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Mihaela Găman,1,2 Ana-Maria Vlădăreanu,1,2 Camelia Dobrea,1 Minodora Onisâi,1,2 Cristina Marinescu,1,2 Diana Cîşleanu,1,2 Cristina Ciufu,1,2 Daniela Vasile,1,2 Horia Bumbea,1,2 Irina Voican2 1Department of Hematology, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania; 2Department of Hematology, University Emergency Hospital Bucharest, Bucharest, Romania Abstract: POEMS syndrome (acronym consisting of: polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) is an uncommon disorder associated with an underlying plasma cell dyscrasia. There is no single specific test for POEMS, and due to its rarity and heterogeneity, patients are often mis- or underdiagnosed. Castleman disease (CD) is a rare lymphoproliferative disorder, closely related to POEMS syndrome; ~11%–30% of POEMS patients are associated with concomitant CD. In contrast to frequently published reports on vascular events in POEMS syndrome affecting coronary arteries or lower limbs, cases of cerebrovascular events are rarely mentioned in literature. We hereby report a patient with POEMS syndrome accompanied by CD who presented recurrent strokes and splenic infarction. Keywords: POEMS, chronic inflammatory demyelinating polyradiculopathy, M protein, thrombotic risk, stroke, recurrent ischemic events

Kikuchi–Fujimoto disease (KFD) or histiocytic necrotizing lymphadenitis is a rare disease that is frequently underdiagnosed due to clinical features that are similar to those of non-Hodgkin lymphomas, systemic lupus erythematosus (SLE), or infectious reactive lymphadenopathy. An excisional biopsy is required. We report a young Caucasian female diagnosed with KFD with skin lesions, complicating with SLE. The clinical course, laboratory, and CT findings are described, as are histopathologic features, for a better recognition of this rare disorder in clinical practice.

Background Children with chronic refractory Immune Thrombocytopenia are a small, but demanding group, representing 5% of the total cases of Immune thrombocytopenia. Changing the nomenclature itself, from idiopathic to immune, is evidence of the increasing awareness and improvements in the management of immune thrombocytopenia. Treatment for this disease is always a challenge taking into consideration that the few known therapies have significant side effects and toxicities. Aim To evaluate treatment strategies and the effect on heterogenous evolution of children with chronic Immune Thrombocytopenia. Methods Chronic refractory Immune Thrombocytopenia is defined as disease that does not respond to or relapses after first 2 lines of treatment, with over one year of evolution. Based on 8 cases within our clinic, we discuss treatment options available for children with chronic refractory Immune Thrombocytopenia. In addition to detailed history and physical examination, there were analized full blood count, review of the peripheral blood smear, routine tests of hemostasis and bone marrow examination was performed to search for myelodysplastic syndromes. At the same time, infections (CMV,EBV, HIV, HP) and autoimmune disorders (LES, APS) were ruled out. All patients who failed prior treatment, meaning first 2 lines of treatment (multiple steroids, intravenous immunoglobulins, splenectomy) underwent treatment with molecule targeting therapy (Rituximab), nonspecific immunosuppresive agents (Cyclosporin, Mycophenolat Mofetil, Sirolimus) or thrombopoietin receptor agonists. Results A total of 8 patients with chronic refractory Immune Thrombocytopenia were analised. The median age at diagnosis was 6,5 and sex ratio 1:1. Disease evolution is between 3 and 10 years. Treatment for the studied cases consisted of multiple courses of steroids and intravenous immunoglobulins (all patients), splenectomy (4 patient), Rituximab (4 patients), Cyclosporin (6 patients), Mycophenolat Mofetil (6 patients) and Sirolimus (3 patients). 2 patients underwent therapy with thrombopoietin receptor agonist (Romiplostin), with only one favourable response. At present time, 6 patients are receiving combined immunosupressive therapy and steroids, while 2 are stable with one immunosupressive agent. In spite of abnormal platelet count, for these patients is most significant to have no risk factors nor haemorrhagic events. Among immunosupressive agents, early relapse was frequently seen after administration of Cyclosporin, compared to other immunosupressive agents. Conclusions The goal of long-term immunosupressive treatment strategies for Immune Thrombocytopenia is to achieve a platelet count that is associated with adequate hemostasis, rather than normal platelet count. As outcomes vary from one patient to another, aspects regarding age, clinical features, bleeding risks, likely side-effects, economic considerations, life quality as well as the physicians concerns are essential.

