IntroductionThe consumption of energy drinks has increased significantly. We report the case of a patient who presented to our hospital with jaundice, abdominal pain, and markedly increased liver transaminases likely due to the increased consumption of an energy drink. To the best of our knowledge, this is the first case report in the literature linking the development of acute hepatitis to the consumption of an energy drink.Case presentationA 22-year-old Caucasian woman presented to our hospital with epigastric pain, nausea, vomiting, and low-grade fever. She had been drinking 10 cans of an energy drink daily for two weeks prior to presentation. Her physical examination revealed mild epigastric tenderness. Her initial blood tests revealed elevated alanine aminotransferase, aspartate aminotransferase, and total bilirubin. A computed tomographic scan of the abdomen and pelvis was normal, and the patient was discharged to home. She returned to the Emergency Department of our hospital with worsening pain and new-onset jaundice. This time her physical examination revealed epigastric tenderness and icteric sclera. Her aspartate aminotransferase, alanine aminotransferase, and international normalized ratio were markedly elevated. Further radiological studies were non-specific, and she was admitted to our hospital with a diagnosis of acute hepatitis. Her viral serology and toxicology screens were negative. The patient was treated supportively and was discharged after resolution of her symptoms and a marked decrease in her liver enzymes.ConclusionThe development of acute hepatitis in this patient was most likely due to the excessive ingestion of an energy drink, and we speculate that niacin was the culprit ingredient.
Kikuchi’s disease is a benign condition that occurs in women. A young woman presented to the hospital with fevers and cervical lymphadenopathy. Infectious work-up was negative except for streptococcus pharyngitis. Imaging studies revealed the presence of diffuse cervical and axillary lymphadenopathy. The fevers persisted and she underwent excisional cervical lymph node biopsy that revealed histiocytic necrotizing lymphadenitis corresponding to a benign diagnosis of Kikuchi’s disease. Three months later, the patient was afebrile and there was complete resolution of the cervical lymphadenopathy.
A 72-year-old gentleman presented to the hospital with progressively worsening dysphagia to soft foods and liquids. He was diagnosed with severe pharyngeal dysphagia by modified barium swallow. A CT scan of the neck with IV contrast showed anterior flowing of bridging osteophytes from C3–C6, indicative of DISH, resulting in esophageal impingement. He underwent resection of the DISH segments. Following the surgery, a PEG tube for nutrition supplementation was placed. However, the PEG tube was removed after five months when the speech and swallow evaluation showed no residual dysphagia. DISH is a rare non-inflammatory condition that results in pathological ossification and calcification of the anterolateral spinal ligaments.
Background Cancer associated inflammation is one of the key determinants of outcome in patients with cancer. An elevated neutrophil: lymphocyte ratio (NLR) has been identified as a predictor of worse survival in patients with various solid tumors compared to hematologic malignancies but no reports yet examined its impact on multiple myeloma. The aim of this study was to examine the prognostic value of an elevated NLR in multiple myeloma. Methods We had approval by our institutional review board to collect the data on patients diagnosed with multiple myeloma at Staten Island University Hospital between year 2000 and 2012 identified from our local cancer database. Data on demographics, conventional prognostic markers, laboratory analyzes including blood count results, and histopathology were collected and analyzed. A cox proportional survival analysis was carried out to assess the relationship between NLR and mortality. NLR was assessed as a continuous variable as well as categorical variable (quartile 0.5-1.5, 1.6-2.2, 2.3-3.8, and 3.9-22.3). Results A total of 96 patients were identified with a median age at diagnosis of 70 (IQR of 61 to 79) years. The median neutrophil count was 3.5 (2.5—5.1) x 10-9/liters, median lymphocyte count 1.5 (1.05-2.4) × 10-9/liters, while the NLR was 2.28 (1.53-3.88). The median overall survival was 147.5 weeks, IQR (88.5-320). NLR did not prove to be a significant predictor of death as a continuous variable (0.95 (0.85-1.06), p =0.35). Furthermore, there was no significant difference in survival with any of the quartiles of NLR. Compare to lowest quartile of NLR, Hazards ratio for the consecutive quartiles were 1.25 (0.56-2.79, p 0.55), 1.36 (0.61-3.04, p=0.45) and 0.89 (0.36-2.22, p=0.80). Conclusion NLR does not appear to offer useful predictive ability for outcome and survival in multiple myeloma patients. Our study is limited with small sample size, further studies are needed to validate our results. Disclosures: No relevant conflicts of interest to declare.
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