Pleuropericardial Effusion Research Articles

Results of the Simultaneous Combination of Ponatinib and Blinatumomab in Philadelphia Chromosome-Positive ALL.

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.In this analysis, we update our experience with the chemotherapy-free regimen of blinatumomab and ponatinib in 60 patients with newly diagnosed Philadelphia chromosome (Ph)-positive ALL. At a median follow-up of 24 months, the complete molecular response rate by reverse transcriptase-polymerase chain reaction was 83% (67% at the end of course one), and the rate of measurable residual disease negativity by next-generation clono-sequencing was 98% (45% at the end of course one). Only two patients underwent hematopoietic stem cell transplantation (HSCT). Seven patients relapsed: two with systemic disease, four with isolated CNS relapse, and one with extramedullary Ph-negative, CRLF2-positive pre-B ALL. The estimated 3-year overall survival rate was 91% and event-free survival rate was 77%. Three patients discontinued blinatumomab because of adverse events (related, n = 1; unrelated, n = 2) and nine discontinued ponatinib because of cerebrovascular ischemia, coronary artery stenosis, persistent rash, elevated liver function tests with drug-induced fatty liver, atrial thrombus, severe arterial occlusive disease of lower extremities, pleuro-pericardial effusion, and debilitation. In conclusion, the simultaneous combination of ponatinib and blinatumomab is a highly effective and relatively safe nonchemotherapy regimen. This regimen also reduces the need for intensive chemotherapy and HSCT in first remission in the majority of patients.

LYME AND DENGUE FEVER: FROM BANGLADESH TO ITALY

Abstract Background Dengue fever (Flavivirus) and Lyme disease (Borrelia burgdorferi) are rare tropical infectious diseases transmitted by hematophagous vectors (Aedes mosquitoes and ticks, respectively), and they are extremely uncommon in Italy. In European countries, both represent a public health concern as they manifest as imported diseases. Case Report A 54–year–old man from Bangladesh was admitted with symptoms of fever, dyspnea, and pericarditic chest pain. Laboratory and imaging examinations revealed severe acute respiratory failure secondary to left lower lobe pneumonia and pleuropericardial effusion. Broad–spectrum antibiotic therapy and anti–inflammatory treatment were initiated, suspecting para–pneumonic pleuropericarditis. During hospitalization, there was a gradual improvement with a reduction in inflammatory indices and resolution of lung consolidation. The patient was discharged after 14 days with anti–inflammatory therapy (ibuprofen and colchicine). Approximately 7 days later, the patient returned to the emergency department complaining of a recurrence of symptoms and fatigue. The EKG showed phases of 2:1 AV block, EAS and EPS, complete de novo left bundle branch block (LBBB), alternating with an escape atrial rhythm, not evident in previous EKG. During hospitalization, complete AV block emerged with prolonged asystolic phases, requiring urgent placement of a temporary pacemaker. Concurrently, blood tests revealed anemia and increased levels of inflammatory markers, troponin, creatinine, transaminases, cholestatic indices, LDH, and lipase, indicative of multiple organ failure (MOF). Acute pathologies or active bleeding were ruled out by total body CT with contrast. Blood cultures and serological tests were performed to exclude infections by Trichinella, Mycoplasma, Borrelia, Dengue, and other rare infectious diseases. Due to progressive deterioration, the patient was transferred to a tertiary care hospital. In the following days, laboratory results showed positive IgG and IgM for Dengue (without serological evidence of viral RNA) and positive IgG and IgM antibodies for Borrelia burgdorferi. Conclusion In Italy, the incidence of these diseases is low, and their coexistence in the same host is even rarer (if not anecdotal). However, coinfection cannot be excluded in patients from areas where these diseases are endemic, such as Bangladesh.

