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Introduction. Listeria monocytogenes is the third most frequent cause of bacterial meningitis in adults. It commonly affects persons with defective cell-mediated immunity or advanced age, and only a few patients with no underlying predisposition have been reported. Case report. We presented an previously healthy, 18-year-old man with typical clinical features of meningitis. On the account of earlier treatment with ceftriaxone and cerebrospinal fluid finding, an assumption of partially treated bacterial meningitis was made. The initial treatment with vancomycin and ceftriaxone, substituted on day 4 with meropenem, did not produce any clinical effect. On day 6 Listeria monocytogenes was isolated and, even as late as that, the administration of ampicillin was followed by complete recovery of the patient. Conclusion. In younger, immunocompetent individuals, in spite of the existent diagnostic and therapeutic problems, the subacute course of Listeria monocytogenes meningitis provides enough time for appropriate treatment and favorable disease outcome.

Nodular lymphocyte predominant Hodgkin lymphoma appears in 5% of Hodgkin lymphoma. Because of major biological and clinical differences with classical Hodgkin lymphoma and close relationship to T-cell/histiocyte-rich large B-cell lymphoma, lately the term nodular lymphocyte predominant B-cell lymphoma is accepted. The presence of lymphocyte predominant cells with preserved B-cell phenotype and a lack of CD30 is the prerequisite for the diagnosis of nodular lymphocyte predominant Hodgkin lymphoma. Lymphocyte predominant cells are typically embedded in large nodules of B lymphocytes (growth patterns A and B), but variants that are characterized by lymphocyte predominant cells located outside the nodules, a Tcell–rich nodular growth pattern and T-cell–rich or B-cell–rich diffuse growth patterns, respectively, have also been described (growth patterns C, D, E, and F). Variant growth patterns are associated with the recurrence and progression of disease and should be recognized and specified in pathology reports. Broad B-cell immunohistochemical panel, including PAX5, CD79a, Bob.1, and Oct-2 is indicated in these cases to distinguish between nodular lymphocyte predominant Hodgkin lymphoma, classical Hodgkin lymphoma and T-cell/histiocyte-rich large B-cell lymphoma, which have significant differences in clinical behavior and treatment. There are different treatment approaches in patients with nodular lymphocyte predominant Hodgkin lymphoma depending on pathohistological type, clinical presentation and stage of the disease. Treatment may include active surveillance, radiation therapy, immunotherapy or chemotherapy. A multidisciplinary approach is beneficial to optimize the diagnosis and management of patients with nodular lymphocyte predominant Hodgkin lymphoma. [ABSTRACT FROM AUTHOR]

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Myeloid sarcoma is a localized tumor composed of myeloblasts and other immature myeloid cells outside the bone marrow. It is usually associated with acute myeloid leukemia and rarely with chronic myeloproliferative disorders. We present a 43-year-old male who developed a solitary tumor in his left testis 6 years after an initial diagnosis of primary myelofibrosis. Four months later, another infiltrative tumor in the skin overlying his left wrist was discovered. After orchiectomy, the immunohistochemistry revealed tumor cells expressing LCA, CD34, CD117, MPO, CD15, lysozym, and CD43+, which confirmed diagnosis of myeloid sarcoma. The histologic and immunohistochemical findings were similar. The patient was treated with local radiotherapy to the skin tumor site, resulting in regression of the tumor and with chemotherapy when acute myeloblastic leukemia developed. The patient survived 21 months after initial presentation. [ABSTRACT FROM AUTHOR]

Chronic hepatitis C (CHC) is a major cause of liver cirrhosis and hepatocellular carcinoma. Steatosis occurs in almost 50% of patients with CHC, who make a faster progression to cirrhosis. The "atypical " patients are registred too, with normal values of blood sugar, cholesterol, triglycerides, BMI, body weight having non-alcoholic steatohepatitis (NASH) and CHC. The hsCRP levels rise before and simultaneously with the chronic hepatitis and cirrhosis progression, therefore, it is a useful prognostic parameter. According to our knowledge, there are no sufficient data concerning hsCRP concentrations in CHC patients, although it predicts or detects different grades of cirrhosis. For that reason, the aim of our research was to assess the hsCRP in patients with CHC. The investigation involved 45 patients (28 males and 17 females), mean age 41±15years, with CHC, without any accompanying disease. The control group consisted of 45 healthy volunteers (22 males, 23 females), mean age 34±10 years. The CHC patients' group was divided into two subgroups, the first, which consisted of 23 patients with evidenced histological signs of mild steatosis, and the second one, comprising 22 patients without the mentioned signs; hsCRP concentrations were measured in each patients' (sub)group. The findings indicate that the hsCRP value had a statistically significant increase in the CHC patients' group compared to the control group (p<0.05). In the CHC and mild liver steatosis patients subgroup, even more statistically significant hsCRP increase occurred compared to the other subgroup (p<0.001). It can be concluded, based on the acquired results, that hsCRP should be considered as a CHC progression prognostic factor, in order to make a well-timed and special therapeutic approach to the CHC individuals even more prone to the disease progression. [ABSTRACT FROM AUTHOR]

