Unicentric Castleman Disease and Pheochromocytoma

Castleman disease is an uncommon and heterogenous lymphoproliferative disorder which is classified as unicentric or multicentric depending on the number of lymph nodes involved. Each type has a different clinical presentation, aetiology, treatment and prognosis. We report the case of a young woman who presented with cervical lymphadenopathy and a retroperitoneal mass, and was diagnosed with unicentric Castleman disease and pheochromocytoma. We describe the diagnostic steps, the complications that developed, and the importance of the differential diagnosis in the evaluation of these patients.

Primary Adrenal Lymphoma: When B Symptoms Appear Hand in Hand with Adrenal Masses

Primary adrenal lymphoma (PAL) is a very rare type of non-Hodgkin’s lymphoma (NHL). Herein, we report a case of NHL of both adrenal glands in a 69-year-old man. The patient was admitted because of a 1-month history of B symptoms and symptomatic hypotension. Biochemical analysis showed normocytic normochromic anaemia, hyponatraemia, hyperkalaemia, and elevated lactate dehydrogenase, C-reactive protein and D-dimers. A computed tomography scan revealed bilateral enlargement of the adrenal glands. There was no evidence of endocrine adrenal dysfunction. The mass in the right adrenal gland was biopsied and histopathology identified a diffuse large B-cell lymphoma of the activated B-cell subtype. A positron emission tomography 18F-fluorodeoxyglucose scan showed intensive hypermetabolic lesions involving both adrenal glands, as well as other locations, with higher uptake in the adrenal glands. Taken together, these findings suggested the diagnosis of PAL. The patient responded favourably to debulking therapy and is currently undergoing chemotherapy.

Severe Persistent Eczema in a Recipient of the Gam-COVID-Vac vaccine

Since the beginning of the COVID-19 pandemic, efforts have been made to design safe and effective vaccines against SARS-CoV-2. Numerous vaccines have been designed and tested in limited clinical trials in various countries. Among them, the Sputnik V vaccine has shown a relatively safe profile and, to our knowledge, has no associated major side effects. We describe the case of a 40-year-old female healthcare worker who developed severe persistent eczematous lesions on the second day after she received the first dose of the Sputnik vaccine. The eczematous lesions were refractory to an antihistamine and persisted at the 1 month follow-up. Severe persistent eczematous lesions should be viewed as a potential side effect of vaccination with the Sputnik V vaccine. Moreover, a severe allergic reaction to a COVID-2019 vaccine may indicate the vaccine is ineffective in the recipient.

A Severe Case of Molluscum Contagiosum Immune Reconstitution Inflammatory Syndrome in a Patient with Human Immunodeficiency Virus

Paradoxical immune reconstitution inflammatory syndrome (IRIS) in human immunodeficiency virus (HIV)-positive patients initiating antiretroviral treatment (ART) is caused by restored immunity to specific antigens, resulting in worsening of a pre-existing infection. Molluscum contagiosum (MC) is commonly noted in HIV-positive individuals but ART alone is usually sufficient to bring about resolution. We present a rare case of severe MC-IRIS that worsened despite immune reconstitution.

Secukinumab, Pituitary Enlargement and Panhypopituitarism: Are They Related?

Pituitary adenomas represent the most common etiology of hypopituitarism associated with a pituitary enlargement, but other causes have been emerging, namely immune checkpoint inhibitors-induced hypophysitis (ipilimumab, nivolumab and pembrolizumab). Secukinumab is a recently approved human monoclonal antibody used for the treatment of psoriasis, with no know reported cases of hypophysitis. We describe a challenging case of panhypopituitarism in a patient with a pituitary incidentaloma and a timing relationship between secukinumab initiation and the manifestation of clinical features suggestive of hypopituitarism. In such intricate work-up, differential diagnosis should be carefully equated, taking into account the therapeutic and prognostic implications.

Misdiagnosis of Rectus Abdominis Abscess Owing to Delayed Contrast-Enhanced Computed Tomography

A 77-year-old man, who was on anticoagulation, presented with a painful lump on the right abdominal wall. Laboratory tests showed slight anaemia and elevated inflammatory markers. Abdominal plain computed tomography (CT) revealed a mass in the right rectus abdominis muscle. He was admitted with a diagnosis of primary rectus abdominis haematoma. However, on the next day, the diagnosis was corrected to primary rectus abdominis abscess, following contrast-enhanced CT of the abdomen. This case illustrates the importance of considering primary rectus abdominis abscess in patients with suspected primary rectus abdominis haematoma, and contrast should be used when performing CT.

Infected Cavitations, Bullae and Interstitial Lung Disease in a COVID-19 Patient in Lima, Peru

A 48-year-old Peruvian man was diagnosed with COVID-19 in December 2020. His infection resolved and he was discharged from hospital after 14 days. However, 1 week later he presented with haemoptysis, malaise, pleuritic pain, infected cavitations, bullae, extensive interstitial lung disease and pneumomediastinum. He recovered after antibiotic treatment and was discharged after 8 days. His symptoms may have been due alveolar rupture due to persistent cough during and after diffuse inflammation of the lung parenchyma caused by COVID-19 infection.

IgG4-Related Disease Affecting Testicle and Myelodysplastic Syndrome: Just a Coincidence?

Immunoglobulin G4-related disease (IgG4-RD) is progressive immune-mediated fibrotic condition characterised by a tendency to form tumefactive lesions in different organs and by elevated IgG4 serum concentrations. Urological manifestations are rare and normally occur together with other systemic affections. Myelodysplastic syndromes (MDS) are hematopoietic stem cell neoplasms, with different subtypes based on the type of blood cells involved. MDS can be associated with other pathologies or medical treatments. We present an uncommon case of testicular manifestation associated with myelodysplastic syndrome here.

Masson’s Tumour: A Rare Cause of Cervical Mass

Masson's tumour, also known as intravascular papillary endothelial hyperplasia, is a rare non-neoplastic lesion of vascular origin, caused by an excessive reactive proliferation of endothelial cells in normal blood vessels or vascular malformations. It can affect any part of the body, presenting most frequently in the vessels of the head, neck and upper extremities. The authors describe the case of a 76-year-old female patient presenting an anterior cervical mass, measuring 2×2 cm, which was mobile, tender and slightly painful with no alteration of the overlying skin. Complementary study with ultrasound and computed tomography was inconclusive. Total excision of the lesion was performed with histology compatible with intravascular papillary endothelial hyperplasia.

Severe Hypertriglyceridaemia Leading to Factitious Hypobicarbonataemia

Anion gap metabolic acidosis is a laboratory finding commonly encountered in patients with sepsis, diabetic ketoacidosis, acute kidney injury and toxic alcohol ingestion. Serum blood chemistry assessment detects this abnormality. However, this can be falsely low in situations of high triglyceride levels due to lipid interference with measurement of the bicarbonate levels and through volume displacement by these large molecules. Arterial blood gas analysis and a lipid panel are required to confirm accurate bicarbonate levels. Clinicians handling acid-base disorders in hospitalized patients need to be aware of this spurious laboratory value to avoid unnecessary tests and to determine accurate total bicarbonate levels.