Nocardiosis is an opportunistic infection caused by weakly Gram-positive, partially acid-fast, filamentous bacteria of the genus Nocardia . Nocardiosis of the central nervous system (CNS) may manifest as single/multiple abscesses. It could be misinterpreted as a tumor or space-occupying lesion caused by other infectious agents on imaging. Here, we present a case of nocardial brain abscess in a patient with myeloma. Brain biopsy was performed from the intracranial lesion; modified Ziehl-Neelsen staining of the aspirated biopsy material revealed filamentous, acid-fast, branching bacteria, suggestive of Nocardia species. Growth was obtained on blood agar and Lowenstein-Jensen media after 72 hours of incubation. The growth was confirmed by matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF-MS) (BioMérieux France) as Nocardia cyriacigeorgica . The patient was administered intravenous imipenem and trimethoprim-sulfamethoxazole, resulting in significant clinical improvement. Thorough maintenance, interspersed, consolidated therapy with imipenem for 10 days every month was continued for 9 months to prevent relapse.
Introduction Stem cell transplant is the only cure for majority of hematological diseases. Major concerns using haplo HSCT is risk of rejection and CMV reactivation. The treatment of CMV reactivation is toxic to naive marrow leading to graft failure. Effective CMV prophylaxis can reduce the immediate TRM. Letermovir has recently available in our country for CMV prophylaxis. We are presenting our experience using Letermovir for CMV prophylaxis in Haplo HSCT. Method This prospective study conducted at our institute from February 2025 to Sept. 2025. Nineteen consecutive patients undergoing T cell replete Haplo HSCT were considered received Letermovir 240 mg once daily from day + 5 post haplo HSCT till day +100. Patients were monitored for CMV reactivation using quantitative CMV PCR weekly after engraftment for 100 days. The patient details are given in table 1. Objectives End point of study was CMV reactivation, need for CMV therapy, engraftment and graft function. Results Nineteen consecutive patients with the median age of 19 yrs were given Letermovir. There were 12 males and 7 females. Three patients expired before engraftment due to bacterial sepsis. Eighty four percent (16/19) of patients engrafted. Median neutrophil engraftment was achieved on day +14 and platelet engraftment on day+16. All engrafted patients achieved complete donor chimerism on day + 21.(Table 2)Two out of nineteen patients had CMV reactivation on day +20 and day +29 . One patient was asymptomatic and CMV copies were negative on repeat CMV after 1 week without any CMV therapy. Second patient had cytopenias and was given pre emptive therapy with Valganciclovir. There were no clinically significant toxicities of Letermovir in any of patients.On last median follow up of 75 days (range, 64-91) all patients are free from CMV reactivation . Conclusion Letermovir is a highly effective drug in preventing CMV reactivation in high risk transplants especially Haploidentical stem cell transplants.
Background Haplo HSCT using T cell replete grafts has emerged as a curative modality for patients lacking matched donors. Treosulfan and thiotepa have emerged as effective conditioning agents for hematopoietic stem cell transplantation (HSCT), offering reduced toxicity and favorable engraftment profiles compared to busulfan based regimens . Their role in T-cell replete haploidentical HSCT remains less well defined. Methods A total of 24 patients (median age: 10 years; range: 2–42 years) with both malignant and non-malignant haematological conditions underwent haplo-HSCT between March 2024 and Sept. 2025. The conditioning regimen included Treosulfan (36–42 g/m²), Thiotepa (8 mg/kg), and Fludarabine (40 mg/m² × 3–4 days). Patients received unmanipulated T-cell replete grafts. Primary endpoints were neutrophil engraftment, regimen-related non-haematological toxicity, cytokine release syndrome (CRS), engraftment kinetics, and GVHD. Secondary outcomes included relapse, CMV reactivation, non-relapse mortality (NRM), overall survival (OS), and GVHD-free relapse-free survival (GFRS). Results No patient developed non-hematologic regimen-related organ toxicity. CRS occurred in 20 of 24 patients, with most cases being Grade I. Neutrophil and platelet engraftment occurred by a median of Day +13 and +15, respectively. Acute GVHD (Grade II gut) was observed in 6 patients, and chronic GVHD (limited skin) in 4. There was one case of graft rejection. Relapse occurred in 1 patient with relapsed AML, while CMV reactivation was noted in 54.2%. At a median follow-up of 7.9 months (0.4-92.6 months) OS was 79.2%. Conclusion Thiotepa–treosulfan–fludarabine conditioning provides reliable engraftment and acceptable toxicity for haploidentical HSCT. Our findings support the use of treosulfan as a safer alkylating agent, with thiotepa improving engraftment and reducing rejection . Larger multicenter prospective studies are warranted to validate these results.
Hypoplastic posterior mitral leaflet is a congenital dysplastic mitral valve abnormality rarely reported in adults. The presentation is varied, from being asymptomatic to significantly symptomatic due to progressive mitral regurgitation. In many of these cases additional cardiac lesions are noted, most commonly, bicuspid aortic valve and atrial septal defect. Hence, while performing imaging assessment for these conditions, a comprehensive evaluation of the mitral valve apparatus is essential so as not to miss the valvular pathology. The ideal therapeutic approach and timing for intervention in hypoplastic posterior mitral leaflet is still not clear due to a rarity of these cases. Mitral valve repair though preferred, may not be the ideal treatment modality and many patients require mitral valve replacement especially when presenting at an older age. We hereby report about a 56-year-old male patient who was diagnosed with ostium secundum atrial septal defect and hypoplastic posterior mitral leaflet. He underwent successful surgical closure of the atrial septal defect and concomitant bileaflet metallic prosthetic mitral valve replacement. His postoperative course was uneventful and was associated with amelioration of symptoms during follow-up.
Laryngopharyngeal reflux (LPR) presents a diagnostic challenge due to its non-specific symptomatology and frequent overlap with other upper airway disorders. While the Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) are commonly employed in clinical practice, their subjective nature and limited specificity necessitate complementary tools. This study aimed to examine the correlation between RSI and RFS, evaluate the influence of lifestyle factors, and assess quality of life (QoL) using validated indices to improve clinical assessment.A cross-sectional analytical study was conducted on 50 patients with symptoms suggestive of LPR. Participants completed the RSI, Voice Handicap Index-10 (VHI-10), and Short Form-36 Health Survey (SF-36). All patients underwent fibreoptic laryngoscopy, and laryngeal signs were scored using the RFS. Statistical analyses included correlation coefficients and regression models to assess the relationships between symptom scores, laryngoscopic findings, lifestyle irritants (smoking, alcohol, spicy food), and QoL outcomes.A significant positive correlation was observed between RSI and RFS, particularly for the symptom “lump in the throat” (r = 0.82, p < 0.001). Smoking was a significant predictor of both elevated RSI (p = 0.007) and RFS (p = 0.012). An RSI score > 25 predicted RFS positivity (≥ 7) with an 88