Minoxidil Associated Pleural and Pericardial Effusion in Patient on Hemodialysis

Minoxidil is a medication used to treat hypertension by directly dilating the arteries. However, about 3% of patients who take this medication experience pericardial effusion, which can lead to large pleural effusions and may require pleuro pericardiocentesis. In rare cases, patients may develop seroconstrictive pericarditis. This report describes an elderly woman who developed seroconstrictive pericardial effusion and bilateral pleural effusion seven months after taking minoxidil therapy. It has also been reported that minoxidil used in dialysis patients can cause large-volume pleuro pericardial effusions, leading to seroconstrictive pericardial effusion and anasarca, which is not common. Therefore, if a patient is on dialysis and minoxidil and they have a pleural or pericardial effusion that is unresponsive to ultrafiltration, there is a possibility of minoxidil-associated polyserositis. It is important for healthcare providers to be aware of this potential adverse effect, as prompt discontinuation of the drug can save lives.

Improved Prevention and Treatment Strategy of Differentiation Syndrome Contribute to Reduce Early Death of Patients with Acute Promyelocytic Leukemia

Purpose: All-trans retinoic acid (ATRA) with arsenic trioxide (ATO) has been the standard of care for acute promyelocytic leukemia (APL) with high efficacy in china.However,early death (ED) still remains the major reason for treatment failure.Severe differentiation syndrome (DS) with no response to full dose dexamethasone is one of direct or indirect important causes of ED.Therefore,to further optimize prevention and treatment strategy of DS is critical for APL therapy success. Patients and Methods： The APL-01 study was a prospective and single-arm clinical trial in patients with newly diagnosed APL from June 2019 to December 2021.111 eligible patients aged between 18 and 70 years classified as Low-risk APL (WBC count at diagnosis＜10*10 9/L n=78) or High-risk APL (WBC count at diagnosis≥10*10 9/L n=33) received induction therapy consisted of ATRA and intravenous arsenic trioxide or oral tetra-sulfide arsenic formulation (Realgar-Indigo naturalis formula,RIF) with chemotherapy-free or chemotherapy-substantially reduced protocol in China. During the course of induction therapy,we used different intravenous doses of dexamethasone to prevent DS according to the WBC count at presentation or after the initiation of ATRA.For example,if WBC counts≥ 5*10 9/l and <10*10 9/l,5mg per day;if ≥10 *10 9/l,10mg per day.And we gave patients dexamethasone 10mg per 12h as preemptive therapy once DS was suspected.Ruxolitinib was administered when steroids therapy were considerd insensitive. We evaluated the effect of selective steroids prophylaxis and preemptive therapy on the incidence and severity of DS,which contributed to increased early mortality rate. The safety and feasibility of Ruxolitinib as second-line therapy for DS was also explored. Results： In this study,41 of 111 patients (36.9%) experienced DS,16 (14.4%) were severe cases and 25 (22.5%) were moderate cases. Univariate analysis identified the following prognostic factors as regards developing DS（P-value<0.1）:age,sex and WBC count were included for exploring the difference between DS and Non-DS patients Increased WBC count (>4*10*109/l )(OR (95% CI)=1.241 (1.131-1.361)) were potential risk factors for patients with DS.We further investigated the difference between severe DS and moderate DS using age,sex,ECOG,WBC and PLT count.We found that only advanced age (over 40 years old)(OR (95% CI)=12.200 (1.640-90.772)) was associated with developing severe DS. Dyspnea (71%),weight gain (85%) and pulmonary infiltrates(78%) were the most common symptoms of patients with DS.Compared with moderate DS,severe DS patients had more frequency of dyspnea (Fishers exact P=0.013),pleuropericardial effusion (χ2=5.577, P=0.018)and acute renal dysfunction (Fishers exact P=0.018). Among the 41 patients with DS,23 patients were treated effectively with dexamethasone 10mg per 12h.18 patients with steroid resistance received Ruxolitinib to control the cytokine release storm（CRS）,12 of which showed immediate remission, however,the situations of the remaining 6 patients did not alleviate until ATRA was suspended temporarily.All of them（6/41）recovered with the help of noninvasive mechanical ventilation. The total 30-day mortality rate was 1.8% (2/111).During induction treatment,no death owing to DS or infection occurred.Two patients with high-risk APL died due to intracranial hemorrhage,one occurred on day 8 and the other on day 9 after ATRA were initiated. Of all the 109 patients evaluable,78 (100%)Low-risk patients and 31 (100%) high-risk patients achieved complete remission (CR)at the end of induction therapy,respectively.The median follow-up time was 34 months,estimated 2-year overall survival (OS) was 98.7% in the Low-risk group and was 93.9% in the High risk group. Conclusions: Our study suggests individualized steroids prevention,preemptive treatment and Ruxolitinib as second-line therapy for DS contribute to control DS,which in verse lessen the discontinuation of ATRA, consequently decreasing early death due to DS and hemorrhage in APL patients.(clinicaltrials.gov NCT04446806) Keywords: acute promyelocytic leukemia;early death;prophylaxis strategy;pulmonary hemorrhage;differentiation syndrome;retinoid acid syndrome;Ruxolitinib;steroid-resistance;cytokine release syndrome;

