Mahvish Muzaffar

Rapidly Progressing Glomerulonephritis Secondary to Henoch-schonlein Purpura Treated With Mycophenolate Mofetil: A Case Report With Atypical Etiology and Presentation

Henoch-Schonlein purpura (HSP) is an acute leukocytoclastic vasculitis that primarily affects children but also affects approximately 1% of adults. We discuss a case of HSP that started after pantoprazole ingestion. Clinical manifestation included terminal ileitis and rapidly progressing glomerulonephritis. To our knowledge, this is the first reported case of HSP secondary to pantoprazole ingestion. The patient presented with renal failure requiring hemodialysis and was initially unresponsive to intravenous pulse steroids. The patient was treated with mycophenolate mofetil, and his renal function recovered. There are limited data regarding use of mycophenolate mofetil for treating crescentic glomerulonephritis secondary to HSP.

Primary CNS lymphoplasmacytic lymphoma: a case report and review of literature.

Lymphoplasmacytic lymphoma is a chronic lymphoproliferative disorder characterized by a proliferation of plasma cells, small lymphocytes, plasmacytoid lymphocytes and the production of monoclonal IgM. Primary central nervous system lymphomas (PCNSL) are rare non-Hodgkin lymphomas (NHL) that can be found in the brain, leptomeninges, eyes or spinal cord, and are mostly intracerebral. PCNSLs constitute 3-4% of primary brain tumors, and in most cases are diffuse large B-cell lymphomas (DLBCL).(1) Low grade lymphomas as primary central nervous system (CNS) lymphoma are very rare. We present here a case report of a woman who presented with headache and was found to have primary intracranial lymphoplasmacytic lymphoma (LPL).

Micafungin-induced thrombotic thrombocytopenic purpura: a case report and review of the literature.

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening multisystem disorder characterized by microangiopathic hemolytic anemia and thrombocytopenia accompanied by microvascular thrombosis that causes variable degrees of tissue ischemia and infarction leading to organ dysfunction. Drug-associated thrombotic thrombocytopenic purpura and hemolytic uremic syndrome has been recognized for several years. The most commonly implicated drugs are mitomycin C, cyclosporine, quinine, clopidogrel, and ticlopidine. Recent advances have suggested that like in idiopathic TTP, the most likely pathogenesis for drug-induced TTP is either an immune-mediated phenomenon involving the ADAMTS13 metalloprotease or direct endothelial toxicity. In this communication, we report a case of micafungin-induced TTP. Micafungin is a new antifungal drug of the Echinocandins group. Whether micafungin induces autoantibodies against ADAMTS13 or not, this needs further evaluation, but TTP should be recognized as a possible complication of micafungin. Clinicians should be alert to this adverse effect of micafungin and monitor platelet counts in patients receiving this drug.

Aggressive posttransplant lymphoproliferative disease in a renal transplant patient treated with alemtuzumab.

Post transplant lymphoproliferative disease (PTLD) is a rare but potentially fatal complication after solid organ transplantation. The risk of PTLD varies with type of organ transplant, Epstein-Barr virus serostatus of the donor and recipient, age, and intensity of immunosuppression. We report a case of a 45-year-old man who developed aggressive PTLD 7 months after receiving a cadaveric renal transplant. He received 30 mg alemtuzumab intravenously intraoperatively as induction immunosuppression followed by maintenance immunosuppression with tacrolimus and mycophenolate mofetil. The patient presented with intestinal perforation and gastrointestinal bleeding. Histopathology revealed Epstein-Barr virus-positive diffuse large B-cell lymphoma with a high mitotic index involving multiple segments of small and large intestines and leading to perforation of the ileum, jejunum, and cecum. The patient had Stage IV disease and treatment consisted of immunosuppression reduction and 375 mg/m2 rituximab weekly for four doses. Unfortunately, the patient had recurrent intestinal perforation followed by fatal gastrointestinal bleeding. There have been very few case reports of PTLD after alemtuzumab induction in renal transplant and the case discussed had simultaneous multiple perforations in the small intestine and colon.

Acute Pancreatitis Associated With Ado-Trastuzumab Emtansine.

Ado-trastuzumab emtansine (T-DM1) is a novel antibody-drug conjugate with current FDA recommendation for second-line treatment of HER-2-positive metastatic breast cancer. It is a human epidermal growth factor receptor (HER-2)-targeted antibody-drug conjugate composed of trastuzumab, a stable thioether linker, and the potent cytotoxic agent DM1 (derivative of maytansine). Ado-trastuzumab emtansine improved both progression-free and overall survival as reported in EMILIA trial. With ongoing clinical trials in adjuvant and first-line setting for HER-2-positive early and metastatic breast cancer, it is prudent to recognize, report, and treat any adverse events related to T-DM1. We report a case of acute pancreatitis in a 54-year-old woman with metastatic breast cancer after she received her first dose of ado-trastuzumab emtansine. To the best of our knowledge, this is the first reported case of acute pancreatitis with probable association with ado-trastuzumab emtansine.

Association of hyperplastic polyposis syndrome, colorectal cancer and meningioma

Recent research has provided compelling evidence that a subset of hyperplastic polyps may be associated with a risk of colorectal cancer. Colorectal cancer with extracolonic manifestation is usually seen in a hereditary syndrome setting, but some association with meningioma has been reported. The association of colorectal cancer with hyperplastic polyposis and meningioma is extremely rare. This report in a 57-year-old female with no family history of colon cancer or polyps, could be the first case of hyperplastic polyposis syndrome, colorectal cancer and meningioma. Hyperplastic polyposis syndrome was diagnosed as per WHO criteria at the time of colon cancer diagnosis. Within 4 months of colon cancer diagnosis she developed seizures. Imaging of the brain revealed meningioma of the left cerebellopontine angle. The patient underwent surgery followed by chemotherapy.