scholarly journals Axillary Adenopathy Secondary to SARS-CoV-2 Vaccination: a Case Report

2021 ◽  
Author(s):  
Alan Koff ◽  
Florence Chau Etchepare
Keyword(s):  
Latent Tuberculosis ◽  
Vaccine Dose ◽  
Deltoid Muscle ◽  
Patient Anxiety ◽  
Vaccination Site ◽  
Axillary Lymphadenopathy ◽  
Diagnostic Confusion ◽  
History Of ◽  
Fdg Pet Ct ◽  
Unnecessary Testing

Abstract Introduction: SARS-CoV-2 mRNA vaccines are safe and effective for the prevention of COVID-19 infection, though local reactions are commonly reported. Axillary lymphadenopathy has also been reported, which has the potential of causing diagnostic confusion and unnecessary testing and procedures. Case Description: A 58 year-old female with untreated latent tuberculosis was noted to have a pulmonary nodule on chest radiograph. Evaluation for Mycobacterium tuberculosis was undertaken, and a FDG PET/CT was performed to rule out malignancy. While the nodule demonstrated low avidity, highly avid lymph nodes were noted in the left axillary region. Further questioning elicited a recent history of mRNA-1273 (Moderna) COVID-19 vaccination in her left deltoid muscle three weeks prior, and a sensation of axillary fullness. She was managed conservatively with spontaneous resolution of her lymphadenopathy. Conclusions: Axillary lymphadenopathy following mRNA vaccination has been reported, and appears to be more common with mRNA-1273 (Moderna) than BNT162b2 vaccine (Pfizer-BioNTech), in those aged 18 to 64 as compared to age ≥65, and following the second vaccine dose compared to the first dose. Vaccination should be considered in the differential diagnosis of axillary lymphadenopathy, particularly ipsilateral to the vaccination site, to avoid unnecessary testing, treatment, and patient anxiety.

STEREOTACTIC HYPO-FRACTIONAL RADIOTHERAPY OF PATIENTS WITH LUNG CANCER I-IIA CLINICAL STAGE: THE ROLE OF SUVMAX ASSESSMENT IN 18F-FDG PET/CT FOR MONITORING TREATMENT OUTCOMES

2017 ◽  
Vol 63 (4) ◽  
pp. 632-638
Author(s):  
Tatyana Borisova ◽  
Arif Allakhverdiev ◽  
Yuriy Gerasimov ◽  
Nadezhda Meshcheryakova ◽  
Mikhail Dolgushin ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Treatment Effectiveness ◽  
Clinical Stage ◽  
First Year ◽  
Pet Ct ◽  
History Of ◽  
Single Factor Analysis ◽  
Fdg Pet Ct ◽  
Second Tumor ◽  
Monitoring Treatment

Material and methods: Since 2014, 33 patients with lung cancer of clinical stage I-IIa (cT1N0M0 - 12 patients, with T2N0M0 - 21 patients) have undergone SRT. Verification of tumor process was obtained in 30 patients. A third of patients (n = 10) had a history of metachronic primary-multiple tumors and 31 patients had peripheral lung cancer. The used variants of SRT fractionation were as followed: 10Gr x 5 fractions (n = 22) and 7Gr x 8 fractions (n = 11) - BED 100Gy. Results: With a median follow-up of 21 months (range 3-37 months), 4 patients (12 %) within the first year had a loco-regional and distant progression, of which two died. During the year one patient died from complications of treatment, one - from the progression of the second tumor. One- and two-year local control was 94 %. Overall and disease-free 2-year survival was 84 % (95 % CI, 70 - 99) and 83.2 % (95 % CI, 70.5 - 99), respectively. Single-factor analysis revealed a significant effect on the overall survival of the fractionation regimen (p = 0.04). The effect of the baseline SUVmax tended to be reliable (p = 0.07). Conclusions: In order to implement the principles of risk-adaptive radiation therapy it is necessary to consider the initial SUVmax of tumor as one of potential predictive and predicative markers of treatment effectiveness.

scholarly journals Cancer immunotherapy in special challenging populations: recommendations of the Advisory Committee of Spanish Melanoma Group (GEM)

