Phosphaturic Tumor-Induced Osteomalacia.

Tumor-induced osteomalacia (TIO) is a rare complication of certain tumors involving the skeletal bones, mainly in the lower extremities and rarely the spine, that can cause skeletal abnormalities, osteopenia, and osteoporosis. The etiology of these tumors is unknown, and they are considered benign tumors that usually localize in bone or soft tissue anywhere in the body. Symptoms are nonspecific and vague, which causes a delay in diagnosis. These tumors produce fibroblast growth factor-23, which causes hypophosphatemia due to renal wasting of phosphate and inhibits vitamin D3 activation, resulting in osteomalacia. The majority of these tumors are osteoblastic and rarely osteolytic. A PET scan can detect the location and diagnose these tumors. Surgical resection, when feasible, is the treatment of choice and can lead to improvement, resolution of symptoms, and correction of hypophosphatemia. Patients usually present with a wide variety of nonspecific complaints. This case report presents an unusual presentation of TIO from a phosphaturic mesenchymal tumor involving the left acetabulum.

Erlotinib-associated exacerbation of hypothyroidism with pericardial tamponade.

OBJECTIVE: To report a case of erlotinib-associated exacerbation of hypothyroidism complicated by pericardial tamponade. METHODS: We describe the patient's clinical presentation, biochemical workup, and clinical course. RESULTS: Non-small cell lung cancer was diagnosed in a 54-year-old woman. After cisplatin and radiation therapy, she was noted to have subclinical hypothyroidism that did not necessitate treatment. The tyrosine kinase inhibitor erlotinib, 150 mg once daily, was prescribed. Three months later, the patient was documented to have severe hypothyroidism. Levothyroxine was prescribed, but she continued to experience shortness of breath, fatigue, and chest and back pain, which resulted in an emergency department visit. Inpatient workup revealed cardiac tamponade with a large pericardial effusion and a right ventricular diastolic collapse. Pericardiocentesis was performed. CONCLUSIONS: This is the first case report linking erlotinib use and thyroid disease.

Inferior vena cava filter migration: updated review and case presentation.

We report a case of inferior vena cava filter migration to the right ventricle resulting in ventricular tachycardia and elevated troponin. The patient was taken to the cardiac catheterization laboratory and under fluoroscopy the filter was found to be in the right ventricle. Later in the day the filter was removed surgically with the aid of cardiopulmonary bypass. This case, as well as the other 27 reported cases of filter migration, were reviewed. It was noticed that newer retrievable filters made of nitinol, phynox and elgioly have a significantly higher percentage of filter migration into the right ventricle as compared to the old stainless steel and titanium-based Greenfield filters. Similarly, there were also higher percentages of complications and mortality associated with the newer retrievable filters migrating to the right ventricle. Filter migration to the right ventricle as opposed to the right atrium increased over the past 10 years, which has resulted in more serious symptoms, ventricular arrhythmias, deaths and higher rates of surgical removal.