Long induction of tolerance to imatinib

2020 ◽  
Vol 13 (12) ◽  
pp. e237069
Author(s):  
Leyla Bojanini ◽  
Steven Attia ◽  
Haesuk Heagney ◽  
Alexei Gonzalez-Estrada
Keyword(s):  
Adverse Reaction ◽  
Kinase Inhibitor ◽  
Gastrointestinal Stromal Tumour ◽  
Hypersensitivity Reactions ◽  
Imaging Studies ◽  
Cutaneous Side Effects ◽  
Cutaneous Adverse Reaction ◽  
Solid Malignancies ◽  
History Of ◽  
Induction Of Tolerance

Imatinib is used to treat several haematological and solid malignancies. Cutaneous side effects could often limit the use of this medication. We present a case of a 62-year-old woman with a history of a gastrointestinal stromal tumour that developed a delayed cutaneous adverse reaction 10 days after starting imatinib 400 mg daily. She developed the same symptoms with reintroduction at a dose of 100 mg and with an alternative tyrosine kinase inhibitor, nilotinib 50 mg/day. Given that imatinib was considered her best treatment, she underwent a long induction of drug tolerance (IDT) protocol to imatinib. Patient tolerated the medication without further reactions for 6 months and had improvement of her cancer per last imaging studies. IDT should be considered in delayed hypersensitivity reactions to imatinib after a failed reintroduction of the drug or when no other equally effective agents are available.

scholarly journals Pustular Psoriasis and Acute Generalized Exanthematous Pustulosis

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1004
Author(s):  
Morgan Sussman ◽  
Anthony Napodano ◽  
Simo Huang ◽  
Abhirup Are ◽  
Sylvia Hsu ◽  
...  
Keyword(s):  
Adverse Reaction ◽  
Clinical Course ◽  
Pustular Psoriasis ◽  
Topical Steroids ◽  
Inflammatory Disorder ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Cutaneous Adverse Reaction ◽  
History Of ◽  
Exanthematous Pustulosis ◽  
Crucial Part

The similarity between pustular psoriasis (PP) and acute generalized exanthematous pustulosis (AGEP) poses problems in the diagnosis and treatment of these two conditions. Significant clinical and histopathologic overlap exists between PP and AGEP. PP is an inflammatory disorder that has numerous clinical subtypes, but all with sterile pustules composed of neutrophils. AGEP is a severe cutaneous adverse reaction that is also characterized by non-follicular sterile pustules. Clinical features that suggest a diagnosis of PP over AGEP include a history of psoriasis and the presence of scaling plaques. Histologically, eosinophilic spongiosis, vacuolar interface dermatitis, and dermal eosinophilia favor a diagnosis of AGEP over PP. Importantly, PP and AGEP vary in clinical course and treatment. PP treatment involves topical steroids, oral retinoids, and systemic immunosuppressants. Newer therapies targeting IL-36, IL-23, IL-1, and PDE-4 have been investigated. The removal of the offending agent is a crucial part of the treatment of AGEP.

Evaluation of Hypersensitivity Reactions in Pediatric Patients Using Biological Drugs

2021 ◽  
pp. 1-8
Author(s):  
Ozge Yilmaz Topal ◽  
Volkan Kose ◽  
Banu Acar ◽  
Umut Selda Bayrakci ◽  
Derya Ozyoruk ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Additional Treatment ◽  
Hypersensitivity Reactions ◽  
Biological Drugs ◽  
Rheumatologic Diseases ◽  
Culprit Drug ◽  
Dose Infusion ◽  
History Of ◽  
Oncologic Diseases ◽  
Biologic Drug

