reported, with an estimated minimum prevalence of 4.9%. 1 Although BP patients with laryngeal lesions are usually asymptomatic, they can present with hoarseness, stridor, with or without dyspnea in severe cases. 4 We were unable to find previous reports of cases of BP that presented with acute progressive laryngeal involvement requiring emergency tracheostomy. The supraglottis is the most commonly affected laryngeal site in the pemphigoid. Erythematous and edematous laryngeal mucosa with multiple erosions were observed on fiber-optic laryngoscopy. Imaging tests, such as computed tomography, are also needed to evaluate the extent of the disease and assist in the differential diagnosis. An initial airway evaluation using fiber-optic laryngoscopy is required to determine whether a tracheostomy is necessary. Early and aggressive systemic treatment is necessary to prevent airway stenosis and obstruction in BP with laryngeal involvement.Therefore, management with systemic corticosteroids is recommended, with close follow-up to monitor the resolution of laryngeal lesions.In summary, we report a case of BP with laryngeal involvement that presented with critical airway narrowing, requiring emergency tracheostomy. Laryngeal involvement in patients with BP can result in life-threatening airway stenosis and obstruction. BP patients with suspected laryngeal involvement should be promptly evaluated by an otolaryngologist. Although rare, dermatologists should be aware of this since it is a potentially severe complication of BP.
Kidney transplantation increases the life expectancy of recipients; however, it also increases three-fold the risk of urothelial cancer. 1 In fact, de novo bladder cancer (BC) can be diagnosed many years after kidney transplantation, with smoking being the most important risk factor. [1][2][3][4][5] Most BCs in kidney transplant recipients are non-muscle-invasive (NMIBC) and are characterized with an aggressive course. 1 Bacillus Calmette-Guerin (BCG) is an attenuated form of Mycobacterium bovis that can be used as adjuvant treatment for high-risk NMIBC. 1,5 However, two important issues emerge in this setting: would this treatment be equally effective in these immunosuppressed patients and would infectious complications be more frequent and/or severe?Administration of immunosuppressive drugs is necessary after kidney transplantation to improve both recipient and allograft survival. However, these drugs may also alter the host's immune response to BCG and with that reduce the oncologic efficacy of BCG therapy. For this reason, BCG therapy was never used in this immunocompromised population until recently. Initial reports suggested the efficacy and safety of BCG therapy in kidney transplant recipients. 6,7 Later on, different BCG regimens were administered to recipients with NMIBC and resulted in favorable oncologic outcomes, 3,5,8 although other recipients needed consolidation BCG therapy and even surgery. 2,4 Table 1 summarizes the most relevant studies that addressed the efficacy of BCG therapy in kidney transplant recipients. These studies consist mainly of case reports
Intravesical BCG therapy has been for years, the standard of care in nonmuscle-invasive bladder cancer. But upon recurrence/relapse, radical cystectomy is imposed, due to the paucity of other therapeutic options. Immunotherapy has been revolutionizing cancer treatment, and its indications continue to broaden. It has been approved for the treatment of advanced urothelial cancer of the bladder, mainly as a second-line therapy. Its activity is being studied in nonmuscle-invasive bladder cancer that is not responsive to BCG; we herein report the trials investigating these checkpoint inhibitors (pembrolizumab, nivolumab, atezolizumab, durvalumab and avelumab) in this particular setting.
Pelvic organ prolapse (POP) can lead to acute bilateral obstructive pyelonephritis (ABOP) due to bilateral ureteral compression. When this occurs, conservative treatment through POP reduction, intravenous antibiotics and supportive care seems to provide an interesting option in the wait of definitive management of POP. The cornerstone of ABOP management, which is the emergent urinary drainage, seems to have many drawbacks in this context due to both technical and patient-related criteria, making it invasive and compromising patient safety and comfort in many settings. Here, we review the management of ABOP and provide a case of an acute obstructive pyelonephritis due to POP.
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