We report here a 50-years old female with multiple myeloma-associated chronic renal failure who underwent high-dose chemotherapy supported by autologous hematopoietic stem cell transplantation. She developed progressive encephalopathy on day 5 progressing to coma despite hemodialysis and no obvious organ failure. She finally recovered after a single 1-liter plasma exchange. The final diagnosis was metabolic encephalopathy due to hypercytokinemia, particularly high serum TNF levels. We discuss here the pathogenesis and raise an alert for monitoring cytokine levels in patients with renal failure undergoing high-dose chemotherapy.

Vox SanguinisVolume 67, Issue 2 p. 240-240 Third-Generation HIV-1/HIV-2 ELISA Tests Piero Palla, Corresponding Author Piero Palla Department of Transfusion, Santa Chiara Hospital, PisaPz. Toniolo 8 I-56100 Pisa (Italy)Search for more papers by this authorAdolfo Moretti, Adolfo Moretti Department of Transfusion, Santa Chiara Hospital, PisaSearch for more papers by this authorFausto Pecori, Fausto Pecori Department of Transfusion, Santa Chiara Hospital, PisaSearch for more papers by this authorRenato Vanacore, Renato Vanacore Center of Clinical Immunology, University of Pisa, ItalySearch for more papers by this author Piero Palla, Corresponding Author Piero Palla Department of Transfusion, Santa Chiara Hospital, PisaPz. Toniolo 8 I-56100 Pisa (Italy)Search for more papers by this authorAdolfo Moretti, Adolfo Moretti Department of Transfusion, Santa Chiara Hospital, PisaSearch for more papers by this authorFausto Pecori, Fausto Pecori Department of Transfusion, Santa Chiara Hospital, PisaSearch for more papers by this authorRenato Vanacore, Renato Vanacore Center of Clinical Immunology, University of Pisa, ItalySearch for more papers by this author First published: August 1994 https://doi.org/10.1111/j.1423-0410.1994.tb01670.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Jackson Brooks J. Human immunodeficiency virus (HIV): Indeterminate Western blot and latent HIV infection. Transfusion 1992; 32: 497–499. 2 Cavalli P., Pennacchio A., Romanini GI Whole virus lysate or recombinant synthetic ELISA assay of HIV1: Which is better Vox Sang 1992; 63: 234–235. 3 Zaaijer HL, Exel-Oehlers PV, et al. Early detection of antibodies to HIV-1 by third-generation assay. Lancet 1992; 340: 770–772. 4 Palla P., Baicchi U., et al. Test Elisa HIV1 e 2 di 3 gen e sicurezza trasfusionale: valutazione di soggetti W.B. indeterminati, in G. Giorgio, L. Mauro, G. Lotti (eds): Atti del Corso di Aggiornamento: La Moderna Diagnostica in Immunoematologia e delle Malattie Virali Trasmissibili con il Sangue. San Giovanni Rotondo, April 1993, pp. 117–119. 5 Mortimer PP The fallibility of HIV Western blot. Lancet 1991; 337: 286–287. 6 Simon F., Bouchaud O., et al. Reliability of Western blotting for the confirmation of HIV-1 seroconversion. Lancet 1992; 340: 1541–1542. Citing Literature Volume67, Issue2August 1994Pages 240-240 ReferencesRelatedInformation

Hepatitis C virus (HCV) has been demonstrated to be the main cause of non-A, non-B hepatitis and the emergent infectious illness in dialysis units. At present, the anti-HCV 100 ELISA and an immunoblot assay in which 2 new antigens are included, are available. We have tested 110 patients on chronic dialysis with anti-C100 ELISA. Twenty-seven of them were anti-HCV positive. We tested the 27 anti-HCV-positive and 7 anti-HCV-negative patients with the RIBA 4 assay. The results were similar with both test.

The prevalence of hepatitis C virus (HCV) RNA and of antibodies to HCV in an unselected series of 42 mixed cryoglobulinemia patients was investigated in this study. HCV RNA was detected by the polymerase chain reaction technique, and HCV antibodies by two enzyme-linked immunosorbent assays (Chiron ELISA HCV, Second Generation, Emeryville CA, USA; Wellcome Diagnostic, England). HCV RNA was found in 86% of the mixed cryoglobulinemia patients. Using either the Chiron ELISA or the Wellcome ELISA, HCV antibodies were present in 90% of the same samples; anti-HCVAb seropositivity was confirmed in all cases by immunoblot assay (Chiron RIBA HCV, Second Generation Assay). A striking correlation between HCV RNA and anti-HCV antibody seropositivities was recorded. HCV RNA in mixed cryoglobulinemia patients was not correlated with the presence or absence of biopsy-proven liver involvement. These results suggest that the association between HCV and mixed cryoglobulinemia is not fortuitous, and therefore that HCV may have an etiopathogenetic role in this disorder.

The prevalence of antibodies to hepatitis C virus (HCVAb) was investigated in 52 unselected patients with mixed cryoglobulinemia and in 84 patients with other systemic immunologic diseases. HCVAb were detected by an enzyme-linked immunosorbent assay, and their specificity was evaluated by a recombinant-based immunoblot assay. The presence of HBV-related markers was investigated in the same samples. HCVAb were found in 54% of mixed cryoglobulinemia patients, and the finding was confirmed by recombinant-based immunoblot assay in all cases. HCVAb and/or HBV markers were present in 70% of the patients. HCVAb seropositivity was significantly more frequent in mixed cryoglobulinemia patients with biopsy-proven liver involvement (P less than 0.01) and with increased serum transaminase levels (P less than 0.01). HCVAb were virtually absent in control patients with other immunologic diseases. These results support the notion that viral agents, i.e., HCV and possibly HBV, have a role in the pathogenesis of mixed cryoglobulinemia patients.