Brain Freeze: Pembrolizumab-Induced Autoimmune Encephalitis in Triple-Negative Breast Cancer.

This case report presents the first known instance of pembrolizumab-induced autoimmune encephalitis in a 41-year-old female patient with stage IIIc triple-negative breast cancer. The patient developed expressive aphasia three days after starting pembrolizumab in combination with chemotherapy, prompting comprehensive evaluations that ruled out infectious or metastatic causes. A diagnosis of pembrolizumab-associated autoimmune encephalitis was established following a lumbar puncture and MRI.

Thymic Carcinoma Presenting as a Mediastinal Mass Resembling a Cardiac Tumor.

Thymoma and thymic carcinomas are a few of the rarest malignancies seen in humankind. They are mostly seen in the Asian population, many of which are reported in the Southeast Asia region like Japan, China, Vietnam, etc. They usually can be a sequela of other underlying conditions such as myasthenia gravis or some unknown mutations that express later in life.

Flecainide overdose-induced wide-complex tachyarrhythmia treated with sodium bicarbonate infusion.

Flecainide is a medication used to treat supraventricular and ventricular tachyarrhythmias. Cases of overdoses are rare, however, can lead to significant cardiac effects. In previous cases of flecainide toxicity, treatment with sodium bicarbonate, intravenous lipid emulsion and amiodarone have been reported to be effective in preventing cardiovascular collapse and reestablishing baseline rhythm.

Obstacles to Early Diagnosis of Acute Hepatic Porphyria: Current Perspectives on Improving Early Diagnosis and Clinical Management.

Porphyrias are, for the most part, inherited disorders of the heme biosynthetic pathway which lead to accumulation of specific intermediates responsible for most of the symptoms and signs of biochemically active disease. Acute hepatic porphyrias usually come to clinical attention primarily in women in their reproductive years who present with episodic, severe, generalized abdominal pain. Such acute attacks may also be associated with tachycardia, systemic arterial hypertension, hyponatremia, recent history of dark reddish to brownish urine, and anxiety, delirium, and sensory or motor neuropathies.

Catch the Calcium: T-Cell Histiocyte-Rich B-Cell Lymphoma Presenting as Hypercalcemia.

T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) is an extremely rare and aggressive subtype of diffuse large B-cell lymphoma (DLBCL) that typically presents in middle-aged patients and carries a poor prognosis. Hypercalcemia presenting as the initial manifestation of the disease is rare, with only one other case reported in the literature. We report a case of a 90-year-old male who presented with progressive lethargy and unintentional weight loss.

Recognizing Vocal Cord Dysfunction: Exercising Caution Before Intubation.

Vocal cord dysfunction (VCD) is the inappropriate adduction of the vocal cords during inhalation and sometimes, exhalation. Vocal cord dysfunction is often misdiagnosed in the emergency room as asthma exacerbation or laryngeal angioedema, leading to unnecessary and potentially harmful interventions including intubation and mechanical ventilation. Based on this, it is especially important to recognize this condition early to avoid intubation, which can further worsen VCD.

Discussing Difficult News: Reframing Patient and Family Preferences Surrounding the Content and Style of Communication.

Uncomfortable conversations transcend medicine across all sites of care and at all stages of a serious illness. From discussion of prognosis or prognostic uncertainty, to evaluation of competing treatment options, to disclosure of medical errors, to consideration of potentially toxic treatments, clinicians must approach such conversations with sensitivity to a patient's cognitive, emotional, spiritual, and cultural needs. Conversations small and large may be seen as "difficult" by a patient or their family, and there may be discordant views of the perceived "difficulty" of a conversation from the perspective of the medical team as compared to the patient or family.

Targeting CD47-SIRPa axis shows potent preclinical anti-tumor activity as monotherapy and synergizes with PARP inhibition.

The objective was to correlate CD47 gene expression with resistance to immune checkpoint inhibitors (ICI) in tumor tissue of gynecological cancer (GC). Further, we sought to assess the efficacy of targeting CD47 pathway alone and in combination in pre-clinical ovarian cancer (OC) models. We performed transcriptomic analyses in GC treated with ICI.

An Unusual Cause of Digit Pain: Acrometastasis From Lung Adenocarcinoma.

Acrometastasis accounts for 0.1% of all cases of metastatic cancer, with the most common primary tumor being lung cancer. Since acrometastasis is extremely rare and it generally has a nonspecific clinical presentation, it provides a diagnostic dilemma.

Systemic Capillary Leak Syndrome (SCLS) Presentation in Patients Receiving Anti-cancer Treatments.

