PURPOSE: To investigate the frequency of p15 and p16 gene promoter methylation in acute promyeloc... more PURPOSE: To investigate the frequency of p15 and p16 gene promoter methylation in acute promyelocytic leukemia (APL), and to define its value in the detection of minimal residual disease (MRD) and treatment prognostication. PATIENTS AND METHODS: Bone marrow DNA obtained from 26 patients with APL at diagnosis and during follow-up was studied with the methylation-specific polymerase chain reaction (MS-PCR). Serial marrow DNA was studied by MS-PCR for MRD, and disease-free and overall survival were correlated with p15 methylation status at diagnosis. RESULTS: MS-PCR for p16 and p15 gene methylation has a maximum sensitivity of 10-4 and 10-5. At diagnosis, 19 patients (73.1%) exhibited p15 methylation, whereas only three patients (11.5%) exhibited p16 methylation, all of whom had concomitant p15 methylation. During follow-up, p16 methylation was acquired in two patients, one during the third hematologic relapse, and the other during transformation into therapy-related myelodysplastic sy...
2011 UkSim 13th International Conference on Computer Modelling and Simulation, 2011
This paper presents fuzzy based perturb and observe maximum power point tracking in solar panel. ... more This paper presents fuzzy based perturb and observe maximum power point tracking in solar panel. The solar system is modelled and analysed in MATLAB/SIMULINK. The photovoltaic panel has an optimal operating voltage where the PV panel can produce maximum power at this particular point. Due to the nonlinearity of the voltage-current characteristic in solar panel, it is difficult to determine analytically the maximum power operating voltage that varies with the change of solar irradiance and cell temperature. Maximum power point tracking (MPPT) is implemented to identify the maximum power operating point, subsequently regulate the solar panel to operate at that particular operating voltage for maximum power gaining. Perturb and observe (P&O) MPPT and fuzzy based optimized P&O MPPT are developed and the performances of both controllers are examined at variable solar irradiances at different temperatures. Simulation results show that fuzzy based P&O MPPT has better performance where it can facilitate the solar panel to produce a more stable power.
from the cell lines, and expression of HIF-1-a and HIF-2a was analyzed by Western blotting. Small... more from the cell lines, and expression of HIF-1-a and HIF-2a was analyzed by Western blotting. Small interfering RNAs (siRNAs) were used to downregulate HIF-1a and HIF-2a. Activity of the PI3k/Akt/mTOR pathway was examined by western blotting. The effect of PHD3 on cell proliferation was evaluated by using transfectants of PHD3-specific siRNA and a PHD3-expressing plasmid. Results: SMKT-R2 and SMKT-R3 had stable overexpression of PHD3 and HIF-1a/2a. On the other hand, PHD3 expression was induced in the nonconfluent state without accumulation of HIF proteins in Caki-1, whereas ACHN did not have PHD3 expression under normoxia. In Caki-1, in the nonconfluent state, the PI3K/Akt/mTOR pathway was activated, and inhibition of the pathway with LY294002 reduced PHD3 expression. Even in HIF-1a/2a double-knockdown Caki-1, activation of the PI3k/Akt/mTOR pathway induced overexpression of PHD3. In addition, PHD3 siRNA promoted cell proliferation compared with control siRNA in Caki-1 (p < 0.0001) without induction of HIF protein expression. Even in VHL-mutant SMKT-R2 and SMKT-R3, PHD3 siRNA showed the same effect (p < 0.05 and p < 0.01, respectively). On the other hand, PHD3-expressing plasmid transfection into ACHN reduced cell proliferation compared with empty vector transfection (p < 0.005). Conclusions: We demonstrated that PHD3 expression could be induced in VHL-intact RCCs under normoxia by activation of the PI3K/Akt/mTOR pathway, independently of HIF-1a and HIF-2a. In addition, we also found that PHD3 had an anti-proliferative function that was independent of HIF and VHL gene status in RCCs. 677 Growth suppression activity of tensin2 in human hepatocellular carcinoma is dependent on PTEN and SH2 domains
Executive Summary Enterprise Resource Planning (ERP) is a system that has the ability to integrat... more Executive Summary Enterprise Resource Planning (ERP) is a system that has the ability to integrate all departments and functions across a company onto a single computer system. In addition, the information on the server can be made available for all the different ...