<b><i>Introduction:</i></b> Biological drugs are currently used for the treatment of chronic inflammatory, autoimmune, and neoplastic diseases. With their expanding indication spectrum and increasing use, hypersensitivity reactions to these drugs are also becoming more frequent. The present study aimed to report the incidence and the features of such reactions in pediatric patients using biologicals for the treatment of various diseases. <b><i>Methods:</i></b> The medical records of pediatric patients treated with biological agents between October 1, 2011 and August 31, 2019 were reviewed and adverse reactions were evaluated retrospectively. <b><i>Results:</i></b> During the study period, 211 patients (116 boys, 55%) used 21 different biological drugs for the treatment of various diseases. Their median age at the time of the first treatment was 139.9 (IQR: 92.2–187.8) months. Hematologic-oncologic diseases were the most common indication for biological therapy (97/211; 46.0%), followed by rheumatologic diseases (82/211; 38.9%). Of the 211 patients, 14 (6.64%) experienced reactions to biological drugs. The most common culprit agent was rituximab (57.1%). Most of the patients (85.7%) had a history of reactions either during the infusion or within 1 h after taking the drug. Five patients underwent desensitization to the culprit drug, while 7 other patients continued treatment with a reduced dose/infusion rate or premedication. Also 1 patient continued to take the drug without any additional treatment. <b><i>Conclusion:</i></b> It was reported that 6.64% of the patients who received biologic drug therapy for various reasons in our hospital had hypersensitivity. The most common culprit agent was rituximab, and most of the reactions were immediate reactions.

scholarly journals Topical Tofacitinib: A Janus Kinase Inhibitor for the Treatment of Vitiligo in an Adolescent Patient

2021 ◽  
pp. 190-194
Author(s):  
Sineida Berbert Ferreira ◽  
Rachel Berbert Ferreira ◽  
Afonso Cesar Neves Neto ◽  
Silvana Martins Caparroz Assef ◽  
Morton Scheinberg
Keyword(s):  
Case Report ◽  
Skin Disease ◽  
Kinase Inhibitor ◽  
Effective Therapy ◽  
Janus Kinase ◽  
Jak Inhibitor ◽  
Adolescent Patient ◽  
Jak Inhibitors ◽  
Janus Kinase Inhibitor ◽  
History Of

Vitiligo is an autoimmune skin disease presenting with areas of depigmentation. Recent reports suggest that Janus kinase (JAK) inhibitors may be an effective therapy. In this case report, we show our experience with an adolescent patient with a long history of generalized and refractory vitiligo, for which treatment with topical tofacitinib, a JAK inhibitor, associated with phototherapy for 9 months, resulted in near complete repigmentation.

Episodic versus Chronic Dizziness: An Analysis of Predictive Factors

2021 ◽  
pp. 000348942110254
Author(s):  
Eric J. Formeister ◽  
Ricky Chae ◽  
Emily Wong ◽  
Whitney Chiao ◽  
Lauren Pasquesi ◽  
...  
Keyword(s):  
Multivariate Regression ◽  
Treatment Options ◽  
Depression And Anxiety ◽  
Imaging Studies ◽  
Comorbid Depression ◽  
Cross Sectional ◽  
Tertiary Center ◽  
Chronic Dizziness ◽  
Associated Symptoms ◽  
History Of

Objectives: To elucidate differences in demographic and clinical characteristics between patients with episodic and chronic dizziness. Methods: A cross-sectional, observational study of 217 adults referred for dizziness at 1 tertiary center was undertaken. Subjects were split into a chronic dizziness group (>15 dizzy days per month) and an episodic dizziness group (<15 dizzy days per month). Results: 217 adults (average age, 53.7 years; 56.7% female) participated. One-third (n = 74) met criteria for chronic dizziness. Dizziness handicap inventory (DHI) scores were significantly higher in those with chronic dizziness compared to those with episodic dizziness (53.9 vs 40.7; P < .001). Comorbid depression and anxiety were more prevalent in those with chronic dizziness (44.6% and 47.3% vs 37.8% and 35.7%, respectively; P > .05). Abnormal vestibular testing and abnormal imaging studies did not differ significantly between the 2 groups. Ménière’s disease and BPPV were significantly more common among those with episodic dizziness, while the prevalence of vestibular migraine did not differ according to chronicity of symptoms. A multivariate regression that included age, sex, DHI, history of anxiety and/or depression, associated symptoms, and dizziness triggers was able to account for 15% of the variance in the chronicity of dizziness (pseudo- R2 = 0.15; P < .001). Conclusions: Those who suffer from chronic dizziness have significantly higher DHI and high comorbid rates of depression and anxiety than those with episodic dizziness. Our findings show that factors other than diagnosis alone are important in the chronification of dizziness, an observation that could help improve on multimodal treatment options for this group of patients.

