Systemic allergic reaction to galcanezumab (emgality): a case report.

BACKGROUND: A previously unreported systemic reaction to Galcanezumab (Emgality) is described. Galcanezumab is a humanized monoclonal antibody designed to bind to calcitonin gene-related peptide, a neuropeptide associated with neurogenic inflammation during migraine attacks. Although clinical trials showed that Galcanezumab had few adverse reactions (injection site related erythema, pruritus, and swelling), no systemic drug reactions have been noted. CASE REPORT: A 50-year-old female with chronic migraine, mast cell disorder, Hashimoto's disease, positive antinuclear antibody and positive anti-cyclic citrullinated peptide antibody not on immune modulators received the initial dose of galcanezumab 240 mg after failing multiple migraine treatments. The following day, she developed injection site reaction, malar erythema and flu-like symptoms. Symptoms progressed the second day after injection, and she developed swelling in her lips and throat. Intravenous steroid and antihistamines improved airway symptoms, and the remaining symptoms improved after a course of oral steroids. CONCLUSIONS: Delayed system allergic reaction to Galcanezumab requiring emergency intervention may occur. A history of autoimmune disorder may be a predisposing factor.

Spinal Cord Stimulation for Intractable Testicular Pain: Case Report and Review of the Literature.

OBJECTIVE: Treating chronic testicular pain is often challenging, and few treatment options have been reported. We report a case of intractable testicular pain successfully treated with spinal cord stimulation (SCS). CASE: A 59-year-old male with a 40-year history of bilateral testicular pain after ruptured epididymitis presented for consultation after failing multiple medical and surgical treatments. Repeat genitofemoral nerve block gave him temporary relief. SCS trial to target this distribution resulted in complete pain relief, and the patient was referred for implantation. He reported continued relief nine months after implantation. DISCUSSION: This is the third reported case of intractable chronic testicular pain successfully treated with SCS. Although evidence is scarce, SCS appears to be a potential treatment for patients with testicular pain presenting with a clear distribution of pain.

Propranolol for Paroxysmal Sympathetic Hyperactivity with Lateralizing Hyperhidrosis after Stroke.

Brain injury can lead to impaired cortical inhibition of the hypothalamus, resulting in increased sympathetic nervous system activation. Symptoms of paroxysmal sympathetic hyperactivity may include hyperthermia, tachycardia, tachypnea, vasodilation, and hyperhidrosis. We report the case of a 41-year-old man who suffered from a left middle cerebral artery stroke and subsequently developed central fever, contralateral temperature change, and hyperhidrosis. His symptoms abated with low-dose propranolol and then returned upon discontinuation. Restarting propranolol again stopped his symptoms. This represents the first report of propranolol being used for unilateral dysautonomia after stroke. Propranolol is a lipophilic nonselective beta-blocker which easily crosses the blood-brain barrier and may be used to treat paroxysmal sympathetic hyperactivity.

Patient safety at handoff in rehabilitation medicine.

The Joint Commission Center for Transforming Healthcare has cited communication as the most frequent root cause in sentinel events, with failed patient handoffs playing a "role in an estimated 80% of serious preventable adverse events." Handoff, or transfer of patient care information, occurs formally and informally many times each day, within and between care teams, across all levels of care providers and between institutions. Handoff at rehabilitation admission is at a particularly high risk for communication failure, potentially affecting patient safety. This review of the patient handoff literature discusses the importance of safe handoff, the information to be included, barriers to handoff, and improvement methodologies.