Background and aim Marginal zone lymphomas represent 3% of all lymphomas and are divided into extranodal (ENMZL), splenic and nodal. ENMZL is characterised by indolent natural history, is usually diagnosed in localised stages (70%) and chronic antigen stimulation seems to be involved in its pathogenesis. Typically seen in the 6th decade of life, it is responsible for 8% of adult non-Hodgkin lymphoma. According to multicentre NHL-BFM studies, the incidence of ENMZL in children is 0.1%, most commonly found in the gastrointestinal tract (44%). The salivary gland is involved only in 5% of paediatric patients, being preceded in 1/3 cases by Sjogren syndrome (SS). Herein, we report a 15-year-old girl with advanced ENZML of salivary glands following SS, a very rare diagnosis in children. METHOD AND Results Female patient, 13y, presented with enlarged jaw area, was evaluated by an oral-maxillofacial surgeon and cherubism was excluded. Laterocervical ultrasound, head and neck MRI: hypertrophic parotid glands with cystic images, small adenopathies. Based on parotid swelling, dry mouth and eyes, bilateral hypo-lacrimation on Schirmer’s test, positive anti-Ro, anti-La and anti-nuclear antibodies, she was diagnosed with primary SS. At age 15: progressive parotid swelling, no ‘B’ symptoms, leucopenia 3.38 × 10^9/l, anaemia 10.5 g/dl, sedimentation rate 33 mm/h, LDH 225UI (n Conclution ENMZL of parotid glands following SS is rarely seen, especially in paediatric patients, thus the knowledge about this lymphoma type is limited. It is low-grade and responds well to R-CHOP chemotherapy, even in advanced stages. Nevertheless, regular follow-up is required, as relapses can occur during the course of the disease.

O1 HIV-1 diversity in Bulgaria (current molecular epidemiological picture) Ivailo Alexiev, Reneta Dimitrova, Anna Gancheva, Asya Kostadinova, Mariyana Stoycheva, Daniela Nikolova, Ivaylo Elenkov O2 Knowledge, attitudes and practices of the general population on HIV/AIDS, hepatitis B and C in Romania Cătălin Tilișcan, Mioara Predescu, Bogdan Păunescu, Anca Streinu-Cercel, Oana Săndulescu, Claudiu Mihai Șchiopu, Mădălina Hristache, Lăcrămioara Aurelia Brîndușe, Adrian Streinu-Cercel O3 The prevalence of human leukocyte antigen-B*57:01 allele carriers and CXCR4 tropism among newly diagnosed HIV infected patients in Serbia Marija Todorovic, Marina Siljic, Dubravka Salemovic, Valentina Nikolic, Ivana Pesic-Pavlovic, Jovan Ranin, Djordje Jevtovic, Maja Stanojevic O4 HIV transmission among stable serodiscordant couples from the former Pediatric Cohort follow up in the National Institute of Infectious Diseases Ana Maria Tudor, Delia Vlad, Mariana Mărdărescu, Sorin Petrea, Cristina Petre, Ruxandra Neagu-Drăghicenoiu, Rodica Ungurianu, Alina Cibea, Odette Chirilă, Cristian Anghelina, Ileana Coserea O5 Unemployment is associated with syringe sharing among people who inject drugs in Greece Pantelia-Amalia Krikelli, Eirini Pavlitina, Mina Psichogiou, Demetris Lamnisos, Leslie Williams, Anya Korobchuk, Britt Skaathun, Pavlo Smyrnov, John Schneider, Vana Sypsa, Dimitrios Paraskevis, Angelos Hatzakis, Samuel R. Friedman, Georgios K. Nikolopoulos O6 Correlation of adipocytokine levels in different types of lipodystrophy in HIV/AIDS patients Gordana Dragović, Danica Srdić, Al Musalhi Khawla, Ivan Soldatović, Jelena Nikolić, Djordje Jevtović, Devaki Nair O7 IP10 – a possible