Pseudoeosinophilia with Abnormal WBC Scattergram: an Important Diagnostic Clue on Hematology Analyzer

Malaria is one of the most common parasitic diseases causing a significant burden on health care, especially in India. Light microscopy, the gold standard for malaria diagnosis is time-consuming especially in a setup where the caseload is high and parasite index is low. Knowledge of abnormal scattergrams by the malarial parasite is very essential to suspect malaria and screen those cases thoroughly on a peripheral smear for accurate diagnosis. A timely and accurate diagnosis is crucial to the prognosis of this disease. Herein, we report a case of a 40-year-old male from Punjab who presented to the emergency with fever and an altered sensorium. Analyzer showed characteristic pseudo eosinophilia with greying of neutrophil eosinophil zone with double eosinophil cluster. According to flagging rules because of eosinophilia, peripheral blood film (PBF) was made and examined, which revealed Plasmodium falciparum gametocytes.

ANOSMIA AND AGEUSIA IN PATIENTS WITH COVID-19

Objective: To evaluate the prevalence and diagnostic significance of anosmia and ageusia among COVID-19 positive patients of Karachi, Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Dr Ruth K. M. Pfau Civil Hospital, (Dow University of Health Sciences), Karachi Pakistan, from Jan 2021 to Feb 2021. Methodology: The data were collected prospectively from 265 COVID-19 positive patients. Some patients were interviewed over the telephone, while for patient's ease, an online Google form was also formed, facilitating the online data collection. The patient's demographics, comorbidities, allergies, and COVID-19 associated characteristics were inquired. The statistical analysis was performed on SPSS version 23. Results: The observed frequency of anosmia and ageusia in COVID-19 patients was 49.1% & 43.8% respectively. The median time to recovery was 8-8.5 days (median) for both symptoms. We found no significant difference for gender, BMI, marital status, residential area, comorbidities and reason for long-standing breathing difficulties between patients with or without both anosmia and ageusia (p>0.05). Furthermore, most of the cigarette smokers reported none of the two symptoms (anosmia and ageusia), 24% and 25.2% of COVID-19 positive cases with smoking history were presented without anosmia and ageusia, respectively (p<0.05). Conclusion: Loss of sense of smell and taste was reported in almost half of the studied population infected by the SARS-CoV-2 virus. Therefore, screening for anosmia and ageusia must be considered while COVID-19 suspicion as an important diagnostic clue.

Therapy-Related Acute Myeloid Leukemia Diagnosed at Postmortem in a Long-term Survivor of Advanced Hepatocellular Carcinoma

Acute myeloid leukemia (AML) is a common hematologic malignancy with high mortality and a short survival period in adults. About 10% of these cases, called therapy-related AML, are reported to be the consequence of chemotherapy or radiotherapy of previous malignancy. In a clinical setting, this is usually diagnosed by peripheral blood smear or bone marrow biopsy by assessing the proportion of blasts. However, postmortem blood samples are not suitable for smear analysis because of hemolysis. Therefore, ancillary tests for identifying leukemic infiltration or related molecular change can provide an alternative diagnostic clue for AML. The deceased had been treated for 3 years for a combined type of hepatocellular carcinoma with multiple pulmonary metastases. Treatments included the resections of primary and metastatic tumors, chemotherapy, and radiotherapy, which prevented further progression of his cancer. One year after the last treatment, he suddenly collapsed without any specific symptoms and shortly died. The microscopic examination of the autopsy samples revealed extensive extramedullary infiltration of leukemia, which was confirmed as an AML by a series of ancillary immunohistochemical staining. This case illustrates both the importance of careful hematologic observation in cancer survivors and the necessity of a detailed medical diagnosis in a medicolegal autopsy.

A case of Castleman disease with hemophagocytic syndrome derived from HHV8 infection

Background For a patient presenting with fever, multiple lymphadenopathy and splenomegaly, pathogen infection should be preferentially considered, followed by lymphoid malignancies. When traditional laboratory and pathological detection cannot find the pathogenic microorganism, metagenomic sequencing (MGS) which targets the person’s genome for exceptional genetic disorders may detect a rare pathogen. Case presentation Here, we introduced the diagnostic clue of a case of multicentric Castleman disease (MCD) with hemophagocytic syndrome which was elicited from the detection of human herpesvirus-8 in the blood of a HIV-1 infected person by MGS technology during pathogen inspection. This case highlights the need to increase the awareness of MCD among clinicians and pathologists. Conclusions MGS technology may play a pivotal role in providing diagnostic clues during pathogen inspection, especially when pathogens are not detectable by conventional methods.

PPP2R5D-Related Neurodevelopmental Disorder or Developmental and Epileptic Encephalopathy?: A Novel Phenotypic Description and Review of Published Cases

Background Protein phosphatase 2 regulatory subunit B′ delta (PPP2R5D)-related neurodevelopmental disorder is caused by pathogenic variations in the PPP2R5D gene, product of which is involved in dephosphorylation. This is a rare disorder with description limited to case reports. Its phenotypic spectrum has expanded over the last decade. Methods We report a child with a developmental and epileptic encephalopathy phenotype with a pathogenic PPP2R5D variant. This phenotype has not been previously reported. We also reviewed the previously published reports of patients with this disorder. Results Including the index child, 28 cases (15 girls) were identified from nine relevant research items for analysis. All patients had developmental delay. History of seizures was observed in seven patients while macrocephaly was seen in nearly 80% of patients. Nonneurological manifestations were observed in 13 patients with the most common one being ophthalmological manifestations. The most common genetic variation was c.G592A (p.E198K). The common phenotypic associations of this variation were developmental delay, macrocephaly (11/15), and epilepsy (6/15). Conclusion PPP2R5D gene variations should be suspected in children with developmental delay, autistic features, macrocephaly with or without epilepsy in the absence of any clear etiology. Dysmorphic features might provide a diagnostic clue. DEE phenotype may also be the presenting feature and might be an underreported entity.

Anti-Ganglioside Antibody Negative Miller Fisher Syndrome with Atypical Features: A Case Report

Miller Fisher Syndrome (MFS), a variant of Guillain Barre Syndrome (GBS), is an immune-mediated neuropathy presenting with the classical clinical triad of ophthalmoplegia, ataxia, and areflexia. Although the clinical triad is the cardinal diagnostic clue, it can also present with a variety of other atypical neurological symptoms and signs beyond the classical triad. IgG anti-GQ1b antibodies are a powerful serological marker for the diagnosis of MFS, however, they can be absent in 10-15% cases of MFS. Here, we are describing a case of a 55-year old lady with an anti-ganglioside negative case of MFS with ptosis and bulbar palsy, who improved with IVIg.