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1.
Cureus ; 16(3): e55374, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38562339

RESUMEN

Splenic marginal zone lymphoma (SMZL) usually presents with splenomegaly or symptoms related to cytopenia. We report a case of a 56-year-old female with previously diagnosed antiphospholipid syndrome (APS) on warfarin therapy who initially presented with abdominal pain and was found to have massive splenomegaly and splenic infarction on CT imaging. Initial clinical presentations and imaging findings were attributed to the subtherapeutic coagulation profile. The patient was later diagnosed with SMZL following workup for pancytopenia including bone marrow biopsy, flow cytometry, and PET scan. Cytopenias, splenomegaly, and abnormal metabolic activity in the spleen on the PET scan improved after treatment with four cycles of weekly rituximab. Our report presents a case of a patient with longstanding APS presenting with splenic infarction and pancytopenia who was subsequently diagnosed with SMZL and successfully treated with rituximab.

2.
Clin Case Rep ; 11(7): e7617, 2023 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-37397578

RESUMEN

Isolated mesenteric vein thrombosis associated with Fusobacterium is rare. Physicians should be aware regarding the association of Fusobacterium with thrombosis at various sites.

3.
Cureus ; 15(2): e35276, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36825072

RESUMEN

Immune checkpoint inhibitors (ICI) such as program cell death protein 1 (PD-1) inhibitors are widely used for the treatment of patients with recurrent, locally advanced or metastatic, gastric or gastroesophageal (GE) junction adenocarcinoma. Immune-related adverse events (irAE) such as endocrinopathies have been reported after patients received ICI. We report a case of pembrolizumab-induced hyperthyroidism and type 1 diabetes mellitus (DM1) presenting with diabetic ketoacidosis (DKA). A 53-year-old African American male with no history of diabetes or hyperthyroidism was treated with two cycles of pembrolizumab for recurrent GE junction adenocarcinoma after which he was admitted with hyperthyroidism (thyroid stimulating hormone [TSH] 0.070mIU/L, free thyroxine 1.85mIU/L) and DKA (pH 7.06, glucose 583 mg/dL, beta-hydroxybutyrate 8.63 mmol/L, anion gap 27 meq/L). The patient was treated with intravenous insulin and aggressively hydrated. Given the lack of other precipitating factors for the two endocrinopathies, it was determined that the most likely etiology was recent treatment with pembrolizumab (a PD-1 inhibitor). In our case, pembrolizumab monotherapy developed two irAE (hyperthyroidism and DKA), which is unique as most combined immunotherapy regimens are associated with the development of multiple endocrinopathies. Our case emphasizes the importance of baseline monitoring of thyroid function and blood glucose prior to the start of ICI to monitor and evaluate patients with immune-related adverse events, including endocrinopathies.

4.
J Med Case Rep ; 16(1): 379, 2022 Oct 18.
Artículo en Inglés | MEDLINE | ID: mdl-36258260

RESUMEN

BACKGROUND: An acute abdomen can have a variety of causes. A commonly missed cause of abdominal pain is direct substance abuse and its sequelae. The use of methamphetamine is rising in the United States resulting in significant morbidity and mortality. There has been no reported case of methamphetamine-induced adrenal infarction based on an extensive review of available literature. CASE PRESENTATION: We present a case of a 34-year-old Hispanic man who presented with acute abdominal pain secondary to adrenal infarction in the setting of methamphetamine use. Left paraumbilical tenderness was present on abdominal examination. Contrast-enhanced CT of the abdomen and pelvis revealed internal hypoenhancement of the left adrenal gland, consistent with acute left adrenal infarction. The patient was managed with enoxaparin and apixaban. CONCLUSION: Substance abuse, especially among young patients, can at times present with acute abdomen. This mandates physicians to be vigilant and take into consideration the history of substance abuse and relevant investigations. Timely diagnosis and management can prevent life-threatening complications.


Asunto(s)
Abdomen Agudo , Traumatismos Abdominales , Enfermedades de las Glándulas Suprarrenales , Metanfetamina , Masculino , Humanos , Adulto , Metanfetamina/efectos adversos , Enoxaparina , Enfermedades de las Glándulas Suprarrenales/diagnóstico , Traumatismos Abdominales/complicaciones , Dolor Abdominal/inducido químicamente , Infarto/inducido químicamente , Infarto/diagnóstico por imagen
5.
Am J Case Rep ; 22: e929437, 2021 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-33837173

RESUMEN

BACKGROUND Hodgkin lymphoma (HL) is a relatively rare etiology of superior vena cava (SVC) syndrome, with only 24 cases reported in the literature. The characteristics, management, and prognosis of HL-associated SVC syndrome remain unclear. This case report describes nodular sclerosis classical HL and the associated clinical manifestations presenting as SVC syndrome in a middle-aged patient, and it summarizes the characteristics of HL-associated SVC syndrome. CASE REPORT In this case report, we present a 53-year-old Hispanic man with progressively worsening dyspnea, dry cough, facial and neck edema, and dysphagia. SVC syndrome was diagnosed, and pathology revealed nodular sclerosis classical HL. The patient was treated with doxorubicin, bleomycin, vinblastine, and dacarbazine. SVC syndrome improved, and repeated imaging showed that the lymphoma had decreased in size and had become metabolically inactive. CONCLUSIONS We reviewed the characteristics, management, and prognosis of HL-associated SVC syndrome, which may indicate more advanced and recurrent progression in patients with HL. This possibility suggests that physicians should provide urgent diagnosis and closer follow-up, and more aggressive therapies may be needed because of the high risk of recurrence. Therapy may induce late-onset SVC syndrome in patients with HL.


