Pembrolizumab-induced myocarditis with complete atrioventricular block and concomitant myositis in a metastatic bladder cancer patient: a case report and review of the literature.

BACKGROUND: The cardiovascular system is among the least systems affected by immune-related adverse events. We report a rare life-threatening case of pembrolizumab-induced myocarditis with complete atrioventricular block and concomitant myositis in a metastatic bladder cancer patient. CASE PRESENTATION: An 82-year-old Caucasian female with invasive urothelial carcinoma, started on first-line pembrolizumab, was admitted four days after receiving her second dose for severe asthenia, diffuse muscle aches, neck pain, and lethargy. In the emergency department, she had several episodes of bradycardia reaching 40 beats per minute associated with general discomfort and fatigue. Electrocardiography showed a third-degree atrioventricular heart block, while the patient remained normotensive. Cardiac damage parameters were altered with elevated levels of creatine phosphokinase of 8930 U/L, suggestive of immune checkpoint inhibitor-induced myositis, and troponin T of 1.060 ng/mL. Transthoracic echocardiography showed a preserved ejection fraction. Pembrolizumab-induced myocarditis was suspected. Therefore, treatment was initiated with high-dose glucocorticoids for 5 days, followed by a long oral steroid taper. A pacemaker was also implanted. Treatment resulted in the resolution of heart block and a decrease in creatine phosphokinase to the normal range. CONCLUSION: Life-threatening cardiac adverse events in the form of myocarditis may occur with pembrolizumab use, warranting vigilant cardiac monitoring. Troponin monitoring in high-risk patients, along with baseline echocardiography may help identify this complication promptly to prevent life-threatening consequences.

Work ability, psychosocial hazards and work experience in prison environments.

BACKGROUND: Work ability is predicted by age- and work-related psychosocial hazards; however, its association with work experience has not been studied. Work ability has not been studied in prison environments as well. AIMS: To describe work ability and its associates among prison workers. METHODS: A cross-sectional study was carried out in two prisons in Spain, one large and one medium prison, randomly selected from 17 in total. Prison workers were randomly administered a voluntary anonymous questionnaire to measure work ability [Work Ability Index (WAI)], work-related psychosocial hazards (Spanish version of COPSOQ), sociodemographic, lifestyle and work-related variables. RESULTS: Four hundred and forty-one workers (54%) participated. Results confirmed that older and more experienced workers (analysis of variance analysis) and workers in large prisons (t-student) presented significantly lower WAI scores. Quantitative and emotional demands, family work conflict, low work control, low autonomy, low social support from colleagues and stress had negative significant associations with WAI. Age, which highly correlated with work experience (Spearman's r = 0.85), had significant association with WAI (beta = -0.62). In the stepwise linear regression, the association between age and WAI lost statistical significance after controlling for work experience, which maintained significant correlation with WAI (beta = -0.37). CONCLUSIONS: The apparent association between age and WAI was confounded by work experience. Interventions to improve work ability among prison workers may benefit from results of this study to focus their efforts on the risk groups in such a psychologically demanding work environment rarely examined in previous research.

[Cardiobacterium hominis endocarditis. A case report]. / Endocardite à cardiobacterium hominis. A propos d'un cas.

We report the case of a Cardiobacterium hominis endocarditis causing an acute mitral insufficiency complicated of left heart failure. The patient has been treated after a few days by surgical valvuloplasty. Cardiobacterium hominis is a bacteria of the HACCEK group, bacille gram-negative, sometimes anaerobic, difficult to isolate. Recently, Polymerase Chain Reaction analysis appears to be effective for the the diagnosis in the identification of fastidious micro-organisms like Cardiobacterium hominis. We have reviewed in the literature 71 cases of Cardiobacterium hominis endocarditis; clinical presentation is often sub-acute, the bacteriological diagnosis is based on hemocultures for which the culture is slow and require enriched environments. Hemodynamic and thrombo-embolic complications are frequent because of the high pathogenicity of the bacteria which provides big and friable vegetations. Despite a high sensibility to antibiotherapy, surgical intervention is often required.

[Thrombolytic treatment of obstructions of mechanical valve prostheses. Apropos of 4 cases and analysis of the literature]. / Traitement thrombolytique des obstructions des prothèses valvulaires mécaniques. A propos de quatre cas et analyse de la littérature.

The obstruction of the mechanical valve prothesis (OMVP) is a serious complication. The treatment of this complication was classically surgical. Recently, the thrombolytic treatment was introduced as an alternative approach for patients with high perioperative risk and for those in whom the mechanism of the obstruction is a recently formed thrombus. The authors report four cases of OMVP treated by a thrombolytic agent (Streptokinase, SK, Streptase). Immediate success was obtained in all theses four cases. One late recurrence with fatal issue was noted. All four prostheses were Saint Jude medical (SJM), three in mitral and one in aortic position respectively. The details of the clinical presentation (acute or progressive dyspnea) as well as the contribution of the echocardiography to the diagnosis were presented. The evolution of this therapeutic approach and the international recommendations were reviewed.