Myositis - A common but underreported adverse effect of osimertinib: Case series and review of the literature.

BACKGROUND: Lung cancer is the second most common cancer in both men and women and the leading cause of cancer death worldwide. The development of novel tyrosine kinase inhibitors (TKIs) represented a paradigm shift in the management of lung cancer and has resulted in markedly prolonged survival. Osimertinib is a TKI that was fast-tracked by the United States Food and Drug Administration in 2015 and subsequently approved for the treatment of metastatic epidermal growth factor receptor T790M mutation-positive non-small cell lung cancer. However, despite the generally favorable outcomes associated with osimertinib, rapid development and deployment of any new drug increases the risk of unforeseen adverse effects. Post-marketing surveillance studies therefore play an important role in further elucidating the risks and benefits of novel anti-neoplastic agents. MATERIAL AND METHODS: We describe four patients with non-small cell lung cancer who developed myositis after beginning treatment with osimertinib. In addition, we review the literature on osimertinib-associated myositis. Using PubMed, the following terms were searched and relevant citations assessed: creatine phosphokinase, myositis, osimertinib, rhabdomyolysis, osimertinib, and Tagrisso. CASE PRESENTATION: Thirty-eight patients were treated with osimertinib in our community clinic. Four with non-small cell lung cancer developed myositis after beginning treatment. The onset of symptoms and/or elevation of creatine phosphokinase occurred between two weeks and eleven months after osimertinib was initiated. Alternative causes for myositis were not identified. In two patients, myositis resolved within one month of withdrawing treatment. Two other patients continued osimertinib treatment with close monitoring. CONCLUSION: Myositis is a serious and potentially underreported adverse effect of osimertinib. Previous studies suggest that osimertinib-associated myositis is rare, occurring in less than 1% of patients. However, myositis occurred in over 10% of patients treated with osimertinib in our clinic population. We suggest regular monitoring for myositis among patients being treated with osimertinib and dose-reduction or cessation of treatment if clinically indicated.

Burden of arrythmias in transgender patients hospitalized for gender-affirming surgeries.

BACKGROUND: We sought to describe the burden of arrhythmias and their impact on in-hospital outcomes in transgender patients who underwent gender re-assignment surgery. METHODS: The study utilized data from the National Inpatient Sample from January 2012 to September 2015. RESULTS: 16 555 adult transgender patients were included in this study. A total of 610 adults developed arrhythmia out of which atrial fibrillation (N = 475, 2.87%) was the most frequent arrhythmia. In-hospital mortality increased substantially with arrhythmias. CONCLUSIONS: New-onset arrythmias, while infrequent in the inpatient setting is associated with significantly higher in-hospital mortality and resource utilization.

ABC-type diffuse large B-cell lymphoma presenting as rotator cuff tendinopathy: A diagnostic dilemma and review of the literature.

Diffuse large B-cell lymphoma often presents with extranodal manifestations involving the musculoskeletal system. Shoulder pain is particularly worrisome for malignancy. Individuals presenting with refractory upper extremity complaints should undergo a prompt and thorough evaluation for cancer, as a delay in diagnosis can result in an unfavorable outcome.

Vaping Is Not Safe: A Case of Acute Eosinophilic Pneumonia following Cannabis Vapor Inhalation.

There is a well-established association between inhalational exposures and acute eosinophilic pneumonia (AEP). The most reported exposure is cigarette smoking. Here, we present a case of progressive shortness of breath and nonproductive cough in a college student with no significant medical history, approximately 10 days after inhaling cannabis aerosols on two separate occasions. He was started on empiric antibiotics and bronchodilators without improvement. He was diagnosed with AEP based on peripheral eosinophilia and high-resolution CT image results. He made rapid recovery on intravenous glucocorticoids. Vaping has gained popularity among young adults mainly due to the perception that it is a safe alternative to smoking. This case shows that there may be a false sense of security with vaping. Vaping poses a yet-to-be quantified public health threat, which requires further studies.

A Case of Right-Sided Direct Carotid Cavernous Fistula: A Diagnostic Challenge.

BACKGROUND Carotid cavernous fistulas (CCFs) are rare potentially sight-threatening abnormal connections between carotid artery and cavernous sinus. CASE REPORT We report a case of CCF in an 83-year-old female, who presented with swollen and painful right eye. The patient was initially treated with empiric antibiotics for suspected peri-orbital cellulitis, as noted clinically and in computed tomography (CT) orbits. However, lack of clinical improvement, physical finding of orbital bruit/thrill, and enlarged superior ophthalmic vein in magnetic resonance (MR) orbits suggest alternate diagnoses. Eventually, CT angiogram (CTA) and carotid-arteriography confirmed the diagnosis of right-sided direct CCF, which was subsequently treated with endovascular embolization. Not only does this case highlight the importance of CCF, which could be a differential diagnosis of swollen red eye, it also addresses the vital importance of physical examination in modern medicine despite the seemingly promising technologies. CONCLUSIONS Internists should have a low threshold of clinical suspicion for CCF in a patient with swollen red eyes in order to provide timely and proper management.