Prasanta Basak

Nephrogenic systemic fibrosis: Current concepts

Nephrogenic systemic fibrosis (NSF) was first described in 2000 as a scleromyxedema-like illness in patients on chronic hemodialysis. The relationship between NSF and gadolinium contrast during magnetic resonance imaging was postulated in 2006, and subsequently, virtually all published cases of NSF have had documented prior exposure to gadolinium-containing contrast agents. NSF has been reported in patients from a variety of ethnic backgrounds from America, Europe, Asia and Australia. Skin lesions may evolve into poorly demarcated thickened plaques that range from erythematous to hyperpigmented. With time, the skin becomes markedly indurated and tethered to the underlying fascia. Extracutaneous manifestations also occur. The diagnosis of NSF is based on the presence of characteristic clinical features in the setting of chronic kidney disease, and substantiated by skin histology. Differential diagnosis is with scleroderma, scleredema, scleromyxedema, graft-versus-host disease, etc. NSF has a relentlessly progressive course. While there is no consistently successful treatment for NSF, improving renal function seems to slow or arrest the progression of this condition. Because essentially all cases of NSF have developed following exposure to a gadolinium-containing contrast agent, prevention of this devastating condition involves the careful avoidance of administering these agents to individuals at risk.

Recurrent lower gastrointestinal bleeding due to primary colonic Kaposi's sarcoma in a patient with AIDS

Epidemic Kaposi’s sarcoma remains the most common cancer in patients with human immunodeficiency virus and is associated with significant morbidity and mortality in AIDS patients. Primary visceral Kaposi’s sarcoma (Kaposi’s sarcoma without cutaneous lesions) presenting with lower gastrointestinal bleeding (LGIB) has rarely been reported. Though Kaposi’s sarcoma can occur anywhere in gastrointestinal tract, gastrointestinal symptoms are often non-specific such as chronic blood loss anaemia, vomiting, diarrhoea, intestinal obstruction. In these patients, severe gastrointestinal bleeding requiring repeated blood transfusions is extremely rare. Clinicians should be aware of gastrointestinal tract Kaposi’s sarcoma since visceral Kaposi’s sarcoma can present in the absence of cutaneous involvement. Endoscopy with biopsy is useful in the diagnosis for severe LGIB in patients with AIDS. Furthermore, gastrointestinal Kaposi’s sarcoma should be considered in the differential diagnosis of GI bleeding. We report a case of primary colonic KS who presented with recurrent GI bleeding which was eventually diagnosed by sigmoidoscopy and confirmed pathologically.

Life-threatening hypoglycemia with moxifloxacin in a dialysis patient

269 2012 52 269-271 Fluoroquinolones are one of the most commonly used antibiotics in inpatient and outpatient settings. They are generally considered safe with relatively few adverse effects and drug–drug interactions. Hypoglycemia is a rare but well-documented side effect of fluoroquinolones and is usually seen when they are used along with oral hypoglycemic drugs in diabetic and elderly patients. Hypoglycemia with gatifloxacin and ciprofloxacin has been reported, and fatal cases have recently been reported with levofloxacin. Hypoglycemia with moxifloxacin has not been reported to date. We report a case of moxifloxacininduced life-threatening hypoglycemia in a nondiabetic patient with end stage renal disease. A 69-year-old nondiabetic male with end stage renal disease on hemodialysis was admitted with a diagnosis of community-acquired right lower lobe pneumonia. He was started on moxifloxacin 400 mg intravenous daily. He responded well to antibiotic therapy with improvement of cough, fever, reduced phlegm, and improving leucocytosis. On day 3 of his hospital stay, he was found to be unresponsive to verbal and tactile stimuli. No facial asymmetry, tongue bite, or neck rigidity were noted, and both pupils were equal and reactive to light. Computed tomography (CT) scan of the head, cardiac enzymes, blood gases, serum electrolytes, blood count, and electroencephalogram were negative. Profound hypoglycemia with serum glucose 15 mg/dL was detected at the time of the acute event. He received intravenous dextrose and his mental status returned to baseline. During the next 24 hours, he received 6 intravenous boluses of 50% dextrose as his finger stick blood sugars were consistently below 70 mg/dL. On day 4, he was started on 10% dextrose and his blood sugar stabilized between 110 to 150 mg/dL. On day 5, he was taken off the dextrose drip because of his dialysis dependence and fluid status. Soon after stopping the dextrose infusion, his blood sugars dropped to 58 mg/dL and remained low necessitating multiple boluses of 50% dextrose again. Moxifloxacin was also discontinued after he got the scheduled dose on day 5. On day 6, his blood sugars started to improve and stabilized between 130 to 220 mg/dL from day 7 until his discharge. Regular hemodialysis was continued throughout his hospital stay.

