A Rare Case of Metastatic Glioblastoma Diagnosed by Endobronchial Ultrasound-Transbronchial Needle Aspiration.

Glioblastoma is a common primary brain tumor that has a high mortality rate. Reports of intrathoracic metastases are uncommon, with the most commonly reported site for metastases are the lung and pleura. However, involvement of the mediastinum is not well documented, and few reports of confirmed mediastinal metastases diagnosed by endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) exist. Herein, we report a rare case of metastatic glioblastoma to the thorax. A lady in her 40s has been previously diagnosed with intracranial glioblastoma with multiple incidences of disease recurrence despite treatment with chemoradiotherapy, adjuvant chemotherapy, and repeated surgical resections. She presented with dyspnea and pleural effusion, for which radiological imaging revealed lung, pleural, and mediastinal lesions. Further diagnostic workup with EBUS and pleural fluid sampling confirmed metastatic disease to both sites. The pleural fluid showed highly atypical cells positive for GFAP, and EBUS-TBNA immunostains were GFAP, S100, and synaptophysin positive, giving an overall picture consistent with metastatic glioblastoma. The patient was referred for palliative care, and unfortunately, she passed away after several months.

A Rare Case of Rapid Onset Thrombocytopenia Induced by Piperacillin/Tazobactam in a Liver Transplant Recipient.

Drug-induced thrombocytopenia is a relatively common clinical condition. However, acute thrombocytopenia after initiation of piperacillin/tazobactam is rare, with only a few cases reported in the literature. The mechanism by which it happens is still unclear but it is thought to be immune-mediated. We present the first case of rapid-onset thrombocytopenia induced by piperacillin/tazobactam in a liver transplant recipient. Our patient had previous exposure to the antibiotic, and thrombocytopenia was treated by merely stopping the culprit antibiotic (piperacillin/tazobactam). The patient had a successful challenge with cefepime afterward despite possible cross-reactivity, making this the second case report of successful re-challenging with cefepime.

Leifsonia Species Bacteremia in a Hemodialysis Patient: A Difficult-to-Identify Organism.

Leifsonia is an environmental gram-positive rods bacteria. Infections due to Leifsonia are not common. In this report, we present a case of a hemodialysis patient with Leifsonia bacteremia. A 56-year-old lady had been receiving hemodialysis through the femoral line. She presented with nonspecific symptoms. Multiple blood cultures taken from the central line and peripherally grew gram-positive bacilli, which were identified by polymerase chain reaction (PCR) as Leifsonia species. This serious infection resolved only after the removal of the central venous catheter (CVC) and treatment with vancomycin for four weeks from the first negative blood culture. Leifsonia species are a rare cause of CVC-associated infections. Leifsonia should be considered in hemodialysis patients with gram-positive rod bacteremia. Leifsonia also has the ability to produce a biofilm. Removal of the line along with antibiotics is necessary to cure the infection.

Castleman's Disease with Pulmonary Artery Aneurysm: A Rare Presentation of Behçet's Disease.

Diagnosing Behcet's disease (BD) in a patient already diagnosed with Castelman's disease (CD) is rare. There are only a few cases reported in the literature and all of them were diagnosed as BD prior to the patient experiencing symptoms and signs of CD. We present a patient who was initially diagnosed as having CD. However, after being managed with chemotherapy, specifically after the fourth cycle, the patient was found to have an incidental finding of pulmonary artery aneurysm, which led to the diagnosis of BD. For that, he received the appropriate management of high-dose steroid, azathioprine, and oral anticoagulant. Currently, the patient is doing well, and the latest computed tomography scan showed complete resolution of his pulmonary aneurysm. We suggest taking a thorough history from all patients with BD symptoms and signs, especially in CD patients as they may overlap, for early diagnosis and to prevent complications.

Health education to diabetic patients before the start of Ramadan: Experience from a teaching hospital in Dammam.

BACKGROUND AND OBJECTIVE: Studies have shown that pre-Ramadan structured educational program for patients with diabetes mellitus (DM) is beneficial. In this study, our aim was to evaluate the degree of adherence of treating physicians to such programs and their influence on the patient's knowledge and behavior. MATERIALS AND METHODS: This cross-sectional study was carried out on adult patients with DM attending a university hospital, who were observed while fasting during Ramadan 1436/2015. Data was collected using a questionnaire-based interview. Baseline characteristics were obtained, and patients were asked whether they had had pre-Ramadan education or not and who the provider was. Patients' knowledge of the components of the recommended structured pre-Ramadan educational program was also tested. Comparison between patients who had the education and those who did not was done using Chi-square test and independent samples Student's t-test; p ≤ 0.05 was considered statistically significant. RESULTS: A total of 298 patients with type 1 or type 2 DM were included in the study; 75.5% of the patients were aged 40 years or older. Only 30% had pre-Ramadan education delivered mainly by diabetic educators or the treating physicians (52% and 44%, respectively). Patients who had the education were younger (mean age: 45.6 ± 17.4 vs. 50.3 ± 14.4, respectively, p = 0.0048), had higher educational qualifications, were more likely to be employed, and self-monitored their blood glucose more frequently (p = 0.0001). There was no difference between the two groups with regard to their knowledge of diet and exercise. CONCLUSION: The adherence to the pre-Ramadan educational program by the treating physician was low. It is necessary to increase the awareness about the importance of these programs among health-care professionals. The programs should target the less educated, the unemployed, and older patients.