Severe Mpox Among People With Advanced Human Immunodeficiency Virus Receiving Prolonged Tecovirimat in New York City.

Severe mpox has been observed in people with advanced human immunodeficiency virus (HIV). We describe clinical outcomes of 13 patients with advanced HIV (CD4 <200 cells/µL), severe mpox, and multiorgan involvement. Despite extended tecovirimat courses and additional agents, including vaccinia immune globulin, cidofovir, and brincidofovir, this group experienced prolonged hospitalizations and high mortality.

Application of natural killer immunotherapy in blood cancers and solid tumors.

PURPOSE OF REVIEW: Natural killer (NK) cells are innate lymphoid cells characterized by their ability to attack aberrant and cancerous cells. In contrast to the activation of T-cells, NK cell activation is controlled by the interaction of NK cell receptors and their target cells in a manner independent of antigen organization. Due to NK cells' broad array of activation cues, they have gained great attention as a potential therapeutic agent in cancer immunotherapy. RECENT FINDINGS: Ex vivo activation, expansion, and genetic modifications, such as the addition of a chimeric antigen receptor (CAR), will allow the next generation of NK cells to enhance cytotoxicity, promote survival, and create "off-the-shelf" products. In addition to these that are poised to greatly enhance their clinical activity, the inherent lack of potential for causing graft-versus-host disease (GVHD) and cytokine release syndrome (CRS) suggest that CAR NK cells have the potential to be complementary to CAR-T cells as a component of therapeutic strategies for cancer. SUMMARY: In this review, we will provide a general understanding of NK cell biology, CAR-NK cell advantages over CAR-T cell therapy, barriers to making NK cell immunotherapy viable, and current NK cell clinical trials for hematological malignancies and solid tumors. The next generation of NK cells has potential to change the circumstances guiding present cancer immunotherapies.

New-Onset Heart Failure in the Setting of T4-Conversion Disorder.

Thyroid hormone is essential in accomplishing the appropriate metabolism of the body. Achieving euthyroidism is of importance due to the deadly ramifications of being hypothyroid, such as multiple organ failure, profound decrease in mentation and even death. We present a case of an 80-year-old female with a history of hypertension, coronary artery disease, chronic kidney disease, hypothyroidism due to total thyroidectomy, and a cerebral vascular accident who presented with slurred speech, decreased appetite, dizziness and lethargy with new-onset weakness. She was adherent to all her medications. Her labs were significant for elevated thyroid-stimulating hormone, elevated free thyroxine, and low total triiodothyronine. Brain MRI revealed no acute pathology. She was given her home dose of Levothyroxine and was admitted to the telemetry unit for evaluation of her symptoms and abnormal thyroid panel. During her hospital course, she was found to have an abnormal rhythm and worsening lethargy. Subsequent electrocardiogram and laboratory values revealed new T-wave inversions and elevated troponin. An echocardiogram revealed a new severely reduced left ventricular function with severe global hypokinesis of the left ventricle and an ejection fraction of 30%. It was only after initiating combination therapy of levothyroxine and liothyronine that her symptoms and abnormal cardiac rhythm resolved. With this careful titration of the patient's medication, we concluded that combination therapy was essential to the patient being euthyroid. This phenomenon was also cited in multiple literature, which warrants an investigation of a certain population's inability to convert T4 to T3. By sharing this case, we aim to aid providers with their differential diagnoses and bring to light a potential area of further investigation. Ultimately, by optimizing and tailoring these medications, we hope to improve their quality of life.

Thymic cancer: A not-so-indolent cause of pericardial effusion.

The incidence of pericardial effusion in the U.S. is roughly 3.4% [1]. While most causes of pericardial effusions are indolent and transient, malignancy is a much more insidious cause that cannot be overlooked. Most cases of documented pericardial effusion secondary to malignancy have been due to mass effect from benign thymic tumors, such as thymomas. Our case highlights a 41-year-old male who presented with a dry cough and epigastric pain, found to have a large pericardial effusion and incidental thymic mass. The mass was biopsied and found to be keratinizing squamous cell carcinoma. This case expands our knowledge base as clinicians that pericardial effusions can be caused by malignant extension of tumors, rather than simply by mass effect of benign tumors.

Surgicel-Induced Anaphylaxis Post Permacath Placement.

This case report details the resulting anaphylaxis and angioedema following placement of Surgicel hemostatic agent in a 38-year-old male postoperatively. Our patient experienced minor postoperative bleeding at the placement site of a dialysis catheter, which was controlled using Surgicel. Within minutes of the placement of Surgicel in the incision, the patient experienced an anaphylactic reaction with facial angioedema resulting in a Rapid Response being called to intervene. Incidences of Surgicel-induced anaphylaxis and hypersensitivity reactions are rare, but this report aims to bring awareness to this potential complication, as well as to assist with guiding management of future adverse reactions and surveillance of patients afterward.