Calciphylaxis, also referred to as calcific uremic arteriolopathy, is a rare, life-threatening cutaneous systemic disease that typically occurs in the setting of end-stage renal disease (ESRD). ESRD is the most recognized risk factor for calciphylaxis but it is not the sole risk factor. Calciphylaxis has also been associated with liver cirrhosis with or without concurrent renal disease. The current case describes a patient who developed calciphylaxis in the setting of hemodialysis, liver cirrhosis, and atrial fibrillation managed with warfarin therapy, all risk factors for calciphylaxis. The need for alternatives to warfarin therapy, specifically in patients with atrial fibrillation on hemodialysis for ESRD who are at increased risk for calciphylaxis, is discussed. Specifically, the left atrial appendage occluder device is described and the need for interdisciplinary management of these patients is stressed.
ABSTRACT Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a teledermatology case of bullous impetigo.
Drug-induced autoimmunity occurs when exposure to a causative agent leads to serologic or clinical autoimmune responses. Syndromes that may be associated with drug-induced autoimmunity include antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) and drug-induced lupus (DIL). When drug-induced autoimmunity involves the kidney, histological patterns of injury include pauci-immune glomerulonephritis (GN), which occurs with AAV, and immune complex-mediated GN, which is associated with DIL. We present a case of hydralazine-induced dual ANCA-positive vasculitis and nephritis.
Carotid body tumors (CBT) are a rare form of paragangliomas of the head and neck. They are described as rare, slow-growing, mostly benign, clinically silent tumors of neural crest cells. This tumor should be considered as a differential diagnosis when evaluating a lateral neck mass. A report of a rare case, a carotid body tumor, is presented that was incidentally noted as a lateral neck mass during a screening sonogram. A mass located at the level of the left carotid bifurcation demonstrated significant vascular flow with the use of contrast enhanced ultrasound (CEUS) techniques. Computed tomography angiography (CTA) was also performed to further analyze the tumor’s anatomical relation to the extra cranial vessels.
Acute limb ischemia is defined as a sudden and rapidly progressing decrease in limb perfusion, usually producing new or worsening symptoms or signs, and often threatening limb viability. Acute limb ischemia is most commonly caused by an acute thrombotic occlusion of a preexisting stenotic arterial segment (60% of cases) or by embolus (30%). Prompt diagnosis and urgent medical and percutaneous/surgical interventions are warranted. If not identified and addressed immediately, decreased perfusion and thrombosis can result in a high degree of limb loss–related morbidity. This report focuses on a rare case of an acute lower extremity ischemia following a lower extremity femoral vein access site–related intervention.
Pertuzumab significantly improved the rates of invasive-disease-free survival among patients with HER2-positive, operable breast cancer when it was added to trastuzumab chemotherapy.Pertuzumab is a HER2/neu receptor antagonist is indicated by Food and Drug Administration for: 1) Use in combination with trastuzumab and docetaxel for treatment of patients with HER2positive MBC who have not received prior anti-HER2 therapy or chemotherapy for metastatic disease; or 2) Use in combination with trastuzumab and docetaxel as neoadjuvant treatment of patients with HER2-positive, locally advanced, inflammatory, or early stage breast cancer (either greater than 2 cm in diameter or node positive) as part of a complete treatment regimen for early breast cancer.Pertuzumab use can be associated with cardiac-related adverse events, including CHF and decline in LVEF.Patients should be screened into low and high-risk categories.Prior to initiating this combination therapy, a detailed clinical history of cardiovascular risk factors is indicated along with protocol-driven periodic TTE monitoring during therapy.
Calcinosis cutis refers to the deposition of calcium salts in the cutaneous and subcutaneous tissue and is frequently associated with inflammation. Gastric calcinosis can be classified into metastatic, dystrophic, and idiopathic; metastatic calcinosis is the most common type. In metastatic calcification, calcium salts are deposited in normal soft tissues in the setting of altered metabolism of serum calcium and phosphorus and is a rare and serious complication of chronic renal failure. The important factors contributing to the development of metastatic calcinosis are hypercalcemia, hyperphosphatemia, and an elevated calcium-phosphate product. The most striking feature of this diagnosis is the calcification around the large joints. While it mostly involves dermis of small and medium-sized vessels, it can rarely affect the mucosal layers of the gastrointestinal (GI) tract. Calcinosis presents as a marker for the presence of calcifications in other organs, such as heart or lung, which can be life-threatening. Patients rarely present with clinical symptoms of GI upset, dyspepsia, or epigastric pain that are attributed to calcinosis. If patients present with GI symptoms, infectious causes remain to be higher on the differential. We present a case of incidental finding of gastric mucosal calcinosis during the workup and treatment of dysphagia.