NON-HODGKIN LYMPHOMA PRESENTING AS RECURRENT PLEUROPERICARDIAL EFFUSION- A CASE REPORT

Non-Hodgkin lymphoma is a lymphoproliferative disorder usually affecting lymphoid organs. 20% patients with non-Hodgkin lymphoma may present with pleural effusion but pericardial involvement is rare. Pleural & pericardial effusion in lymphoma are usually due to direct seeding of malignant cells or by obstruction to the lymphatic drainage of pleura & pericardium. We report a case of non-Hodgkin lymphoma presenting as recurrent pleuro-pericardial effusion. A middle aged male with chief complaints of progressive dyspnea, palpitation & generalized pufness for past 2 months was found to have bilateral pleural effusion, pericardial effusion, ascites & generalized lymphadenopathy. Right supraclavicular lymph was node was evaluated using FNAC & excisional biopsy. Pleural & pericardial uids were analyzed. He was diagnosed as Non-Hodgkin lymphoma and started with Rituximab, Prednisolone, Cyclophosphamide, Vincristine & Doxorubicin. Patient improved on subsequent follow up

Castlemans Disease – Presenting with Recurrent Pleuropericardial Effusions- Mimicking Tuberculosis

Castleman disease (CD) is an uncommon heterogeneous group of lymphoproliferative disorders which can affect the lymph nodes of the neck, chest, abdomen and pelvis. It was first described by Castleman, in 1954, known as benign mediastinal lymph node hyperplasia, which was histologically similar to thymoma of unknown cause. [1] It is divided into unicentric (localized ) Castleman disease (UCD) and multicentric ( generalized) Castleman disease (MCD) based on the number of lymph nodes involved. Castleman disease has varied presentations. Clinically it can present as localized masses, or localized lymph node enlargement. Symptoms can result from compression effects of the enlarged lymph nodes and in asymptomatic patients it can be an incidental finding on radiological imaging. It can also present as diffuse lymphadenopathy with severe systemic symptoms . Rarely it presents with pleuro-pericardial effusions . We present a case of a; young gentleman presenting with anorexia, weight loss and night sweats . He had large exudative pleural effusion with pericardial effusion leading to constrictive pericarditis .He was started on ATT empirically, which was later stopped due to poor response . Extensive radiological work revealed multi loculated pleural effusion and multiple lymph nodes in the axillary and cervical area . Excisional Biopsy of the lymph nodes revealed Castleman disease .

Pleuro-Pericardial Inflammation and Effusion: A Rare Acute Initial Presentation of Rheumatoid Arthritis