The Wnt pathway has been shown recently, to be activated in patients with chronic lymphocytic leu... more The Wnt pathway has been shown recently, to be activated in patients with chronic lymphocytic leukemia (CLL). This is the first study to examine the role of Wnt inhibitory factor-1 (Wif-1) methylation in the pathogenesis of haematolymphoid malignancies. Wif-1, a putative tumor suppressor, is a soluble negative regulator of the Wnt pathway activated in CLL. We studied the role of methylation of Wif-1 in 43 Chinese patients with CLL. At diagnosis, Wif-1 methylation was detected in 5/43 (11.6%) CLL marrow samples. Wif-1 methylation occurred more frequently in patients with advanced age (p = 0.059) but there was no correlation between Wif-1 methylation and sex, lymphocyte count and Rai stage at diagnosis. In conclusion, Wif-1 is infrequently methylated in CLL. Other factors leading to activation of the Wnt pathway warrant further study.
Primary granulocytic sarcoma (GS) is rare, and poses a diagnostic pitfall for both pathologists a... more Primary granulocytic sarcoma (GS) is rare, and poses a diagnostic pitfall for both pathologists and oncologists. Previous literature showed that almost half of the patients with primary GS were misdiagnosed initially. We presented the clinico-pathological and radiological features of a patient with primary mediastinal GS, and discussed the differential diagnoses and clinical management.
Background: Bortezomib, an NFkB inhibitor, is an active agent for the treatment of myeloma (MM). ... more Background: Bortezomib, an NFkB inhibitor, is an active agent for the treatment of myeloma (MM). We have reported a promising complete remission (CR) rate for newly diagnosed myeloma patients treated by a staged approach, in which chemosensitive patients underwent autologous haematopoietic stem cell transplantation (auto-HSCT) while less chemosensitive patients received salvage therapy with bortezomib/thalidomide/dexamethasone prior to auto-HSCT. Methods: Herein, with an additional 13 months of follow-up, we reported the updated survivals, and examined potential prognostic factors impacting event-free (EFS) and overall survival (OS). Results: With a median follow-up of 30 months, the projected OS was 73% and EFS was 50.2%. Age, gender, clinical stage and DAPK methylation could not account for the differential chemosensitivity. Advanced ISS stage and DAPK methylation adversely impacted OS whereas oligoclonal reconstitution predicted superior EFS.
p300 is a widely expressed transcriptional coactivator, and is involved in DNA repair, cell growt... more p300 is a widely expressed transcriptional coactivator, and is involved in DNA repair, cell growth, differentiation, and apoptosis. Recent data suggest that it may function as a tumor suppressor. We investigated the frequency of aberrant methylation of p300 promoter in seven leukemic cell lines, as well as in the diagnostic samples of 46 patients with acute myelocytic leukemia (11 with M1, 22 with M2, 3 with M4, and 1 with M5), 24 patients with acute promyelocytic leukemia, and 22 patients with acute lymphoblastic leukemia (3 with T-cell, 1 with pre-B, 2 with Burkitt, 2 with early B-precursors, and 14 with common). None of the cell lines and patient samples showed p300 gene methylation. Therefore, hypermethylation of p300 is not an important mechanism in leukemogenesis.
Complex variant 15;17 translocations are increasingly recognized in acute promyelocytic leukemia ... more Complex variant 15;17 translocations are increasingly recognized in acute promyelocytic leukemia (APL). We report a novel three-way translocation in APL involving chromosomes 15, 17, and X in the form of t(X;17;15)(q13;q12;q21). Southern blot analysis showed retinoic acid receptor alpha (RARA) gene rearrangement at intron 2. Clinical and morphologic findings are typical of APL, and a complete remission was attained with a course of conventional chemotherapy. A review of three-way complex variants of 15;17 translocation in the literature reveals 21 published cases in addition to ours. PML/RARA fusion was observed in all 8 cases in which molecular genetic analysis had been performed. More cases need to be analyzed to determine if clustering to particular chromosomal bands occurs in variant translocations, and whether APL cases harboring complex 15;17 variants differ clinically from those with classical 15;17 translocation.
