T-Cell Lymphoblastic Lymphoma Presenting as Acute Clavicular Pain.

An anterior mediastinal mass has a broad differential. We report a case of a large anterior mediastinal malignancy in a pediatric patient presenting with left-sided supraclavicular pain without symptoms of cardiopulmonary compromise. The mass was revealed with CT imaging and diagnosis of T-cell lymphoblastic lymphoma was confirmed after supraclavicular lymph node biopsy. The patient was initially treated with methylprednisolone for cytoreduction and a combination of rasburicase and allopurinol for asymptomatic tumor lysis syndrome. There was then a 34-day induction phase of chemotherapy with vincristine, daunorubicin, PEG-asparaginase, and intrathecal methotrexate. CSF sampling and bone marrow biopsies were both negative at the end of induction. The patient is currently in the consolidation phase, taking cyclophosphamide, cytarabine, and 6-MP, and is tolerating the treatment well.

Treatment of Immune Checkpoint Inhibitor Induced Colitis with Infliximab.

Several immunotherapeutic agents function against the T cell immune checkpoint inhibitor pathways thereby reestablishing immune response to elusive malignancies. Namely, the programmed death-1 co-receptor (PD-1) or ligand (PD-L1) and cytotoxic T lymphocyte- associated protein 4 (CTLA-4) are well known checkpoint targets of current FDA approved drugs. Among these drugs nivolumab, an IgG4 anti-PD-1 antibody, and ipilimumab, an anti-CTLA-4 antibody, are used to treat numerous malignancies but carry a large list of potential side effects termed immune-related adverse effects (irAEs). We describe the presentation, clinical course, and resolution of steroid-resistant immune checkpoint inhibitor-induced colitis secondary to administration of these two drugs in a 66-year-old female patient treated with infliximab.