No abstract

Leishmaniasis is a chronic protozoan disease that is found in diverse geographical areas of the world. Leishmania spp. are endemic in the Mediterranean coasts of southern Europe. Tumour necrosis factor alpha (TNF-α) plays an important role in the defence of the host against infection by Leishmania spp. In this case report we describe Leishmania infection caused by a monoclonal antibody against TNF-α: infliximab. A 51-year-old patient with psoriatic arthritis treated with infliximab, 5 mg/kg every 6 weeks as immunomodulatory treatment and methotrexate 10 mg weekly as a conventional disease-modifying antirheumatic drug, visited his otorhinolaryngologist owing to a lesion in his left nostril. The lesion was diagnosed as cutaneous leishmaniasis so treatment with infliximab was suspended. The patient was then treated with liposomal amphotericin B and showed a total recovery of the lesion; liposomal amphotericin B was maintained at 5 mg/kg monthly.

to local guidelines. Data included demographics, clinical assessment performed by the prescriptor (syndrome, source, severity at onset, type of acquisition), microbiological samples taken and antimicrobial prescriptions including the drug, dose and route of administration, if empirical or targeted, and mono or combination. Multivariate analysis was performed using logistic regression. Results Overall, 406 ATs were analysed. The most frequent syndromes were pneumonia (24%), urinary tract infections (22%) and non-pneumonic lower respiratory tract infections (22%); 51.5% (n=209) AT were inadequate (26% of them: drug with a reasonable spectrum was prescribed despite not being recommended as first line, 45% antibiotic not needed, 25% 'inadequate spectrum' and 4% others). In multivariable analysis, microbiological samples before AT (OR: 1.9; 95% CI: 1.2 to 2.8; p=0.004), specification of the source of infection in patient's charts (OR: 2.0; 95% CI: 1.1 to 4.2; p=0.05) and severe sepsis or shock (OR: 1.9; 95% CI: 1.2 to 2.9; p=0.003) were independent predictors of adequate AT.

checkpoint. They have demonstrated their efficacy and safety in the treatment of different solid tumours. Purpose To evaluate the incidence of adverse events (AE) associated with immune checkpoint inhibitors and to analyse the management of the toxicity. Material and methods Descriptive and retrospective study which included every patient treated with Nivolumab or Pembrolizumab between April 2015 and September 2018 in a third-level hospital. Demographics and clinical variables were collected from the electronic medical records: sex, age, type of tumour, number of cycles, causes of treatment suspension, AE and its severity, as well the need for referral to other specialist, pharmacological treatment or hospitalisation for its handling. Results We included 71 patients (74.6% males), 60.6% were treated with Nivolumab and 39.4% with Pembrolizumab. Average age was 67.6 years (SD 10.3) and the median number of cycles was eight (1-70). The most frequent types of tumours were non-small-cell lung cancer (63.0%), bladder cancer (15.1%) and renal cancer (8.2%).74.7% of patients presented >1 AE, all immunomediated: 79.1% with Nivolumab (8.9% grade 3) and 71.4% with Pembrolizumab (22.5% grade 3). The most common AE in both groups were asthaenia (53.5% with Nivolumab and 32.1% with Pembrolizumab), skin toxicity (37.2% and 25% respectively) and diarrhoea (14% and 21.4% respectively). Immunemediated toxicity was the cause of permanent treatment suspension in 15.1% of patients (45.5% hepatitis and 18.2% pneumonitis).Referral to other specialists was necessary in 20.9% of patients treated with Nivolumab and 25% with Pembrolizumab. 32.6% of patients with Nivolumab and 39.3% with Pembrolizumab required pharmacological management. Also, 7% of cases required hospitalisation to control AE due to Nivolumab and 25% due to Pembrolizumab. Conclusion All treatment-related AE are immune-mediated. Despite being less frequent, there are certain AE which, due to their clinical relevance, led to the permanent suspension of treatment. The incidence of grade 3 EA was higher in patients treated with Pembrolizumab, as well as hospitalisation required. The role of a multidisciplinary team is essential in handling possible related EA, achieving an adequate treatment optimisation.

Results Seventy-four patients, 64% men, mean age 58.6 years. All of them were high/very high CDV risk (stable or unstable coronary artery disease, ischaemic stroke, transient ischaemic attack or peripheral arterial disease). Eighty per cent presented baseline LDL-C levels higher than 150 mg/dL. Forty (54%) patients reached the targeted range for LDL-C. Thirty-four (46%) patients reached LDL-C levels>70. All of them started with 75 mg every 14 days. Only nine patients (27%) have increased the dose of praluent to 150 mg/14 days in the week 12. Conclusion Dosage adjustments according to LDL-C levels should be followed closely to achieve better outcomes. The dose should be increased to 150 mg every 2 weeks at week 12 if LDL-C is greater or equal to 70 mg/dL at week 8. An adequate organisation and coordination between the different implicated medical services would be desirable, as the dates for monitoring LDL-C and the optimal monitoring interval are already established.