Soft tissue sarcoma is a rare and aggressive disease with a 40 to 50% metastasis rate. The limited efficacy of traditional approaches with surgery, radiation, and chemotherapy has prompted research in novel immunotherapy for soft tissue sarcoma. Immune checkpoint inhibitors such as anti-CTLA-4 and PD-1 therapies in STS have demonstrated histologic-specific responses. Some combinations of immunotherapy with chemotherapy, TKI, and radiation were effective. STS is considered a ‘cold’, non-inflamed tumor. Adoptive cell therapies are actively investigated in STS to enhance immune response. Genetically modified T-cell receptor therapy targeting cancer testis antigens such as NY-ESO-1 and MAGE-A4 demonstrated durable responses, especially in synovial sarcoma. Two early HER2-CAR T-cell trials have achieved stable disease in some patients. In the future, CAR-T cell therapies will find more specific targets in STS with a reliable response. Early recognition of T-cell induced cytokine release syndrome is crucial, which can be alleviated by immunosuppression such as steroids. Further understanding of the immune subtypes and biomarkers will promote the advancement of soft tissue sarcoma treatment.
Infective endocarditis is an infection of the endocardium that affects the heart valves. It is usually caused by bacteremia secondary to distant infections such as urinary tract infections, surgical procedures, or other sources of pathogenic entry into the blood. It often affects damaged native valves, as well as prosthetic valves, and is primarily caused by Gram-positive bacteria, such as
Staphylococcus aureus
. Infective endocarditis secondary to
Escherichia coli
is rare, despite
E. coli
being one of the most common pathogens causing Gram-negative bacteremia. Between 1909 and 2002, 36 cases of native valve infective endocarditis were reported that met Duke criteria. The majority were secondary to urinary tract infections due to
E. coli
. Infective endocarditis secondary to
E. coli
bacteremia in the setting of acute cholecystitis is highly uncommon, and this case report aims to highlight this unusual presentation of infective endocarditis.
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