Background: Rheumatoid arthritis is a systemic inflammatory arthritis characterized by joint pain and morning stiffness. The affected joints are typically symmetrically affected, and given the inflammatory nature of this condition, patients often present with warmth and erythema around affected joints as well as fatigue. Extra-articular manifestations, especially pleuro-pericardial inflammation, are rare initial presentations, although may be seen in advanced or undertreated disease. Case Presentation: We describe a case of a rheumatoid arthritis presenting atypically in a middle-aged male who came to the emergency department complaining of diffuse muscle pain and swelling in the distal extremities. Cardiac ultrasound revealed pleuro-pericardial inflammation and effusions. Myositis and infectious causes were ruled out and bilateral hand x-rays did not show erosions or any evidence of arthritic changes. All rheumatological auto-antibodies were negative except for rheumatoid factor and anti-cyclic citrullinated peptide (CCP) and a diagnosis of rheumatoid arthritis was made. The patient was started on prednisone with excellent response. Conclusions: This case highlights that rheumatoid arthritis can uncommonly present initially with extra-articular manifestations that are often manifested in advanced disease. Typically, extra-articular manifestations, especially those as severe as this patient’s, occur with untreated, advanced disease and could accompany extensive arthritic joint changes. Thus, it is important to have an understanding of rare, atypical presentations of rheumatoid arthritis so that a high index of suspicion can be maintained to make the diagnosis and initiate treatment in a timely manner.

A Rare Case of Hypothyroidism Presenting as Massive Pleuropericardial Effusion

A Rare Case of Hypothyroidism Presenting as Massive Pleuropericardial Effusion

259 PERICARDITIS AND PERICARDIAL EFFUSION IN CHRONIC GRAFT-VERSUS-HOST DISEASE AFTER ALLOGENIC HEMATOPOIETIC STEM CELL TRANSPLANTATION

Abstract Background Pericarditis and pericardial effusion (PE) are rare but potentially life-threatening complications in chronic graft-vs-host disease (cGVHD). Limited data are currently available in this setting, based on small single-center retrospective studies. The purpose of this study is to characterize the clinical presentation, management, and outcomes of pericarditis and PE complicating cGVHD in allogeneic hematopoietic cell transplant recipients. Material and Methods We included all consecutive patients referred to our pericardial diseases referral center from 1st May 2008 to 1st May 2022. All patients had no previous cardiovascular or autoimmune diseases and suffered from severe cGVHD with involvement of at least 2 organs. Pericarditis and PE were diagnosed according to ESC guidelines. Conditioning-related toxicity and infections were carefully excluded. Results Pericarditis was diagnosed in 4 patients (2 males, mean age 48.5 ±9.0 years), of whom 2 developed mild PE. PE without pericarditis was diagnosed in 5 patients (80% male, aged 53.2 ±8.9 years), in 2 patients it was reported as severe, requiring pericardial drainage. The average time after allogeneic hematopoietic stem cell transplantation was 22 months (range, 4 to 58 months). All patients required escalation of the corticosteroid therapy they were chronically taking, and in 4 cases the therapy was boosted with non-steroidal anti-inflammatory drugs. Only one patient developed a recurrence and died of multiorgan failure associated with severe cGVHD (involving eyes, mucous membranes, skin, joints, liver, pleuro-pericardial effusion) refractory to immunosuppressive therapy. Overall survival was 89% and no patient developed constrictive pericarditis. Mean follow-up was 69±55 months. Conclusions Pericarditis and PE related to cGVHD typically occur with mild clinical signs in the context of severe cGVHD, however in our study 22% of patients required pericardial drainage at diagnosis. The mainstay of treatment is high-dose steroids and usually the majority of patients have a favorable outcome.

The Association of Minimally Invasive Surgical Approaches and Mortality in Patients with Malignant Pleuropericarditis-A 10 Year Retrospective Observational Study.

Background and Objectives: Malignant neoplasms are common causes of acute pleuropericardial effusion. Pleuropericarditis denotes poor patient prognosis, is associated with shortened average survival time, and represents a surgical emergency. Materials and Methods: We analyzed the impact of two minimally invasive surgical approaches, the type of cancer, and other clinical variables on the mortality of 338 patients with pleuropericarditis admitted to an emergency hospital in Romania between 2009 and 2020. All patients underwent minimally invasive surgeries to prevent the recurrence of the disease and to increase their life expectancy. Log-rank tests were used to check for survival probability differences by surgical approach. We also applied univariate and multivariate Cox proportional hazard models to assess the effect of each covariate. Results: No significant differences were found in the 2-year overall survival rate between patients who underwent the two types of surgery. The multivariate Cox proportional regression model adjusted for relevant covariates showed that age, having lung cancer, and a diagnosis of pericarditis and right pleural effusion increased the mortality risk. The surgical approach was not associated with mortality in these patients. Conclusion: These findings open up avenues for future research to advance the understanding of survival among patients with pleuropericarditis.

