Padmanabhan Krishnan

The use of vasopressin in the setting of recalcitrant hypotension due to calcium channel blocker overdose

Treatment of hypotension caused by calcium channel blocker overdose (CCB) remains a challenge. We describe the successful use of vasopressin in two patients with massive CCB overdoses in whom hypotension was unresponsive to calcium, glucagon, insulin, and conventional vasopressor therapies. While various modes of treatments have been used to treat the hypotension of CCB overdose, this is the first report to our knowledge of the successful use of vasopressin in this clinical setting.

Hypercalcemia-leukocytosis syndrome in a patient with cavitating squamous cell carcinoma of the lung

IntroductionLung cancer is the leading cause of death among the cancers seen in the United States. Hypercalcemia and leukocytosis are two common paraneoplastic syndromes associated with lung cancer. Unfortunately patients presenting with Hypercalcemia- leukocytosis syndrome has a worse prognosis than patients presenting with lung cancer alone.Case presentationWe present a 67 yr old Caucasian male with a history of active smoking presenting as pneumonia being diagnosed as cavitating squamous cell carcinoma of the lung with hypercalcemia-leukocytosis syndromeConclusionThere should be a high degree of suspicion to diagnose lung cancer in patients presenting with symptoms of paraneoplastic syndrome.

Central Bronchiectasis in Allergic Bronchopulmonary Aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA), seen in 3% to 5% of the asthmatic population, is a hypersensitivity disease of the lungs characterized by a type I, type III, and type IV allergic response to Aspergillus antigens, almost always to that of A. fumigatus. If untreated, permanent lung damage in the form of bronchiectasis and fibrosis ensues. Recurrent pulmonary opacities on chest radiography, peripheral blood eosinophilia, and refractory asthma should raise suspicion for ABPA. A positive skin test for A. fumigatus and elevated levels of serum IgE strongly suggest the diagnosis of ABPA. The demonstration of central bronchiectasis is also highly suggestive of ABPA, particularly when high attenuation mucoid impaction is encountered. Corticosteroid therapy remains the cornerstone of treatment.