Human herpesvirus 6 myelitis after chimeric antigen receptor T-cell therapy.

This article reports a fatal case of human herpesvirus 6 (HHV-6) myelitis following CD19-targeted chimeric antigen receptor T-cell therapy. Infection from HHV-6 reactivation after haematopoietic stem cell transplant is established, and outside of this population is limited to case reports. The patient developed cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome that responded to corticosteroids both clinically and on imaging. Subsequently, ascending flaccid paralysis developed, leading to neuromuscular respiratory failure and, ultimately, death. Disease progression was refractory to foscarnet and multiple immunomodulating agents. HHV-6 should be considered in patients with encephalitis and myelitis after adoptive T-cell therapy.

Norovirus in Cancer Patients: A Review.

Norovirus (NoV) is the leading cause of viral-related diarrhea in cancer patients, in whom it can be chronic, contributing to decreased quality of life, interruption of cancer care, malnutrition, and altered mucosal barrier function. Immunosuppressed cancer patients shed NoV for longer periods of time than immunocompetent hosts, favoring quasispecies development and emergence of novel NoV variants. While nucleic acid amplification tests (NAATs) for NoV diagnosis have revolutionized our understanding of NoV burden of disease, not all NAATs provide information on viral load or infecting genotype. There is currently no effective antiviral or vaccine for chronic NoV infections. Screening for inhibitors of NoV replication in intestinal organoid culture models and creation of NoV-specific adoptive T cells are promising new strategies to develop treatments for chronic NoV in immunosuppressed patients. Herein we summarize data on the epidemiology, clinical manifestations, diagnostic challenges, and treatment of NoV infection in patients with cancer.

A Case of Pulmonary Epithelioid Hemangioendothelioma with Literature Review.

Pulmonary epithelioid hemangioendothelioma is a rare vascular tumor and infrequently described in medical literature as case reports and case series. Diagnosis is often incidental with high index of histopathological suspicion from clinical pathologist. The pathological pattern is quite unique with distinct immunohistochemical stains. Up to this day, there is no established standard treatment owing to the scarcity of this tumor. In this case report, we describe a case of pulmonary epithelioid hemangioendothelioma unexpectedly diagnosed with transthoracic needle biopsy, along with a review of the current literature.

Staphylococcal Pericarditis Causing Pericardial Tamponade and Concurrent Empyema.

Bacterial pericarditis is a rare presentation and is usually due to secondary infection from a hematogenous cause or can occur secondary to trauma, intrathoracic surgery, or due to spread of infection from a contiguous focus via ligaments that anchor the pericardium to its surrounding structures. Its course is fulminant characterized by a high mortality rate from sepsis, tamponade, and constriction. We describe a rare case of Staphylococcus aureus pericarditis with concurrent unilateral empyema. The patient rapidly developed tamponade and was successfully treated with antibiotics and urgent percutaneous pericardial drainage with placement of a temporary catheter. Treatment for bacterial pericarditis typically is 4-6 weeks long. Thoracic surgery should be consulted as soon as possible to determine need for surgical intervention, as fibrin deposition may occur, making percutaneous drainage incomplete and leading to complications of persistent purulent pericarditis or constrictive pericarditis.

When it is not just DKA; diabetic ketoacidosis as a first presentation of pancreatic adenocarcinoma.

Pancreatic cancer is the fourth leading cause of cancer related-deaths in the United States. Early symptoms of pancreatic cancer are nonspecific, and most cases are diagnosed at an advanced stage. DKA as a first presentation of pancreatic adenocarcinoma is a seldom reported condition. We present a case of a 59 year old female with type 2 diabetes, who presented to the emergency department with confusion, abdominal pain, polyuria and polydipsia. Laboratory workup showed a high anion gap metabolic acidosis and a blood glucose level of 419 mg/dl with positive serum ketones. She was diagnosed with DKA and admitted to the ICU. A CT abdomen/pelvis was performed to assess for pancreatic pathology as her DKA took longer time to resolve, it showed a pancreatic mass with multiple lesions in the liver. She had biopsies done which were positive for poorly differentiated pancreatic ductal adenocarcinoma. DKA occurs less commonly in patients with type 2 diabetes. Common precipitating factors for DKA in type 2 diabetes include medication noncompliance, infection, or possibly treatment with SGLT2 inhibitors. DKA as a first presentation of pancreatic cancer has been reported more with endocrine islet cell tumors but rarely with adenocarcinoma of the exocrine pancreas. Studies have shown that diabetes is an independent risk factor for development of pancreatic cancer. Other studies suggested that diabetes might be a result of pancreatic cancer or a paraneoplastic effect. One study suggested that diabetes associated with pancreatic cancer occurs at a resectable stage of the disease.