Group B Streptococcus Persistently Colonizing the Adenosquamous Carcinoma of the Lung: A Blessing in Disguise?

Group B Streptococcus (GBS), also known as Streptococcus agalactiae, is a gram-negative, beta-hemolytic facultative anaerobe that causes neonatal pneumonia and sepsis. The neoplastic epithelial cells in adults, especially those of squamous origin, can show special adhesive properties toward GBS, which tends to reside within these tumors. There are some animal and human studies proving this association. Here, we present a 64-year-old female patient who had lung carcinoma of mixed adeno and squamous origin found to have persistent GBS every time the bronchoscopy was done for tumor ablation or cryotherapy. Subsequently, after starting her on chemo-radiotherapy, she also presented with multiple episodes of pneumonia caused by GBS and Pseudomonas aeruginosa. Moreover, many animal studies have shown the anti-tumor properties of GBS toxin that can prevent its metastasis and stop vascular growth surrounding the tumor. This property of GBS toxin can prove a blessing in disguise.

Cushing's Disease Associated With Partially Empty Sella Turcica Syndrome: A Case Report.

The association between empty sella turcica (EST) syndrome and Cushing's disease has been rarely reported. It is plausible to hypothesize that EST syndrome in association with Cushing's disease can be attributed to intracranial hypertension. In this case report, we present a 47-year-old male patient who presented with weight loss, fatigue, easy bruising, acanthosis nigricans, and skin creases hyperpigmentation. Investigations revealed hypokalemia and confirmed the diagnosis of Cushing's disease. Magnetic resonance imaging (MRI) brain showed a partial EST syndrome and a new pituitary nodule as compared with previous brain imaging. Transsphenoidal surgery was pursued and was complicated by cerebrospinal fluid leakage. This case reflects the rare association of EST syndrome and Cushing's disease, suggesting the increased risk of postoperative complications in this setting and the diagnostic challenge that EST syndrome imposes. We review the literature for a possible mechanism of this association.

A Case of Advanced Multifocal Cholangiocarcinoma With Excellent Response to Pembrolizumab.

The role of immune checkpoint inhibitors (ICIs) continues to receive more attention as evidence emerges of their efficacy and improved survival in patients with advanced biliary tract malignancies including cholangiocarcinoma (CCA). In line with this evidence, we describe the case of a 52-year-old male patient who presented initially in October 2019 with abdominal pain. Investigations revealed multifocal hepatic masses that proved to be CCA that was considered unresectable. Chemotherapy with cisplatin (C) and gemcitabine (G) was initiated. In January 2020, progressive disease was noted, prompting the initiation of 5-fluorouracil (5-FU) and oxaliplatin along with pembrolizumab. Since March 2020, pembrolizumab monotherapy was pursued with radiological evidence of excellent response. Pembrolizumab monotherapy was continued through August 2022, where positron emission tomography (PET)/CT scan showed no evidence of active disease. This case serves to supplement the ongoing evidence of ICI efficacy especially as a durable, sustained radiological response was evident for more than three years from the time of diagnosis.

Nivolumab-Induced Organizing Pneumonia in Management of Non-small Cell Lung Carcinoma: A Case Report.

Nivolumab is an immune checkpoint inhibitor (ICI) that has proven efficacy in managing certain malignancies, including non-small lung carcinoma. In this case, we present a 53-year-old female patient diagnosed with metastatic non-small lung carcinoma. After management with radiation (both external beam and brachytherapy) and tumor debulking by bronchoscopic cryotherapy, she developed an initial pneumonitis attributed to nivolumab and ipilimumab. This was successfully managed with steroid therapy and allowed nivolumab monotherapy to restart. However, several months later, she developed organizing pneumonia, prompting immunotherapy discontinuation and initiation of corticosteroid therapy. This case serves as a reminder to clinicians that although ICIs constitute a novel, effective therapy for certain malignancies, immunological side effects can be debilitating and prevent continued immunotherapy. Through this case, we aim to review the literature about this rare side effect of nivolumab-induced pneumonitis, risk factors, diagnosis, and management.

Report of a Rare Case of Intracranial Extramedullary Hematopoiesis Mimicking a Brain Tumor.

Failure of the bone marrow to maintain adequate blood cell production to match blood metabolic demand incites the production of cell lines outside the bone marrow, which is known as extramedullary hematopoiesis. Herein, we are reporting an 80-year-old male patient who presented with two weeks of worsening headaches and behavioral changes. Labs showed thrombocytosis and imaging showed a large right-sided hemorrhagic brain mass. No evidence of malignancy was seen elsewhere. Brain mass biopsy showed intracranial extramedullary hematopoiesis (IEMH) and bone marrow biopsy confirmed the diagnosis of essential thrombocythemia (ET)/myelofibrosis. This case adds to a few reported cases of IEMH, and to the best of our knowledge, this is the first reported case of IEMH in association with ET. It helps remind clinicians to keep IEMH in the differential diagnosis of those presenting with signs and symptoms of elevated intracranial pressure (ICP) and a newly found brain mass on the background of previously diagnosed or suspected myeloproliferative neoplasms.