1.
Chronic Myeloid Leukemia Associated Hypercalcemia: A Case Report and Literature Review.
Toro-Tobón, D, Agosto, S, Ahmadi, S, Koops, M, Bruder, JM
The American journal of case reports. 2017;:203-207
Abstract
BACKGROUND Hypercalcemia associated with chronic myeloid leukemia (CML) is an ominous sign. Although rare, several cases have been reported and multiple pathophysiologic mechanisms have been independently proposed. We present a patient case and a literature review of the clinical presentation and mechanisms of CML-associated hypercalcemia. CASE REPORT A 58-year-old male with a past medical history of CML diagnosed six years earlier, presented to the emergency department with one week of acute confusion, disorientation, polyuria, and polydipsia. On physical examination, we observed tachycardia, altered mental status, and dehydration. Blood analysis revealed leukocytosis, thrombocytosis, and marked hypercalcemia (18.6 mg/dL). His chest CT scan showed diffuse lytic lesions and bone destruction concerning for diffuse bone marrow involvement. The patient was diagnosed with hypercalcemia in the context of a CML blast phase. Treatment with hydration, calcitonin, and zoledronic acid lead to control of his symptoms and normalization of his serum calcium levels. After discharged, the patient was maintained on palliative treatment and zoledronic acid management without new episodes of hypercalcemia. However, eight months later, the patient died. CONCLUSIONS Evidence from the literature demonstrates a highly variable clinical presentation of CML-associated hypercalcemia, commonly occurring during an accelerated or a blast phase, and associated with poor survival. Multiple mechanisms could be involved and are not exclusive of each other. Better understanding of the pathophysiologic mechanisms involved in CML-associated hypercalcemia could lead to improvement in clinical and laboratory evaluation of these patients and be the foundation for the development of better management strategies and possibly target-directed therapy to positively improve prognosis.
2.
Adding Water to the Mill: Olmesartan-Induced Collagenous Sprue-A Case Report and Brief Literature Review.
Desruisseaux, C, Bensoussan, M, Désilets, E, Tran, HK, Arcand, R, Poirier, G, Wisniewski, A, Manière, T
Canadian journal of gastroenterology & hepatology. 2016;:4837270
Abstract
Collagenous sprue (CS) is a distinct clinicopathological disorder histologically defined by a thickened subepithelial band (Freeman, 2011). It is a rare condition which has been recently observed in a significant proportion of sprue-like enteropathy associated with olmesartan, a novel entity described by Rubio-Tapia et al. in 2012. CS is historically associated with a poor prognosis (Marthey et al., 2014). However, histological and clinical improvements have been described in most studies with concomitant usage of corticosteroids and/or gluten-free diet (Marthey et al., 2014). We report a unique case of olmesartan-induced collagenous sprue in a 79-year-old man that showed complete histological and clinical remission with the sole withdrawal of the incriminating drug. The literature on this topic is briefly reviewed.
3.
Pediatric Visine (tetrahydrozoline) ingestion: case report and review of imidazoline toxicity.
Daggy, A, Kaplan, R, Roberge, R, Akhtar, J
Veterinary and human toxicology. 2003;(4):210-2
Abstract
Visine, an over-the-counter, tetrahydrozoline topical ophthalmic decongestant, possesses central and peripheral alpha2-adrenergic properties. We present a case of accidental pediatric oral exposure with resultant neurological and cardiovascular complications. Visine is not marketed in childproof containers, despite the potential severity of an accidental ingestion. Over-the-counter medications with potent pharmacological properties should be stored in areas out of the reach of children, and manufacturers should package these products in childproof containers.