RESUMO
Background: Non-Hodgkin's lymphoma (NHL) is a monoclonal proliferation of lymphoid cells from B lineage. Although NHLs are primarily hematological tumors of lymph nodes but rarely can involve extranodal sites such as the spleen. Case report: A 29-year-old female patient presented with low-grade fever, cough, anemia, weight loss, tender left hypochondrium, and splenomegaly. A hypodense lesion in the spleen with central necrosis, having strong positivity for common leukocyte antigen (LCA), CD 20, and CD 10, led to a diffuse large B cell lymphoma diagnosis. The patient had an excellent clinical post-splenectomy response to combination chemotherapy and immunotherapy. Conclusion: NHL can present with symptomatic extra-nodal involvement without enlarged lymph nodes.
RESUMO
Diabetic ketoacidosis (DKA) is considered a medical emergency, most commonly associated with type 1 diabetes mellitus, and is relatively rare in type 2 diabetes mellitus (T2DM). We discuss a case of a 45-year-old woman with T2DM who presented to the emergency room with worsening lethargy and weakness. Before her presentation, her physician had recently added empagliflozin, a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, to her anti-diabetic drug regimen along with glimepiride and a combination drug of vildagliptin and metformin. Based on the clinical examination and lab findings, DKA was suspected, but her glucose level was below the cutoff value for DKA diagnosis. However, her lab results showed significant metabolic acidosis and ketonemia with no clinical or laboratory features of sepsis. Therefore, the diagnosis of euglycemic diabetic ketoacidosis (eu-DKA) was made. She was successfully treated according to the DKA protocol and discharged in good condition. In this report, our aim is to discuss the relationship between SGLT-2 inhibitors with eu-DKA. Given the absence of significant hyperglycemia, recognition of this entity by clinicians may be delayed. Serum ketones should be obtained in diabetic patients with symptoms of nausea, vomiting, or malaise while taking SGLT-2 inhibitors, and SGLT-2 inhibitors should be discontinued if ketoacidosis is confirmed.
RESUMO
The recent monkeypox outbreak in non-endemic countries is a rare event. It is a zoonosis with clinical features similar to smallpox, transmitting from animal to human and human to human. Since 2000, the number of monkeypox cases in humans had increased in African countries, resulting in its spread to the other parts of the world. On May 26, 2022 World Health Organization has confirmed 120 cases of monkeypox in 23 non-endemic countries. The decreased immunity to the Orthopoxviruses, human migration from endemic to non-endemic regions, genetic mutations in the viral genome, and reduced surveillance may contribute to the recent outbreaks. A multi-pronged approach comprising health education, tracking human migration, developing diagnostic facilities, and an effective vaccine could prevent transmission and pathogenicity.