Rare case of metastatic adenocarcinoma to the maxillary sinus

2021 ◽  
Vol 14 (9) ◽  
pp. e244485
Author(s):  
Apurwa Prasad ◽  
Taha Alrifai ◽  
Sumathi Vijaya Rangan ◽  
Jessica Garcia
Keyword(s):  
Metastatic Disease ◽  
Colorectal Adenocarcinoma ◽  
Metastatic Adenocarcinoma ◽  
Imaging Studies ◽  
Timely Manner ◽  
Posterior Aspect ◽  
Delay In Diagnosis ◽  
Immune Histochemistry ◽  
History Of ◽  
Intestinal Type Adenocarcinoma

Colorectal carcinoma metastases to the head and neck are exceedingly rare. Patients may present with vague symptoms that may lead to a delay in diagnosis. We report the case of a 51-year-old man with a known history of stage IIIB colorectal adenocarcinoma who presented with right-sided molar tooth bleeding and right-sided palate swelling that led to difficulty speaking, eating and weight-loss of 15 pounds. Imaging studies revealed a 3.1×4.8×3 cm mass that was centred around the posterior aspect of the maxilla. Pathology revealed moderately differentiated intestinal type adenocarcinoma of colonic subtype, immune histochemistry was positive for CDX2, CK20 and MUC2, thus confirming metastatic disease to the maxilla. The patient is undergoing chemoradiation therapy for palliation of his symptoms. Clinicians should be aware of this potentional site of metastatic disease and suspect the diagnosis in a timely manner to avoid delays in making a diagnosis.

A case of nodular episcleritis mimicking a solitary giant episcleral mass

2021 ◽  
pp. 112067212110528
Author(s):  
Lan Zhou ◽  
Juanjuan Wang ◽  
Guihua Xu ◽  
Dingding Wang ◽  
Xiaoyi Wang ◽  
...  
Keyword(s):  
Topical Steroid ◽  
Inflammatory Cells ◽  
Systemic Hypertension ◽  
Eye Drops ◽  
Definite Diagnosis ◽  
Imaging Studies ◽  
Immunohistochemical Examination ◽  
History Of ◽  
Inflammatory Drugs

Purpose To describe an atypical nodular episcleritis mimicking a solitary giant episcleral mass, which is not attributed to any systemic diseases and identified only after immunohistochemical examination. Case report A sixty-year-old Chinese woman with systemic hypertension presented with 6-month history of giant, solitary and redness epibulbar mass arising from the superior aspect of her left eye. The lesion gradually enlarged, even with 6-month history of irregular topical steroid eye drops treatment. Imaging studies and laboratory test revealed a 10 mm × 8 mm episcleral mass absence of any infection indicator and autoimmune antibody changes. The mass was completely removed before its extension through the deep scleral, histopathologic examination revealed a nodular episcleritis composed of various chronic inflammatory cells infiltration. Topical steroid eye drops treatment combined with oral steroidal anti-inflammatory drugs was then administrated regularly for 1 month, and no recurrence occurred after 1-year follow-up. Conclusion Nodular anterior episcleritis is characterized by underlying chronic inflammation of the anterior episclera and can be presented as asymptomatic episcleral mass. Besides a thorough investigation systemically, tissue biopsy is required for definite diagnosis.

