Inflammatory complications of CGRP monoclonal antibodies: a case series.

BACKGROUND: Calcitonin gene-related peptide (CGRP) is expressed throughout the body and is a known mediator of migraine, exerting this biological effect through activation of trigeminovascular, meningeal and associated neuronal pathways located in close proximity to the central nervous system. Monoclonal antibodies (mAb) targeting the CGRP pathway are an effective new preventive treatment for migraine, with a generally favourable adverse event profile. Pre-clinical evidence supports an anti-inflammatory/immunoregulatory role for CGRP in other organ systems, and therefore inhibition of the normal action of this peptide may promote a pro-inflammatory response. CASES: We present a case series of eight patients with new or significantly worsened inflammatory pathology in close temporal association with the commencement of CGRP mAb therapy. CONCLUSION: This case series provides novel insights on the potential molecular mechanisms and side-effects of CGRP antagonism in migraine and supports clinical vigilance in patient care going forward.

Tacrolimus for the Management of Delayed Onset and Treatment-Refractory Immune-Related Hepatitis.

Immune checkpoint inhibitors, such as pembrolizumab, are effective in the management of metastatic malignancies, such as melanoma, and are associated with a spectrum of immune-related organ toxicities, including immune-related hepatitis (ir-hepatitis). The clinical presentation of ir-hepatitis varies in onset and severity, and management involves immunosuppression with corticosteroids and mycophenolate mofetil as first and second-line agents. Several agents have been proposed as third-line options for treatment-refractory disease. We report the successful use of tacrolimus for delayed onset and treatment-refractory ir-hepatitis secondary to pembrolizumab.

Synchronous p16+ nasopharyngeal and oropharyngeal squamous cell carcinoma: a case report and review.

We report a case of synchronous p16+ SCC involving both the nasopharynx and base of tongue treated with definitive chemo-radiotherapy with concurrent high dose cisplatin. The nasopharyngeal lesion was detected incidentally on PET/CT imaging. Head and neck clinicians treating p16+ SCC should consider the possibility of synchronous lesions, including lesions which may be located in the lymphoid tissue of the nasopharynx.

Gallbladder lymphoma detected by 18F-fluorodeoxyglucose positron emission tomography.

Gallbladder involvement in lymphoma is rare, with only a few cases reported in the literature, predominately in the pre positron emission tomography (PET) era. 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) has now become the modality of choice in the staging of lymphoma. We report a case of gallbladder involvement by high-grade B-cell lymphoma detected by PET/CT.

Helicobacter pylori Colonisation in Heterotopic Gastric Mucosa in Meckel Diverticulum: Case Report and Review of the Literature.

Meckel diverticulum is the most common congenital abnormality of the gastrointestinal system. Although most Meckel diverticula are asymptomatic, they can also present with bleeding, obstruction, or perforation. Helicobacter pylori is pathognomonic for the development of a peptic ulcer. We present a case report of a patient with a Meckel diverticulum with Helicobacter pylori colonising its heterotopic gastric mucosa. This is a rare histopathologic finding. We also reviewed the literature of other similar cases published in English.