2021 ◽  
Vol 9 (3) ◽  
pp. e001664
Author(s):  
Maria Gonzalez-Cao ◽  
Teresa Puertolas ◽  
Mar Riveiro ◽  
Eva Muñoz-Couselo ◽  
Carolina Ortiz ◽  
...  
Keyword(s):  
Cancer Immunotherapy ◽  
Multidisciplinary Approach ◽  
Checkpoint Inhibitors ◽  
Solid Organ Transplantation ◽  
Latent Tuberculosis ◽  
Solid Organ ◽  
Chronic Infections ◽  
Immunosuppressed Patients ◽  
History Of ◽  
Evidence Based Guidelines

Cancer immunotherapy based on the use of antibodies targeting the so-called checkpoint inhibitors, such as programmed cell death-1 receptor, its ligand, or CTLA-4, has shown durable clinical benefit and survival improvement in melanoma and other tumors. However, there are some special situations that could be a challenge for clinical management. Persons with chronic infections, such as HIV-1 or viral hepatitis, latent tuberculosis, or a history of solid organ transplantation, could be candidates for cancer immunotherapy, but their management requires a multidisciplinary approach. The Spanish Melanoma Group (GEM) panel in collaboration with experts in virology and immunology from different centers in Spain reviewed the literature and developed evidence-based guidelines for cancer immunotherapy management in patients with chronic infections and immunosuppression. These are the first clinical guidelines for cancer immunotherapy treatment in special challenging populations. Cancer immunotherapy in chronically infected or immunosuppressed patients is feasible but needs a multidisciplinary approach in order to decrease the risk of complications related to the coexistent comorbidities.

scholarly journals Prevalence of latent tuberculosis infection and feasibility of TB preventive therapy among Thai prisoners: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sivaporn Gatechompol ◽  
Weerakit Harnpariphan ◽  
Ruamthip Supanan ◽  
Gompol Suwanpimolkul ◽  
Jiratchaya Sophonphan ◽  
...  
Keyword(s):  
Latent Tuberculosis ◽  
Cross Sectional Study ◽  
Preventive Therapy ◽  
Sectional Study ◽  
Cross Sectional ◽  
Ltbi Prevalence ◽  
History Of ◽  
Chest X Ray ◽  
Latent Tb ◽  
Latent Tb Infection

Abstract Background Prisons are considered as major reservoirs for tuberculosis. Preventive therapy for latent TB infection (LTBI) is an adjunctive strategy to control TB. However, LTBI data in Thai prisoners is limited. This study assessed the prevalence of LTBI and feasibility of isoniazid preventive therapy (IPT). Methods A cross-sectional study was conducted among prisoners in Klong Prem Central Prison, Bangkok. Participants were screened for active TB by questionnaire and chest X-ray. LTBI was evaluated by Tuberculin skin test (TST) and QuantiFERON-TB Gold Plus (QFTP) among subgroup. Participants with positive TST or QFTP were considered to have LTBI. Participants with LTBI were offered IPT. Results From August 2018–November 2019, 1002 participants were analyzed. All participants were male with a median age of 38 (IQR 32–50) years. LTBI identified by either TST/QFTP was present in 466 (46.5%) participants. TST was positive in 359 (36%) participants. In the subgroup of 294 participants who had both TST and QFTP results, 181/294 (61.6%) tested positive by QFTP. Agreement between TST and QFTP was 55.1% (Kappa = 0.17). The risk factors associated with LTBI were previous incarceration (aOR 1.53, 95%CI, 1.16–2.01, p = 0.002), history of prior active TB (aOR 3.02, 95%CI, 1.74–5.24, p < 0.001) and duration of incarceration ≥10 years (aOR 1.86, 95%CI, 1.24–2.79, p = 0.003). Majority of LTBI participants (82%) agreed to take IPT. Three hundred and 56 (93%) participants completed treatment whereas 27 (7%) participants discontinued IPT due to the side effects of INH. Conclusion This is the first study to evaluate the prevalence of LTBI and feasibility of IPT among Thai prisoners. LTBI prevalence in male prisoners in Thailand is high. LTBI screening and treatment should be implemented together with other preventive components.