Asunto(s)
Enfermedad de Hodgkin , Síndrome de la Vena Cava Superior , Doxorrubicina/uso terapéutico , Enfermedad de Hodgkin/complicaciones , Enfermedad de Hodgkin/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Síndrome de la Vena Cava Superior/diagnóstico , Síndrome de la Vena Cava Superior/etiología , Vena Cava Superior
6.
Cureus ; 12(9): e10739, 2020 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-33029471

RESUMEN

Metastasis of extra-intestinal carcinoma to the gastrointestinal tract (GIT) is a rare event, most commonly occurring with malignant melanoma. Anti-PD-1 (programmed death-1) immunotherapeutic agents are immune checkpoint inhibitors with proven benefit across multiple cancer types, including squamous cell carcinoma of the head and neck (SCCHN). Here we describe a case of small bowel perforation attributed to a primary SCCHN metastasizing to the GIT in the setting of treatment with PD-1 inhibitors.

7.
Artículo en Inglés | MEDLINE | ID: mdl-30357018

RESUMEN

Burkitt lymphoma is a late complication of HIV, and bilateral cranial nerve palsies are extremely rare in patients with AIDS. A twenty year old Caucasian male with known congenital HIV who had been non-adherent with anti-retroviral therapy presented with multiple cranial nerve palsies and was eventually diagnosed with Burkitt lymphoma. Before chemotherapy, he was started on radiation therapy to the brain, meninges, and base of skull with the intent of improving cranial nerve palsies and preventing further neurological sequelae since the cranial nerve palsies were dense and there was concern that intrathecal chemotherapy would have less penetration than radiation. He eventually died due to overall disease burden. We hereby present what we believe is the first reported case of Burkitt lymphoma presenting with bilateral facial, vestibulocochlear, left abducens, and mandibular nerve palsies. Recognition of different presentations of Burkitt lymphoma is extremely important as it would aid in early diagnosis and initiation of both chemotherapy and anti-retroviral therapy potentially leading to improved outcomes.

8.
Artículo en Inglés | MEDLINE | ID: mdl-30181835

RESUMEN

Acquired Hemophilia A (AHA) is a bleeding diathesis related to the development of factor VIII inhibitor, which can frequently go undetected. It commonly manifests as spontaneous mucosal bleeds without any known history of a bleeding disorder, but has the potential to cause life threatening bleeding especially in elderly patients with underlying comorbidities. Here we describe a case of AHA in a 78 year old female presenting with spontaneous mucocutaneous bleeding as tongue hematoma and recurrent gastrointestinal (GI) bleeding. Underlying etiology remained unclear in this case. While she did not require any reversal agents to control bleeding, the patient received steroids and rituximab as inhibitor eradication therapy.

10.
Cancer Genet Cytogenet ; 177(2): 135-8, 2007 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-17854669

RESUMEN

A 22-year-old woman presented with lymphadenopathy in a similar manner as she had presented at age 4. At age 4, she was diagnosed with acute myelogenous leukemia (AML) with t(18;22)(q23;q11.2) and received chemotherapy until age 6 under a pediatric study protocol. At age 22, a lymph node biopsy confirmed granulocytic sarcoma, and a bone marrow aspirate showed increased myeloblasts with no dysplasia. Cytogenetic analyses of the lymph node and the bone marrow were positive for t(18;22)(q23;q11.2). The patient was treated for relapsed AML and at writing had been disease-free for 9 months. Translocation between chromosomes 18 and 22 has been reported in indolent lymphoproliferative disorders, but not in AML. Although we do not know the precise molecular etiology of this leukemia, the uncommon presentation for AML and late relapse with the same chromosomal abnormality may indicate a causal relationship between this novel chromosomal abnormality and the AML. This observation also suggests the possible presence of dormant stem cells containing the chromosomal abnormality in this particular patient.


Asunto(s)
Aberraciones Cromosómicas , Cromosomas Humanos Par 18/genética , Cromosomas Humanos Par 22/genética , Leucemia Mieloide Aguda/genética , Recurrencia Local de Neoplasia/genética , Adolescente , Preescolar , Femenino , Humanos , Hibridación Fluorescente in Situ , Cariotipificación , Leucemia Mieloide Aguda/patología , Recurrencia Local de Neoplasia/patología
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