ABSTRACT
INTRODUCTION: Pembrolizumab is an immune checkpoint inhibitor that promotes effector T-cell functions on malignant cells by binding to programmed cell death protein 1 (PD-1). Pembrolizumab is well tolerated in most cases with an adverse event profile consisting mainly of pruritus, fatigue, and anorexia. Cardiotoxicity comprises 1% of the total adverse events. CASE REPORT: We present a case of a 64-year-old female with non-small cell lung cancer (NSCLC) who developed pleuropericarditis following pembrolizumab therapy. MANAGEMENT & OUTCOME: The patient was successfully managed with colchicine, furosemide, and timely initiation of methylprednisolone with the improvement of her symptoms. The decision to discontinue pembrolizumab was made, and six months after this intervention, the patient has remained asymptomatic. DISCUSSION: Clinicians should recognize these potential immune-mediated adverse effects to provide effective and timely management and optimize patient care.
Subject(s)
Carcinoma, Non-Small-Cell Lung , Drug-Related Side Effects and Adverse Reactions , Lung Neoplasms , Female , Humans , Middle Aged , Carcinoma, Non-Small-Cell Lung/therapy , Cardiotoxicity , Drug-Related Side Effects and Adverse Reactions/drug therapy , Immune Checkpoint Inhibitors/adverse effects , Lung Neoplasms/diagnosisABSTRACT
Hypoglycemia may present with a multitude of signs and symptoms ranging from subjective feelings of anxiety or diaphoresis to neuroglycopenic manifestations of altered sensorium or seizure. The differential diagnosis of hypoglycemic disorders is broad, and in rare instances may occur following intentional induction by undisclosed insulin administration or insulin secretagogue ingestion in patients with an underlying factitious disorder. While basic laboratory studies can reliably confirm the presence of exogenous insulin in patients with hyperinsulinemic hypoglycemia, increased endogenous insulin secretion following sulfonylurea ingestion can mimic a biochemical pattern of findings also seen with insulinoma, a rare pancreatic insulin-producing tumor. We present a case of severe hypoglycemia manifesting as diminished consciousness in a patient with multiple medical comorbidities. Following initial laboratory workup suggestive of endogenous hyperinsulinemic hypoglycemia, the results of a serum oral hypoglycemic panel confirmed the presence of glipizide, an unprescribed insulin secretagogue of the sulfonylurea class, in the patient's serum. In conjunction with psychiatric services, the patient was diagnosed with an underlying factitious disorder and her hypoglycemia was deemed likely the result of surreptitious sulfonylurea ingestion as a pathologic healthcare-seeking behavior. Our case report and subsequent review shed light on critical components in the diagnostic approach to hypoglycemic disorders, which carry significant morbidity for patients regardless of the underlying cause and emphasize several clinical and ethical considerations associated with the identification and management of persons with factitious disorder in medical practice.
ABSTRACT
PURPOSE: To evaluate treatment options for vitreomacular traction (VMT). METHODS: A retrospective, consecutive case series and a literature search with Boolean search logic. A random-effects meta-analysis was conducted to combine the rates of VMT resolution per treatment. Patients from studies analyzed were placed into cohorts based on the treatment received. CASE SERIES: Zero of 10 control, 3 of 7 intravitreal ocriplasmin (IVO, P = 0.10), 7 of 8 intravitreal expansile gas (pneumatic vitreolysis, PV, P < 0.01), and 10 of 10 pars plana vitrectomy (P < 0.01)-treated eyes experienced VMT release (VMTr) at Day 28. No patients developed retinal tears or detachment. One PV-treated (12.5%) eye developed a macular hole. Meta-analysis: Twenty-three of 131 prospective or retrospective and consecutive articles were included. Sixty-three eyes were treated with PV, 726 eyes were treated with intravitreal ocriplasmin, and 253 eyes were characterized as the control group (saline injection). The weighted rate of VMT resolution for the control group was 0.09 (95% confidence interval [CI]: 0.06-0.13), PV was 0.84 (95% CI: 0.76-0.92), and intravitreal ocriplasmin was 0.26 (95% CI: 0.23-0.29). CONCLUSION: Our analysis found that PV releases VMT in most patients and suggest that PV may be as effective or superior to nonsurgical options for VMTr at Day 28 with a similar risk profile.
