Rifampicin-induced pure red cell aplasia

Article Abstract:

Pure red cell aplasia (PRCA) is a severe normochromic, normocytic anemia characterized by an abnormal increase in the number of immature red blood cells and a deficiency of mature red blood cells (erythrocytes). PRCA occurs without any known cause, but it has been associated with diseases of the lymph and immune systems as well as exposure to drugs. Acute PRCA has been attributed to izoniazide, an antibiotic, and dilantin, an antiepileptic medication. This case study details the findings of a 30-year-old patient who had been treated with the antibiotic rifampicin for an infection which developed in her arm subsequent to a fracture. The patient's hemoglobin level (iron-containing pigment of red blood cells) was 127g/L and her hematocrit level (expressed as a percent, the volume of red blood cells separated by centrifuge from a volume of blood) was 38 percent when rifampicin and pefloxacin were prescribed for her infection. Six weeks later the patient complained of weakness, shortness of breath and nausea; she stopped the rifampicin. Upon re-evaluation it was found that the patient's blood values had dropped to a hemoglobin of 35g/L and a hematocrit of 28 percent, and the patient was diagnosed with PRCA. Pefloxacin was also discontinued. The patient was transfused with red blood cells and her recovery progressed satisfactorily. Rifampicin was demonstrated to have an inhibitory effect on colony-forming unit-erythroids (CFU-E, a series of immature cells that will develop erythrocytes) in the blood sample that was obtained at the time of PRCA diagnosis, but not on the sample obtained during remission. Pefloxacin had no inhibitory effect. Rifampicin must be considered as a cause of PRCA.

Analysis, Measurement, Hemoglobin, Hemoglobins, Erythrocytes, Red blood cells, Blood diseases, Hematologic diseases, Rifampin, Aplastic anemia, Hematocrit

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Detection of Epstein-Barr virus DNA by in situ hybridization and polymerase chain reaction in salivary gland biopsy specimens from patients with Sjogren's syndrome

Article Abstract:

Sjogren's syndrome (SS) is characterized by the accumulation of lymphocytes, a type of immune cell, in the salivary and lacrimal (tear) glands, and the production of abnormal immune proteins called autoantibodies. Several lines of evidence suggest that infection with the Epstein-Barr virus (EBV) may be involved in the development of SS. However, the role of EBV infection in the development of SS remains unclear. The presence of EBV was assessed in the salivary glands of patients with SS using molecular biology methods. The DNA of EBV was detected by in situ hybridization in the epithelial cells located on the surface of the salivary glands from: four of eight patients (50 percent) with primary SS, or SS unrelated to other medical conditions; none of six patients (0 percent) with secondary SS, or SS associated with another medical problem; and three of 39 subjects (8 percent) without SS. Another molecular biology technique, the polymerase chain reaction, was used to detect EBV DNA in six of seven patients (86 percent) with primary SS; three of five patients (60 percent) with secondary SS; and seven of 24 subjects (29 percent) without SS. These results show that the genetic material of EBV can be detected with a greater frequency in patients with SS than subjects without SS. The epithelial cells of the salivary glands appeared to be the major site of infection by EBV. These findings suggest that EBV infection plays a role in the pathogenesis of SS. However, it remains unclear whether the virus causes deterioration of the salivary glands or whether infection occurs after injury of the gland. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Testing, Sjogren's syndrome, Mouth diseases, Epstein-Barr virus, Epstein-Barr virus diseases

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Danazol-induced hepatocellular adenoma

Article Abstract:

The androgen steroid drug danazol is used to treat various diseases such as endometriosis, the abnormal location of endometrial tissue, which normally lines the uterus; angioneurotic edema, large areas of swelling within tissues beneath the skin, such as fat, mucous membranes, and internal organs; and idiopathic thrombocytopenic purpura (ITP), a bleeding disorder associated with a reduction in blood platelets, which are involved in clotting. Treatment with androgen steroids has been associated with various toxic effects on the liver, including impaired liver function, jaundice, and formation of liver tumors. A case is described of a 34-year-old obese woman with ITP, who was treated with danazol and developed a hepatocellular adenoma, a type of liver cell tumor. The tumor was characterized by rapid growth, large size, and internal bleeding. Danazol was withdrawn and the tumor was surgically removed. The patient recovered and her liver function returned to normal. Although danazol is a weak androgen, it causes the same adverse effects as other steroids of similar structure. The incidence of liver damage and liver tumor formation is not known for other types of anabolic steroids. It is recommended that only minimal doses of danazol be used during long-term therapy, and liver function and structure of patients on long-term danazol therapy should be routinely monitored. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Liver, Adenoma, Danazol, Liver tumors

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