BMJ case reports
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Abdominal wall endometriosis (AWE) is a rare entity presenting as a painful lump with a cyclical pattern, associated with previous caesarean section (CS). AWE is typically located at the site of the CS scar. The diagnosis is challenging in the rare instance when AWE presents at a location distant to the CS scar. ⋯ Histology confirmed endometriosis, and the patient recovered uneventfully. The rarity of this clinical entity and the fact that AWE mostly presents to non-gynaecologists make the diagnosis challenging prolonging its physical and psychological morbidity. Thorough history-taking with emphasis on the pattern of pain and a previous history of CS should raise suspicion of AWE.
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Currently, North America is facing a national opioid overdose crisis. Opioid use disorder (OUD) is a chronic, relapsing condition requiring varying intensities of treatment. ⋯ This case highlights the effectiveness of the provision of iOAT in a low-barrier setting. More specifically, we discuss a patient with severe OUD and untreated HIV infection, who was disengaged from medical care and, consequently, was prescribed iOAT in a supportive housing setting.
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Oral anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKI) have shown significant benefit in the management of ALK-rearranged non-small cell lung cancer (NSCLC). However, almost all patients will experience disease progression after front-line ALK-TKIs such as crizotinib. Treatment with third generation ALK-TKI lorlatinib can have a significant clinical impact following disease progression, even in patients with a very poor performance status. ⋯ However, disease progressed rapidly in the central nervous system with severe neurological symptoms. Treatment with lorlatinib, a third-generation ALK-TKI, led to a rapid radiological and clinical cerebral response in both patients. Lorlatinib can overcome ALK resistance to crizotinib, and the presented cases suggest a potential role for lorlatinib in patients with rapidly progressive cerebral and leptomeningeal metastases.
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Case Reports
Pitfalls in diagnosing geriatric general pain: coexistence of polymyalgia rheumatism and fibromyalgia.
Polymyalgia rheumatism and fibromyalgia are clinically similar. As there are no specific diagnostic markers, they are difficult to distinguish. A 92-year-old woman with a 3-month history of general pain, including left hip pain, was referred to our hospital. ⋯ We found 3 of 18 asymmetrical tender points. No symptoms had recurred at the 1-month follow-up visit. Her case provides an opportunity to highlight the possible pitfalls when diagnosing geriatric general pain.