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  • br Discussion Clinically HES may be separated into two subgr

    2019-06-11


    Discussion Clinically, HES may be separated into two subgroups: HES with, and HES without gene abnormality such as PDGFRA, PDGFRB, or FGFR1. The standard therapy of HES without gene abnormality is steroid; by contrast, the first-line therapy of HES with gene abnormality is imatinib. Although in-depth and durable molecular responses occur with imatinib, discontinuation of the drug can lead to relapse. In the French series, imatinib was stopped in 11 patients - 6 of those patients subsequently relapsed. According to these studies, we may presume that imatinib could suppress abnormal clones, but not clear them out. In 17-aag to CML, very few cases of acquired imatinib resistance have been reported with almost 10 years of experience in treating FIP1L1-PDGFRA-positive disease. Most of the cases have involved the T674I mutation within the ATP-binding domain. The T674I mutation is analogous to the T315I BCR-ABL mutation in CML which confers resistance to the tyrosine kinase inhibitors imatinib, dasatinib, and nilotinib. In this case, our laboratory could not provide the test detecting the T674I mutation. According to the study of David M. et al, imatinib with 400 mg per day could elicit durable hematologic and cytogenetic remissions. However, this patient developed resistance to imatinib 400 mg per day. Then, dasatinib 70 mg per day was prescribed but her symptoms did not improved. Following the patient\'s insistence of dasatinib 50 mg per day, we tried the combination therapy with dasatinib, steroid, and hydroxyurea. Fortunately, this regimen was effective as to this patient. We did not answer the mechanism of this salvage therapy and just provided a feasible regimen in treating imatinib-resistant HES.
    Introduction Amebiasis is caused by the protozoal organism Entamoeba histolytica infection. It is commonly found in developing countries but rare in developed areas. However, the incidence of this disease in developed countries is increasing, arising from travelers in highly epidemic area or immigration and immunocompromised populations. Some patients who are malnourished, infant, elderly, pregnant, receiving glucocorticoids, diabetes, or suffering from alcoholism have an increased risk of fulminant disease of amebiasis. Amebiasis is a multifaceted disease which may present with inflammation ranging from acute to chronic, and symptoms from asymptomatic to abscess. Up to 90% of those patients diagnosed with amebiasis are asymptomatic, and the most common symptom is amebic colitis. The primary site of Entamoeba histolytica infection is in the colon but may extend to other organs via hematogenous spread to cause liver abscess. The toxin of Entamoeba histolytica presents in the microfilament of the colon and causes mucosal defect associated with parasite invasion to the nutrient arterioles of the colon. This results in arteriole occlusion and ischemia of the bowel wall, where the bowel wall may progress from the initial superficial ulceration to transmural necrosis and perforation.
    Case report A 39-year-old female presented to our facility who was diagnosed with moderately differentiated nasopharyngeal squamous cell carcinoma, T3N1M0 stage III, who had completed one year of combined chemotherapy and radiotherapy. She reported intermittent dull abdominal pain with diarrhea after traveling to China\'s Hainan Province approximately 3 months ago. This time, she felt acute abdominal pain and progress in the last 3 days prior to admission. Physical examination of the patient revealed diffused peritoneal sign. Abdominal computed tomography revealed a cecal tumor and intra-abdominal abscess (Fig. 1). Exploratory laparotomy was undertaken and revealed infiltrating yellowish tumor about 7 cm over cecal with massive serous ascites over her whole abdomen, especially the pelvis. There was no significant cecal perforation. Right hemi-colectomy with end-to-end ileo-colic anastomosis was performed because of suspected cecal malignancy and intra-cecal abscess formation, but no protective stoma was done. We did not send the specimen for intra-operative frozen section diagnosis. Pathology reported ambeic colitis with an undermined ulcer and abcess formation (ameboma) of the cecum. Microscopic review found 17-aag numerous typical amebic trophozoites (Fig. 2). The post-operative hemodynamic was noted to be stable, with a persistent high fever and even empiric antibiotics for intra-abdominal abscess. There was no evidence of anastomosis leakage. The patient died 7 days after operation due to sepsis.