biomarker for the progression of HIV infection Aura Temereanca, Adelina Rosca, Luminita Ene, Benchawa Soontornniyomkij, Carmen Diaconu, Claudia Dita, Cristian Achim, Simona Ruta O8 A permanent challenge: persistent low viremia in HIV positive patients on ART Șerban Benea, Ruxandra Moroti, Raluca Jipa, Eliza Manea, Andrada Stan, Elisabeta Benea, Dan Oțelea, Adriana Hristea O9 Infections in IDUs according to their HIV status Adriana Hristea, Irina Lăpădat, Raluca Jipa, Ruxandra Moroti, Șerban Benea, Doina Antonică, Irina Panait, Roxana Petre O10 Trends in combined antiretroviral therapy used in methadone program integrated with HIV care - 20 years of experience Justyna D. Kowalska, Ewa Pietraszkiewicz, Ewa Grycner, Ewa Firlag-Burkacka, Andrzej Horban O11 Extracellular cyclophilin A – inflammatory mediator in HIV infected patients Ovidiu Vlaicu, Leontina Bănică, Simona Paraschiv, Ana-Maria Tudor, Ruxandra Moroti, Dan Oțelea O12 High cardiovascular disease risk in Serbian population, an issue of concern Bojana Dimitrijević, Ivan Soldatović, Đorđe Jevtović, Jovana Kusić, Dubravka Salemović, Jovan Ranin, Gordana Dragović O13 Genotypic rifampicin resistance in HIV/ tuberculosis coinfected patients from a tertiary level infectious diseases hospital Dragoș Florea, Ioana Bădicuț, Alexandru Rafila, Cornel Camburu, Adriana Histrea, Mihaela Frățilă, Dan Oțelea O14 Occurrence of residual HCV RNA in liver and peripheral blood mononuclear cells among patients with chronic hepatitis C infection and/or HCV/HIV coinfection after IFN-based therapy Ivana Gmizic, Dubravka Salemovic, Ivana Pesic-Pavlovic, Marina Siljic, Valentina Nikolic, Miljana Djonin-Nenezic, Ivana Milosevic, Branko Brmbolic, Maja Stanojevic O15 Romanian nationwide screening for infection with HIV and hepatitis B and C viruses Anca Streinu-Cercel, Oana Săndulescu, Alina Cristina Neguț, Mioara Predescu, Alexandra Mărdărescu, Mihai Săndulescu, Adrian Streinu-Cercel O16 Treatment emergent variants to combined direct antiviral agents therapy against hepatitis C virus Ana Belen Pérez, Natalia Chueca, Marta Álvarez, Juan Carlos Alados, Antonio Rivero, Francisco Vera, Marcial Delgado, Javier Salmeron, Miguel Jiménez, Maria José Blanco, Moises Diago, Miguel Garcia-deltoro, Marta Alvarez, Francisco Téllez, Federico García O17 Clinical and epidemiological aspects in tuberculosis/HIV coinfected patients Diana Tănase, Eliza Manea, Rodica Bacruban, Dragoș Florea, Dan Oțelea, Alexandru Rafila, Mariana Mărdărescu, Adriana Hristea O18 Resistance to NS3 protease inhibitors in persons with chronic hepatitis C infected with hepatitis C virus subtype 1a from Croatia Ivana Grgic, Ana Planinic, Maja Santak, Lana Gorenec, Snjezana Zidovec Lepej, Adriana Vince O19 Analysis of a simplified diagnostic score for tuberculous meningitis in HIV-infected adults with meningitis Eliza Manea, Adriana Hristea, Șerban Benea, Ruxandra Moroti, Diana Tănase, Cristian M. Niculae, Simona Merisor, Raluca Jipa O20 Molecular tracing of the origin of HIV-1 infection among persons who inject drugs in Athens: a phyloethnic study Dimitrios Paraskevis, Evangelia Kostaki, Georgios K. Nikolopoulos, Vana Sypsa, Mina Psichogiou, Dimitra Paraskeva, Athanassios Skoutelis, Meni Malliori, Samuel R. Friedman, Angelos Hatzakis O21 The dynamics of virological response to HIV-1 infection and antiretroviral therapy initiation in patients with and without HLA-B*5701 