Intraosseous Epidermoid Inclusion Cyst in a Great Toe

2003 ◽  
Vol 127 (7) ◽  
pp. e298-e300 ◽  
Author(s):  
Beverly Y. Wang ◽  
Jesse Eisler ◽  
Dempsey Springfield ◽  
Michael J. Klein
Keyword(s):  
Frozen Section ◽  
Inclusion Cyst ◽  
Great Toe ◽  
Imaging Studies ◽  
Benign Lesions ◽  
Work Related ◽  
Frozen Section Diagnosis ◽  
History Of ◽  
Radiolucent Lesion ◽  
Epidermoid Inclusion Cyst

Abstract Epidermoid inclusion cysts are benign lesions that occasionally occur in the distal phalanges of the fingers but are less frequently identified and underreported in the toes. We describe a 55-year-old man with a history of work-related trauma followed by painful expansion of his right great toe, resulting in great anxiety. Imaging studies revealed a radiolucent lesion in the distal phalanx of his right hallux. Clinical differential diagnoses included the possibility of an intramedullary inclusion cyst and other various radiolucent lesions. During surgery, a cystic lesion that contained creamy material was discovered. Frozen section diagnosis of the lesion was an intraosseous epidermoid inclusion cyst. The lesion was removed and the patient recovered uneventfully. Although it has been reported that an unduly large number of phalangeal cysts have been treated by amputation, the judicious use of intraoperative frozen sections can prevent this scenario.

scholarly journals Autoinfarction of Giant Parathyroid Adenoma after Preoperative Withdrawal of Anticoagulants

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Raoul Verzijl ◽  
Pim J. Bongers ◽  
Geetha Mukerji ◽  
Ozgur Mete ◽  
Karen M. Devon ◽  
...  
Keyword(s):  
Parathyroid Adenoma ◽  
Elective Surgery ◽  
Histopathological Examination ◽  
Neck Mass ◽  
Bone Lesions ◽  
Imaging Studies ◽  
Cystic Change ◽  
Parathyroid Adenomas ◽  
History Of ◽  
Brown Tumors

A 71-year-old man with known history of atrial fibrillation (treated with routine rivaroxaban therapy) was found to have incidental biochemical elevated calcium and parathyroid hormone (PTH) levels. His physical examination demonstrated the presence of a palpable right neck mass. Subsequent imaging studies revealed a large parathyroid mass as well as multiple bone lesions, raising the suspicion of parathyroid carcinoma. The anticoagulant therapy was stopped 5 days prior to his elective surgery. The night before his elective surgery, he presented to the emergency room with profound hypocalcemia. The surgery was postponed and rescheduled after calcium correction. Intraoperative findings and detailed histopathological examination revealed an infarcted 4.0 cm parathyroid adenoma with cystic change. His bony changes were related to brown tumors associated with long-standing hyperparathyroidism. Autoinfarction of a large parathyroid adenoma causing severe hypocalcemia is a rare phenomenon and may be considered in patients with large parathyroid adenomas after withdrawal of anticoagulants.

The Differentiation between Pancreatic Neoplastic Cysts and Pancreatic Pseudocyst

2005 ◽  
Vol 94 (2) ◽  
pp. 161-164 ◽  
Author(s):  
J. Sand ◽  
I. Nordback
Keyword(s):  
Pancreatic Pseudocyst ◽  
Emission Tomography ◽  
Cystic Lesions ◽  
Imaging Studies ◽  
Cystic Neoplasms ◽  
Fluid Analysis ◽  
Positron Emission ◽  
Serous Cystadenomas ◽  
History Of ◽  
Quality Imaging

The number of small and often asymptomatic cystic lesions detected in pancreas has increased during the last decade. Historically the vast majority of the pancreatic cystic lesions were considered pseudocysts, but in recent series the incidence of various neoplastic cysts, such as intraductal papillary mucinous neoplasm, serous cystadenomas and cystic endocrine tumours, has increased. The possible malignant potential in these cystic neoplasms warrants careful diagnostic workup to choose the optimal treatment for each patient. Patient's age, symptoms and a possible history of acute or chronic pancreatitis with known aetiology together with high quality imaging studies are important in the differential diagnosis between pseudocysts and neoplastic cysts. Endoscopic ultrasound, cyst fluid analysis and positron emission tomography may be used in selected patients, but the accuracy of these methods needs further investigation.

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