845 Progressive external ophthalmoplegia in sleep apnea presenting as floppy eyelid syndrome

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A329-A329
Author(s):  
Pratibha Anne ◽  
Rupa Koothirezhi ◽  
Ugorji Okorie ◽  
Minh Tam Ho ◽  
Brittany Monceaux ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Surgical Treatment ◽  
Sleep Apnea ◽  
Genetic Disorder ◽  
Deltoid Muscle ◽  
Progressive External Ophthalmoplegia ◽  
Ataxic Gait ◽  
Pressure Setting ◽  
Obstructive Sleep ◽  
History Of

Abstract Introduction Floppy eye lid syndrome (FES) is known to be associated with Obstructive sleep apnea (OSA) and chronic progressive external ophthalmoplegia (CPEO) is a rare genetic disorder with mitochondrial myopathy that may present with isolated eye lid ptosis in the initial stages. In a patient with loud snoring and obesity, treating obstructive sleep apnea may improve Floppy eyelid syndrome. Report of case(s) 52-year-old African – American male with past medical history of Hypertension, obesity, glaucoma, CPEO status bilateral blepharoplasty with failed surgical treatment. Patient was referred to Sleep medicine team to rule out Obstructive Sleep Apnea aa a cause of possible underlying FES and residual ptosis. On exam, patient was noted to have bilateral brow and eyelid ptosis and mild ataxic gait. MRI brain with and without contrast was unremarkable. Deltoid muscle biopsy was suggestive of possible congenital myopathy and mild denervation atrophy. Polysomnogram showed severe OSA with AHI of 74.1 per hour and patient was initiated on Auto CPAP at a pressure setting of 7–20 cm H2O. CPAP treatment improved snoring, OSA and subjective symptoms of excessive day time sleepiness but did not improve the residual ptosis. Conclusion Treatment of severe OSA in a patient previously diagnosed with CPEO and failed surgical treatment with bilateral blepharoplasty, did not alter the course of residual ptosis/ floppy eyelids even though his other sleep apnea symptoms have improved. Support (if any) 1. McNab AA. Floppy eyelid syndrome and obstructive sleep apnea. Ophthalmic Plast Reconstr Surg. 1997 Jun;13(2):98–114. doi: 10.1097/00002341-199706000-00005. PMID: 9185193.

scholarly journals Breastfeeding Mother and Child Clinical Outcomes After COVID-19 Vaccination

2021 ◽  
pp. 089033442110565
Author(s):  
Jia Ming Low ◽  
Le Ye Lee ◽  
Yvonne Peng Mei Ng ◽  
Youjia Zhong ◽  
Zubair Amin
Keyword(s):  
Adverse Effects ◽  
Study Protocol ◽  
Messenger Rna ◽  
Hospital Admissions ◽  
Vaccine Dose ◽  
Common Side Effect ◽  
Short Term ◽  
Serious Adverse Events ◽  
Axillary Lymphadenopathy ◽  
Breastfed Infants

Background: Pre-approval clinical trials of the Pfizer/BioNTech messenger RNA COVID-19 vaccine, BNT162b2 did not include participants who were breastfeeding. Therefore, there is limited evidence about outcomes of breastfeeding mother–child dyads and effects on breastfeeding after vaccination. Research Aims: To determine: (1) solicited adverse effects (e.g., axillary lymphadenopathy, mastitis, and breast engorgement), which are unique to lactating individuals; and (2) systemic and local adverse effects of COVID-19 mRNA vaccine on mothers and potential effects on their breastfed infants. Method: This was a prospective cohort study of lactating healthcare workers ( N = 88) in Singapore who received two doses of BNT162b2 vaccination (Pfizer/BioNTech). The outcomes of mother–child dyads within 28 days after the second vaccine dose were determined through a participant-completed questionnaire. Results: Minimal effects related to breastfeeding were reported by this cohort; three of 88 (3.4%) participants had mastitis, one (1.1%) participant experienced breast engorgement, five of 88 (5.7%) participants reported cervical or axillary lymphadenopathy. There was no change in human milk supply after vaccination. The most common side effect was pain/redness/swelling at the injection site, which was experienced by 57 (64.8%) participants. There were no serious adverse events of anaphylaxis or hospital admissions. There were no short-term adverse effects reported in the infants of 67 lactating participants who breastfed within 72 hr after BNT162b2 vaccination. Conclusions: BNT162b2 vaccination was well tolerated in lactating participants and was not associated with short-term adverse effects in their breastfed infants. Study Protocol Registration: The study protocol was registered at clinicaltrials.gov (NCT04802278).