Allele Malgorzata Hackiewicz, Piotr Zabek, Ewa Firlag-Burkacka, Andrzej Horban, Justyna Dominika Kowalska O22 Increase in the numbers of non-B subtypes and potential recombinant forms circulating among Slovenian MSM in the recent years Maja M. Lunar, Jana Mlakar, Mario Poljak O23 Genotyping intrahost polymorphisms in hepatitis C virus E2 protein associated with resistance to antibody neutralization Leontina Bănică, Eliza Martin, Valeriu Gheorghiță, Andrei Petrescu, Dan Oțelea, Costin-Ioan Popescu, Simona Paraschiv O24 Genotyping of HCV NS3 protease inhibitors resistance and phenotyping of rare double resistance mutations in HCV cell culture system Emil Neaga, Vlaicu Ovidiu, Andrei Juncu, Leontina Bănică, Simona Paraschiv, Dan Oțelea, Costin-Ioan Popescu O25 Employment status controls the relationship between neurocognitive impairment and depression in a cohort of young HIV-infected adults since childhood Adrian Luca, Florin Lazăr, Anca Elena Luca, Luminița Ene, Cristian Achim O26 Predictors of survival in parenterally-infected HIV positive children and youth diagnosed with progressive multifocal leukoencephalopathy Cosmina Gingăraş, Ștefan Adrian Anton, Roxana Rădoi, Simona Tetradov, Grațiela Țârdei, Maria Nica, Razvan Alexandru Capşa, Cristian L. Achim, Cristiana Oprea, Luminița Ene O27 Neurocognitive and brain functioning in HIV-infected young MSM treated with cART Bogna Szymańska, Natalia Gawron, Agnieszka Pluta, Emilia Łojek, Ewa Firląg – Burkacka, Andrzej Horban, Robert Bornstein, et HARMONIA3 Study Group O28 Clinical value of RT-PCR detection of Toxoplasma gondii DNA in cerebrospinal fluid Olivia Burcoș, Simona Manuela Erscoiu, Filofteia Bănicioiu Cojanu, Andreea Toderan, Maria Nica, Ionuț Cristian Popa, Emanoil Ceaușu, Petre Iacob Calistru O29 Characteristics of sleep disorders in Romanian adults infected with human immunodeficiency virus Manuela Arbune, Mirela Alexandrache, Anca-Adriana Arbune, Doina-Carina Voinescu O30 Diagnosing neuroHIV: the rift between clinicians and pathologists Ioan-Alexandru Diaconu, Laurențiu Stratan, Victoria Aramă, Luciana Nichita, Alexandra Diaconu, Anca Negru, Alina Orfanu, Anca Leuștean, Daniela Adriana Ion O31 A challenging neurological complication in a HIV-infected young woman with multiple opportunistic infections Irina Ianache, Cristiana Oprea O32 Brain abscess with uncertain etiology in a late-presenter HIV infected patient Anca Leuștean, Cristina Popescu, Alina Orfanu, Anca Negru, Remulus Catana, Cristina Murariu, Ioan-Alexandru Diaconu, Mihaela Rădulescu, Cătălin Tilișcan, Victoria Aramă O33 Cerebral toxoplasmosis and left crural monoparesis with fatal evolution in a noncompliant patient with AIDS C3 Iosif Marincu, Patricia Poptelecan, Valeria Bică, Florin Lazăr, Livius Tirnea O34 Opportunistic infections still a problem in HIV-infected patients in cART era: a Romanian single center experience Irina Ianache, Roxana Rădoi, Manuela Nica, Grațiela Țârdei, Luminița Ene, Emanoil Ceaușu, Petre Calistru, Cristiana Oprea P1: Epidemiological aspects of co-infection of HIV/TB in Moldova Iurie Osoianu, Ala Halacu P2 Perinatal exposure at HIV infection in Oltenia region Andreea Cristina Stoian, Florentina Dumitrescu, Iulian Diaconescu, Augustin Cupșa, Lucian Giubelan, Loredana Ionescu, Irina Niculescu P3 Women living with HIV in Mureș county Carmen Chiriac, Nina Șincu, Iringo Zaharia Kezdi, Anca Georgescu, Brândușa