Secondhand Smoke Exposure Among Community-Dwelling Adult Cancer Survivors in the United States: 1999–2012

Background: Little is known about the prevalence of secondhand smoke exposure (SHSe) among cancer survivors. We sought to determine the prevalence, trends, and correlates of SHSe among nonsmoking adult cancer survivors in the United States. Methods: Interview and serum cotinine data for nonsmoking adults, age 20 years and older, with a history of cancer (N = 686) were obtained from consecutive two-year cross-sectional cycles of the National Health and Nutrition Examination Survey from 1999 to 2012. SHSe was defined as serum cotinine 0.05–10 ng/mL among nonsmokers. We calculated and trended the prevalence of SHSe among nonsmoking cancer survivors. Multivariable logistic regression was used to examine the associations of SHSe with sociodemographic, smoking, and clinical characteristics. Survey weights were applied in estimating prevalence rates, adjusted ORs, and confidence intervals (CI). Results: The weighted aggregate SHSe and self-reported indoor SHSe prevalence rates over the study period were 28.26% (95% CI: 24.97%–31.55%) and 4.53% (95% CI: 3.48%–5.57%), respectively. SHS exposure declined from 39.61% (95% CI: 27.88%–51.34%) in 1999/2000 to 15.68% (95% CI: 9.38%–21.98%) in 2011/2012 (Ptrend < 0.001). Age ≥ 60 years was protective against SHSe, while being black, having less than high school education, poverty, and a smoking-related cancer history were associated with higher odds of SHSe. Conclusions: Fortunately, SHSe among nonsmoking cancer survivors in the United States is on the decline, although certain subgroups remain disproportionately burdened. Impact: These findings highlight clinical and public health imperatives to target socioeconomically disadvantaged nonsmoking cancer survivors to reduce their SHSe. Cancer Epidemiol Biomarkers Prev; 26(8); 1296–305. ©2017 AACR.

Diffuse large B cell lymphoma with central pontine myelinolysis

Introduction: Diffuse large B cell lymphoma is the most common type of non-Hodgkin, lymphoma among adults, with an annual incidence of 7–8 cases per 100, 000 people per year. Case Report: We report a case of diffuse large B cell lymphoma with isolated splenomegaly, complicated by central pontine myelinolysis. Solitary splenic non-Hodgkin’s lymphoma is rare; with an incidence less than 1%. Treatment of diffuse large B cell lymphoma led to the resolution of the pontine lesion. The association of central pontine myelinolysis with diffuse large B cell lymphoma is exceedingly rare, with only one case report published till date. Conclusion: Diffuse large B cell lymphoma presenting as isolated splenomegaly is rare and can be a diagnostic challenge. The association of central pontine myelinolysis with diffuse large B cell lymphoma is rare and the possibility that central pontine myelinolysis could be an early manifestation of lymphoma or a paraneoplastic syndrome needs to be further explored.

Co-trimoxazole is useful in community acquired MRSA cellulitis

Phoenix and colleagues confirm that doxycycline, minocycline, and clindamycin are effective drugs in treating community acquired meticillin resistant Staphylococcus aureus (CA-MRSA) cellulitis,1 but co-trimoxazole …