Univentricular Heart

Introduction: The univentricular heart refers to a pathophysiological concept in which a single functional ventricle provides both pulmonary and systemic aortic flow in parallel. The aim of this study was to conduct an epidemiological study of the univentricular heart, to study the circumstances of discovery, to analyze the problems posed by the diagnostic and therapeutic management of these patients in our Moroccan context by evaluating the diagnostic role of Doppler echocardiography and finally evaluating the evolution of these operated children. Methods: This was a retrospective study in the cardiovascular surgery department of CHU IBN ROCHD in Casablanca, over a period of 3 years from January 2017 to December 2019 involving 4 patients, whose age varies between 6 months and 7 years. Results: The sex ratio was 1. The average age of the patients was 8 months and 6 years respectively for the pulmonary artery cerclage and for the Fontan treatment. Consanguinity, diabetes, hypertension and advanced maternal age were the main antecedents. Several circumstances of discovery have been highlighted, the most common are: perioral cyanosis in 3 patients, growth restriction with eating difficulties in 3 patients and dyspnea in 2 others. Pulmonary arterial hypertension and pulmonary stenosis were present in 50% of the patients. The diagnosis was made by echocardiography and the most common anatomical form of the single ventricle was tricuspid atresia in 2 patients. All patients were operated: 2 received pulmonary artery cerclage and 2 others received Fontan treatment, 1 of them had primary pulmonary artery cerclage in his history. In our study, no deaths were reported. Postoperative complications were dominated by atelectasis, infectious complications, bleeding and pleuro-pericardial effusion. The short and medium-term postoperative evolution was favorable for all our patients with weight gain, symptom reduction and improvement in O2 saturation.

Eosinophilic Pleuropericardial Effusion due to Valproic Acid

Valproic acid is widely used in the treatment of many diseases. It has common side effects such as nausea, vomiting, diarrhea, dizziness, tremor, hair loss, thrombocytopenia. Valproic acid can rarely cause eosinophilic pleuropericardial effusion. Case report; a 31-year-old male patient who had been using valproic acid since childhood due to epilepsy presented with respiratory distress. Eosinophilic pleuropericardial effusion was detected in the examinations performed in the patient with progressive respiratory distress. After excluding other etiological causes, this condition is assumed to be related to valproic acid. Drug changes were made. The end of six months, was observed to be completely cured. Conclusion: This adverse is generally thought to result from drug hypersensitivity reaction. But it is seen that it is an important factor in drug dosage.

O07 Managing relapsing and refractory lupus nephritis in juvenile systemic lupus erythematosus: a case report

O07 Managing relapsing and refractory lupus nephritis in juvenile systemic lupus erythematosus: a case report

A case report of pleuro‐pericardial effusion in a patient on hemodialysis and a cardiac pacemaker

There are multiple causes of pleuro-pericardial effusion (PPEF) and more so in a patient with end-stage renal disease (ESRD). Postcardiac injury syndrome (PCIS) is a loosely defined term for occurrence of pericardial and/or pleural effusion (PLEF), low-grade fever, with or without systemic upset, which occurs after myocardial infarction (MI), and other cardiac interventions. PPEF is one of its salient manifestations. We report occurrence of PCIS, presenting as pericardial effusion and massive PLEF, after insertion of cardiac pacemaker in a patient with ESRD, on maintenance hemodialysis (MHD). It was successfully managed with a short course of oral steroids.