A 74-year-old female with stage IV follicular lymphoma achieved complete remission with anti-CD20... more A 74-year-old female with stage IV follicular lymphoma achieved complete remission with anti-CD20 antibody plus chemotherapy. Nine months later, she developed recurrent cervical lymphadenopathy and biopsy showed large cell transformation of follicular lymphoma. The lymphadenopathy resolved after further chemotherapy but she developed sudden onset of confusion. Magnetic resonance imaging showed leptomeningeal enhancement, consistent with lymphomatous involvement of the central nervous system (top, arrowed, Coronal post-Gadolinium image). This was confirmed by lumbar puncture, which showed centroblast-like lymphoma cells immunoreactive for CD20 (bottom). She expired 3 days after admission.
The treatment results of indolent lymphoid malignancies in Chinese are poorly reported. The effic... more The treatment results of indolent lymphoid malignancies in Chinese are poorly reported. The efficacy of FND (fludarabine 25 mg/m2/d, x3; mitoxantrone 10 mg/m2/d, x1; dexamethasone 20 mg/d, x5; monthly cycles, x6) in 95 Chinese patients with indolent B-cell malignancies (at diagnosis: 55, relapse/refractory disease: 40) and nine Chinese patients with T-cell large granular lymphocyte leukaemia (T-LGL leukaemia) (at diagnosis: two, refractory disease: seven) was evaluated. For B-cell malignancies, the complete response (CR), partial response (PR) and overall response (OR) rates were 50.5%, 18% and 68.5% respectively. Better results were obtained for primary versus relapse/refractory disease (CR: 60% vs. 37.5%, P = 0.03; OR: 84% vs. 47.5%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; median progression-free survival (PFS): 44 months vs. 22 months; 2-year PFS: 66% vs. 47%, P = 0.039; overall survival (OS): not reached vs. 32%; 2-year OS: 92% vs. 58%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Responsive patients (CR/PR) had a better median PFS (44 months vs. 5 months, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and OS (67 months vs. 13 months, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) than unresponsive patients. For T-LGL leukaemia, the CR and molecular-remission rates were 56% and 67% (median follow-up: 23 months). FND is an active regimen for the treatment of indolent B- and T-cell malignancies in Chinese patients, with results comparable with Western patients with similar indolent lymphomas.
To the Editor: A 58-year-old man presented 7 years ago with Binet stage II of CLL. Because of rap... more To the Editor: A 58-year-old man presented 7 years ago with Binet stage II of CLL. Because of rapidly rising lymphocyte count of 46.9 Â 10 9 /L [normal range: (1.5-4.0) Â 10 9 /L], he was treated with FND (fludarabine, mitoxantrone, dexamethasone), which resulted in recurrent neutropenia [1]. Six weeks after the fourth cycle of chemotherapy, he developed fever of unknown origin. Complete blood count showed hemoglobin 9.1 g/dL, platelets 58 Â 10 9 /L, leucocyte count 7.7 Â 10 9 /L [normal range: (4-11) Â 10 9 /L]. Differential count showed neutrophils 2.3 Â 10 9 /L [normal range: (2-7.5) Â 10 9 /L], lymphocytes 5.4Â 10 9 /L [normal range: (1.5-4)Â 10 9 /L], and absence of monocytes, eosinophils, and basophils. CD4 count was 0.2 Â 10 9 /L with a reversed CD4/CD8 ratio of 0.45:1. Serum IgG measured 346 mg/dL (normal >819 mg/dL), IgA 14 mg/dL (normal >70 mg/dL), and IgM 13 mg/dL (normal >55 mg/dL). Eight days after admission, he developed painful left thigh swelling. Computed tomography revealed hypodensities at the left rectis femoris, vastus intermedius, and vastus lateralis, which yielded pus on drainage (Fig. 1). Histological examination of tissue adjacent to the abscess revealed abundant Ziehl-Neelsen-positive mycobacteria, and subsequent culture confirmed Mycobacterium tuberculosis.
