Hafez Mohammad Ammar Abdullah

Small cell cancer is an aggressive neoplasm of neuroendocrine origin that is most commonly found in the lungs. However, up to 5% of cases can be extrapulmonary. These have been reported to be located in the gastrointestinal and genitourinary systems and rarely in other locations. Only five prior cases of small cell cancer have been reported where the primary lesion is at the adrenal gland. Here we present the case of a female patient in her mid-50s who presented with right upper quadrant pain and was diagnosed with metastatic small cell carcinoma of the adrenal gland. The patient received palliative chemotherapy for her metastatic cancer and was ultimately admitted to hospice after progression of her disease. This case and the accompanying literature review highlight a rare manifestation of extrapulmonary small cell cancer.

Mohamed A. Abdallah, Kimberlee Bohy, Ashwani Singal, Chencheng Xie, Bhaveshkumar Patel, Morgan E. Nelson, Jonathan Bleeker, Ryan Askeland, Ammar Abdullah, Khalil Aloreidi, Muslim Atiq. Ann Hepatobiliary Pancreat Surg 2022;26:91-7. https://doi.org/10.14701/ahbps.21-111

Yersinia enterocolitica is a Gram-negative coccobacillus that is known to cause gastroenteritis and symptoms mimicking appendicitis or terminal ileitis. It is also one of the culprit infections implicated in causing reactive arthritis. Rarely, it can cause musculoskeletal infections including osteomyelitis, septic arthritis, and discitis. We describe the case of a 70-year-old female with multiple comorbidities who presented with left knee pain and swelling after recent gastroenteritis. She was found to have Yersinia enterocolitica septic arthritis in her left knee prosthetic joint. The patient underwent an exchange of her prosthetic material and was successfully treated with a six-week course of ceftriaxone. Our article aims to highlight a rare manifestation of Yersinia enterocolitica infection and to point out an important differential for reactive arthritis after Yersinia enterocolitica infection.

Background: Hemophagocytic Lymphohistiocytosis (HLH) is an aggressive and life threatening clinical syndrome that involves the rapid and excessive activation of the immune systems. It is associated with many conditions including infections, rheumatologic and autoimmune conditions, and drug-induced especially from chemotherapy. However, HLH associated with malignancy has especially poor outcomes. In this study we aim to investigate the clinical predictors of outcomes in patients who were admitted with malignancy associated HLH. Methods: The National Inpatient Sample (NIS) was queried for all hospitalizations with a primary diagnosis of Hemophagocytic Lymphohistiocytosis from 2011 to 2017 using ICD-9-CM code 288.5 and ICD-10-CM code D 76.1. We looked at the most common malignancies associated with HLH. We also examined the most common comorbidities in this patient population. We analyzed the relation of different malignancies and co-morbidities with adverse outcomes, primarily the mortality rate. Data was analyzed using SPSS 27.0 Results: A total of 650 patients were identified during this studied time period who were admitted for malignancy associated with HLH. The mean age of this patient population was 52.41 years. Amongst these patients n=431 (66.7%) were males and the rest were females. By far the most common malignancy associated with HLH included Lymphomas, which were present in n=483 (74.3%) patients. Non-Hodgkin's Lymphoma was much more common and present in n=431 (66.3%) patients, while Hodgkin's Lymphoma was present in n=56 (8.6%) of the patients. The other common malignancies included various leukemias n= 129 (19.8%), including AML n=35 (5.4%), ALL n=20 (3.1%), and CML n= 35 (5.4%), and solid tumors n=36 (5.4%), including lung cancer n=9 (1.4%) ,Breast Cancer n=9 (1.4%), and GI cancers n=10 (1.5%). The most common comorbidities present in this HLH population included hypertension n=169 (26%), weight loss/malnutrition n=150 (23.5%), Kidney disease n=70 (10.8%), Diabetes n=97 (14.9%), heart failure n=55 (8.5%) liver disease n=72 (11.1%), rheumatologic disorders n=33 (5.1%) and obesity n=28 (4.3%). The main patient outcome assessed was inpatient mortality. The overall inpatient mortality was 24.6 % in this patient population. In those patients who died, the odds of having bone and soft tissue cancer was the highest (odd ratio of 2.24). The odds ratio for other malignancies included AML (OR=2.12), Hodgkin's Lymphoma (OR=1.21), Multiple Myeloma (OR=1.20), CLL (OR=0.89), NHL (OR=0.79), Breast cancer (OR=0.3). In those patient who died, the odds of having various comorbidities was the highest for liver disease (OR=2.7), alcohol abuse (OR=2.6), coagulopathy (OR=2.4), weight loss (OR=1.91), heart failure (OR=1.5), pulmonary disease (OR=1.31) and renal disease (OR=1.31). Conclusion: HLH is an aggressive clinical syndrome that is rarely associated with various malignancies. Analysis of the National Inpatient Sample (NIS) data from hospital admissions in the United States shows that it is more common in males (66.7%). Despite advances in medical treatments the mortality is around 24.6%. By far the most common malignancy reported in this patient population is Non-Hodgkin's lymphoma that is present in (66.3%) of this patient population. Worse mortality rates were associated with patients who had underlying bone and soft tissue cancer, AML, Multiple Myeloma, and Hodgkin's lymphoma. Comorbidities including liver disease, alcohol abuse, coagulopathy, heart failure, and renal disease were also associated with worse mortality rates. Disclosures: Anwer: BMS / Celgene: Honoraria, Research Funding; Janssen pharmaceutical: Honoraria, Research Funding; GlaxoSmithKline: Research Funding; Allogene Therapeutics: Research Funding.

Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the United States. It has a variable presentation with most patients having asymptomatic lymphocytosis. Many other patients present with lymphadenopathy or enlargement of other organs of the reticuloendothelial system. However, CLL can present with extramedullary involvement. Most commonly, this is in the form of skin or central nervous system involvement, though rarely it can present with gastrointestinal involvement. Here, we present the case of a 70-year-old Caucasian male who presented with chronic diarrhea for over 4 months. After failing conservative treatment, a colonoscopy was performed which showed diffuse mucosal nodularities with a biopsy revealing CLL. The patient was treated successfully with chemotherapy and his diarrhea improved. This is a differential to keep in mind in patients with chronic diarrhea, once the more common causes have been ruled out.

The Brugada pattern is identified on the EKG by a coved ST-segment elevation accompanied by a negative T wave in the early precordial leads in the absence of a cardiac structural abnormality. Bruga...

Amiodarone is an antiarrhythmic agent that is associated with many adverse effects, the most common being pulmonary manifestations. Interstitial pneumonitis is one of the most common complications, however rarely amiodarone can cause diffuse alveolar haemorrhage (DAH) too. We describe the case of a 73-year-old woman who presented with shortness of breath and haemoptysis 4 days after starting amiodarone. She was diagnosed with amiodarone-induced DAH based on imaging and bronchoalveolar lavage. She was treated with intravenous and then oral steroids, and amiodarone was discontinued. The patient made a significant clinical and radiological recovery. She was discharged 10 days after her presentation. This case highlights a rare but potentially life-threatening complication of a commonly used medication.