Bilateral Corneal Graft Rejection Associated With Pembrolizumab Treatment.

PURPOSE: To report the first case of corneal graft rejection presumably associated with pembrolizumab immunotherapy. METHODS: Case report and literature review. RESULTS: An asymptomatic 85-year-old woman with a history of bilateral penetrating keratoplasty presented for a follow-up visit with bilateral diffuse keratic precipitates and subepithelial infiltrates. There were no anterior chamber cells. Bilateral subclinical corneal graft rejection was suspected. Three months previously, pembrolizumab immunotherapy was started for a metastatic urothelial cell tumor. Corneal graft rejection was managed with topical dexamethasone drops, which were tapered slowly. Pembrolizumab treatment was continued with careful ophthalmological follow-up. Unfortunately, recurrence of corneal graft rejection was observed 8 weeks after cessation of topical dexamethasone drops. After consulting the treating oncologist, pembrolizumab treatment was stopped to prevent recurrent corneal graft rejection. CONCLUSIONS: We report the first case of corneal graft rejection presumably associated with pembrolizumab immunotherapy. Corneal graft rejection may be successfully managed with corticosteroid therapy. However, constant vigilance and follow-up are advised because of the risk of recurrence in case of continued pembrolizumab treatment. Given the subclinical presentation, baseline ophthalmological screening is advised in all corneal graft patients after initiating immune checkpoint inhibitor therapy.

Abscopal effect in metastatic renal cell carcinoma.

We report a case about a possible abscopal effect in a patient with metastatic renal cell carcinoma. Palliative conventional radiation of a metastatic lesion in the neck was performed and in the months after this treatment had been applied, clearance of the non-irradiated lung metastases and a subcutaneous nodule was observed. The abscopal effect is a phenomenon in which local radiotherapy is associated with regression of metastatic cancer at a distance from the irradiated site. It's a rare phenomenon; until now, only case reports and small series demonstrate the abscopal effect. This case supports the fact that further studying of this rare event must be encouraged.

Unique health care utilization patterns in a homeless population in Ghent.

BACKGROUND: Existing studies concerning the health care use of homeless people describe higher utilisation rates for hospital-based care and emergency care, and lower rates for primary care by homeless people compared to the general population. Homeless people are importantly hindered and/or steered in their health care use by barriers directly related to the organisation of care. Our goal is to describe the accessibility of primary health care services, secondary care and emergency care for homeless people living in an area with a universal primary health care system and active guidance towards this unique system. METHODS: Observational, cross-sectional study design. Data from the Belgian National health survey were merged with comparable data collected by means of a face-to-face interview from homeless people in Ghent. 122 homeless people who made use of homeless centres and shelters in Ghent were interviewed using a reduced version of the Belgian National Health survey over a period of 5 months. 2-dimensional crosstabs were built in order to study the bivariate relationship between health care use (primary health care, secondary and emergency care) and being homeless. To determine the independent association, a logistic model was constructed adjusting for age and sex. RESULTS AND DISCUSSION: Homeless people have a higher likelihood to consult a GP than the non-homeless people in Ghent, even after adjusting for age and sex. The same trend is demonstrated for secondary and emergency care. CONCLUSIONS: Homeless people in Ghent do find the way to primary health care and make use of it. It seems that the universal primary health care system in Ghent with an active guidance by social workers contributes to easier GP access.