Deep phenotyping of post-infectious myalgic encephalomyelitis/chronic fatigue syndrome.

Post-infectious myalgic encephalomyelitis/chronic fatigue syndrome (PI-ME/CFS) is a disabling disorder, yet the clinical phenotype is poorly defined, the pathophysiology is unknown, and no disease-modifying treatments are available. We used rigorous criteria to recruit PI-ME/CFS participants with matched controls to conduct deep phenotyping. Among the many physical and cognitive complaints, one defining feature of PI-ME/CFS was an alteration of effort preference, rather than physical or central fatigue, due to dysfunction of integrative brain regions potentially associated with central catechol pathway dysregulation, with consequences on autonomic functioning and physical conditioning. Immune profiling suggested chronic antigenic stimulation with increase in naïve and decrease in switched memory B-cells. Alterations in gene expression profiles of peripheral blood mononuclear cells and metabolic pathways were consistent with cellular phenotypic studies and demonstrated differences according to sex. Together these clinical abnormalities and biomarker differences provide unique insight into the underlying pathophysiology of PI-ME/CFS, which may guide future intervention.

When Zebras Collide: A Case of Synchronous Wolff-Parkinson-White Syndrome and Pheochromocytoma.

BACKGROUND Pheochromocytoma is a rare catecholamine-secreting tumor arising from chromaffin cells of the adrenal medulla. Wolff-Parkinson-White (WPW) pattern is a rare congenital cardiac conduction disorder in which 1 or more accessory pathways connects the atria and ventricles, bypassing the atrioventricular (AV) node. Patients with this type of accessory pathway who also experience pre-excitation evoked arrhythmias have what is termed WPW syndrome. Here, we present a patient with a WPW pattern who underwent surgical resection of a pheochromocytoma, review considerations relating to the perioperative management, and briefly summarize the hormonal effects of pheochromocytoma in a patient with a WPW accessory pathway. CASE REPORT A man in his early 30's with a history of hypertension developed shortness of breath with palpitations, was noted to have delta waves on electrocardiogram (ECG), and was given a diagnosis of WPW syndrome. Six years later, he developed headache, chest pain, and flank discomfort in addition to his daily palpitations and shortness of breath. Plasma catecholamine levels were measured and found to be elevated, and imaging studies noted the presence of a large right-sided adrenal mass, consistent with a pheochromocytoma. A decision was made to proceed with a laparoscopic right adrenalectomy, which was successful and uneventful. Through the 30-day postoperative period, he reported no further episodes of symptomatic palpitations for the first time in several years. CONCLUSIONS To the best of our knowledge, this is only the fourth case in the literature describing pheochromocytoma with co-existing WPW syndrome. In our case, resection of the pheochromocytoma ameliorated the patient's chronic WPW-related tachyarrhythmia.

A Case of Polymyalgia Rheumatica Following Robotic-Assisted Radical Prostatectomy for High-Grade Prostate Cancer.

BACKGROUND Polymyalgia rheumatica (PMR) is a common rheumatic disease in patients over the age of 50 years. Underlying triggers for PMR are not well understood, but there have been reports of cases presenting prior to the diagnosis of prostate cancer, with one case of PMR presenting following prostatectomy. This report is of a case of PMR that presented following robotic-assisted radical prostatectomy for high-grade prostate cancer and includes a discussion of the possible associations. CASE REPORT A 61-year-old man underwent a robotic-assisted radical prostatectomy for high-grade prostate adenocarcinoma, Gleason grade 4+4=8. The surgical procedure and the patient's postoperative recovery were uneventful, and he was discharged from hospital on the day after surgery. Approximately two weeks later, he developed bilateral symptoms of pain in the groin, thigh, and shoulder girdle. His erythrocyte sedimentation rate (ESR) (30 mm/h) and C-reactive protein (CRP) (16.2 mg/L) levels were raised. A diagnosis of PMR was made and treatment with tapered dosing of methylprednisolone resulted in a 90% improvement in symptoms after four weeks. CONCLUSIONS A case of PMR following robotic-assisted prostatectomy for high-grade prostate carcinoma is presented. To the author's knowledge, this is only the second report of PMR following prostatectomy and the only reported case following robotic-assisted radical prostatectomy.