is difficult to diagnose due to vague presentation and inconclusive imaging. Surgical intervention is mainstay of treatment although it may be removed endoscopically in accessible parts of the gut and may even pass with defecation without any intervention.

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