Year 2021, Volume 5 - Issue 4

Background: Warfarin is affected by many variables such as diet, alcohol, and medications; however, it is unclear if brand to generic conversion may also play a role. This case reports a patient with fluctuating international normalized ratio (INR) while being switched from brand to generic temporarily. Case Presentation: A 60-year-old obese white male taking brand name Jantoven© (warfarin) at home for 9 years at a consistent dose for atrial fibrillation was in hospital for treatment of cellulitis. He was switched to generic warfarin at his home dose on admission. While in hospital, he required dose escalation to three times his home dose to achieve a therapeutic INR. Conclusion: Generic warfarin may have different effects on INR when compared to brand name Jantoven©. More research is warranted to determine if differences may truly exist and potential ways to address the issue. Until then, providers should be cognizant of interchanging the two products to monitor for INR variation.

Background: Primary cutaneous malignant melanoma with gastric metastases is a rare phenomenon, which usually occurs within one year from the time of the primary tumor diagnosis. In this case, the diagnosis of primary melanoma was 8 years prior to gastric metastases diagnosis. Case Presentation: A 75-year-old male with a history of malignant melanoma presented with ferropenic anemia was found to have metastases to the stomach, detected on endoscopy. A Palliative Subtotal Gastrectomy was performed because of recurrent gastrointestinal bleeding. After surgery, the patient was referred to our oncology clinic for chemotherapy. Conclusion: Surgical intervention offered symptomatic relief while attempting to prolong the patient’s survival. Most publications on this topic are limited to single case-reports given the low frequency of gastric lesions in patients with primary cutaneous melanoma. This case report contributes to the understanding of this rare phenomenon while reaffirms that Metastatic Melanoma in the stomach should be suspected in any patient with a previous history of Melanoma.

Background: Bardet-Biedl Syndrome (BBS) is a rare autosomal ciliopathy disorder caused by mutations in genes encoding the proteins localized in primary cilia or basal body complex resulting in derangement of functions of various systemic organs containing cilia. The syndrome is characterized by classic phenotype features. Renal failure is a major cause of morbidity and mortality in these patients and early detection offers disease management benefit. Case Presentation: We report for the first time in India, a case of BBS in advanced renal failure chronic kidney disease due to mutation in BBS12 gene, confirmed by next-generation sequencing. We also present clinical data, molecular genetics, and treatment of BBS. Conclusion: Early diagnosis will help in the management of renal failure, thereby progression of the disease may be retarded. Further genetic mutations in all BBS genes can be studied by routine genotyping of all patients and followed up clinically.

Background: Glucagonoma is a rare functional pancreatic neuroendocrine tumor. Necrolytic migratory erythema (NME) is a paraneoplastic manifestation of glucagonoma and is often the first presenting symptom. The misdiagnosis of this rare entity can affect the patient’s quality of life and his life expectancy. Case Presentation: We report a case of a 48-year-old man presenting with pruritic scaly rash, ulcerated skin lesions, and periorbital edema, who was diagnosed and treated for atopic eczema for a 7-year period. Despite treatment, his dermatitis and general conditions progressively worsened, until he was admitted to the emergency department due to weight loss and fatigue. An uncontrolled diabetes was found and the computer tomography scan of the abdomen revealed a tumor located in the tail of the pancreas with liver metastases. Subsequently, liver biopsy and high levels of glucagon confirmed the diagnosis of glucagonoma. The patient was treated with short-acting subcutaneous octreotide for 2 weeks and then with intramuscular slowrelease octreotide every 28 days, with a significant improvement of the symptoms. Conclusion: This case provides further knowledge about NME, since a timely recognition and treatment of this misleading disease can prevent morbidity from the dermatitis and mortality from the malignancy itself.

Background: Acute promyelocytic leukemia is a subtype of acute myeloid leukemia most noted for a high rate of cure with prompt treatment and high early mortality if unrecognized, typically presenting with symptoms of bone marrow failure and lifethreatening coagulopathy. Case Presentation: We report the case of a patient who was found to have this unexpected diagnosis during workup of persistent back pain following a fall. In this example, the incidental finding of abnormal bone marrow signal on magnetic resonance imaging prompted a bone marrow biopsy which confirmed the diagnosis. Conclusion: This case highlights the significance and emerging role of imaging techniques in identifying abnormalities in the bone marrow which may provide the initial clues and support the timely diagnosis of hematological malignancies.

Background: Craniofacial teratoma is a rare congenital malformation. We present a case of an intracranial expanding orofacial teratoma, where pathological examination revealed the findings of remarkable ultrasonographic signs and magnetic resonance imaging (MRI). Case Presentation: In the 23-week ultrasound examination, a solid cystic mass lesion was revealed in the craniofacial region. MRI showed that the mass had an intracranial extension and spread to the fetal face, and also revealed a marked nasopharyngeal obstruction by the mass. There was a growing tumor protruding from the fetus’s mouth. Slight polyhydramnios was also detected. Conclusion: In detecting prenatal anomaly, although the ultrasound is the first scan method applied, MRI in prenatal diagnosis is very useful for evaluating the extent, nasopharyngeal obstruction degree, and extension into the intracranial region of craniofacial teratoma.

Background: Mesenteric Leiomyosarcoma (LMS) is a rare soft tissue tumor that takes its origin from smooth muscle cells, usually mesenteric blood vessels. Immunohistochemical (IHC) staining is deemed necessary for the diagnosis. Surgical resection with negative microscopic margins is the best treatment available, with limited role of chemo and radiotherapy. Case Presentation: We present a case of 46-year-old male who presented with large abdominal mass and obstructive symptoms. Surgical excision was performed and diagnosis of LMS was established on the basis of IHC stains. Currently, the patient is under follow up and has not developed any recurrence. Conclusion: Due to limited cases recorded globally, definitive guidelines for the management of this tumor are lacking. Work needs to be done to explore further about Primary Mesenteric LMS.