Primary cardiac large B cell lymphoma.

A female patient in her mid-60s presented with progressive shortness of breath, pleuritic chest pain and bilateral leg swelling for 1 week. Initial diagnostic workup revealed pericardial effusion, and a localised pericardial tubular mass on CT chest. Pericardial fluid analysis showed elevated white cells, with predominance of medium-large sized atypical lymphoid cells. Atypical lymphocytes stained positive for CD79a, CD10, PAX-5, BCL-2 and BCL6. Fluorescence in situ hybridisation testing demonstrated MYC and BCL6 rearrangements without BCL2 gene rearrangement. The overall morphological, immunohistochemical and cytogenetic findings supported a diagnosis of high-grade B cell lymphoma with MYC and BCL6 rearrangements. After extensive staging workup, localised disease involving the pericardium with a diagnosis of primary cardiac large B cell lymphoma was established. She was treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab chemotherapy. Rituximab was discontinued owing to largely absent CD20 expression. Interim positron emission tomography-CT after three cycles revealed a complete response, and the patient completed six cycles of therapy.

Lady Windermere Syndrome: Unravelling an Older Lady's Nightmare.

Infection with nontuberculous mycobacteria (NTM) is an increasingly important cause of pulmonary disease, particularly in immunocompromised patients or those suffering from chronic lung conditions. However, though rare, non-tubercular mycobacterial infection and bronchiectasis may also occur in an immunocompetent patient. This unusual condition is typically seen in middle-aged or elderly white females, with bronchiectasis having a predilection for the middle lobe and lingula. Here, we present a similar case of Mycobacterium avium complex (MAC) infection with middle lobe bronchiectasis in an elderly immunocompetent female, recognized as Lady Windermere Syndrome (LWS).

Virtual patient education for hypertension: The truth about behavioral change.

Anti-hypertensive education is an important public health intervention to decrease the mortality and burden of the disease. Using digital technologies for education as a part of preventive measures for hypertension is a cost-effective approach and helps low-income communities and vulnerable populations overcome barriers to healthcare access. The coronavirus disease 19 pandemic further highlighted the need of new health interventions to address health inequalities. Virtual education is helpful to improve awareness, knowledge, and attitude toward hypertension. However, given the complexity of behavioral change, educational approaches do not always provide a change in behavior. Some of the obstacles in online hypertensive education could be time limitations, not being tailored to individual needs and not including the different elements of behavioral models to enhance behavior change. Studies regarding virtual education should be encouraged and involve lifestyle modifications emphasizing the importance of Dietary Approaches to Stop Hypertension diet, salt restriction, and exercise and should be used adjunct to in-person visits for the management of hypertension. Additionally, to stratify patients according to hypertension type (essential or secondary) would be useful to create specific educational materials. Virtual hypertension education is promising to increase awareness regarding risk factors and most importantly motivate patients to be more compliant with management helping to decrease hypertension related complications and hospitalizations.

Intravenous Immunoglobulin Induced Transaminitis.

Intravenous immunoglobulin (IVIG) is a common therapeutic modality used in immune-mediated neuropathy. While the therapeutic benefits are well known, adverse reactions have been reported. One such adverse event, though rare, is transaminitis, which appears to be a transient and a self-limiting adverse reaction. Though most of the cases implicate the stabilizing agent to be the culprit, the exact mechanism is unknown. Thus far, it has been speculated that maltose, which has been commonly used as a stabilizer, is the cause of IVIG transaminitis. We present a unique case of a patient who developed transaminitis post-IVIG in which glycine was used as a stabilizing agent. We aim to draw a potential association between IVIG therapy and the development of transaminitis, thereby providing insight into the underlying mechanisms, as well as clinical features, and possibly encouraging further research on this topic.