BMJ case reports
-
Case Reports
Epidural pneumatosis associated with spontaneous pneumomediastinum: a rare complication of diabetic ketoacidosis.
Pneumomediastinum and epidural pneumatosis are rare complications of diabetic ketoacidosis (DKA). These result from the emesis and hyperventilation associated with DKA which lead to alveolar rupture and air escape into the mediastinal and epidural spaces. ⋯ Oesophageal contrast studies are only required if oesophageal perforation is suspected in patients presenting with persistent vomiting and chest pain. We report the rare association of pneumomediastinum and epidural pneumatosis complicating DKA in a 19-year-old female patient.
-
The new capability to generate mimicking chemical analogues and perform mass screenings of candidate drugs has been tested on B-cell receptor signalling, a driver of B-cell malignancies. These efforts have identified ibrutinib as a potent inhibitor of Bruton's tyrosine kinase. ⋯ To date, the most common reported secondary malignancy is non-melanoma skin cancer; however, we present a case of secondary primary lung adenocarcinoma becoming clinically apparent shortly after initiating therapy with ibrutinib. Our patient had a sudden regression of the tumour with discontinuance of ibrutinib, and based on our understanding of paradoxical tumour growth caused by tyrosine kinase inhibitors it is our hypothesis that the complex multikinase activity of ibrutinib may stimulate tumour growth by targeting a subset of protein kinases critical for growth in some cancer cells.
-
Primary mediastinal large B-cell lymphoma (PMBCL) is confined to the mediastinum or contiguous nodal areas in most cases. Extramediastinal and abdominal involvement, especially at diagnosis, is extremely rare. Our case describes the first case of histologically proven ileal involvement of PMBCL at diagnosis that led to ileal perforation. Positron emission tomography CT could increase the sensitivity of staging by detecting unusual sites of disease localisation, and could impact clinical management.