Internal medicine
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Case Reports
Composite Lymphoma after Treatment with Infliximab for Sarcoidosis and Ankylosing Spondylitis.
Lymphoid proliferations and lymphomas associated with immune deficiency and dysregulation (LP/L-IDD) are rare entities associated with the use of immunosuppressive drugs (ISD) for autoimmune conditions. Composite lymphomas, featuring both B-cell and T-cell lymphomas, are infrequent, and their occurrence as LP/L-IDD is rare. ⋯ CHOP chemotherapy led to significant remission. This case report emphasizes the need to consider lymphoma in patients with autoimmune diseases such as sarcoidosis and ankylosing spondylitis, especially those treated with ISDs.
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Case Reports
Tumor Lysis Syndrome in a Patient with BRAFV600E Mutated Colon Cancer Treated with Cetuximab and Encorafenib.
Tumor lysis syndrome (TLS) is a fatal complication associated with chemotherapy. We herein report a case of TLS in a 73-year-old woman with metastatic BRAFV600E mutated colon cancer after she received combined treatment with cetuximab and encorafenib. ⋯ Diuresis and rasburicase were initiated for TLS, and the laboratory data all normalized on day 8. Thus, the possibility of TLS being induced by targeted drugs in patients with solid tumors, including colorectal cancer, must not be overlooked.
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X-linked agammaglobulinemia (XLA) is associated with an increased risk of gastrointestinal cancers including gastric cancer (GC). We herein report the case of a 30-year-old male patient with XLA who developed GC and extensive atrophic gastritis. ⋯ Immunoglobulin deficiency makes these patients susceptible to progressive atrophic gastritis and the associated risk of GC. Therefore, patients with XLA are advised to undergo an evaluation for Helicobacter pylori infection as well as monitoring for GC.
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Objective Intravenous fluid therapy, including peripheral parenteral nutrition (PPN), administered via a peripheral intravenous catheter (PVC) can occasionally lead to bloodstream infections (BSIs). PPN may thus be a risk factor for PVC-related BSI (PVC-BSI). However, the risk factors and incidence of PVC-BSI have not been previously reported, and evidence for these conditions remains unclear. ⋯ An average daily infusion time of PPNs ≥12.0 h and an average daily infusion time of intravenous fluids ≥18.0 h were identified as predictive risk factors for BSI. When both risk factors were present, the sensitivity, specificity, and odds ratio for the development of BSI were 85.0%, 83.2%, and 27.9, respectively. Conclusion This study identified the incidence of and risk factors for developing BSI, such as a longer average daily infusion time of PPNs and all intravenous fluids, in patients receiving PPN therapy.
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Case Reports
A Case of Multiple Cerebral Infarcts Due to Severe Anemia Preceded by Migraine-like Headache with Aura.
We herein report a 47-year-old woman who developed migraine-like headache with aura and subsequent multiple cerebral infarcts, likely due to severe iron deficiency anemia (IDA) from menorrhagia. The progression from IDA to ischemic stroke involves several pathophysiological mechanisms, including reduction of erythrocyte deformability, reactive thrombocytosis, and anemic hypoxia. ⋯ This case highlights the transition from migraine-like headache to ischemic stroke. New-onset migraine-like headache is a warning of impending ischemic stroke, and IDA may be a potential underlying cause.