Utility of D-Dimer LEVEL As a Marker for Differentiation Syndrome, Infection, and Death in ACUTE Promyelocytic Leukemia (APL)

IntroductionAcute Promyelocytic Leukemia (APL) is the most curable leukemia with reported survival >90% in large co-operative group studies. Induction-related deaths from bleeding, infection, and differentiation syndrome (DS) remain a threat with early death (ED) rate of 30%. DS is a unique and life-threatening complication of APL induction, characterized by unexplained fever, weight gain, pleuropericardial effusion, hypoxemia, hypotension, and/or vascular capillary leak syndrome leading to peripheral edema and acute renal failure. These pathophysiologic complications are sequelae cytokine release from malignant promyelocytes. This clinical diagnosis is without identifying markers. We report our observation on the utility of D-dimer level as a potential marker for the identification of DS, infection and death during APL induction.MethodsWe conducted retrospective chart reviews of APL patients treated at Emory University and co-managed at community and academic treatment centers throughout Georgia, South Carolina and bordering states from 7/2013 to 4/2017 with the purpose of decreasing ED. IRB approval was obtained. Elevations in D-dimer were based on laboratory specific reference values.Results138 patients were enrolled in this study, of whom 44 patients (32%) developed DS and 18 patients (13%) developed infection during induction. We followed the D-dimer trends in those patients that had serial levels obtained throughout induction therapy. At time of presentation, 100% of patients had elevated D-dimer. As disseminated intravascular coagulation (DIC) corrected, there was a drop in D-dimer. D-dimer re-elevated in 6 patients prior to DS onset (14%), 9 patients on day of DS onset (20%), and 6 patients after DS onset (14%). 3 patients (7%) that developed DS had D-dimers that remained elevated at levels unquantifiable by lab testing. 4 patients demonstrated no re-elevation in D-dimer in relation to DS onset (9%). Data was not available to ascertain D-dimer correlation with DS onset in 16 patients (36%). Infection data was collected and patients who developed infection during induction, excluding viral etiologies and pneumonia/pneumonitis due to correlation and overlap with DS presentation, were included totaling 18 patients. Re-elevation of D-dimer was noted in 4 patients in correlation to infection onset (22%), no re-elevation was noted in 3 (17%), and data was not available in 11 patients (61%). 12 patients died due to induction-related complications. D-dimer was re-elevated in relation to timing of death in 7 patients (58%), remained unmeasurably high in 1 (8%), and data was not available in 4 patients (33%). Table 1.ConclusionD-Dimer is a marker of inflammation and is elevated in inflammatory processes. Most patients presenting with APL have high D-dimer levels secondary to DIC. A repeat elevation after an initial decrease might be a useful marker of foreboding complications in APL, including DS, infection, and death. As evidenced in our study, there remain a significant number of patients with inconsistencies in D-dimer serial monitoring or entire lack thereof. Given the impressive correlation between D-dimer and aforementioned complications that our review demonstrates, this supports incorporating D-dimer in daily lab monitoring as a standard of care. Our observations, if confirmed in larger studies, could be a valuable addition to identifying induction-related complications earlier and decreasing incidence of early deaths. [Display omitted] DisclosuresArellano:Cephalon Oncology: Research Funding. Kota:Xcenda: Consultancy; Leukemia Lymphoma Society: Research Funding; Takeda Pharmaceuticals: Consultancy; Incyte: Consultancy; Novartis: Consultancy; Pfizer: Consultancy.

Atypical Case of Minoxidil-Induced Generalized Anasarca and Pleuropericardial Effusion

Minoxidil is an antihypertensive medication used to control blood pressure that is resistant to three or more antihypertensive medications including diuretics. There have only been a few reported cases of minoxidil-induced pleuropericardial effusion with anasarca. Here, we discuss the case of a 70-year-old male with a history of uncontrolled hypertension who presented to the hospital with swelling of the extremities. He was on minoxidil 10 mg twice a day and complained of generalized body swelling and extremity pain with symptoms of dyspnea on exertion, paroxysmal nocturnal dyspnea, weight gain, abdominal distention, and intermittent, throbbing extremity pain (8/10). The patient denied a history of cardiac disease, pulmonary embolism, deep vein thrombosis, and malignancy. His vitals were stable with a blood pressure of 152/67 mmHg. The physical examination findings were significant for positive jugular vein pressure, bilateral crackles at the lung bases with abdominal distention, fluid thrill, and flank edema. The extremities showed pitting edema in the upper and lower extremities that were tender to palpation. Laboratory results were only significant for uremia and elevated brain natriuretic peptide. Electrocardiography, echocardiography, and CT of the chest and abdomen exhibited findings consistent with pericardial effusion, pleural effusion, abdominal ascites, and anasarca in the soft tissues of the axilla and chest wall. After discontinuation of minoxidil and starting intravenous diuretics, the patient showed clinical improvement. This case report reviews and explains that minoxidil-induced anasarca should be considered as a differential diagnosis in patients taking minoxidil as knowledge of this rare finding may lead to early diagnosis and management.

