Capnocytophaga canimorsus is a catalase-positive and oxidase-positive gram-negative bacillus commonly found in dog saliva that is a rare cause of infection in immunocompromised individuals. We report the case of a 70-year-old woman with Waldenström macroglobulinemia treated with ibrutinib and a history of bilateral shoulder arthroplasty and bilateral knee arthroplasty who reported a 1-year history of multi-joint pain and swelling. The patient resides with two pet dogs that often scratch and bite, penetrating the skin, and on culture was found to have Capnocytophaga canimorsus.
4391 In May 2008, The William W. Backus Hospital changed the unfractionated heparin dosing protocol and the monitoring parameter for the treatment of thromboembolic disease. The original protocol utilized the Rashke's method (Bolus dose 80 units/kg and initial infusion of 18 units/kg/hour) monitored with aPTT (Therapeutic range 61–80.9 seconds). The newer protocol is a novel model utilizing a bolus dose of 26 units/kg and initial infusion rate of 15 units/kg/hour, calculated using the methodology designed by Rosbourough et al monitored with anti-Xa (Therapeutic range 0.3–0.7 anti Xa units). This is a retrospective study comparing of the efficacy and safety of each protocol. Methods: Data abstraction was completed through electronic medical record review of two hundred patients. Time point 0 was the date of changing to the new protocol. One hundred patients in reverse chronological order were reviewed for the original protocol and one hundred patients in chronological order with the new protocol. Data included demographics, duration of time prior to achieving therapeutic parameters, number of dosage changes, diagnosis of cancer, bleeding events and recurrent thrombotic events. Unpaired Student t tests were utilized to statistically analyze the differences between the cohorts. Results: Conclusion: Both methodologies achieved therapeutic levels rapidly. The Rosbourough method required statistically significant less dosage changes when compared to the Rashke method. The incidence of major and minor bleeding was similar between the two dosing algorithms. Although not statistically significant, the incidence of recurrent thromboses was numerically higher with the Rosbourough method compared to Rashke method. This is concerning and suggests that the higher loading dose may be more appropriate. A prospective comparison of these two monitoring methods using Rashke dosing is planned. Disclosures: Off Label Use: Discuss alternative dosing and anti Xa monitoring of unfractionated heparin infusion.
A 73 y/o Caucasian female presented with abdominal pain for 2 years, gradually worsening in the recent past. The pain was more severe at night, especially while sleeping on her abdomen. An A/P CT scan showed a mid-abdominal mesenteric mass measuring 8 x 4 cm, which was new since prior examinations. The new mass was accompanied by prominent retro-peritoneal lymph nodes, the largest along the left paraaortic region measuring 1.9 x 1.6 cm. She reported good appetite and denied fever, chills, night sweats or unexplained weight loss. She admitted to a 6-month history of diarrhea consisting of 2-3 loose stools daily. Her clinical presentation was felt to be concerning for Carcinoid tumor. A GA-68 dotatate PET/CT showed uptake within the known mesenteric mass, most likely representing carcinoid tumor. Minimal uptake observed in retroperitoneal lymph nodes felt to represent early metastatic disease. The patient underwent laparotomy, small bowel resection and retroperitoneal lymph node resection. Pertinent laboratory studies - Chromogranin level, pre op - 625 (ref 25 - 140) Chromogranin level post op - 54 Pathology showed grade 2, follicular lymphoma. The neoplastic cells predominantly composed of small, irregular cleaved centrocytes mixed with a minor population of centroblasts (less than 15 per high-power field). Neoplastic follicles were diffusely positive for CD20, PAX5, CD10, BCL6, and BCL2. Ki67 showed 10-20% proliferation index. Cyclin D1 was negative. Flow cytometry identified monoclonal B-cell population positive for CD10, CD19 (dim), and CD20, which expressed dim monotypic lambda light chain. CD5 negative. Discussion: There is evidence that lymphoma cells express somatostatin receptors (SSTR). Octreotide scan (111In-pentetreotide - binds to SSTR2 and SSTR5) uptake has been described in lymphomas with variable degree of avidity. Gallium Dotatate scan (68Ga-Dotatate - binds selectively to SSTR2) uptake has been previously described in a patient with large cell lymphoma. Here we describe a case of follicular lymphoma presenting with symptoms suggestive of carcinoid that showed uptake on Gallium Dotatae scan. This finding therefore warrants recognition by clinicians for potential of lymphoma presenting with positive Gallium Dotatate scan. Ruuska et al* have shown that 62% of various PET positive lymphomas (DLBCL, follicular and Hodgkin's) were also 68Ga-DOTONAC PET/CT positive and there was concordance between SSTR2 positivity by IHC and 68Ga-DOTONAC PET/CT. If this finding is confirmed in further studies, perhaps this may lead to a possible therapeutic application for 177Lu-DOTA-TATE in management of some refractory lymphomas. *Tina Ruuska et al, Acta Oncologica, 2018, vol 57, no. 2. 283-289 Figure Disclosures No relevant conflicts of interest to declare.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.