Melatonin aspiration: Treatment with flexible bronchoscopy.

A 68-year-old male with past medical history 84 pack year smoking history (quit in 2000), mild chronic obstructive pulmonary disease (COPD), adenocarcinoma of right upper lobe treated with surgery and chemoradiation, and melanoma resection in 2013 presented with a one-month history of cough with sputum production and progressive dyspnea on exertion. He did not improve with standard treatment of antibiotics and steroids. He underwent flexible bronchoscopy that revealed an aspirated pill. This was successfully removed in the same session with the flexible bronchoscope.

Impending Cardiac Tamponade as the Initial Manifestation of BCR-ABL Positive Chronic Myeloid Leukemia.

Leukemia involves all organs and tissues of the body. Leukemic infiltration of the pericardium has been documented frequently at post-mortem examinations. Clinically, however, pericardial effusion with cardiac tamponade is rare, and only isolated case reports have been described. In all the reported cases, therapeutic pericardiocentesis was required for the relief of cardiac tamponade with the risk of bleeding since these patients often had deranged hemostasis. We are reporting a rare case of hemorrhagic pericardial effusion in chronic myeloid leukemia before starting the tyrosine kinase inhibitors. The patient required therapeutic pericardiocentesis and hydroxyurea treatment.

Non-Ketotic Hyperglycemia Causing a Transient Unilateral Homonymous Hemianopia: A Manifestation of Occipital Lobe Seizure.

Focal seizures related to non-ketotic hyperglycemia (NKH) are rare in clinical practice. Plasma glucose levels are usually above 16.6 mmol/L and with normal or slightly elevated serum osmolality. The occurrence of focal seizures may be augmented by the absence of ketoacidosis. Electroencephalogram (EEG) during seizures usually confirms the diagnosis, however, the absence of epileptiform discharges does not rule out seizures. A non-ketotic hyperglycemia-associated occipital lobe seizure can manifest itself as color flashes, blurry vision with periodic confusion, and usually resolves with insulin treatment and rehydration. We are reporting a 65-year-old male patient who presented with intermittent confusion and left-sided visual disturbances, found to have a blood glucose of 33.7 mmol/L with a normal anion gap of 10 and calculated serum osmolality of 303 mOsm/L. The patient's visual disturbances responded very well to rehydration and insulin treatment.

A Rare Case of Immune-Mediated Primary Adrenal Insufficiency With Cytotoxic T-Lymphocyte Antigen-4 Inhibitor Ipilimumab in Metastatic Melanoma of Lung and Neck of Unknown Primary.

Immunotherapy with checkpoint inhibitors such as ipilimumab, a cytotoxic T-lymphocyte antigen-4 (CTLA-4) inhibitor, and nivolumab, a programmed death-1 (PD-1) inhibitor, has significantly improved the survival of patients with metastatic melanoma. The immune-related endocrinopathies of these treatments have been well documented, such as hypothyroidism, hyperthyroidism, primary adrenal insufficiency (PAI), insulin-dependent diabetes, and hypophysitis. We report the onset of PAI in a patient with metastatic melanoma to the lung and neck of unknown primary origin who was treated with ipilimumab. The patient's symptoms resolved with steroid replacement. After the completion of 16 cycles of another checkpoint inhibitor, nivolumab, full remission was achieved.