Agranulocytosis Associated with Topiramate: A Case Report and Review of Published Cases.

A 41-year-old female presented to the hospital with sore throat and shortness of breath. She was hypoxic with an oxygen saturation of 87% in room air. Physical examination revealed swollen uvula with exudates. She had been started on topiramate for treatment of migraine few months ago. The dose of topiramate was increased to 100 mg twice daily 2 weeks ago. Complete blood count revealed an absolute neutrophil count (ANC) of 8 c/m

Pembrolizumab-Associated Hypothyroidism: Case Report and Review of Literature

Pembrolizumab is a Programmed Death 1 (PD-1) inhibitor used to treat advanced malignant melanoma and metastatic non-small cell lung cancer. It causes various endocrinological side effects including immune mediated thyroiditis. Thyroiditis caused by Pembrolizumab can mimic other immune mediated thyroiditis like Hashimoto thyroiditis and Grave’s disease

Formation Evaluation of Lower Goru Sands of Khipro Block, Lower Indus Basin, Pakistan

Formation evaluation is widely used in exploration and production in order to minimize the risk, uncertainty, and understanding of the detailed characteristics of potential reservoir rocks. This study is aimed to evaluate the Petrophysical characteristics of upper and lower basal sands of the Cretaceous lower Goru Formation in Niamat-01 and Siraj-01 wells and to focus on hydrocarbon exploration potential. These wells have been drilled in the Khipro block, lower Indus basin, which is the least explored for the reservoir quality evaluation. Present study characterized the lower Goru sands of the Khipro block. It is interpreted that the thickness of upper and lower Basal sands are 13m and 10m, respectively in Naimat Basal 01, whereas 9m and 17m, respectively, are reported in SirajSouth-01. The average effective porosity is 11% in upper Basal sands while 26% is interpreted for lower Basal sand in Naimat Basal-01. An average porosity of 11% is found for upper Basal sands in Siraj South-01 and 11% for lower Basal sand. Water saturation (Sw) calculated for upper and lower Basal sands are 22% and 19%, respectively. The hydrocarbon saturation (Sh) of 78% is interpreted for upper Basal sands and 81% hydrocarbon saturation reported for lower Basal sands in Naimat basal-01. However, 36% and 45% Sw have been recognized for upper and lower Basal sands, respectively. Whereas hydrocarbon saturations of 64% and 55% are reported for the upper and lower basal sands, respectively, in SirajSouth-01. Crossover effects in front of targeted formations confirmed the presence of hydrocarbons in the zone of interest. Lower sands of the lower Goru Formation in the Khipro block are favorable for hydrocarbon production and have potential for future hydrocarbon exploration activities

Bevacizumab: A Rare Cause of Nonischemic Cardiomyopathy.

Left ventricular dysfunction is a rare side effect of bevacizumab occurring in 2-4% of cases. We report the case of a 68-year-old woman who presented to the emergency department (ED) with sudden onset of shortness of breath, orthopnea, and paroxysmal nocturnal dyspnea. She was tachypneic and in respiratory distress. Physical examination revealed jugular venous distention, diffuse expiratory wheeze, and bipedal edema. She had been started on bevacizumab for the treatment of hereditary hemorrhagic telangiectasia 1 month prior to presentation. Laboratory tests revealed BNP of 1697 pg/ml with slightly elevated troponin 0.05 ng/ml. Chest X-ray showed interstitial edema with cardiomegaly, and transthoracic echocardiogram showed ejection fraction of 30% with global hypokinesia. Left heart catheterization revealed widely patent coronary arteries. Flash pulmonary edema secondary to acute left ventricular dysfunction in this case was attributed to recent treatment with bevacizumab after ruling out other possible etiologies. This case highlights the importance of early recognition of this rare but potentially reversible side effect of bevacizumab to prevent long-term sequelae

Bevacizumab: A Rare Cause of Nonischemic Cardiomyopathy

Left ventricular dysfunction is a rare side effect of bevacizumab occurring in 2–4% of cases. We report the case of a 68-year-old woman who presented to the emergency department (ED) with sudden onset of shortness of breath, orthopnea, and paroxysmal nocturnal dyspnea. She was tachypneic and in respiratory distress. Physical examination revealed jugular venous distention, diffuse expiratory wheeze, and bipedal edema. She had been started on bevacizumab for the treatment of hereditary hemorrhagic telangiectasia 1 month prior to presentation. Laboratory tests revealed BNP of 1697 pg/ml with slightly elevated troponin 0.05 ng/ml. Chest X-ray showed interstitial edema with cardiomegaly, and transthoracic echocardiogram showed ejection fraction of 30% with global hypokinesia. Left heart catheterization revealed widely patent coronary arteries. Flash pulmonary edema secondary to acute left ventricular dysfunction in this case was attributed to recent treatment with bevacizumab after ruling out other possible etiologies. This case highlights the importance of early recognition of this rare but potentially reversible side effect of bevacizumab to prevent long-term sequelae

Rash that itches and is all over: look beyond the skin

Generalized pruritic rash in Hodgkin's disease is most commonly due to paraneoplastic manifestation. It can sometimes precede other manifestations of Hodgkin's disease by weeks or months. Hence, if other possible causes have been ruled out, Hodgkin's disease should be considered a possible cause of generalized pruritic rash. Consideration of Hodgkin's disease as a cause of generalized pruritic rash can help in early identification of Hodgkin's disease. We present a case of a 71-year-old female who presented to the hospital with generalized pruritic rash for 4 days. Further workup revealed Stage IV Hodgkin's disease. The rash completely disappeared after receiving chemotherapy, which established that the rash was paraneoplastic manifestation of Hodgkin's disease

Disseminated gonococcal infection: an unusual presentation

Gonococcus typically affects the mucosal surfaces but in rare cases can spread to bloodstream causing disseminated gonococcal infection (DGI). The usual presentation of DGI is rash, polyarthralgia, and tenosynovitis. We present the case of a 23-year-old female who presented to our hospital with pustular rash and tenosynovitis of hand and was sent home on Augmentin. Her symptoms worsened despite treatment and she presented back to the ED. On investigation, she was found to have DGI and was appropriately treated. DGI should be kept in mind in sexually active youngsters who have only one or two features of the classic triad of rash, tenosynovitis, and arthritis. Timely management and appropriate treatment of DGI is very important to avoid complications and morbidity