PURPOSE: To investigate the frequency of p15 and p16 gene promoter methylation in acute promyeloc... more PURPOSE: To investigate the frequency of p15 and p16 gene promoter methylation in acute promyelocytic leukemia (APL), and to define its value in the detection of minimal residual disease (MRD) and treatment prognostication. PATIENTS AND METHODS: Bone marrow DNA obtained from 26 patients with APL at diagnosis and during follow-up was studied with the methylation-specific polymerase chain reaction (MS-PCR). Serial marrow DNA was studied by MS-PCR for MRD, and disease-free and overall survival were correlated with p15 methylation status at diagnosis. RESULTS: MS-PCR for p16 and p15 gene methylation has a maximum sensitivity of 10-4 and 10-5. At diagnosis, 19 patients (73.1%) exhibited p15 methylation, whereas only three patients (11.5%) exhibited p16 methylation, all of whom had concomitant p15 methylation. During follow-up, p16 methylation was acquired in two patients, one during the third hematologic relapse, and the other during transformation into therapy-related myelodysplastic sy...
2011 UkSim 13th International Conference on Computer Modelling and Simulation, 2011
This paper presents fuzzy based perturb and observe maximum power point tracking in solar panel. ... more This paper presents fuzzy based perturb and observe maximum power point tracking in solar panel. The solar system is modelled and analysed in MATLAB/SIMULINK. The photovoltaic panel has an optimal operating voltage where the PV panel can produce maximum power at this particular point. Due to the nonlinearity of the voltage-current characteristic in solar panel, it is difficult to determine analytically the maximum power operating voltage that varies with the change of solar irradiance and cell temperature. Maximum power point tracking (MPPT) is implemented to identify the maximum power operating point, subsequently regulate the solar panel to operate at that particular operating voltage for maximum power gaining. Perturb and observe (P&O) MPPT and fuzzy based optimized P&O MPPT are developed and the performances of both controllers are examined at variable solar irradiances at different temperatures. Simulation results show that fuzzy based P&O MPPT has better performance where it can facilitate the solar panel to produce a more stable power.
from the cell lines, and expression of HIF-1-a and HIF-2a was analyzed by Western blotting. Small... more from the cell lines, and expression of HIF-1-a and HIF-2a was analyzed by Western blotting. Small interfering RNAs (siRNAs) were used to downregulate HIF-1a and HIF-2a. Activity of the PI3k/Akt/mTOR pathway was examined by western blotting. The effect of PHD3 on cell proliferation was evaluated by using transfectants of PHD3-specific siRNA and a PHD3-expressing plasmid. Results: SMKT-R2 and SMKT-R3 had stable overexpression of PHD3 and HIF-1a/2a. On the other hand, PHD3 expression was induced in the nonconfluent state without accumulation of HIF proteins in Caki-1, whereas ACHN did not have PHD3 expression under normoxia. In Caki-1, in the nonconfluent state, the PI3K/Akt/mTOR pathway was activated, and inhibition of the pathway with LY294002 reduced PHD3 expression. Even in HIF-1a/2a double-knockdown Caki-1, activation of the PI3k/Akt/mTOR pathway induced overexpression of PHD3. In addition, PHD3 siRNA promoted cell proliferation compared with control siRNA in Caki-1 (p < 0.0001) without induction of HIF protein expression. Even in VHL-mutant SMKT-R2 and SMKT-R3, PHD3 siRNA showed the same effect (p < 0.05 and p < 0.01, respectively). On the other hand, PHD3-expressing plasmid transfection into ACHN reduced cell proliferation compared with empty vector transfection (p < 0.005). Conclusions: We demonstrated that PHD3 expression could be induced in VHL-intact RCCs under normoxia by activation of the PI3K/Akt/mTOR pathway, independently of HIF-1a and HIF-2a. In addition, we also found that PHD3 had an anti-proliferative function that was independent of HIF and VHL gene status in RCCs. 677 Growth suppression activity of tensin2 in human hepatocellular carcinoma is dependent on PTEN and SH2 domains
Executive Summary Enterprise Resource Planning (ERP) is a system that has the ability to integrat... more Executive Summary Enterprise Resource Planning (ERP) is a system that has the ability to integrate all departments and functions across a company onto a single computer system. In addition, the information on the server can be made available for all the different ...
