Innovations in Antibody-Drug Conjugate (ADC) in the Treatment of Lymphoma.

Chemoimmunotherapy and cellular therapy are the mainstay of the treatment of relapsed/refractory (R/R) lymphomas. Development of resistance and commonly encountered toxicities of these treatments limit their role in achieving desired response rates and durable remissions. The Antibody-Drug Conjugate (ADC) is a novel class of targeted therapy that has demonstrated significant efficacy in treating various cancers, including lymphomas. To date, three ADC agents have been approved for different lymphomas, marking a significant advancement in the field. In this article, we aim to review the concept of ADCs and their application in lymphoma treatment, provide an analysis of currently approved agents, and discuss the ongoing advancements of ADC development.

Two primary cancers appeared after discontinuation of nivolumab in the course of treating Hodgkin lymphoma: a case report.

Background: Nivolumab is a human monoclonal antibody against programmed death-1 (PD-1) that blocks interactions of PD-1 with both PD-L1 and PD-L2 and upregulates tumor antigen-specific T cell to develop appropriate immune response against cancer cells. It has been approved by the US Food and Drug Administration (FDA) in the treatment of various malignancies including Hodgkin lymphoma (HL). Case Description: Our patient is a 75-year-old man diagnosed with nodular sclerosis HL. After relapse of disease on several lines of treatment including autologous stem cell transplant, Nivolumab was started as part of a clinical trial. Partial response (PR) was noted on nivolumab for a few years which was eventually discontinued due to disease progression. A few weeks later, the patient was noted to have a suspicious lesion on the right earlobe and another on the base of the tongue, which were pathologically diagnosed as Merkel cell carcinoma (MCC) and oropharyngeal squamous cell carcinoma (SCC), respectively. Conclusions: Immune checkpoint inhibitors (ICIs) like nivolumab have demonstrated anti-tumor efficacy in several cancers to date. We describe here a unique observation of nivolumab suppressing the growth of two separate malignancies apart from the primary malignancy, discontinuation of which has then contributed to their growth and subsequent diagnosis. Our case report showcases the broad activity of ICIs and brings attention to the possibility of uncovering new malignancies after discontinuation of ICIs in high-risk patients.

Hereditary hemochromatosis: Temporal trends, sociodemographic characteristics, and independent risk factor of hepatocellular cancer - nationwide population-based study.

BACKGROUND: Hereditary hemochromatosis (HH) has an increased risk of hepatocellular cancer (HCC) both due to genetic risks and iron overload as iron overload can be carcinogenic; HH impacts the increasing risk of HCC, not only through the development of cirrhosis but concerning hepatic iron deposition, which has been studied further recently. AIM: To evaluate HH yearly trends, patient demographics, symptoms, comorbidities, and hospital outcomes. The secondary aim sheds light on the risk of iron overload for developing HCC in HH patients, independent of liver cirrhosis complications. The study investigated HH (without cirrhosis) as an independent risk factor for HCC. METHODS: We analyzed data from National Inpatient Sample (NIS) Database, the largest national inpatient data collection in the United States, and selected HH and HCC cohorts. HH was first defined in 2011 International Classification of Disease - 9th edition (ICD-9) as a separate diagnosis; the HH cohort is extracted from January 2011 to December 2019 using 275.01 (ICD-9) and E83.110 (ICD-10) diagnosis codes of HH. Patients were excluded from the HH cohort if they had a primary or secondary diagnostic code of cirrhosis (alcoholic, non-alcoholic, and biliary), viral hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease (NAFLD), and non-alcoholic steatohepatitis (NASH). We removed these patients from the HH cohort to rule out bias or ICD-10 diagnostic errors. The HCC cohort is selected from January 2011 to December 2019 using the ICD-9 and ICD-10 codes of HCC. We selected a non-HCC cohort with the 1:1 fixed ratio nearest neighbor (greedy) propensity score method using the patients' age, gender, and race. We performed multivariate analysis for the risk factors of HCC in the HCC and non-HCC matched cohort. We further analyzed HH without cirrhosis (removing HH patients with a diagnosis of cirrhosis) as an independent risk factor of HCC after adjusting all known risk factors of HCC in the multivariate model. RESULTS: During the 2011-2019 period, a total of 18031 hospitalizations with a primary or secondary diagnosis of HH (excluding liver diseases) were recorded in the NIS database. We analyzed different patients' characteristics, and we found increments in inpatient population trend with a Ptrend < 0.001 and total hospital cost of care trend from $42957 in 2011 to $66152 in 2019 with a Ptrend < 0.001 despite no change in Length of Stay over the last decade. The multivariate analyses showed that HH without cirrhosis (aOR, 28.8; 95%CI, 10.4-80.1; P < 0.0001), biliary cirrhosis (aOR, 19.3; 95%CI, 13.4-27.6; P < 0.0001), non-alcoholic cirrhosis (aOR, 17.4; 95%CI, 16.5-18.4; P < 0.0001), alcoholic cirrhosis (aOR, 16.9; 95%CI, 15.9-17.9; P < 0.0001), hepatitis B (aOR, 12.1; 95%CI, 10.85-13.60; P < 0.0001), hepatitis C (aOR, 8.58; 95%CI, 8.20-8.98; P < 0.0001), Wilson disease (aOR, 4.27; 95%CI, 1.18-15.41; P < 0.0001), NAFLD or NASH (aOR, 2.96; 95%CI, 2.73-3.20; P < 0.0001), alpha1-antitrypsin deficiency (aOR, 2.10; 95%CI, 1.21-3.64; P < 0.0001), diabetes mellitus without chronic complications (aOR, 1.17; 95%CI, 1.13-1.21; P < 0.0001), and blood transfusion (aOR, 1.80; 95%CI, 1.69-1.92; P < 0.0001) are independent risk factor for liver cancer. CONCLUSION: Our study showed an increasing trend of in-hospital admissions of HH patients in the last decade. These trends were likely related to advances in diagnostic approach, which can lead to increased hospital utilization and cost increments. Still, the length of stay remained the same, likely due to a big part of management being done in outpatient settings. Another vital part of our study is the significant result that HH without cirrhosis is an independent risk factor for HCC with adjusting all known risk factors. More prospective and retrospective large studies are needed to re-evaluate the HH independent risk in developing HCC.

