Guillain-Barre Syndrome Secondary to the Use of Dabrafenib and Trametinib for the Treatment of Advanced Thyroid Carcinoma.

BRAF V600E mutation in thyroid malignancies is associated with an aggressive phenotype with more rapid tumor growth and higher mortality. V600E is a driver mutation in the BRAF proto-oncogene, where valine (V) is substituted by glutamic acid (E) at amino acid 600. New chemotherapeutic agents targeting the mitogen-activated protein kinase (MAPK) pathway, including direct BRAF inhibitors, have become available and are increasingly used in various advanced thyroid malignancies. These agents are associated with various rare neurological adverse effects. We present a case of Guillain-Barre syndrome (GBS) secondary to dabrafenib and trametinib therapy for the management of anaplastic thyroid carcinoma. A few cases of GBS have been reported previously with the use of these agents in the treatment of melanoma. To our knowledge, this is the first case of GBS with the use of dabrafenib and trametinib for advanced thyroid malignancy. The knowledge of this rare, potentially life-threatening condition is important for clinicians to know, given the increased use of these agents in managing advanced thyroid malignancies.

Thyrotoxic Periodic Paralysis With Severe Hypokalemia Precipitated by Acute Alcohol Intoxication in a Patient With Graves' Disease.

We present a case of a 29-year-old male who presented with thyrotoxic periodic paralysis (TPP) precipitated by acute alcohol intoxication. TPP is an endocrine emergency that presents with an episode of acute flaccid paralysis with hypokalemia in the setting of thyrotoxicosis. Individuals who present with TPP are thought to have an underlying genetic predisposition. Overactivation of the Na+/K+ ATPase channel leads to large-scale intracellular shifts in potassium, leading to low serum levels and the clinical manifestations of TPP. Severe hypokalemia can lead to life-threatening complications such as ventricular arrhythmias and respiratory failure. Therefore, timely recognition and management are essential in cases of TPP. In addition, understanding the precipitating factors is necessary for adequate counseling of these patients to prevent further episodes.

Osteoporosis in a 60-Year-Old Male With a History of Chronic Myeloid Leukemia Treated With Imatinib Mesylate.

Secondary osteoporosis is defined as a decline in bone mineral density due to any underlying etiology, which usually results in accelerated bone loss than expected for the individual's age or gender. Almost 50-80% of men diagnosed with osteoporosis have secondary osteoporosis. We present a case of a 60-year-old male with secondary osteoporosis with a history of imatinib mesylate-treated chronic myeloid leukemia (CML). Imatinib mesylate has revolutionized the management of individuals with chronic myeloid leukemia, which is now managed as a chronic disease. Imatinib has been demonstrated to cause dysregulation of bone metabolism. The long-term effects of imatinib on bone metabolism are still unknown.

Renin-Angiotensin System: Updated Understanding and Role in Physiological and Pathophysiological States.

The classical view of the renin-angiotensin system (RAS) is that of the circulating hormone pathway involved in salt and water homeostasis and blood pressure regulation. It is also involved in the pathogenesis of cardiac and renal disorders. This led to the creation of drugs blocking the actions of this classical pathway, which improved cardiac and renal outcomes. Our understanding of the RAS has significantly expanded with the discovery of new peptides involved in this complex pathway. Over the last two decades, a counter-regulatory or protective pathway has been discovered that opposes the effects of the classical pathway. Components of RAS are also implicated in the pathogenesis of obesity and its metabolic diseases. The continued discovery of newer molecules also provides novel therapeutic targets to improve disease outcomes. This article aims to provide an overview of an updated understanding of the RAS, its role in physiological and pathological processes, and potential novel therapeutic options from RAS for managing cardiorenal disorders, obesity, and related metabolic disorders.

Progesterone Hypersensitivity Induced by Exogenous Progesterone Exposure.

Progesterone hypersensitivity (PH) is a rare hypersensitivity reaction to either endogenous or exogenous progesterone. There are around 200 reported cases of progesterone hypersensitivity in the medical literature. We present the case of a 31-year-old female who presented with cyclical urticaria and angioedema after exogenous progesterone exposure. Her symptoms would begin a few days before her menstrual cycle began and resolve after menstruation. She only had partial recovery of her symptoms with antihistamines, steroids, montelukast, and omalizumab. She needed treatment with oral contraceptives and had a resolution of symptoms, but subsequently developed a recurrence again. Given the rarity of this condition, the diagnosis is often delayed. This diagnosis should be considered for women of reproductive age who present with cyclic hypersensitivity or allergic symptoms.

A Clinicopathological Study of Skin Tumors from a Tertiary Care Centre in North India.

BACKGROUND: There is a huge spectrum of skin tumors which can be confused clinically with malignancies, particularly when they are pigmented or inflamed, and histopathological examination of a biopsy specimen is required to establish a definitive diagnosis and to facilitate appropriate intervention and follow up. AIM: To evaluate all skin tumors and categorize them according to their origin. METHODS: The present study was conducted over a period of 4 years (July 1, 2013 to June 31, 2017) comprising of 1.5 years prospective and 2.5 years retrospective analysis in the departments of Dermatology and Pathology, at a tertiary hospital in North India. All specimens of skin tumors were analyzed grossly and microscopically. Immunohistochemistry was done wherever possible. RESULTS: A total of 232 skin tumors were seen; of which 123 cases were benign (53.0%) and 109 cases were malignant (47.0%). The mean age of patients with benign and malignant skin tumors was 40.3 ± 19.9 and 60.8 ± 14.8 years, respectively. The most common site was face (n = 106; 45.7%) followed by limbs (n = 44; 19.0%). The male:female ratio of benign and malignant tumors was 1.01:1 and 1.31:1, respectively. Among the benign tumors, keratinocytic tumors were the commonest (n = 57; 46.3%) followed by the melanocytic tumors (n = 37; 30.1%) and appendageal tumors (n = 29; 23.6%). The most common malignant skin tumors were the keratinocytic tumors (n = 87; 79.8%) followed by 12 cases (11%) of hematolymphoid tumors and five cases (4.6%) each of melanocytic and appendageal tumors. LIMITATIONS: The lack of clinical and dermatoscopic correlation and inclusion of retrospective data are the limitations of this study. CONCLUSIONS: Skin tumors affect people of all ages. The benign tumors are seen in the younger age group as compared to malignant tumors. Face is the most common site and keratinocytic tumors are the most common skin tumors in both benign and malignant categories.

Metastatic Crohn's Disease of the Vulva: A Rare Presentation.

Crohn's disease, a chronic inflammatory granulomatous disease of gastrointestinal tract, may rarely have extra intestinal manifestations. Vulvar Crohn's disease may be contiguous or noncontiguous with the gastrointestinal tract. It can cause significant symptoms and has a major impact on quality of life.

Lamotrigine-induced Systemic Lupus Erythematosus: A Diagnostic Dilemma.

Many drugs are known to cause systemic lupus erythematosus (SLE), however there are no well defined criteria for drug induced lupus erythematosus (DILE). We present a rare case of lamotrigine induced lupus presenting as acute syndrome of apoptotic pan epidermolysis (ASAP).

Palisaded Encapsulated Neuroma: An Unusual Presentation.

Palisaded encapsulated neuroma (PEN) is a distinctive benign neural tumor, which usually presents as a solitary skin-colored papule or a nodule. It is a benign lesion and may clinically mimic a cutaneous neurofibroma, melanocytic nevi, or cutaneous schwannoma. Here we report a rare case of multifocal cutaneous PENs and its differentiation from cutaneous schwannomas, which is possible by histopathology.