Post-Pericardiotomy Syndrome Disguised as Fever of Unknown Origin

Introduction: Post -Pericardiotomy syndrome (PPS) is a clinical diagnosis characterized by fever, pericardial or pleural effusions, and a pericardial friction rub occurring over several days after cardiac surgery. The infrequency of PPS can cause delay in recognition and management, thus leading to significant morbidity. We present a case of fever of unknown origin, pericardial and pleural effusion secondary to postpericardiotomy syndrome 10 days after an Aortic Valve Replacement (AVR) Poster presented at: American College of Physicians Southeast Regional Meeting on October 15th, 201

An unknown reaction to pembrolizumab: giant cell arteritis.

An 88 year old female with a past medical history of a hypertension, atrial fibrillation, and stage IV non-small cell lung cancer (NSCLC) presented to the emergency department with sudden onset left eye blindness and abdominal pain. She was noted to have worsening anemia and heme-occult positive stools, however abdominal imaging did not indicate any acute pathology. Given her baseline poor functional status, the patient was not a candidate for aggressive interventions. One week prior to presentation, the patient had received a first dose of pembrolizumab, 200 mg intravenous infusion, which was to be administered once every 3 weeks. Upon consultation with an ophthalmologist, she was found to have biopsy confirmed giant cell arteritis (GCA). For her GCA, she was treated with high dose oral prednisone with close clinical monitoring. She endured a prolonged hospital course with constipation, anemia and atrial fibrillation with rapid ventricular rate. The patient was cardioverted twice, and her anemia was treated with two separate transfusion of packed red blood cells

Image-Guided High-Dose Rate Intracavitary Brachytherapy in the Treatment of Medically Inoperable Early-Stage Endometrioid Type Endometrial Adenocarcinoma

To report the experience with high dose rate, image guided intracavitary brachytherapy in the treatment of medically inoperable, early stage endometrial cancer. Poster presented at: American Brachytherapy Society Annual Meeting April 20-22, 2017 in Boston MA

Posterior reversible encephalopathy syndrome (PRES) after bevacizumab therapy for metastatic colorectal cancer.

Posterior reversible encephalopathy syndrome (PRES) is an increasingly recognizable neuro-clinical syndrome. Clinical and neurological manifestations of PRES include hypertension, headache, encephalopathy, seizures, and symmetrical white matter changes on brain MRI. Most common precipitants of PRES are acute medical illness, hypertensive crisis, eclampsia, immunosuppressive therapy, and chemotherapy. Bevacizumab is a monoclonal antibody that halts angiogenesis by inhibiting vascular endothelial growth factor. It has gained widespread popularity in oncology world especially for metastatic and recurrent cancers due to its inherent ability to stop angiogenesis; a vital step for tumor growth. Bevacizumab has also been implicated as the cause of PRES due to dysregulation of the blood-brain barrier. We are reporting a case of PRES induced by Bevacizumab in a patient of colorectal cancer

Lung Cancer: A Multidisciplinary Approach

Learning Objectives Lung cancer screening Common presentations Work-up Staging Treatment

A Case of Refractory Gestational Trophoblastic Neoplasia requiring Hysterectomy after Methotrexate

Gestational trophoblastic neoplasia (GTN) refers to a group of malignant conditions that develop due to abnormal fertilization causing abnormal proliferation of tissue. GTN is primarily treated with surgical evacuation of the underlying proliferative tissue. Approximately half of cases of GTN arise from molar pregnancy1. GTN include invasive moles, choriocarcinomas, placentalsite trophoblastic tumors and epithelioid trophoblastic tumors. The most common risk factors associated with GTN are prior molar pregnancy, advanced maternal age (\u3e40 years of age), and Asian and Native American ancestry2-4. Following evaluation of a molar pregnancy, a post-molar GTN is diagnosed based on the International Federation of Gynecology and Obstetrics (FIGO) criteria, which includes elevated human chorionic gonadotropin (hCG) levels, hCG levels increasing \u3e10% across three values recorded over a two-week duration, weekly hCG level plateauing (remaining within +/- 10% of the previous week’s results) over a three-week period, and persistence of detectable serum hCG for more than six months after molar evacuation5. A pathologic diagnosis of prior molar pregnancy by curettage with increased hCG levels also would be acceptable for diagnosis. According to the World Health Organization scoring system of GTN, factors including age, antecedent pregnancy, interval months from index pregnancy, pretreatment HCG, largest tumor size, site and number of metastases and previous failed chemotherapy help stratify the risk of patients and determine the type of treatment (table 1)

A Slow Burning Diagnosis: A Case Report of Hemophagocytic Lymphohistiocytosis Preceding the Diagnosis of Subcutaneous Panniculitis-Like T-Cell Lymphoma

HLH is a severe inflammatory syndrome characterized by primary or secondary immune dysregulation causing excess activation of macrophages and cytotoxic lymphocytes, leading to multi-system dysfunction. Diagnosing and managing HLH can be challenging for clinicians, with HLH-2004 criteria for diagnosis requiring a molecular diagnosis or the presence of at least five of the following: fever, splenomegaly, cytopenia involving two or more cell lineages, hypertriglyceridemia and/or hypofibrinogenemia, hemophagocytosis in the bone marrow, spleen or lymph nodes with no evidence of malignancy, low or no NK cell activity, elevated ferritin, or elevated soluble IL-2 receptor1. These criteria have been utilized to develop the HScore, a tool used to assist in determining the probability of HLH based on the aforementioned abnormalities2. After diagnosis, treatment typically includes chemotherapy and immunosuppression, followed by allogeneic bone marrow transplant3

Comprehensive review of acute oesophageal necrosis.

Acute oesophageal necrosis, also known as \u27black oesophagus\u27, is a rare condition characterised by the black discolouration of the oesophageal mucosa on endoscopy and involves the distal oesophagus in majority of cases but may also extend proximally. A number of conditions are found to be associated with it and it is thought to occur due to a combination of hypovolaemia and inadequate oesophageal protective mucosal barrier function. Gastric secretions may have a direct effect on the oesophageal mucosa. We present a case of a woman who presented with haematemesis and significant hypotension after a session of haemodialysis. Black oesophagus was confirmed on esophagogastroduodenoscopy. She was given two units of packed red blood cells and one unit of platelets, and started on a pantoprazole infusion. However, despite rigorous attempts at resuscitation the patient failed to recover