RESUMO
Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulator therapy has previously been contraindicated in solid organ transplant recipients. This was due to lack of data and concern for interactions with immunosuppressive drug regimens. However, in post-lung transplant recipients, CFTR modulators may improve extrapulmonary manifestations of cystic fibrosis without impacting graft function or immunosuppressive drug levels. Herein, we present our single center experience with the use of elexacaftor/tezacaftor/ivacaftor, Trikafta, in adult post-lung transplant recipients.
Assuntos
Aminofenóis/uso terapêutico , Benzodioxóis/uso terapêutico , Agonistas dos Canais de Cloreto/uso terapêutico , Regulador de Condutância Transmembrana em Fibrose Cística/agonistas , Fibrose Cística/tratamento farmacológico , Fibrose Cística/cirurgia , Indóis/uso terapêutico , Transplante de Pulmão , Pirazóis/uso terapêutico , Piridinas/uso terapêutico , Quinolinas/uso terapêutico , Adulto , Glicemia , Índice de Massa Corporal , Combinação de Medicamentos , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
Case of disseminated Nocardia beijingensis, initially diagnosed and treated by health department as tuberculosis, presented with worsening symptoms and new lesions. Adjustment to antinocardial treatment resulted in significant clinical and radiographic improvement. Maintain a high index of suspicion for Nocardia in patients diagnosed with tuberculosis with worsening lesions despite therapy.
RESUMO
CASE PRESENTATION: A 42-year-old man with a history of progressive multiple myeloma and chronic kidney disease presented with worsening shortness of breath and fever. He was scheduled for a planned admission for chemotherapy on the day of presentation and had developed these symptoms the night before. He had also developed worsening fatigue but denied any new cough, sputum production, or abdominal pain. The patient had been previously admitted 3 weeks prior for neutropenic fever and colitis during his first cycle of chemotherapy.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Mieloma Múltiplo/complicações , Mieloma Múltiplo/tratamento farmacológico , Adulto , Biópsia por Agulha , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Serviço Hospitalar de Emergência , Febre/diagnóstico , Febre/etiologia , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/métodos , Humanos , Imuno-Histoquímica , Masculino , Mieloma Múltiplo/diagnóstico , Derrame Pleural/diagnóstico , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Prognóstico , Doente Terminal , Tomografia Computadorizada por Raios X/métodosAssuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Neoplasias Brônquicas/patologia , Encefalite por Varicela Zoster/tratamento farmacológico , Sarcoma de Kaposi/patologia , Síndrome da Imunodeficiência Adquirida/complicações , Aciclovir/administração & dosagem , Aciclovir/uso terapêutico , Antirretrovirais/uso terapêutico , Antivirais/uso terapêutico , Neoplasias Brônquicas/diagnóstico por imagem , Neoplasias Brônquicas/tratamento farmacológico , Neoplasias Brônquicas/virologia , Broncoscopia/métodos , Líquido Cefalorraquidiano/virologia , Encefalite por Varicela Zoster/líquido cefalorraquidiano , Evolução Fatal , Herpesvirus Humano 3/genética , Herpesvirus Humano 3/isolamento & purificação , Herpesvirus Humano 8/metabolismo , Humanos , Masculino , Adesão à Medicação , Sarcoma de Kaposi/diagnóstico por imagem , Sarcoma de Kaposi/tratamento farmacológico , Sarcoma de Kaposi/virologia , Punção Espinal/métodos , Adulto JovemRESUMO
Pleural effusions occur in up to 70% of cases of malignant pleural mesothelioma (MPM). However, MPM rarely presents as a chylous effusion making it a diagnostic challenge. There are only six reported cases to date. Most cases of chylothoraces due to malignancy are due to lymphoma or bronchogenic carcinoma. We report an interesting case of MPM in a 75-year-old man who presented with recurrent chylothorax. He reported a four-month history of dyspnea and chest discomfort. Chest x-ray revealed a pleural effusion. Pleural fluid analysis was consistent with a chylothorax. Pleural fluid cytology was negative for malignancy. Computed tomography of the chest showed pleural calcifications, mediastinal adenopathy and left lung infiltrate. A fine needle aspirate of the lymph node and transbronchial biopsy specimen (TBBX) of the left lung infiltrate showed extensive reactive appearing mesothelial cells but none that appeared malignant. A video assisted thoracoscopic surgery was suggested but the patient declined. He returned 3 months later with recurrent pleural effusion and worsening airspace disease. Thoracentesis revealed a chylothorax again. Repeat analysis of TBBX and lymph node specimens showed extensive reactive appearing mesothelial cells. Due to concern for MPM, ancillary testing was obtained - loss of BRCA1 associated protein (BAP-1) and CDKN2A/p16 gene deletion. BAP1 staining was lost in the mesothelial cells supporting MPM. This case highlights a rare cause of MPM presenting as a chylous effusion. In a patient with an unknown etiology of chylothorax, MPM must remain in the differential.
RESUMO
OBJECTIVE: Anti-N-methyl-d-aspartate receptor encephalitis is a rare but emerging cause of autoimmune encephalitis. Our objective is to present a case of this rare disease while highlighting the importance of an aggressive search for underlying malignancy as well as the common mischaracterization of primary psychiatric illness that occurs in these patients. METHODS: A young Caucasian female with no known psychiatric history presented with acute onset of seizures and psychosis. RESULTS: Magnetic resonance imaging abdomen and pelvis showed a 6-mm ovarian teratoma which was not visualized on initial computed tomographic scans. Pathology was consistent with a mature teratoma. Both serum and cerebrospinal fluid N-methyl-d-aspartate receptor antibodies were positive. CONCLUSION: An exhaustive search for underlying malignancy and specifically ovarian teratoma in young women should be completed in these patients. Diagnosis often is delayed given the prominent psychiatric manifestations and providers should be aware and strongly consider this in younger women with acute onset of neuropsychiatric symptoms.