"Acne Vaccinatum"—A Complication of Smallpox Vaccination

PEDIATRICS ◽  
1971 ◽  
Vol 48 (5) ◽  
pp. 815-816
Author(s):  
Barton S. Schmitt ◽  
Melvin I. Marks
Keyword(s):  
Case Report ◽  
Acne Vulgaris ◽  
Deltoid Muscle ◽  
Smallpox Vaccination ◽  
Specific Reference ◽  
Axillary Lymphadenopathy ◽  
Left Axilla

Although most textbook and committee recommendations on immunizations mention eczema and other more acute dermatitides as contra-indications to vaccination, no specific reference could be found regarding the significance of acne vulgaris.1,2 We have recently observed a serious complication of primary smallpox vaccination in a patient with acne vulgaris. Case Report Ten days after receiving a primary smallpox vaccination, a 16-year-old male was seen for a 2 x 2 x 2 cm tender node in his left axilla. He was afebrile and had a primary pustular vaccination reaction of the skin over the left deltoid muscle as well as left axillary lymphadenopathy.

scholarly journals Antibody-Mediated Extreme Insulin Resistance: The Importance of Pre-Treatment Screening

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Tina Mosaferi ◽  
Sahar Sherf ◽  
Laura Y. Sue ◽  
Ines Donangelo
Keyword(s):  
Insulin Resistance ◽  
Latent Tuberculosis ◽  
Abrupt Onset ◽  
Immunomodulatory Therapy ◽  
Intravenous Insulin ◽  
Hyperosmolar Hyperglycemic State ◽  
History Of ◽  
Pre Treatment ◽  
New Diagnosis ◽  
Hispanic Male

We report the case of a 56 year-old Hispanic male with a 10-year history of type 2 diabetes who presented with abrupt onset of hyperglycemia resistant to escalating doses of intravenous insulin infusion (>2500 units daily). He was diagnosed with antibody-mediated insulin resistance given the presence of hyperglycemia despite receiving >200 units insulin/day, a lack of identifiable precipitants for diabetic ketoacidosis or hyperosmolar hyperglycemic state, and elevated insulin antibodies. He underwent pre-immunomodulatory therapy screening for infections, rheumatologic disorders, and malignancy, which uncovered a new diagnosis of latent tuberculosis. While concurrently being treated for latent tuberculosis, he successfully responded to immunomodulatory therapy with rituximab, dexamethasone, and cyclophosphamide. Insulin was discontinued completely, and he maintained appropriate glycemic control on oral diabetic agents (metformin and pioglitazone). This case supports the use of immunomodulatory therapy for the treatment of antibody-mediated insulin resistance and highlights the importance of pre-immunomodulatory therapy screening to uncover occult infection or identify underlying neoplastic/rheumatologic disease prior to immunosuppression.

scholarly journals Audit of safety, efficacy, and cost-effectiveness of local anaesthetic cystodiathermy

2010 ◽  
Vol 92 (8) ◽  
pp. 706-709 ◽  
Author(s):  
Kim Davenport ◽  
Francis X Keeley ◽  
Anthony G Timoney
Keyword(s):  
Cost Effectiveness ◽  
Local Anaesthetic ◽  
Past History ◽  
Transitional Cell ◽  
General Anaesthetic ◽  
Patient Anxiety ◽  
Bladder Transitional Cell Carcinoma ◽  
Flexible Cystoscopy ◽  
History Of

