Case: A 68-year-old woman with a history of stage IIIC (T3bN1bM0) melanoma with metastases to her right axilla status after 10 cycles of nivolumab presented with right shoulder pain. Radiographs showed a progressive erosive glenohumeral joint lesion. The workup was negative for metastasis and infection. Her clinical and radiographic findings were consistent with erosive arthritis. The patient underwent shoulder hemiarthroplasty and experienced substantial improvements. Conclusion: This is an unusual case of inflammatory arthritis associated with nivolumab, an antiprogrammed cell death protein 1, and is an important reminder of the musculoskeletal toxicities associated with immunotherapies.
Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Department SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR'S ACRONYM(S) SPONSOR/MONITOR'S REPORT NUMBER(S) DISTRIBUTION I AVAILABILITY STATEMENTApproved for public release; distribution is unlimited. 14. ABSTRACT U.S. warfighters may encounter difficulties obtaining suitable drinking water while in a deployed situation. Commercial-Off-the-Shelf (COTS) water purification devices are often used to provide microbiologically safe drinking water when an Army-provided water supply is not available. However, many of these devices have not been adequately tested and are not approved for U.S. military use. The study described herein was performed to assess the capabilities of the COTS water purification devices. A decision analysis methodology known as Multi-Criteria Decision Making was used to evaluate available devices and develop recommendations for various operational scenarios. More information on the individual devices can be found in the database developed as a result of this effort: http://usachppm.apgea.army.mil/WPD/Default.aspx. SUBJECT TERMS Blank EXECUTIVE SUMMARYWater supply is a critical requirement for service member sustainment on the battlefield, and emergency individual water purifiers (IWPs) are a critical component of water supply. Emergency IWPs provide microbiologically safe water to keep soldiers mission-ready in cases where they do not have access to an Army-provided water supply. Soldiers are currently procuring and using commercial-off-the-shelf (COTS) IWP devices. However, there is a lack of information on the performance of these devices, and it is unknown whether they provide microbiologically safe drinking water.To address this problem, the U.S. Army Center for Health Promotion and Preventive Medicine (CHPPM) conducted a study to assess the performance and suitability of the available devices. A market survey was conducted to identify and collect information on COTS devices, and each device under consideration was procured by CHPPM for the evaluation.The U.S. Army Edgewood Chemical Biological Center Decision Analysis Team developed a Multi-Criteria Decision Making approach for the evaluation. In this methodology, each COTS IWP was scored against criteria that addressed performance, operational, and logistical factors in a model developed using the software package Logical Decisions for Windows. Each factor in the model was developed with a definition and a performance scale for assessing the devices. The factors were weighted based on their importance to and impact on the evaluation. Four scenarios of use were identified to address...
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