ABSTRACT
Goodpasture's disease is a life-threatening autoimmune disease that can lead to end stage renal disease and death. We report a case of 61-year-old female who presented with deteriorating renal function. Initial laboratory investigations were negative for autoimmune antibodies including negative anti-neutrophilic cytoplasm antibodies and anti-glomerular basement membrane (anti-GBM) antibodies using both enzyme-linked immunosorbent assay and indirect immunofluorescence. However, renal biopsy was positive for linear IgG staining. Despite starting plasmapheresis and corticosteroids treatment, her renal functions continued to deteriorate and she was started on regular hemodialysis. This case highlights the challenging presentation and diagnosis of anti-GBM disease, which requires a high clinical suspicion necessarily for early diagnosis and treatment to improve survival rates.
ABSTRACT
Nivolumab is a monoclonal antibody against the programmed death protein 1 and is used for patients with advanced melanoma. It is associated with potentially immune-related adverse events, including disorders of the skin, GI tract, and the thyroid; these disorders were successfully treated with prednisone and infliximab. Other immunotherapeutic agents were observed to induce the formation of antiphospholipid antibody (APA) including α-interferon and interleukin-2. We present a case of APA development after the third dose of nivolumab in a 71-year-old male with advanced melanoma. The APA was detected after finding a prolonged aPTT; the lupus anticoagulant assay tested positive. The patient was treated with prednisone but, unfortunately, he expired a few days later.
ABSTRACT
Fingolimod, a sphingosine-1-phosphate receptor modulator, is used for the treatment of relapsing-remitting multiple sclerosis. It is well known to cause bradyarrhythmias. We present a 63-year-old woman who was admitted to the hospital with sustained monomorphic ventricular tachycardia 2 weeks after fingolimod initiation. Further evaluation showed that the patient's ventricular tachycardia was most likely secondary to her medication. Medical practitioners need to be aware of such possible life-threatening side effects while using fingolimod.
