Weeding Out the Culprit: Cannabinoid-Associated Stevens-Johnson Syndrome.

We describe a case of Stevens-Johnson syndrome (SJS) in a 32-year-old female who initially presented with a several-day history of worsening rash. Diagnosis of cannabinoid-associated SJS was established following skin biopsy and detailed history-taking of medication and other recreational drug usages. The patient was treated with pain management, antihistamines, and topical steroids with no complications following discharge. There currently exists limited literature describing SJS due to recreational drug usage.

Atypical Manifestation of VZV Infection in a Vaccinated Immunocompetent Adult.

Introduction: Aseptic meningitis can occur from different types of infections of which viral etiologies are the most common. Varicella zoster virus (VZV) nowadays is considered a familiar entity of aseptic meningitis. However, it is usually reported in immunocompromised patients. For cases of VZV meningitis that are observed, a rash has been noted before the onset of meningitis or sometimes after it. Clinical Case. We present an uncommon case of VZV meningitis in an 18-year-old immunocompetent male who did not have a rash on presentation and did not develop one during his course either. Cerebrospinal fluid showed lymphocyte-predominant leukocytosis and elevated protein with normal glucose suggestive of aseptic meningitis. Cerebrospinal fluid polymerase chain reaction (CSF PCR) was positive for VZV; cerebrospinal fluid cultures and blood cultures were negative. The patient had complete resolution of symptoms with no complications on intravenous acyclovir therapy and was discharged home on oral valacyclovir therapy. Conclusion: It is important to consider varicella zoster virus as an etiology of aseptic meningitis as clinical presentation can be without a vesicular rash and in immunocompetent patients.

Cancer immunotherapy in adult patients with HIV.

The availability of antiretroviral therapy (ART) has increased the life expectancy of people with HIV (PWH) and reduced the incidence of AIDS-associated malignancies, yet PWH have a significantly increased incidence of malignancy and less favorable outcomes of cancer treatment compared with the general population.Immunotherapy has revolutionized cancer therapy, becoming the standard of care for various malignancy treatments. However, PWH are an underserved population with limited access to clinical trials and cancer treatment.This review of the available evidence on different classes of cancer immunotherapy in PWH is mostly based on case reports, case series, but few prospective studies and clinical trials due to the exclusion of PWH from most oncologic clinical trials. The results of the available evidence support the safety of immunotherapy in PWH. Immunotherapy has similar effectiveness in PWH, an acceptable toxicity profile, and has no clinically significant impact on HIV viral load and CD4-T cell count. In addition, there is no reported change in the incidence of opportunistic infections and other complications for PWH with well-controlled viremia.This review aims to briefly summarize the current state of immunotherapy in cancer, guide clinicians in the management of immunotherapy in cancer PWH, and encourage the inclusion of PWH in clinical trials of cancer immunotherapy.

Are We Prescribing Enough HIV Pre-Exposure Prophylaxis in Missouri?: A Cross-Sectional Study at University of Missouri Health Care.

Despite the proven efficacy and safety of HIV pre-exposure prophylaxis (PrEP), it remains underutilized. PrEP use among Missouri providers has increased as the rate of new HIV infections grows statewide, but remains lower than the Midwest and United States (U.S.) averages. Because the Centers for Disease Control and Prevention (CDC) identify Missouri as at-risk for an HIV outbreak, we seek to characterize HIV testing practices and PrEP knowledge and use among Missouri healthcare providers.

Intracardiac metastasis from head and neck squamous cell carcinoma.

Cardiac metastasis from head and neck cancer is an extremely rare and devastating condition with an abysmal prognosis. Most of our knowledge about this condition is from case reports and series. We present a case of squamous cell carcinoma of the tonsils that was complicated by embolic stroke and critical limb ischemia that were found to be secondary to intracardiac metastasis. We believe that this condition is under-reported; hence, we conducted a thorough review of the literature to highlight the characteristics and previous therapeutic experiences with various presentations of cardiac metastasis from head and neck carcinoma. Clinicians are encouraged to report their experience with evaluating and managing this type of metastasis.

Immune checkpoint inhibitors induced colitis, stay vigilant: A case report.

BACKGROUND: Colitis is one of the immune-related side effects of immunotherapy. Usually, such type of side effect was reported to develop within a few weeks of treatment initiation, our case started within a few days. CASE SUMMARY: We present a case of a 37-year-old gentleman with bright red loose stools, abdominal pain, and tenesmus. A diagnosis of colitis was made based on endoscopic and histologic findings. Treatment was thereafter continued with oral steroids and discontinuation of the immunotherapy medications. Symptoms resolved after starting the treatment and the patient continued to be symptom-free on subsequent follow-up. The unique about this case report is that the patient developed bloody diarrhea within five days of the 1st immunotherapy cycle, and the patient was on combined ipilimumab and nivolumab. CONCLUSION: Immunotherapy related complications might occur within days from being on immunotherapy; we need more research to open the way for future pathological and clinical research to further understand the pathophysiology behind it.

Acute Esophageal Necrosis in a Patient With Prostate Cancer Postchemotherapy.

Acute esophageal necrosis (AEN) describes a potentially irreversible injury to esophageal mucosa secondary to vascular hypoperfusion. An 84-year-old man was admitted for the correction of a displaced nephrostomy tube and management of acute kidney injury. During his stay, the patient developed odynophagia and acute gastrointestinal hemorrhage. Despite mild initial symptoms, diffuse circumferential black esophageal mucosa was visualized on endoscopy, and a diagnosis of AEN was made. This unique case highlights the association between AEN and leukopenia, vascular disease, hypercoagulability, and infection. Presentations such as this patient should prompt the physicians' consideration of this differential earlier.

Adrenocorticotropic Hormone-producing Extrapulmonary Small Cell Carcinoma of the Breast.

Extrapulmonary small cell carcinoma (EPSCC) of the breast is a very rare tumor. Adrenocorticotropic hormone (ACTH) production from these tumors is extremely rare and seldom reported resulting in significant diagnostic and therapeutic challenges and delays. We present a case of a 38-year-old female who presented with a breast lump and was diagnosed with primary EPSCC of the breast. Eighteen months later, she presented with refractory hypokalemia and metabolic alkalosis. Ectopic ACTH production was found to be the reason for her metabolic derangement. Extensive diagnostic evaluation, including a comprehensive metastatic workup, is necessary to differentiate this tumor from other primary malignancies such as lung and other breast cancers. We review the literature and discuss the diagnostic approach and suggested therapies.