Asymptomatic benzocaine spray-induced methaemoglobinaemia in preoperative sedation for oesophagogastroduodenoscopy.

Methaemoglobinaemia is defined as elevated methaemoglobin in the blood which is characterised by conversion of some of the reduced ferrous iron elements [Fe2+] to the oxidised ferric [Fe3+] form which does not have capacity to bind and transport oxygen resulting in functional anaemia. Causes can be genetic mutations or acquired by medications such as dapsone, nitrates or benzocaine. Benzocaine is currently being used as a topical anaesthetic agent before certain procedures. We report a case of benzocaine spray-induced methaemoglobinaemia in a patient who underwent oesophagogastroduodenoscopy for evaluation of upper gastrointestinal bleeding.

Left Ventricular Thrombus Formation in a Structurally and Functionally Normal Heart: A Case Report and Literature Review.

Left ventricular (LV) thrombosis usually occurs as a complication of acute anterior myocardial infarction (MI) and dilated cardiomyopathy. It also occurs in patients with a hypercoagulable state. However, in the setting of normal systolic function, LV thrombi are extremely rare. We present a case of a healthy woman who had LV thrombus despite normal LV systolic function that presented as an acute aortoiliac embolism.

Can Lenalidomide Protect against Severe COVID-19 Symptoms in Multiple Myeloma Patients? A Case Series and Review of the Literature.

We present a case series of three multiple myeloma (MM) patients on lenalidomide for maintenance therapy who were at high risk of coronavirus disease 2019 (COVID-19) complications and mortality. However, our patients had minor symptoms after testing positive for COVID-19 although they were unvaccinated. We think that lenalidomide might have a protective effect against severe COVID-19 symptoms. LEARNING POINTS: Multiple myeloma (MM) patients with active disease need treatment to avoid morbidity and mortality; the risk of relapse is also higher without treatment.Our three unvaccinated patients had mild COVID-19 infection while being treated with lenalidomide despite having high-risk comorbidities generally associated with severe COVID-19.Some small studies have reported that lenalidomide is protective against severe COVID-19, but larger clinical trials are required to determine whether or not to continue lenalidomide in MM patients with COVID-19.

Phentermine-Associated Atrial Fibrillation: A Case Report and Literature Review.

