Vulvar Cancer with Cutaneous and Breast Metastases.

Vulvar cancer accounts for about 5% of cancer of female genitalia. It may initially present as benign symptoms resulting in potential delay in diagnosis. Few cases of distant metastases to skin or breast have been reported. We present the case of a 76-year-old female with possible delay in diagnosis of her squamous cell carcinoma of vulva. After 4 months of the diagnosis, she presented with concurrent cutaneous and breast metastases.

A rare case of eptifibatide-induced thrombocytopenia.

Eptifibatide is a glycoprotein (GP) IIb/IIIa receptor antagonist, used for the treatment of acute coronary syndrome with high-risk features or ongoing ischemia. Several case reports have described thrombocytopenia as a rare side effect of eptifibatide administration. The exact mechanism remains unclear but may be due to immune destruction of circulating platelets in the peripheral blood. We present the case of acute-onset severe thrombocytopenia in a 76-year-old female undergoing percutaneous coronary intervention.

A Case of Vancomycin-Induced Immune Thrombocytopenia.

Vancomycin-induced immune thrombocytopenia (ITP) is a rare, potentially life-threatening complication from an antibiotic frequently used in medical practice. We report a case of an 81-year-old male with recent removal of an infected right knee prosthesis and insertion of an articulating antibiotic spacer, presenting from rehabilitation for severe thrombocytopenia (1 X 103/µL). The patient's thrombocytopenia was initially falsely attributed to rifampin-induced ITP, a much more common cause of drug-induced thrombocytopenia. Only later, after a second precipitous drop in platelet count, vancomycin was correctly identified as the culprit. The patient's serum was tested for drug-dependent platelet antibodies with and without vancomycin. A positive reaction for IgG was detected by flow cytometry in the absence of vancomycin, which was potentiated in the presence of vancomycin. The result indicated the presence of vancomycin-dependent and nondrug-dependent platelet reactive antibodies and confirmed the diagnosis of vancomycin-induced ITP. In this case, the correct diagnosis was masked by the simultaneous administration of two drugs that cause drug-induced ITP and highlights the importance of early recognition of rare, vancomycin-induced ITP.

Synchronous Presence of EGFR, ALK Driver Mutations Along With PD L1 Overexpression in a Resected Early Stage Non-Small Cell Lung Cancer: A Case Report and Review of Literature.

Treatment of lung cancer has been revolutionized with development of drugs that target key driver mutations and immune checkpoints. Until recently, it was believed that these driver mutations are mutually exclusive. However, few reports have emerged citing the presence of both mutations either synchronously or metachronously. We describe a case report of lung adenocarcinoma harboring two driver mutations in the same tumor cells as well as exhibiting high PDL1 expression. We further discuss the possible association of these driver mutations with PDL1 expression.

Correction: Rapidly Progressing Myelodysplastic Syndrome Initially Presenting as Acute Leukemia.

[This corrects the article DOI: 10.7759/cureus.1096.].

Rapidly Progressing Myelodysplastic Syndrome Initially Presenting as Acute Leukemia.

Myelodysplastic syndrome (MDS) refers to a group of various stem cell disorders, characterized by dysplastic and ineffective production in one or more cell lines. In general, MDS tends to present slowly over months to years and is commonly detected with routine bloodwork by primary care physicians. Patients may be asymptomatic and depending on age, comorbidities and risk classification of MDS may not require aggressive therapy. However, MDS carries the risk of progressing to acute leukemia over time. We present a case of rapidly progressive MDS in a previously healthy middle-aged female, originally presenting and treated as acute leukemia.

Large Granular Lymphocytic Leukemia: A Report of Response to Rituximab.

Large granular lymphocytic (LGL) leukemia is a rare form of low grade leukemia characterized by large cytotoxic T cells or natural killer cells on morphological examination. Immunosuppressive therapy is employed as first-line therapy. Treatment options in refractory cases include the anti-CD52 antibody alemtuzumab and purine analogues. We report a rare case that responded to the anti-CD20 monoclonal antibody rituximab. A 77-year-old female presented with complaints of fatigue, fever, and chills of 3 months' duration. A CBC showed that pancytopenia with an absolute neutrophil count (ANC) was 0. Peripheral blood flow cytometry detected increased number of T cell large granular lymphocytes and T cell receptor rearrangement study detected a clonal T cell population. Bone marrow biopsy showed peripheral T cell lymphoma, most consistent with T-large granulocytic leukemia. The patient was treated with prednisone and oral cyclophosphamide for four months with no response. Thereafter, she received four weekly infusions of rituximab with improvement in her blood counts. A response to rituximab in refractory cases such as ours has been reported and may guide us towards exploring other immune-based therapeutics in this rare disease.