INTRODUCTION The aim of this study was to audit our experience of cystodiathermy under local anaesthetic (LA) at the time of flexible cystoscopy for recurrent superficial bladder transitional cell carcinoma (TCC). PATIENTS AND METHODS A total of 264 flexible cystoscopies were performed on patients with a past history of TCC. The number and site of recurrences were recorded and selected patients were offered cystodiathermy. Patient tolerability was noted. At follow-up, any recurrence was recorded. RESULTS Eighty patients (30%) had 91 procedures showing one or more recurrences. Fifty-one of the 80 patients (64%) were treated with cystodiathermy under LA. All completed treatment. Forty-five (88%) tolerated the procedure well. Forty-seven (92%) treatments were completed within 5 min. At a median follow-up of 15 weeks, 30 (59%) treated patients had no recurrence and three (6%) had recurrence at the site of treatment. CONCLUSIONS LA cystodiathermy is an effective and well-tolerated alternative to general anaesthetic cystodiathermy that enables treatment at the time of detection and may, thereby, reduce patient anxiety.

scholarly journals Lung Adenocarcinoma with Cheek Dysesthesia as an Initial Symptom: A Case Report and Literature Review

2019 ◽  
Vol 12 (2) ◽  
pp. 650-656
Author(s):  
Nobuyuki Bandoh ◽  
Haruyuki Ichikawa ◽  
Atsuyoshi Asahi ◽  
Michihisa Kono ◽  
Shohei Harabuchi ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Lung Carcinoma ◽  
Sphenoid Bone ◽  
Initial Symptom ◽  
Pet Ct ◽  
Ct Analysis ◽  
History Of ◽  
Foramen Rotundum ◽  
Fdg Pet Ct ◽  
Egfr Gene Mutation

Metastasis from lung carcinoma to the sphenoid bone is rare. Patients with symptoms related to sphenoid bone metastasis as the initial presentation of carcinoma are thus also rare. Herein, we report the case of a patient presenting with only cheek dysesthesia as the first sign of lung adenocarcinoma. The 74-year-old woman presented with a 2-month history of left cheek dysesthesia. CT showed a tumor around 2.5 cm in diameter with heterogeneous enhancement of the central focus at the left foramen rotundum in the sphenoid bone. We endoscopically biopsied the tumor through the left sphenoid sinus. Results of histologic examination were consistent with lung adenocarcinoma. FDG-PET/CT analysis demonstrated lung carcinoma that had already metastasized to mediastinal lymph nodes and multiple bones, such as the ribs and lumbar vertebras, in addition to the sphenoid bone. As EGFR gene mutation (p.L858R) was identified, the patient was treated with oral gefinitib. This treatment proved quite effective, and the patient remains alive without tumor growth as of 18 months.

scholarly journals A case of remitting hemicrania continua with seasonal variation and clustering: a diagnostic confusion with cluster headache

2019 ◽  
Vol 12 (5) ◽  
pp. e229650
Author(s):  
Sanjay Prakash ◽  
Kalu Singh Rawat
Keyword(s):  
Discrete Series ◽  
Primary Headache ◽  
Complete Response ◽  
Hemicrania Continua ◽  
Therapeutic Trial ◽  
Cranial Autonomic Symptoms ◽  
Unilateral Headache ◽  
Continuous Background ◽  
Diagnostic Confusion ◽  
History Of

Hemicrania continua (HC) is an indomethacin responsive primary headache that is characterised by a continuous strictly unilateral headache with periodic exacerbations. About 15% may have a remitting subtype of HC. Herein, we are reporting a 36-year-old man who had a 5-year history of episodic right-sided headaches. The headaches used to occur in a discrete series lasting 4–6 weeks, separated by pain-free remissions of 10–11 months. In each relapse, he had continuous background pain with superimposed exacerbations. The superimposed exacerbations were 1–2 attacks per day, lasting for 2–5 hours, and were associated with ipsilateral cranial autonomic symptoms. However, the patient did not respond to usual therapies of custer headache (CH). He had a complete response to indomethacin. We suggest that remitting subtype of HC may mimic CH. A therapeutic trial of indomethacin should be done in all strictly unilateral headaches who are not responding to other drugs.

Sign in / Sign up

Export Citation Format

Share Document