Managing a Rare Case of Mixed Extrapulmonary Small Cell Carcinoma and Adenocarcinoma of the Prostate.

This report presents a remarkable and unusual case of extrapulmonary small cell carcinoma (EPSCC) occurring in the prostate of a 77-year-old male patient with a previous history of prostate adenocarcinoma and multiple metastases. EPSCC is a highly aggressive form of cancer that often results in unfavorable survival outcomes, posing significant challenges in terms of management due to the absence of established treatment protocols. Despite receiving standard treatment including bicalutamide and leuprorelin, the patient's condition showed no improvement. Consequently, the medical team made the decision to administer a carboplatin-etoposide chemotherapy regimen along with durvalumab, drawing upon the efficacy observed in similar treatment approaches for small cell carcinoma of the lung. This case highlights the critical need for further research and clinical trials to establish optimal treatment strategies for EPSCC affecting the prostate. By enhancing our understanding of this rare malignancy, we can potentially improve patient outcomes and develop targeted therapies tailored to its aggressive nature.

Role of the PLASMIC Score in the Management of Thrombotic Thrombocytopenic Purpura.

We report the case of a middle-aged male presenting with fatigue and abdominal pain. Prompt investigations demonstrated microangiopathic hemolytic anemia and thrombocytopenia on a peripheral blood smear. Thrombotic thrombocytopenic purpura was suspected based on the PLASMIC score. The patient significantly improved with therapeutic plasma exchange and prednisone within the next few days. The disintegrin and metalloprotease with a thrombospondin type 1 motif, member 13 levels reduction is a definitive hallmark leading to microvascular thrombosis. However, some medical centers in the United States do not promptly have quick allowance to the levels. Hence, the PLASMIC score becomes imminent in initiating immediate management and preventing life-threatening complications.

Pulmonary Cryptococcosis and Pulmonary Fibrosis: A Complication of COVID-19 Pneumonia.

Acute respiratory distress syndrome (ARDS) and pulmonary fibrosis (PF) are increasingly identified as complications of coronavirus disease 2019 (COVID-19) infection, the latter being managed with tapering dose glucocorticoids. Studies have shown improved outcomes with steroid use in this subset of patients; however, the use of high doses of steroids predisposes these patients to develop various complications such as opportunistic infections. The incidence of pulmonary cryptococcosis (PC) in patients with post-COVID-19 PF is not known. Here, we discuss a middle-aged male, with no pulmonary comorbidities, who developed PC secondary to the immunocompromised state from high-dose steroid use for the management of post-COVID-19 PF.

Potential Role of High-Dose Steroids in the Treatment of COVID-19-Associated Nephropathy.

With the increasing number of COVID-19-associated nephropathy (COVAN), biopsy-proven cases of collapsing variety of focal segmental glomerulosclerosis (FSGS) are emerging. Though the recommendations on treatment for COVID-19-associated respiratory symptoms are evolving, there is still no definitive treatment for the collapsing FSGS secondary to COVAN. We report a case of a 47-year-old male admitted with acute kidney injury from COVID-19 infection and found to have collapsing FSGS on renal biopsy. Almost all the patients who were found to have similar conditions were treated with a relatively smaller dose of steroids and ultimately required dialysis. Our patient showed improvement with the trial of higher doses of steroids and never required dialysis. Hence, our case report emphasizes the need for a randomized controlled trial (RCT) with regard to the use of high-dose steroids in COVAN.

Recurrent Myocarditis Following COVID-19 Infection and the mRNA Vaccine.

COVID-19 infection has cardiovascular manifestations such as acute myocarditis, arrhythmia, ischemic cardiomyopathy, heart failure, pericardial effusion, cardiac tamponade, and thromboembolism. The COVID-19 mRNA vaccines BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna), and viral vector vaccine Ad26.COV2.S (Johnson & Johnson - Janssen) were initially approved for emergency authorized use by the US-FDA. Cases of myocarditis were reported primarily in adolescents and young adults after administration of COVID-19 mRNA vaccines, with the subsequent emergence of cases of myocarditis after administration of viral vector vaccine Ad26.COV2.S. A majority of these cases were observed after the second dose of the mRNA vaccine. This case report demonstrates the occurrence of symptomatic myocarditis in a patient during acute COVID-19 infection, followed by recurrence of symptoms after the first dose of mRNA COVID-19 vaccine and subsequent recurrence of cardiac MRI-proven myocarditis after the second dose of mRNA COVID-19 vaccine. This case stands out due to the occurrence of symptoms with COVID-19 infection and after vaccination, suggesting possible incomplete interval resolution of infection-related myocarditis.

Isolated Facial Nerve Palsy Due to Temporal Bone Metastasis.

Isolated facial nerve palsy resulting from temporal bone metastasis is rare and has been sparsely reported in the literature to be the initial presentation of cancer. The most commonly reported sites of origin of such metastases include the breast, lung, kidney, gastrointestinal tract, larynx, prostate, and thyroid, to name a few. Here, we discuss a patient initially presenting with isolated lower motor neuron facial nerve palsy. The diagnosis was revised to that of breast cancer with metastasis to the temporal bone resulting in facial nerve paralysis following the subsequent clinical presentation.

Unusual cause of chest pain, Bornholm disease, a forgotten entity; case report and review of literature.

Chest pain is a common symptom culminating in hospital admissions and specialist referrals. Although cardiac work up is pursued in most of the cases, cardiac etiology is found to be the culprit in minority of the cases. Acute chest pain is a clinical syndrome that may be caused by almost any condition affecting the thorax, abdomen, or internal organs. On occasions this extensive and expensive diagnostic work up can be avoided with awareness of commoner and non-lethal reasons. We report a case of a woman with Bornholm disease secondary to Coxsackievirus B5 (CB5) infection and supplementary review of literature till date.

Symptoms of anxiety and depression are independently associated with inflammatory bowel disease-related disability.

BACKGROUND: Inflammatory bowel disease (IBD) frequently results in disability. The relevance of psychological effects in causing disability, and whether disability occurs similarly in non-Western cohorts is as yet unknown. AIM: We assessed the relationship between symptoms of anxiety and depression, quality of life and disability in a Singaporean IBD cohort and their predictors. METHODS: Cross-sectional study. We assessed consecutive IBD subjects' IBD-Disability Index (IBD-DI), Hospital Anxiety and Depression Scale (HADS), and IBD questionnaire (IBDQ). Clinical and demographic variables were collected. Non-parametric statistical analyses were performed. Independent predictors of disability were identified through multivariate logistic regression. RESULTS: 200 consecutive subjects were recruited (males: 69%; median age: 43.8 (±15.4) years; 95 had Crohn's disease (CD), 105 had ulcerative colitis (UC); median IBD duration: 10.8 (±9.0) years.) 27% of the cohort had anxiety and/or depression, which worsened disability (IBD-DI: -9 (±14) with anxiety vs 6 (±13) without anxiety, P<0.001; -12 (±16) with depression vs 5 (±13) without depression, P<0.001). Age at diagnosis, use of prednisolone, stricturing CD and active IBD were significant predictors of disability. IBDQ strongly correlated with IBD-DI(rs=0.82, P<0.01). CONCLUSION: Symptoms of anxiety and depression were common in this Asian cohort of IBD and were strongly associated with IBD-related disability. Recognizing psychological issues contributing to disability in IBD is important to ensure holistic care and appropriate treatment.