Țilea, Cristina Girbovan, Andrea Incze, Andrea Fodor P4 Late diagnosis of HIV infection in children - a challenge for Romania Alina Cibea, Mariana Mărdărescu, Cristina Petre, Ruxandra Drăghicenoiu, Rodica Ungurianu, Ana Maria Tudor, Delia Vlad, Carina Matei P5 Cirrhosis Assessment in Patients Co-infected HIV-Hepatitis B Virus Elena Dumea, Lucian Cristian Petcu, Simona Claudia Cambrea P6 HIV late presenters in Craiova Regional Center, Romania Florentina Dumitrescu, Augustin Cupsa, Andreea Cristina Stoian, Lucian Giubelan, Irina Niculescu, Iulian Diaconescu, Dan Hurezeanu, Livia Dragonu, Mioara Cotulbea P7 Some aspects of malignancies in patients HIV / AIDS Simona Manuela Erscoiu, Ionuț Cristian Popa, Denisa Stroie, Petronela Ionescu, Nedeea Duță, Camelia Dobrea, Irina Voican, Emanoil Ceaușu, Petre Iacob Calistru P8 Factors associated with resilience among people living with HIV in Romania Florin Lazăr P9 Fever in HIV-infected patients: a thorny problem to be solved by the clinicians Lucian Giubelan, Augustin Cupșa, Iulian Diaconescu, Florentina Dumitrescu, Dan Hurezeanu, Livia Dragonu, Irina Niculescu, Andreea Cristina Stoian, Oana Obretin, Mariana Stănescu, Mihai Jianu P10 Th1, Th2, Th9, Th17 and Th22 cytokines in acute and chronic HIV-1 infection Lana Gorenec, Snjezana Zidovec Lepej, Ivana Grgic, Ana Planinic, Janja Iscic Bes, Adriana Vince, Josip Begovac P11 Dyslipidemia in HIV-infected patients treated with protease inhibitors – case report Luminița Elena Horga P12 Why use less treatment for the metabolic abnormalities in HIV patients-too many drugs? Corina Itu, Luminița Elena Horga, Laura Augusta David-Aldea, Anca Ciorogar, Cristian Jianu, Mihaela Lupșe P13 Sacral Herpes Zoster, with hyperalgesic form, in a patient with C3 stage HIV infection Iuliana Caramangiu, Ovidiu Roșca, Monica Cialma, Andreea Ardeleanu, Iosif Marincu P14 Factors associated with in-hospital mortality in tuberculous and cryptococcal meningitis Raluca Jipa, Eliza Manea, Șerban Benea, Irina Lăpădat, Nicoleta Irimescu, Irina Panait, Cristian Niculae, Adriana Hristea P15 Lipodystrophy: still present adverse event in resource-limited settings Jovana Kusic, Djordje Jevtovic, Dubravka Salemovic, Jovan Ranin, Bozana Dimitrijevic, Gordana Dragovic P16 TB and HIV coinfected patient, an emergent challenge - case report Laura-Augusta Aldea-David P17 Efficacy of prophylactic antiretroviral treatment in new-born infants from HIV-positive mothers in 2012-2014, for the North-Eastern part of Romania Carmen Manciuc, Cristina Nicolau, Liviu Prisăcariu, Alexandra Largu P18 Surveillance of mother to child transmission of HIV in Romania – 31 December 2015 Mariana Mărdărescu, Adrian Streinu-Cercel, Cristina Petre, Marieta Iancu, Sanda Vintilă, Daniela Vitelaru, Iosif Ionel, Claudiu Mihai Șchiopu, Alexandra-Henriette Mărdărescu P19 The antiretroviral therapy failure and the need to select the effective treatment in the Republic of Moldova Pavel Micsanschi, Tiberiu Holban, Ina Bîstrițchi, Lucia Pârțână, Angela Nagîț, Svetlana Popovici, Maria Talmaci, Irina Cucerova P20 Disseminated cryptococcosis in a patient with C3 HIV stage and multiresistant to antiretroviral therapy with lethal evolution Sorina Georgiana Mitrescu, Dana Mihalcea, Iulia Caramangiu, Ovidiu Roșca, Iosif Maricu P21 Aspects of tuberculosis infection in HIV-positive patients from Romania – our experience Anca Negru, Daniela