Treatment-naïve spontaneous tumor lysis syndrome in metastatic prostate adenocarcinoma: An unusual suspect.

Tumor lysis syndrome (TLS) is a potentially fatal condition defined both by laboratory and clinical criteria. It is caused by the catabolism of tumor cells which leads to considerable release and elevated levels of phosphate, potassium and uric acid in the bloodstream. These electrolyte derangements predispose patients to renal tubule uric acid precipitation, acute kidney injury, arrhythmias, neuromuscular irritability and even seizures. Although this phenomenon is well described with hematological malignancies, it is also known to occur among solid tumors. We present a rare case of treatment-naïve spontaneous TLS that occurred in a 69-year-old male with metastatic prostate adenocarcinoma with hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia, elevated liver enzymes, AKI and hemodynamic instability. Despite our best resuscitative efforts with intravenous hydration, electrolyte monitoring, Rasburicase and renal replacement therapy, the patient continued to decline, was made comfort care and expired shortly thereafter. Physicians encountering patients with the above presentation must entertain a diagnosis of TLS despite its rarity in solid tumors, as early diagnosis leads to timely treatment, thereby maximizing patients' chances at survival.

Treatment of multiple unresectable basal cell carcinomas from Gorlin-Goltz syndrome: a case report.

BACKGROUND: Nevoid basal cell carcinoma syndrome (NBCCS), which is also known by other names, including Gorlin-Goltz syndrome and multiple basal-cell carcinoma (BCC) syndrome, is a rare multi-systemic disease inherited in a dominant autosomal manner with complete penetrance and variable expressivity. The main clinical manifestations include multiple BCCs, odontogenic keratocysts of the jaw, hyperkeratosis of the palms and soles, skeletal abnormalities, intracranial calcifications and facial deformities. PATIENTS AND METHODS: A 31-year-old male diagnosed with Gorlin-Goltz syndrome with multiple unresectable facial BCCs was treated with the Hedgehog inhibitor vismodegib. RESULTS: After one month of therapy on vismodegib, there were significant reductions in the size of multiple BCCs on the patient's face. The patient remains on this therapy. CONCLUSION: Hedgehog pathway inhibition is an effective strategy to treat unresectable BCCs from Gorlin-Goltz syndrome. Although vismodegib shows some promising clinical results in the early phase of its use, there are concerns of possible resistance developing within months. Duration of therapy, role of maintenance treatment and drug modification to reduce resistance need to be explored in future case studies.

Campylobacter fetus bacteremia in a young healthy adult transmitted by khat chewing.

Campylobacter fetus is a pathogen affecting almost exclusively patients with immunosuppression and chronic debilitating diseases. We report the case of a healthy young man with C. fetus bacteremia presenting with fever, hypotension and meningitis. The patient had no exposure to contaminated sources except from khat chewing, which we describe as a possible source of transmission for the first time.