Etanercept induced pleuro-pericardial effusion - a rare adverse effect.

Many of the pharmacological agents used in clinical practice can potentially cause some adverse reaction in any part of the pulmonary system. As more drugs are being discovered, the list of pulmonary toxicities also is getting longer. We present a case of a 25 year old man, known case of Ankylosing spondylitis, who presented with orthopnea and was found to have pleuro-pericardial effusion. Investigations revealed exudative eosinophilic fluid with low adenosine deaminase levels. Thoracoscopic pleural biopsy showed dense eosinophilic infiltration of the pleura. Infection and malignancy were ruled out by relevant tests. A diagnosis of drug induced pleuro-pericardial effusion was made by exclusion of other causes.. Etanercept was witheld and patient was started on steroids after which he showed significant improvement on follow up. We suggest Etanercept be considered in the growing list of drugs causing pleuro-pericardial effusion. To our knowledge, a case of pleuro-pericardial effusion with eosinophilic pleural infiltration due to Etanercept specifically has not been previously described.

Refractory Effusions, Crumbly Bones, Mystifying Cachexia and an Absent Mind: An Unusual Presentation of Whipple's Disease with Review of Literature.

Whipple’s disease is a bacterial infection caused by Tropheryma whipplei and is known to cause perplexing clinical presentations, making its diagnosis challenging. The beginning by the involvement of the gastrointestinal tract, Whipple's disease can slowly progress to affect almost any organ system and lead to chronic multi-system inflammatory disease. Hereby, we present a middle age man who initially manifested with shortness of breath and chronic weight loss. He subsequently developed pleuro-pericardial effusion, ascites, mesenteric lymphadenopathy, possible myocarditis, and severe osteopenia with multiple vertebral fractures during his illness. Esophagogastroduodenoscopy with the biopsy and subsequent molecular confirmation of disease led to the confirmation of WD. Therapeutic management included two separate antibiotic regimens in an attempt to address the refractory course of WD in this patient.

Kompleksna i retka prezentacija trovanja pirinčanom tabletom - prikaz slučaja

Aluminum phosphide, known as "rice tablet" (RT), is a common cause of suicide in adult women in Iran, with a high rate of lethal outcome. We report a patient with RT toxicity, with a complex syndrome of hepatic failure, renal failure, Brugada electrocardiography (ECG) patterns, and pleuropericardial effusion. The patient received conventional management with fluid therapy, gastric washing, activated charcoal followed by intra-aortic balloon pump insertion, inotropic drugs support, and mechanical ventilation. The unique features of our case are related to a combination of multiorgan failure with Brugada atypical ECG patterns and pleuropericardial effusion. Among the aforementioned complications, pleuropericardial effusion, ascites, and Brugada syndrome are exceedingly rare events. The patient was treated with high-dose inotropic drugs and intra-aortic balloon pump insertion. Despite tremendous management of metabolic acidosis, all efforts failed, and the patient died with sudden cardiac arrest.

Coronavirus Disease 2019 in Recipient of Allogeneic Hematopoietic Stem Cell Transplantation: Life-threating Features Within the Early Post-engraftment Phase.

Coronavirus Disease 2019 in Recipient of Allogeneic Hematopoietic Stem Cell Transplantation: Life-threating Features Within the Early Post-engraftment Phase.