The Wnt pathway has been shown recently, to be activated in patients with chronic lymphocytic leu... more The Wnt pathway has been shown recently, to be activated in patients with chronic lymphocytic leukemia (CLL). This is the first study to examine the role of Wnt inhibitory factor-1 (Wif-1) methylation in the pathogenesis of haematolymphoid malignancies. Wif-1, a putative tumor suppressor, is a soluble negative regulator of the Wnt pathway activated in CLL. We studied the role of methylation of Wif-1 in 43 Chinese patients with CLL. At diagnosis, Wif-1 methylation was detected in 5/43 (11.6%) CLL marrow samples. Wif-1 methylation occurred more frequently in patients with advanced age (p = 0.059) but there was no correlation between Wif-1 methylation and sex, lymphocyte count and Rai stage at diagnosis. In conclusion, Wif-1 is infrequently methylated in CLL. Other factors leading to activation of the Wnt pathway warrant further study.
Primary granulocytic sarcoma (GS) is rare, and poses a diagnostic pitfall for both pathologists a... more Primary granulocytic sarcoma (GS) is rare, and poses a diagnostic pitfall for both pathologists and oncologists. Previous literature showed that almost half of the patients with primary GS were misdiagnosed initially. We presented the clinico-pathological and radiological features of a patient with primary mediastinal GS, and discussed the differential diagnoses and clinical management.
Background: Bortezomib, an NFkB inhibitor, is an active agent for the treatment of myeloma (MM). ... more Background: Bortezomib, an NFkB inhibitor, is an active agent for the treatment of myeloma (MM). We have reported a promising complete remission (CR) rate for newly diagnosed myeloma patients treated by a staged approach, in which chemosensitive patients underwent autologous haematopoietic stem cell transplantation (auto-HSCT) while less chemosensitive patients received salvage therapy with bortezomib/thalidomide/dexamethasone prior to auto-HSCT. Methods: Herein, with an additional 13 months of follow-up, we reported the updated survivals, and examined potential prognostic factors impacting event-free (EFS) and overall survival (OS). Results: With a median follow-up of 30 months, the projected OS was 73% and EFS was 50.2%. Age, gender, clinical stage and DAPK methylation could not account for the differential chemosensitivity. Advanced ISS stage and DAPK methylation adversely impacted OS whereas oligoclonal reconstitution predicted superior EFS.
p300 is a widely expressed transcriptional coactivator, and is involved in DNA repair, cell growt... more p300 is a widely expressed transcriptional coactivator, and is involved in DNA repair, cell growth, differentiation, and apoptosis. Recent data suggest that it may function as a tumor suppressor. We investigated the frequency of aberrant methylation of p300 promoter in seven leukemic cell lines, as well as in the diagnostic samples of 46 patients with acute myelocytic leukemia (11 with M1, 22 with M2, 3 with M4, and 1 with M5), 24 patients with acute promyelocytic leukemia, and 22 patients with acute lymphoblastic leukemia (3 with T-cell, 1 with pre-B, 2 with Burkitt, 2 with early B-precursors, and 14 with common). None of the cell lines and patient samples showed p300 gene methylation. Therefore, hypermethylation of p300 is not an important mechanism in leukemogenesis.
Complex variant 15;17 translocations are increasingly recognized in acute promyelocytic leukemia ... more Complex variant 15;17 translocations are increasingly recognized in acute promyelocytic leukemia (APL). We report a novel three-way translocation in APL involving chromosomes 15, 17, and X in the form of t(X;17;15)(q13;q12;q21). Southern blot analysis showed retinoic acid receptor alpha (RARA) gene rearrangement at intron 2. Clinical and morphologic findings are typical of APL, and a complete remission was attained with a course of conventional chemotherapy. A review of three-way complex variants of 15;17 translocation in the literature reveals 21 published cases in addition to ours. PML/RARA fusion was observed in all 8 cases in which molecular genetic analysis had been performed. More cases need to be analyzed to determine if clustering to particular chromosomal bands occurs in variant translocations, and whether APL cases harboring complex 15;17 variants differ clinically from those with classical 15;17 translocation.
