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With the rising prevalence of organ transplantation, clinicians must be aware of the many potential complications that may arise. One such complication is post-transplantation melanoma. Herein, we present a case of advanced metastatic melanoma following orthotopic liver transplantation (OLT). This is a 54-year-old cirrhotic male who underwent OLT that was complicated by metastatic melanoma. Despite adherence to yearly screening guidelines and timely radiation and immunotherapy, the disease course was rapidly progressive and fatal. This case aims to highlight the risk of post-transplantation melanoma and the potential need for screening modifications to identify melanoma earlier in its development. The association between organ transplantation and melanoma is well-reported, but the underlying risks and mechanisms remain incompletely understood. One potential risk factor is post-transplant immunosuppressive therapy, which may result in fatally aggressive melanoma. Understanding the potential mortality risks in transplant patients, modifications to peri-transplant screening guidelines, and immunosuppressive therapy may be lifesaving.
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Malaria has various causative agents that can have a spectrum of disease manifestations, some potentially fatal. Various species have been established as etiologies of malaria, though our understanding of the severity of various species is changing. We present a unique case of Plasmodium vivax malaria that resulted in severe disease, a magnitude rarely seen in previous literature. Our patient was a 35-year-old healthy woman who presented to the emergency department with abdominal pain, nausea, vomiting, and fever. Further workup revealed severe thrombocytopenia with prolonged prothrombin (PT) and partial thromboplastin time (PTT). An initial thick smear failed to detect any Plasmodium species, but a thin smear revealed P. vivax. The patient's hospital stay was complicated by septic shock requiring intensive care unit (ICU) admission. This unique case represents P. vivax as the causative agent of severe malaria even in healthy, immunocompetent patients.
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Background: Little is known about the mortality and utilization outcomes of short-stay intensive care unit (ICU) patients who require <24 h of critical care. We aimed to define characteristics and outcomes of short-stay ICU patients whose need for ICU level-of-care is ≤24 h compared to nonshort-stay patients. Methods: Single-center retrospective cohort study of patients admitted to the medical ICU at an academic tertiary care center in 2019. Fisher's exact test or Chi-square for descriptive categorical variables, t-test for continuous variables, and Mann-Whitney two-sample test for length of stay (LOS) outcomes. Results: Of 819 patients, 206 (25.2%) were short-stay compared to 613 (74.8%) nonshort-stay. The severity of illness as measured by the Mortality Probability Model-III was significantly lower among short-stay compared to nonshort-stay patients (P = 0.0001). Most short-stay patients were admitted for hemodynamic monitoring not requiring vasoactive medications (77, 37.4%). Thirty-six (17.5%) of the short-stay cohort met Society of Critical Care Medicine's guidelines for ICU admission. Nonfull-ICU LOS, or time spent waiting for transfer out to a non-ICU bed, was similar between the two groups. Hospital mortality was lower among short-stay patients compared to nonshort-stay patients (P = 0.01). Conclusions: Despite their lower illness severity and fewer ICU-level care needs, short-stay patients spend an equally substantial amount of time occupying an ICU bed while waiting for a floor bed as nonshort-stay patients. Further investigation into the factors influencing ICU triage of these subacute patients and contributors to system inefficiencies prohibiting their timely transfer may improve ICU resource allocation, hospital throughput, and patient outcomes.