Introduction. Special entities like solitary bone plasmocytoma (SBP) or extramedullary plasmacytoma (EMP) can be found in a less than 5% of patients with plasma cell disorders. EMP of the tongue represents very rare localization of the head and neck plasmacytoma. Case report. We report a case of 78-years-old woman who developed EMP of the tongue base detected by the magnetic resonance imaging (MRI) of the head and neck region. Immunohistochemical profile of the tumor tissue biopsy (CD38, IgG, kappa positivity) indicated diagnosis of EMP. The diagnosis was established with additional staging which confirmed the absence of other manifestation of the disease. The patient was treated with 40 Gy of radiotherapy in 20 doses resulting in the achievement of the complete remission of the disease. This case was discussed with the reference to the literature. Conclusion. EMP of the tongue base is a very rare entity of plasma cell dyscrasias. Appropriate irradiation results in the achievement of a long-term remission and a potential cure of the disease.

Background. The ocular adnexal region is the primary localization of extranodal lymphoma in 5% to 15% of all Non-Hodgkin lymphoma. Intraocular lymphoma of T-cell origin is extremely rare and such sites of infiltration have been rarely observed in clinical examination. Case report. We presented a 56-year-old man with iris infiltration by primary intraocular peripheral T-cell lymphoma. The patient was in clinical stage I BE and the treatment was initiated according to cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone (CHOP) regimen. When the second course of the therapy was scheduled, the patient developed central nervous system lymphoma infiltration. Although De Angelis regimen was used, 3 months after the diagnosis was established, lethal outcome ensued due to disease progression. Conclusion. According to our experience we can conclude that further therapeutical approach to patients with primary intraocular Tcell lymphoma requires modification of conventional treatment regimens. The lower median survival in these patients suggests that the disease may be of more aggressive course.

Introduction. One of the more uncommon etiological factors responsible for the development of acute pancreatitis (AP) is hypercalcemia. Hyperparathyroidism (HPT), as a cause of hypercalcemia, is responsible for 1.5-13% of AP according to a number of studies. A mechanism of the development of AP in hyperparathyroidism is still unclear. Case report. We presented a 47-year-old female patient, who had five episodes of AP in total before the etiological factors were finally determined. The patient had certain comorbidities which were considered to be potential causes of AP. She had chronic renal insufficiency (she was on a regular hemodialysis program), systemic lupus erythematosus and mioma uteri. She used to regularly take an antiepileptic drug (combination of sodium valproate and valproic acid). During the fifth episode of AP, the serum calcium level was for the first time elevated to twice the normal value. Level of parathyroid hormone was several times higher. A static scintigraphy found hyperplasia or hyperfunctional adenoma of the right inferior and superior parathyroid glands. Abdominal multislice computed tomography (MSCT) scan verified the enlargement of the entire pancreas, as well as the presence of heterogeneous structures with diffuse amorphous calcifications. The lytic lesions in the pelvic bones could be seen in both sides. Parathyroidectomy was being postponed by an endocrine surgeon because of the poor overall condition of the patient. In the next period the patient had five more episodes of AP. The condition was significantly contributed by increasingly more frequent and longer episodes of metrorrhagia. Despite all therapeutic measures that were taken, systemic inflammatory response syndrome (SIRS) developed, and fatal outcome occurred. Conclusion. In case of recurrent pancreatitis, hyperparathyroidism is to be considered even if a significant elevation of serum calcium is not present. This is especially the case for patients with chronic renal insufficiency or impaired vitamin D metabolism, who have a higher risk of secondary hyperthyroidism. [ABSTRACT FROM AUTHOR]