Obesity has become a major public health problem with increased prevalence and is associated with cardiovascular mortality. Phentermine is approved for short-term obesity treatment in conjunction with lifestyle modifications. Palpitations are a well-documented side effect of phentermine, but atrial fibrillation (AF) is rarely reported. We present a case of new-onset AF in a healthy woman who had been recently started on phentermine for weight loss. LEARNING POINTS: Atrial fibrillation usually occurs secondary to intrinsic disorders such as hypertension, coronary artery disease, abnormal heart valves, thyroid dysfunction and medication side effects.Phentermine is used for a short period together with diet and exercise to treat obesity; atrial fibrillation is an unusual cardiovascular side effect of phentermine that warrants clinician caution.The importance of medication reconciliation is exemplified in this case as it is essential to rule out secondary causes of atrial fibrillation, including medication side effects.

Wernicke encephalopathy after Roux-en-Y gastric bypass in a young patient.

We report a case of Wernicke encephalopathy (WE) in a woman in her 20s who had Roux-en-Y gastric bypass surgery for severe obesity, which resulted in a severe depletion of the patient's thiamine reserve and development of WE syndrome, we also emphasise the importance of prompt diagnosis of this serious complication in addition to the importance of adequate therapy.

Streptococcus intermedius: unusual presentation and complication of lung abscess.

We report a case of a 54-year-old immunocompetent male who had lung abscess secondary to Streptococcus intermedius that led to discitis by contiguous spread of infection. He initially presented with constant chest pain for 6 weeks that radiated to lower back, with no fever, chills or weight loss. He denied smoking cigarettes, alcohol use or any illicit drug. On investigation, a mass was identified on the posterior medial aspect of the right lower lobe with direct infiltration into right side of the T5-T6 vertebral bodies. Histopathology identified organising pneumonia with abscess. Tissue cultures showed S. intermedius, and were negative for other microorganisms. This case highlights a rare presentation of S intermedius discitis by contiguous spread of infection from posterior right lower lobe lung abscess. S intermedius usually occurs in older patients with pulmonary infections complicated with pleural effusion or lung abscess, but can present in young patients with no clear symptoms of lung infection, like our patient.

A Thoracic Endometriosis-Related Catamenial Hemopneumothorax in a Woman With Premature Ovarian Failure.

Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity. It is usually confined to the pelvis, particularly the ovaries, cul-de-sac, broad ligaments, and uterosacral ligaments, but it can also expand outside the pelvis. The thorax is among the common extrapelvic locations. Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of functioning endometrial tissue in the pleura, lung parenchyma, and airways. This report presents a case of a young female patient with advanced endometriosis and premature ovarian failure who was admitted with dyspnea that turned to be due to a rare endometriosis-related complication.

Colchicine-induced rhabdomyolysis: a review of 83 cases.

A 74-year-old man with medical history significant for atrial fibrillation, hyperlipidaemia and coronary artery disease on atorvastatin presented to the emergency department with profound weakness. The patient reports he first noticed his weakness 4 weeks after starting colchicine, prescribed for recurrent pericarditis with pericardial effusion, a complication following recent coronary artery bypass grafting. The patient was also on prednisone therapy for presumed post-pericardiotomy syndrome. The weakness involved all four limbs but was more notable in the lower extremities, with preserved sensation and tenderness to palpation. Labs showed an elevated creatinine phosphokinase and serum creatinine consistent with rhabdomyolysis. Discontinuation of the offending medications, including colchicine and atorvastatin, as well as intravenous fluid resuscitation with physical rehabilitation, led to improvement in the patient's symptoms. He was eventually discharged to a rehabilitation facility to continue physical therapy.

A Paraneoplastic Leukemoid Reaction in Primary Lung Sarcoma.

Pulmonary malignancies are known to have high prevalence and mortality. They are associated with different paraneoplastic syndromes, especially pulmonary carcinomas, because they are more common than pulmonary sarcomas. We present a case of a 56-year-old African American male who was admitted to our institution with a three-month history of a dry cough, progressive shortness of breath, and two to three days of right arm swelling. He had extreme leukocytosis (WBC count of 106,500 cells/mm3). Computed tomography (CT) scan of the thorax demonstrated an irregular, thick-walled 14-cm lung mass occupying the middle and upper hemithorax. CT-guided biopsy of the mass confirmed the diagnosis of lung sarcoma.

Silent Sigmoid Colon Diverticular Perforation: A Case Report.

Colonic perforation is associated with high mortality rates, and it requires prompt diagnosis and intervention to ensure favorable patient outcomes. The condition usually presents with typical peritoneal signs and symptoms, but atypical presentations can be a diagnostic challenge. In this report, we present a case of sigmoid diverticulosis perforation in an elderly patient who had no symptoms after the perforation developed. This case highlights the importance of detailed history, physical examination, and a low threshold of suspicion in patients with risk factors for atypical presentations.

