RÉSUMÉ
Nintedanib, a tyrosine kinase inhibitor, is a cornerstone in the management of idiopathic pulmonary fibrosis through its anti-fibrotic effects; however, its impact on wound healing is less studied. We present a case of medication-related osteonecrosis of the jaw (MRONJ) following the initiation of nintedanib. The patient's presentation prompted a drug holiday of nintedanib, resulting in a marked improvement in her symptoms. MRONJ is a disease requiring a high index of suspicion, and the number of inciting medications continues to rise. Nintedanib, as an inhibitor of angiogenesis, may have contributed to poor wound healing following dental extraction, subsequently leading to MRONJ.
RÉSUMÉ
Cardiac amyloidosis (CA) is an infiltrative disease of the heart characterized by the deposition of insoluble protein aggregates in the myocardium. There are two subtypes of CA, and they are named after the misfolded protein. Transthyretin cardiac amyloidosis (ATTR-CA) is caused by the accumulation of the tetrameric transthyretin protein produced in the liver, and light-chain cardiac amyloidosis (AL-CA) occurs due to circulating abnormal light-chain deposition. Disease manifestation can be very non-specific, and there can be overlap with other cardiac processes. This often leads to a delay in diagnosis and a poor prognosis. Here, we present a case of delayed diagnosis of CA spanning over several years that required a multidisciplinary approach but ultimately resulted in fatality six years after the initial diagnosis.
RÉSUMÉ
Since being approved by the United States Food and Drug Administration (FDA) in 2013, sodium-glucose cotransporter-2 inhibitors (SGLT2is) have emerged as an appealing therapeutic choice for patients with diabetes due to their favorable effects on renal and cardiac health. Recent trials have further expanded the application of these drugs by showing a decrease in mortality rates among patients with both reduced and preserved ejection fraction heart failure, even in those without diabetes. Common adverse effects of SGLT2is include increased urinary frequency and urinary tract infections stemming from elevated glycosuria. Here, we present a case report involving a 66-year-old man who developed Fournier's gangrene (FG) shortly after initiating dapagliflozin - a rare but dangerous adverse effect associated with this medication.
RÉSUMÉ
Macrophage activation syndrome (MAS), synonymous with secondary hemophagocytic lymphohistiocytosis (HLH), is a rare and critical complication of rheumatologic disease stemming from the unregulated activation and rapid multiplication of macrophages and T lymphocytes. While it primarily manifests in children diagnosed with systemic juvenile idiopathic arthritis (sJIA), it can arise less frequently in other rheumatologic conditions. Here, we outline the clinical course, treatment, and outcome of MAS diagnosed in an 18-year-old female previously diagnosed with SLE who exhibited a unique clinical presentation.
RÉSUMÉ
Acute lymphoblastic leukemia (ALL) is an uncommon and rapidly progressing blood cancer originating in the bone marrow, characterized by the abnormal proliferation of immature lymphocytes. Although most cases of ALL are observed in children, the disease pattern shows two peaks: one in early childhood and another around the age of 50. Approximately a fifth to a third of adults diagnosed with ALL exhibit cytogenetic abnormalities involving the Philadelphia chromosome. Despite the existence of several studies on Philadelphia chromosome-positive ALL (Ph+ ALL), our case accentuates the use of a multi-disciplinary approach to treatment and involves a patient from a unique demographic.
RÉSUMÉ
Groove pancreatitis (GP) is an uncommon form of chronic pancreatitis (CP) that affects the area between the duodenum, the head of the pancreas, and the common bile duct (CBD), which is known as the pancreaticoduodenal groove. Our case is based on a 68-year-old male with a past medical history of alcohol use disorder and a 50-pack-year smoking history who presented with nausea, vomiting, and poor oral intake. Computed tomography (CT) of the abdomen and pelvis showed gastric outlet obstruction due to a 6.0 cm mass in the pancreatic groove and the second portion of the duodenum, with dilation of the pancreatic, intrahepatic, and extrahepatic biliary ducts. In order to rule out malignancy and evaluate the acute symptoms, the patient underwent an open pancreaticoduodenectomy (PD). Pathologic findings and negative tumor markers confirmed GP. This case highlights a rare form of CP that symptomatically and radiographically mimics malignancy, but is benign.
RÉSUMÉ
Bacillus cereus is an uncommon nosocomial bacteria, typically dismissed as a contaminant. This case is a unique scenario in which B. cereus bacteremia persisted despite appropriate treatment. Further investigation revealed the presence of a right atrial thrombus believed to harbor a biofilm responsible for the sustained bacteremia. Clearance of the thrombus using the AngioVac system (AngioDynamics, Inc., Latham, NY) led to the resolution of blood cultures, and subsequently, the patient was discharged with a six-week course of intravenous (IV) antibiotics.
RÉSUMÉ
Takayasu arteritis is characterized by blood vessel inflammation involving the aorta and its branches. We describe a patient with Takayasu arteritis with severe multivessel involvement and classic physical examination findings but virtually no symptoms because of the presence of extensive collateral circulation seen on computed tomography angiography and magnetic resonance angiography imaging.
RÉSUMÉ
Tumor-related bleeding is a common manifestation of end-stage head and neck cancer, and it can have a significant impact on a patient's quality of life. Tranexamic acid is an anti-fibrinolytic agent that has been shown to effectively control bleeding and reduce the need for transfusions in various hemorrhagic conditions. Here, we present the case of a patient with end-stage head and neck cancer experiencing recurrent episodes of bleeding, who was able to successfully achieve hemostasis after being treated with tranexamic acid. This case report highlights the role of tranexamic acid as a palliation agent that can help control the unpleasant bleeding symptoms of end-stage head and neck cancer and provide a better quality of life for patients.