Concomitant Kaposi sarcoma and multicentric Castleman's disease in a heart transplant recipient.

Post-transplant human herpes virus -8 (HHV-8)/Kaposi sarcoma herpes virus (KSHV) infection is associated with neoplastic and non-neoplastic diseases. Kaposi sarcoma (KS), multicentric Castleman's disease (MCD), and primary effusion lymphomas (PEL) are the most common HHV-8-associated neoplastic complications described in solid organ transplant (SOT) patients. Concurrent KS and MCD have been previously described after transplantation only twice - once after liver transplantation and once after renal transplantation.

Cardiac transplantation and/or mechanical circulatory support device placement using heparin anti-coagulation in the presence of acute heparin-induced thrombocytopenia.

Background: Patients with congestive heart failure, decreased left ventricular function, and debilitation are frequently maintained on anti-coagulants, including heparin. As such, these patients are at high risk for developing heparin-induced thrombocytopenia (HIT). Some of these HIT-positive individuals will ultimately undergo urgent heart transplantation or placement of a mechanical circulatory support device (MCSD).

Therapeutic implications of T-cell clonopathy of unknown significance in chronic immune thrombocytopenic purpura.

Immune thrombocytopenic purpura (ITP) is typically considered an autoimmune disorder related to the production of autoantibodies; however, recent evidence indicates that cell-mediated cytotoxicity may be important pathogenetically in some cases. We describe seven patients with chronic ITP and concurrent T-cell clonopathy of unknown significance (TCUS), who failed various treatment regimens for ITP, including steroids, gamma globulins, splenectomy and rituximab, but had anecdotal success with azathioprine. These observations support the notion that ITP has heterogeneous biologic mechanisms, and that patients with persistent chronic ITP should be evaluated for T-cell clonality and considered for treatment options that are directed against cytotoxic T-cells.

Are clonal T-cell large granular lymphocytes to blame for unexplained haematological abnormalities?

Abnormalities diagnosed on routine blood work, such as mild neutropenia, anaemia, thrombocytopenia and relative lymphocytosis, often have obscure aetiologies. A series of 30 patients were evaluated for various unexplained haematological abnormalities between 1997 and 2005, and found to have circulating monoclonal T-cell large granular lymphocytes (T-LGL). These patients fit the diagnosis of T-cell clonopathy of unknown significance (TCUS), which may represent a clinical spectrum of clonal T-LGL proliferation.