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Cytomegalovirus
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
CMV is usually asymptomatic or with symptoms so mild that it goes undiagnosed. The symptoms might include a mononucleosis-like or flu-like syndrome, malaise, fatigue, lymphadenopathy, or persistent fever, and abnormal laboratory values (lymphocytosis, or increased aminotransferase levels). Rarely, hepatosplenomegaly, cough, headache, rash, and gastrointestinal symptoms can occur [12]. The presence of symptoms or laboratory abnormalities is highly suggestive of primary infection [13].
Infectious disease
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Causes infectious mononucleosis (‘glandular fever’). Primary infection (after an incubation period of around one month) causes fever, sore throat, headache, malaise and cervical lymphadenopathy. Less common features are splenomegaly, hepatomegaly and jaundice. Investigations: blood tests show a lymphocytosis with ‘atypical lymphocytes’; ‘Monospot’ test is positive. EBV is also associated with lymphoma and nasopharyngeal carcinoma.
The lymphoreticular system and bone marrow
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
A lymphocytosis, increased peripheral lymphocytes, is normal in the first year of life. In older children and adults, reactive lymphocytosis is usually caused by viral infections. Infectious mononucleosis causes a striking lymphocytosis with numerous very atypical forms, which can raise the possibility of malignancy. The other main cause of lymphocytosis in adults is lymphomatous disorders such as CLL and MCL (see Case History 9.3).
Keeping a balance in chronic lymphocytic leukemia (CLL) patients taking ibrutinib: ibrutinib-associated adverse events and their management based on drug interactions
Published in Expert Review of Hematology, 2021
Hee Jeong Cho, Dong Won Baek, Juhyung Kim, Jung Min Lee, Joon Ho Moon, Sang Kyun Sohn
The phenomenon of lymphocytosis following ibrutinib therapy is thought to be associated with the redistribution of CLL cells that were resident in lymphoid tissues, into the peripheral blood [67]. A study quantifying malignant CLL cells showed that Ki67 and CD38 expression in circulating CLL cells in the blood increased as the total tumor burden distributed in different tissue compartments (such as lymph nodes, spleen, and bone marrow) decreased immediately after ibrutinib administration [68]. In clinical trials, it was demonstrated that the sum of the lymph node diameter tended to be concomitantly reduced in addition to an increase in ALC [66]. Ibrutinib-induced lymphocytosis is generally resolved within eight months after ibrutinib initiation; however, prolonged lymphocytosis lasting more than 12 months occurs occasionally, which may be misinterpreted as a sign of disease progression in real-world practice [66,67]. From a report of the molecular and biochemical characteristics of persistent lymphocytes induced by ibrutinib, prolonged CLL cells were found to be associated with the BTK-independent activation of downstream mediators of BCR signaling, thus representing quiescent leukemic cells [69]. Moreover, prolonged lymphocytosis does not have a negative impact on treatment outcomes and survival [69]. To distinguish lymphocytosis from genuine disease progression, other manifestations implying disease progression such as the occurrence of anemia, thrombocytopenia, lymphadenopathy aggravation, or hepatosplenomegaly, should be assessed concomitantly.
Diagnostic value of 18-F fluorodeoxyglucose PET/CT and bone scan in Schnitzler syndrome
Published in Autoimmunity, 2019
L. Alix, A. Néel, B. Cador, A. Smail, J. Serratrice, F. Closs-Prophette, P. Jego, A. Devillers, O. Decaux
Eight of the 42 patients of the Néel et al. cohort underwent at least one 18F FDG PET/CT scan and were therefore included in this study. Two additional patients were diagnosed with SchS between 2014 and 2017 and also had one 18F FDG PET/CT scan. Thus, a total of five men and five women were selected from five centres (Table 3). The mean age at diagnosis was 62 years (from 47 to 80 years). The mean time from diagnosis was 2 years (from 6 months to 16 years). The most common symptoms were urticarial eruption, fever, and weight loss. All patients had IgM monoclonal gammopathy and an inflammatory syndrome (median C-reactive protein (CRP) level 88 mg/L). Seven patients underwent a myelogram, showing insignificant lymphocytosis in one case and dyserythropoiesis in another; it was normal for the other patients. A bone-marrow biopsy was performed in eight patients and revealed benign lymphocytosis in three cases, an insignificant increase of plasma cells in one, and was normal for the other four. Three patients underwent lymphadenopathy biopsy and one underwent a tibial bone biopsy, showing benign lymphoid hyperplasia and non-specific inflammation, respectively. Seven patients eventually received anakinra during their follow-up; the median time between first symptoms and treatment was 36 months (from 9 to 195 months) and they all experienced dramatic clinical improvement within 24 h. The median follow-up was 55 months (from 11 to 99 months).
Evaluation of a 10color protocol as part of a 2tube screening panel for flow cytometric assessment of peripheral blood leukocytic subsets
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2019
Evdoxia Gounari, Vasiliki Tsavdaridou, Aliki Ioakeimidou, Anna-Bettina Haidich, Lemonia Skoura
According to current criteria [16,17] and immunophenotypic, morphological and available clinicolaboratory data, samples were classified into the following six diagnostic categories: (a) chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL)/high count CLL-like monoclonal B lymphocytosis (MBL), (b) low count CLL-like MBL, (c) non-CLL B LPD, (d) T cell large granular lymphocytic leukemia (T LGL), (e) other hematologic malignancies, and (f) no detectable neoplastic PB involvement. All samples with a CLL phenotype displayed a B population corresponding to a Matutes score equal to or greater than 4, with the exception of 1 sample with a score of 3, but fulfilling other immunophenotypic characteristics of CLL (CD43+, CD200+, and ROR-1+) [18,19]. Inversely, non-CLL B LPDs exhibited a CLL score equal to or less than 2 and a phenotype not compatible with CLL.