A 74-year-old female with stage IV follicular lymphoma achieved complete remission with anti-CD20... more A 74-year-old female with stage IV follicular lymphoma achieved complete remission with anti-CD20 antibody plus chemotherapy. Nine months later, she developed recurrent cervical lymphadenopathy and biopsy showed large cell transformation of follicular lymphoma. The lymphadenopathy resolved after further chemotherapy but she developed sudden onset of confusion. Magnetic resonance imaging showed leptomeningeal enhancement, consistent with lymphomatous involvement of the central nervous system (top, arrowed, Coronal post-Gadolinium image). This was confirmed by lumbar puncture, which showed centroblast-like lymphoma cells immunoreactive for CD20 (bottom). She expired 3 days after admission.
The treatment results of indolent lymphoid malignancies in Chinese are poorly reported. The effic... more The treatment results of indolent lymphoid malignancies in Chinese are poorly reported. The efficacy of FND (fludarabine 25 mg/m2/d, x3; mitoxantrone 10 mg/m2/d, x1; dexamethasone 20 mg/d, x5; monthly cycles, x6) in 95 Chinese patients with indolent B-cell malignancies (at diagnosis: 55, relapse/refractory disease: 40) and nine Chinese patients with T-cell large granular lymphocyte leukaemia (T-LGL leukaemia) (at diagnosis: two, refractory disease: seven) was evaluated. For B-cell malignancies, the complete response (CR), partial response (PR) and overall response (OR) rates were 50.5%, 18% and 68.5% respectively. Better results were obtained for primary versus relapse/refractory disease (CR: 60% vs. 37.5%, P = 0.03; OR: 84% vs. 47.5%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; median progression-free survival (PFS): 44 months vs. 22 months; 2-year PFS: 66% vs. 47%, P = 0.039; overall survival (OS): not reached vs. 32%; 2-year OS: 92% vs. 58%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Responsive patients (CR/PR) had a better median PFS (44 months vs. 5 months, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and OS (67 months vs. 13 months, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) than unresponsive patients. For T-LGL leukaemia, the CR and molecular-remission rates were 56% and 67% (median follow-up: 23 months). FND is an active regimen for the treatment of indolent B- and T-cell malignancies in Chinese patients, with results comparable with Western patients with similar indolent lymphomas.
To the Editor: A 58-year-old man presented 7 years ago with Binet stage II of CLL. Because of rap... more To the Editor: A 58-year-old man presented 7 years ago with Binet stage II of CLL. Because of rapidly rising lymphocyte count of 46.9 Â 10 9 /L [normal range: (1.5-4.0) Â 10 9 /L], he was treated with FND (fludarabine, mitoxantrone, dexamethasone), which resulted in recurrent neutropenia [1]. Six weeks after the fourth cycle of chemotherapy, he developed fever of unknown origin. Complete blood count showed hemoglobin 9.1 g/dL, platelets 58 Â 10 9 /L, leucocyte count 7.7 Â 10 9 /L [normal range: (4-11) Â 10 9 /L]. Differential count showed neutrophils 2.3 Â 10 9 /L [normal range: (2-7.5) Â 10 9 /L], lymphocytes 5.4Â 10 9 /L [normal range: (1.5-4)Â 10 9 /L], and absence of monocytes, eosinophils, and basophils. CD4 count was 0.2 Â 10 9 /L with a reversed CD4/CD8 ratio of 0.45:1. Serum IgG measured 346 mg/dL (normal >819 mg/dL), IgA 14 mg/dL (normal >70 mg/dL), and IgM 13 mg/dL (normal >55 mg/dL). Eight days after admission, he developed painful left thigh swelling. Computed tomography revealed hypodensities at the left rectis femoris, vastus intermedius, and vastus lateralis, which yielded pus on drainage (Fig. 1). Histological examination of tissue adjacent to the abscess revealed abundant Ziehl-Neelsen-positive mycobacteria, and subsequent culture confirmed Mycobacterium tuberculosis.
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