ABSTRACT
(1) Background: The use of intravenous antibiotics for severe infections is a common practice, either as inpatient or outpatient treatment. In the case of methicillin-susceptible Staphylococcus aureus (MSSA), nafcillin is a commonly prescribed intravenous antibiotic, given its known efficacy to treat infections related to this organism effectively. However, it is not without side effects. (2) Methods: We present an interesting case of persistent hypokalemia in a patient after he was started on nafcillin infusion for an MSSA infection, which eventually resolved with the completion of the treatment. (3) Results: Hypokalemia is a known side effect of nafcillin infusion, and it is believed to be mainly due to its antibiotic effect as a non-absorbable ion in the distal tubule and/or intracellular redistribution due to volume depletion. (4) Conclusions: A review of the available literature revealed that hypokalemia is a known side effect of nafcillin infusion; however, if present, it is usually mild, and only a few cases of severe hypokalemia have been reported. Usually, hypokalemia resolves when the nafcillin infusion is stopped; however, in certain cases, when this is not possible, oral potassium replacement can be used while the patient is receiving nafcillin. Clinicians should be aware of this rare, but possible, complication when using nafcillin.
ABSTRACT
BACKGROUND: Acute myeloid leukemia (AML) is the most common leukemia in adults. According to the French-American-British (FAB) system, monocytic leukemia is classified as M5. Myeloid sarcoma further occurs in 3-5% of AML. This is defined as an extramedullary tumor of myeloid cells in the lymph nodes, soft tissues, periosteum, bone, central nervous system (CNS), spinal cord, intestine, mediastinum, prostate, uterus, or ovaries. CASE PRESENTATION: Here, we describe the case of a 29-year-old female who presented with fever, swelling of gums, neck pain, and weakness, which had persisted for 1 week. The patient had a white blood cell (WBC) count of 53.5 K/µL, and a peripheral smear revealed a myeloid blast cell (blast) percentage of 8%. Computed tomography (CT) of the neck indicated lymphadenopathy. Fine needle aspiration of the cervical lymph node showed groups of atypical immature myeloid cells, mixed with occasional megakaryocytes, and infiltration of eosinophilic myeloid cells into the lymph node, consistent with myeloid sarcoma. Flow cytometry analysis revealed intermediate to large circulating blasts, with irregular nuclei, fine chromatin, and distinct nucleoli, indicative of AML, with monocytic differentiation. The patient responded well to chemotherapy with fludarabine, cytarabine, granulocyte colony stimulating factor (G-CSF), and idarubicin; WBC counts returned to normal and patient was discharged to home. CONCLUSION: Myeloid sarcoma of the lymph node is a rare co-occurrence with AML. Results of our study are consistent with the conclusion that early diagnosis and appropriate treatment improve survival.