Systemic capillary leak syndrome (SCLS) is due to increased capillary permeability to proteins and fluid extravasation from blood vessels into surrounding tissues and body cavities. This fluid extravasation leads to hypotension, generalized anasarca, pleural effusions, and pericardial effusions -- the more severe cases of SCLS can cause multiorgan dysfunction, including cardiovascular collapse, shock, and death. The treatment includes corticosteroids, diuretics, albumin, immunoglobulins, and crystalloids.

Colorectal Cancer Diagnostic Methods: The Present and Future.

To meet the needs of the colorectal cancer (CRC) patient population, colorectal cancer screening is continuously updated. The most significant advice is to start CRC screening exams at age 45 for people at average risk for CRC. CRC testing is divided into two categories: stool-based tests and visual inspections.

A Once-Thought Lipoma Turned Malignant Chondroid Syringoma.

Chondroid syringoma is a relatively rare benign skin appendageal tumor with an incidence of <0.098%. Malignant chondroid syringoma (MCS) arises from cutaneous sweat glands and occurs on the extremities or trunk more commonly in women with only 51 reported cases.

Cardiac Sarcoidosis With Elevated Cardiac Troponin Mimicking Acute Myocardial Ischemia: A Case Report.

Cardiac sarcoidosis (CS) is a disease entity with variable presentation causing significant morbidity and mortality. Concurrent signs of myocardial injury as evidenced by troponin elevation add to the complexity of an already challenging diagnosis. We present an unusual case of CS with elevated troponin I mimicking an acute ischemic cardiac event.

Left Bundle Branch Area Pacing From a Femoral Approach in a Patient Without Superior Access.

Limited venous access and lateral left ventricular scar are impediments to traditional cardiac resynchronization therapy. We present a case where placement of an implantable cardioverter-defibrillator from a femoral approach while using left bundle branch area pacing led to clinical improvement. ().

Retrospective analyses of the outcomes among hospitalized liver cirrhosis patients with heart failure and COVID-19 infection: Insight from the National Inpatient Sample.

Background: There is paucity of data regarding the impact of Coronavirus Disease 2019 (COVID-19) infection on the outcomes of hospitalized liver cirrhosis (LC) patients with heart failure (HF).

Methods: Utilizing the 2020 National Inpatient Sample (NIS) Database, we conducted a retrospective cohort study to investigate the outcomes of hospitalized LC patients with HF and COVID-19 infection, looking at its impact on in-hospital mortality, risk for acute kidney injury (AKI) and length of stay (LOS).

Results: We identified a total of 10,810 hospitalized LC patients with HF, of which 1.

Systolic Anterior Motion of the Mitral Valve in the Presence of Annular Calcification.

Background: Mitral annular calcification (MAC) has been reported as a possible cause of systolic anterior motion (SAM) of the mitral valve and dynamic left ventricular outflow tract (LVOT) obstruction. While morphologic features predisposing to SAM in other clinical settings have been described, patients with MAC+SAM have not been systematically investigated. We hypothesized that bulky calcium deposits in the mitral annulus could displace the valve toward the septum, thus promoting development of SAM.

Pulmonary Aspergillosis Complicated by Hemophagocytic Lymphohistiocytosis: A Case Report and Literature Review.

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome involving excessive immune activation. It can be primary (familial) or secondary (triggered by infection, malignancy, or rheumatological disease). This is a case of a previously healthy 43-year-old African American woman who presented with fever and confusion.

An Educational Needs Assessment for Outpatient Palliative Care Clinicians.

As the field of palliative medicine continues to grow in community-based settings, outpatient palliative care clinics have become an important site for providing upstream palliative care to patients and families. It is unclear whether current training models, focused predominantly on the inpatient setting, adequately prepare clinicians for outpatient palliative care practice. We performed an online educational needs assessment survey of physicians and advanced practice providers working in outpatient palliative care clinics.

Reverse Takotsubo Cardiomyopathy After Casirivimab-Imdevimab Therapy in a Patient with COVID-19: A Case Report.

BACKGROUND Takotsubo cardiomyopathy, also referred to as apical ballooning syndrome (ABS), stress cardiomyopathy, or broken heart syndrome, initially described in Japan, is characterized by transient wall motion abnormalities involving the apical segment. Several variants have been described, including reverse type, mid-ventricular type, and the focal type. In the reverse type, there is basal hypokinesis and apical hyperkinesis.

Atypical Presentation of Babesiosis With Neurological Manifestations as Well as Hematological Manifestations.

Babesiosis is an infectious disease that is typically known to present with fevers, chills, and myalgias; and less commonly with anorexia, headache, nausea, and vomiting. The least common are shortness of breath, sore throat, neck stiffness, emotional lability, photophobia, and dark urine. Even more unusual are severe neurologic manifestations like altered mental status, motor deficits, and ataxia.