Munteanu, Victoria Aramă, Raluca Mihăilescu, Ioan Diaconu, Remulus Catana, Cristina Popescu, Alina Orfanu, Anca Leuștean, Mihaela Rădulescu, Cătălin Tilișcan, Raluca Năstase, Violeta Molagic, Irina Duport, Cristina Dragomirescu, Ștefan Sorin Aramă P22 Dyslipidemia in HIV-infected patients Nicoleta M Negruț P23 Challenges in the management of an HIV seropositive patient with psoriasis undergoing immunomodulator therapy Violeta Elena Niță, Daniela Ioana Munteanu, Raluca Mihăilescu, Ioan Diaconu, Anca Negru, Cristina Popescu, Victoria Aramă P24 Acute peritonitis as a sign of IRIS in an HIV-infected patient with MAC latent infection Alina Orfanu, Cristina Popescu, Anca Leuștean, Anca Negru, Remulus Catana, Ioan Diaconu, Cătălin Tilișcan, Victoria Aramă, Sorin Ștefan Aramă P25 The virologic outcome of the treatment of chronic hepatitis B among HIV co-infected patients on HAART Ivana Pesic Pavlovia, Dubravka Salemovic, Jovan Ranin, Djordje Jevtovic P26 A case of HIV encephalopathy with aphasia, agnosia, apraxia and right homonymous hemianopsia Ovidiu Roșca, Andreea Ardeleanu, Iulia Caramangiu, Daniela Desaga, Valerica Bică, Sorina Mitrescu, Iosif Marincu P27 Molecular footprints on human immunodeficiency virus -1 genome and association with phylogenetic clustering among subtype B infected patients in Serbia Marina Siljic, Dubravka Salemovic, Valentina Nikolic, Djordje Jevtovic, Ivana Pesic-Pavlovic, Jovan Ranin, Marija Todorovic , Maja Stanojevic P28 Neurosyphilis and human immunodeficiency virus infection: double challenge Nina-Ioana Șincu, Anca Georgescu, Brândușa Țilea, Iringo Zaharia Kezdi, Andrea Incze, Cristina Gârbovan, Carmen Lucia Chiriac P29 Differences between HIV-infected adults since childhood and non HIV-infected persons on managing everyday life Anca Elena Luca, Florin Lazăr, Adrian Luca, Luminița Ene, Roxana Rădoi, Adina Talnariu, Silvia Suciu, Cristian Achim P30 Molecular detection of Bartonella quintana in a HIV immunodepressed patient with fever and isolated lymphadenopathy - Case report Diana Gabriela Iacob, Dragoș Florea, Simona Iacob P31 Present epidemiological characteristics of HIV/AIDS newly diagnosed cases in South-Eastern Romania Manuela Arbune, Miruna Drăgănescu, Alina Iancu P32 The gender’s preferences among opportunists? Ruxandra Moroti, Cristian M Niculae, Simona Merisor, Eliza Manea, Serban Benea, Andrada Stan, Raluca Hrisca, Raluca Jipa, Diana Tanase, Adriana Hristea P33 Polymorphism of interleukin-28B gene in persons with chronic hepatitis C from Croatia Ivana Grgic, Ana Planinic, Lana Gorenec, Snjezana Zidovec Lepej, Adriana Vince

Composite lymphoma refers to the co-occurrence of two or more morphologically and immunophenotypically separate lymphomas in the same topographic site at the time of clinical presentation. It is an infrequent type of lymphoid neoplasm, present in lymphoid tissue and may be due to the existence of two genetically related neoplasms such as transformation of a single lymphoma into another more aggressive lymphoma or be due to the presence of two clonally unrelated lymphomas. This paper is presenting a case of diffuse non-Hodgkin large B-cell lymphoma with areas of low grade and high grade follicular non-Hodgkin B-cell lymphoma in a retroperitoneal lymph node and spleen of an 62 year old woman. Histopathological examination and immunohistochemistry features proved the diagnosis of composite lymphoma.