Current guidelines do not adequately acknowledge the potential acute consequences in patients receiving both rituximab and COVID-19 vaccination. We report a case of rituximab-induced lympholysis and pancytopenia in a patient who received Moderna COVID-19 vaccine ten days before rituximab infusion. These observations highlight the urgent need to update current guideline.
We report a case of a 35-years-old Lebanese pregnant lady with a background of beta-thalassemia major who was diagnosed with COVID-19 infection (Cycle threshold value 18) during her 23rd gestational week. Unfortunately, the pregnancy outcome was unfavorable. To our knowledge, this is the first report of such a case
Here we describe two clinical prenatal cases with rare de novo RIT1 variants which showed more severe clinical manifestations than other Noonan Syndrome genotypes, resulting in fetal death. It is recommended that extra attention would be exercised when these variants are detected, and an appropriate patient counselling would be provided.
A 42-year-old woman presented with myalgia, which ameliorated a week after treatment. She was diagnosed with Basedow's disease. The presence of concomitant autoimmune diseases are important considerations for patients with Basedow's disease presenting with myalgia. Thyrotoxicosis should be included as a rare differential diagnosis for myalgia.
Autoimmune diseases including systemic sclerosis (SSc) increase risk of developing TB. Pericostal tuberculosis (TB) is a rare presentation of skeletal TB. This case report describes pericostal TB in a SSc patient, and emphasizes significance of suspecting pulmonary and extra-pulmonary TB when patients with autoimmune disease follow atypical clinical courses.
Hypokalemia can be multifactorial. When the primary driver of hypokalemia is obvious it is easy to miss other contributing causes that could be vital to optimal patient management and outcomes. Our case report highlights the importance of recognizing recurrent, refractory hypokalemia as a diagnostic clue to thyrotoxic periodic paralysis.
A psychological assessment using biofeedback was performed for an adjustment disorder inpatient who showed less verbal and non-verbal expressions, and experienced difficulty in receiving favorable results from treatment. The assessment revealed hidden problems behind the symptoms. She was subsequently discharged, after which no clinical intervention was required, including medication.
Freeman-Sheldon syndrome (FSS) is characterized by multiple joint contractures, characteristic facial features, such as microtia, defects of the hands and feet, such as clubfoot, and skeletal malformations. This report illustrates the case of a patient with FSS who was managed under local anesthesia with intravenous sedation for oral surgery.
Though generally self-limited, viral myocarditis can lead to acute cardiac failure or chronic dilated cardiomyopathy. We describe three cases of human herpes virus 6 (HHV6) associated -myocarditis unresponsive to conventional therapies, with detection of HHV-6 evidences and initiation of antiviral treatment, we observed significant improvement in clinical status of patients.
A 92-year-old man presented to the hospital with recurrent hypoglycemia with a chronically raised right hemidiaphragm. A CT thorax-abdomen-pelvis showed a large abdominal mass. A ‘big’ IGF-2 secreting non-islet cell tumour was suspected and confirmed. The patient was treated with low dose prednisolone.
Routine examination of an asymptomatic 40-year-old female patient revealed a right unilateral and unifocal renal mass. The patient underwent a partial nephrectomy, and the renal specimen was sent for histopathologic examination. Molecular testing revealed a heterozygous variant NM_003000.3:c.412G>T, p.(Asp138Tyr), in SDHB gene.
Guillain-Barré syndrome (GBS) after surgery may be more common than previously recognized; however, GBS after open heart surgery is exceedingly rare. We describe a rare case of GBS occurring after aortic, tricuspid and mitral valve surgery and review the world’s literature. Vigilance for GBS among post-surgical patients is needed.
Marine Lenhart Syndrome (MLS) is caused by a coexistence of active thyroid nodules and Graves’ disease1. Here, we present a case of hyperthyroidism characterized by the presence of stimulating TSH receptor antibodies, unsuccessful radioactive iodine ablation, ultimately requiring Methimazole followed by thyroidectomy. We review the current literature.
Mixed fibrolamellar hepatocellular carcinoma is a rare liver tumor defined by the presence of both pure fibrolamellar hepatocellular carcinoma and conventional hepatocellular components. It represents up to 25% of cases of fibrolamellar hepatocellular carcinoma, and has been associated with a worse prognosis.
We demonstrate the effectiveness of readministering cetuximab as a salvage chemotherapeutic agent after nivolumab administration to a patient with a recurrence of cervical lymph node metastasis after tongue cancer surgery. We can infer that the immunostimulatory effect of nivolumab and reactivation of cetuximab enhance the antitumor effect of the therapy.