Progression of a Rare Disease, Takayasu Arteritis, With Hematologic and Gastrointestinal Manifestations: A Four-Year Follow-Up Study.

Takayasu arteritis (TA) is a heterogeneous disease whose presentation and progression have not yet been well described. An elderly female was diagnosed with TA after presenting with bilateral arm claudication, elevated ESR, and bilateral subclavian arterial stenosis. In the first two years after diagnosis, she was diagnosed with monoclonal gammopathy of undetermined significance and alpha thalassemia minor. For the next two years, she presented with a non-ST elevation myocardial infarction, three oozing Dieulafoy lesions, and eosinophilic esophagitis. As we observed, TA can have an unusual and unpredictable progression. Therefore, a multidisciplinary approach and clinical surveillance are paramount.

Clozapine-Induced Pericardial Effusion Presenting with Persistent Tachycardia.

Clozapine is an atypical antipsychotic used in refractory schizophrenia and depression. Its use is often complicated by its vast side-effect profile including cardiovascular reactions, agranulocytosis, and seizures. Specifically, the cardiac complications of clozapine have been shown to predominantly cause myocarditis and pericarditis. In this case report, the case of a 58-year-old male being treated for treatment-resistant depression and schizophrenia who suffers from tachycardia is presented. He is treated empirically for orthostatic hypotension with IV fluids without much success. Further imaging and echocardiography demonstrated a pericardial effusion, a rare reaction (≤1 : 10000) that has only been documented in a handful of case reports. This anecdotal evidence highlights the significance of polyserositis/pericardial effusion in the context of clozapine-induced orthostatic hypotension resistant to rehydration. When starting a patient on clozapine, it is important to consider further workup and monitoring with laboratory baseline biomarkers and cardiac evaluation with symptomatic individuals. Upon immediate cessation of clozapine, the pericardial effusion should spontaneously resolve without complication and should not be rechallenged.

Hand, foot and scrotal blisters in a patient with cancer receiving oral chemotherapy.

Tyrosine kinase inhibitors are novel antineoplastic drugs that make use of the molecular abnormalities that have been discovered in certain types of tumours. These agents are associated with important dermatological side effects. This case report discusses an atypical presentation of the hand-foot syndrome in one patient treated with sorafenib. A 78-year-old man, recently started on sorafenib for the treatment of hepatocarcinoma with lung metastasis, presented to the emergency room with painful blistering lesions on the palms, soles and scrotum for 1 week. A punch biopsy was performed and sorafenib was withheld. Direct immunofluorescence study was negative for an autoimmune blistering disorder and histopathology stains did not show any microorganisms. A diagnosis of hand-foot syndrome was made. After 2 weeks, the patient showed marked improvement and the plan was to restart sorafenib at a lower dosage.