Emphysematous endometritis in stage III endometrial cancer.

We report a case of emphysematous endometritis in a 65-year-old patient who has stage III, high-grade, poorly differentiated endometrial cancer; she was on chemotherapy. The patient developed pyogenic emphysematous endometritis complicated by hypovolemic shock and sepsis. She was admitted to the intensive care unit for treatment with vasopressors and antibiotics. The shock was successfully managed and her hospital course was otherwise unremarkable.

Early-stage Burkitt lymphoma remained in remission 7 years from diagnosis after only one cycle of chemoimmunotherapy.

Burkitt lymphoma (BL) is a rare, mature, fast-growing and highly aggressive B-cell neoplasm. It has a high-proliferation rate with distinctive genetic changes in the C-MYC oncogene. Treatment usually requires intense and frequent chemotherapy regimens with central nervous system prophylaxis as the usual regimens used for other non-Hodgkin's lymphoma yield poor survival in BL. This report discusses a patient who was diagnosed with a stage II, high-grade BL who received one cycle of intense chemotherapy and refused further treatment. That patient remained in complete remission in his last follow-up; 7 years from diagnosis without requiring other therapies for his lymphoma.

Spontaneous Coronary Artery Dissection: Case Series and Literature Review.

Spontaneous coronary artery dissection (SCAD) is an important and rare cause of myocardial infarction (MI), particularly among young women without traditional atherosclerotic risk factors. Late pregnancy and postpartum period are associated with more risk for developing SCAD. No enough data exist regarding the ideal management of SCAD due to lack of randomized trials comparing medical therapy and revascularization strategies. We present three cases of SCAD, two of them were postpartum women while one involved an obese young woman with no identifiable risk factors. We describe the pathophysiology, types of SCAD, risk factors, clinical presentation, and management approach. This case series highlights the need to raise awareness of SCAD and to facilitate accurate diagnosis promptly.

Small Intestinal Adenocarcinoma in a Patient With Celiac Disease.

Celiac disease (CD) is a systemic immune-mediated disorder against gluten, leading to an autoantibody response causing damage to the small intestinal mucosa. CD has been associated with gastrointestinal malignancies, most commonly gastrointestinal lymphoma. Rare malignancies have also been reported, such as small intestinal adenocarcinoma. In this report, we present a case of a 91-year-old male with a history of CD, noncompliant with a gluten-free diet, who presented with weight loss, abdominal pain, and gastrointestinal bleeding secondary to a newly discovered adenocarcinoma of the jejunum.

Recurrent Spontaneous Pneumothorax Associated With Marijuana Abuse: Case Report and Literature Review.

Marijuana is the most commonly used illicit recreational drug in the United States. Growing public support for marijuana law reform has resulted in a significant increase in its use. The harmful pulmonary consequences of chronic marijuana smoking are less researched and discussed than those of tobacco smoking. We present a case of recurrent spontaneous pneumothorax in a patient with heavy, persistent marijuana abuse who has no past medical or surgical histories and denied smoking cigarettes or other illicit substance use.

Isolated Native Tricuspid Valve Endocarditis in an HIV Patient due to Streptococcus Pneumoniae: A Rare Clinical Phenomenon.

Streptococcus pneumonia is an important cause of septicemia. Other sites of infection include meningitis, septic arthritis, and endocarditis. Pneumococcal endocarditis is rare and has a poor prognosis. We report a case of a 47-year-old female patient with HIV who developed isolated native tricuspid valve endocarditis secondary to streptococcus pneumonia, which is considered to be a very rare presentation in our patient due to the absence of common risk factors such as intravenous drug use, heart disease, or right heart catheterization.

Coronavirus Disease 2019-Associated Bilateral Massive Pulmonary Emboli Caused Death in a Healthy 35-Year-Old Patient.

Coronavirus disease 2019 (COVID-19) infection was first reported in December 2019. Within three months, the virus caused a global pandemic that has affected the whole world's dynamics. Many causes of death due to COVID-19 infection have been identified, involving but not limited to atypical acute respiratory distress syndrome, hypercoagulability, renal failure, and a proinflammatory cytokine storm, often associated with multiorgan failure. We report the case of a young, previously healthy patient who developed massive pulmonary emboli due to COVID-19 infection, resulting in death.