ABSTRACT
Chylothorax has rarely been reported as a pleuropulmonary complication of Waldenström macroglobulinaemia (WM). In general, when a unilateral effusion is discovered particularly in patients with a history of cancer or active malignancy, a broad differential including chylothorax needs to be considered. We present the case of a 50-year-old woman found to have chylothorax secondary to progression of WM as confirmed by cytology and presence of MYD88 L265P mutation in the pleural fluid specimen and subsequent resolution with chemotherapy. This review centres particularly on non-traumatic causes of chylothorax with a focus on WM and includes a unique patient perspective.
Subject(s)
Chylothorax , Lymphoma, B-Cell , Waldenstrom Macroglobulinemia , Chylothorax/etiology , Female , Humans , Middle Aged , Mutation , Waldenstrom Macroglobulinemia/complications , Waldenstrom Macroglobulinemia/drug therapyABSTRACT
BACKGROUND: Pica is a poorly understood psychiatric disorder that presents with the ingestion of non-nutritious substances for unclear reasons. A high index of suspicion for unusual toxin exposure aids in the diagnosis of pica patients presenting with unexplained neurodegenerative features. METHODS: We present a 47-year-old female with worsening gait over the past year. Prior to this, she was fully independent with activities of daily living, but is now mostly housebound due to frequent falls. Past medical history is significant for menorrhagia, iron deficiency anemia and pica. CBC and iron studies revealed iron deficiency with microcytic hypochromic anemia. MRI brain demonstrated symmetrical T2 hyperintensities within the middle cerebellar peduncles. RESULTS: Differential diagnoses for her clinical deficits and imaging, including Spinocerebellar Ataxia, Multiple System Atrophy and Fragile X Tremor-Ataxia Syndrome, were excluded based on neurological assessment, family history and genetic PCR testing. Collateral history revealed a regular habit of mothball ingestion and serum paradichlorobenzene levels were elevated to 15mcg/mL. The patient was treated with iron replacement therapy and her symptoms gradually improved over several months. CONCLUSION: Iron deficiency anemia is commonly associated with pica, which can lead to toxin ingestion. A high index of suspicion for toxin ingestion in pica patients can immensely aid in the diagnosis. Mothball abuse secondary to pica may affect the CNS and can present with nonspecific neurodegenerative changes. To our knowledge, there have been no reported cases in the literature with paradichlorobenzene neurotoxicity predominantly affecting the middle cerebellar peduncles.
Subject(s)
Chlorobenzenes/toxicity , Insect Repellents/poisoning , Neurotoxicity Syndromes/diagnosis , Pica/complications , Anemia, Iron-Deficiency/etiology , Chlorobenzenes/blood , Chlorobenzenes/poisoning , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Middle Cerebellar Peduncle/diagnostic imagingABSTRACT
A 52-year-old man with no significant past medical history was found to have diabetic ketoacidosis (DKA) in the setting of COVID-19 infection. He presented with hyperglycemia and an anion gap metabolic acidosis, but without a clear infectious precipitant. Inflammatory markers were subsequently checked, and found to be significantly elevated, raising the suspicion for COVID-19 as a possible etiology despite the lack of typical symptoms - a rapid COVID-19 PCR test checked afterwards was found to be positive. The patient's hospital course was uncomplicated, but the case highlights the possibility of COVID-19 serving as an infectious precipitant for DKA, even when a patient is otherwise asymptomatic in terms of having COVID-19.
