A Case of Renal Artery Thrombosis With Concurrent Adrenal Hemorrhage in Polycythemia Vera.

Polycythemia vera (PV) is a rare myeloproliferative neoplasm characterized by the clonal proliferation of hematopoietic stem cells, leading to an elevated red blood cell mass. This hyperproliferative state increases blood viscosity and predisposes patients to thrombotic events, which are a significant cause of morbidity and mortality in PV. The diagnosis of PV is typically confirmed through elevated hemoglobin or hematocrit levels, low serum erythropoietin, and the presence of the Janus kinase 2 (JAK2) mutation. Common complications include venous and arterial thromboses, hemorrhage, and transformation to myelofibrosis or acute leukemia. A 68-year-old female with a history of PV and chronic kidney disease (CKD) presented with uremic symptoms in the form of malaise and nausea. Laboratory investigations indicated acute kidney injury (AKI) and hyperkalemia. Imaging evaluation of renal US Doppler revealed renal artery thrombosis and an incidental adrenal hemorrhage. The patient was managed with intravenous heparin and did not receive thrombolytics or thrombectomy. Her renal function did not improve, necessitating the initiation of hemodialysis (HD) during hospitalization. Over the course of the next few weeks, her renal parameters improved and she managed to be discharged from dialysis. The primary goal of this study was to highlight a rare presentation of renal artery thrombosis secondary to polycythemia vera (PV) and discuss the complexities involved in managing the underlying disease and its thrombotic complication, particularly in the presence of concomitant bleeding. Effective management of PV-related thrombosis requires a delicate balance between anticoagulation to prevent further thrombotic events while carefully addressing the risk of hemorrhage.

Idiopathic Hypereosinophilic Syndrome with Multiple Organ Involvement.

Idiopathic hypereosinophilic syndrome is a rare disease which is diagnosed after excluding other conditions. The syndrome is characterized by multiple organ involvement including the heart, nervous system, lungs, and gastrointestinal tract. The disease is suspected if there is peripheral blood eosinophilia and no clear etiology. The main treatment is corticosteroids. Patients who do not respond to corticosteroids can be treated with imatinib, immunomodulatory agents, myelosuppressive therapy, or mepolizumab. Alemtuzumab can be considered in severe cases that are unresponsive to other therapies. In this paper, we describe a case of idiopathic hypereosinophilic syndrome with mainly cardiac system involvement and left ventricular thrombus formation which was complicated by cerebral thromboemboli while on warfarin with international normalized ratio in the therapeutic range. Our patient responded well to steroids appreciated by improvement in clinical symptoms and decrease in eosinophil count.

An Association of Varicella Zoster Virus, Facial Palsy, and Meningitis in a Young Immunocompetent Male.

Varicella zoster is a secondary infection caused by the virus of chickenpox, after becoming latent in neurons of dorsal root ganglia or trigeminal ganglia. Varicella zoster virus (VZV) can be reactivated years later to produce shingles (zoster), generally in immunocompromised adults to produce neurological deficits and rash. Meningeal involvement of VZV is also reported and can be diagnosed. Herein, we report a 39-year-old immunocompetent male adult with a rare manifestation caused by VZV. The report is an association between facial nerve palsy and a polymerase chain reaction-confirmed VZV meningitis, even without the dermal typical rash. The patient eventually recovered after receiving acyclovir intravenously.

Acute Myeloid Leukemia after Low-Dose Radioiodine Therapy for Papillary Thyroid Carcinoma.

Papillary thyroid carcinoma is the most common primary thyroid cancer. Most frequently treated with surgical resection, some cases require radioactive iodine (RAI) therapy. Studies have suggested that there is an increase in second primary malignancy after RAI therapy amongst thyroid cancer survivors including acute myeloid leukemia (AML) as an infrequent cancer related to RAI therapy; it has a higher relative risk ratio in patients on higher doses of radiation exposure. We would like to report a 30-year-old lady who was diagnosed with papillary thyroid carcinoma. She underwent total thyroidectomy and received a low-dose RAI 131I therapy at a dose of 150 mCi, after which she developed therapy-related AML. Here we would like to highlight the association of AML with low-dose RAI as an infrequent cause of a second primary tumor compared to high doses.

Rituximab Twice Weekly for Refractory Thrombotic Thrombocytopenic Purpura in a Critically Ill Patient with Acute Respiratory Distress Syndrome.

Thrombotic thrombocytopenic purpura (TTP) is a rare, serious, life-threatening disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, and hypercoagulability. The etiology is a deficiency of ADAMTS13 which is usually caused by acquired antibodies. Plasma exchange and steroids is the standard of care in the treatment of TTP. However, there are refractory cases of TTP which require further management. Rituximab appears to be a safe and effective therapy for refractory and relapsing TTP. Here we report a challenging case of TTP that responded to treatment with rituximab twice weekly. According to our knowledge, rituximab twice weekly has never been used for TTP before.

Imatinib-Induced Tremor in a Patient with Chronic Myeloid Leukemia in Chronic Phase.

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by three phases: chronic, accelerated, and blast phase. However; first- and second-generation tyrosine kinase inhibitors are used for the treatment of CML with common and uncommon adverse events. Here, we report a 24-year-old male with CML in chronic phase started on imatinib as upfront medication who developed tremor and recovered spontenously after 3 years.