The deglacial transition from the last glacial maximum at ∼20 kiloyears before present (ka) to the Holocene (11.7 ka to Present) was interrupted by millennial-scale cold reversals, viz., Antarctic Cold Reversal (∼14.5-12.8 ka) and Greenland Younger Dryas (∼12.8-11.8 ka) which had different timings and extent of cooling in each hemisphere. The cause of this synchronously initiated, but different hemispheric cooling during these cold reversals (Antarctic Cold Reversal ∼3 • C and Younger Dryas ∼10 • C) is elusive because CO 2 , the fundamental forcing for deglaciation, and Atlantic meridional overturning circulation, the driver of antiphased bipolar climate response, both fail to explain this asymmetry. We use centennialresolution records of the local surface water δ 18 O of the Eastern Arabian Sea, which constitutes a proxy for the precipitation associated with the Indian Summer Monsoon, and other tropical precipitation records to deduce the role of tropical forcing in the polar cold reversals. We hypothesize a mechanism for tropical forcing, via the Indian Summer Monsoons, of the polar cold reversals by migration of the Inter-Tropical Convergence Zone and the associated cross-equatorial heat transport.
Background
Bullous pemphigoid is an uncommon dermatologic manifestation seen in squamous cell lung cancer, and evidence guiding optimal treatment, especially in the elderly population, is limited. We report herein a case of squamous cell lung cancer diagnosed after being investigated for refractory bullous pemphigoid showing marked response to carboplatin-based chemotherapy. This is the first case report that shows carboplatin can be used as an effective alternative in treatment of malignancy-associated bullous pemphigoid.
Case report
An 80-year-old caucasian man developed extensive vesiculobullous rashes on his trunk, chest, abdomen, and inguinal region associated with significant pruritus causing sleep disturbance. The diagnosis of bullous pemphigoid was confirmed on skin biopsy. The skin lesions continued to worsen even after use of oral and topical steroid in addition to oral doxycycline. Chest computed tomography revealed a spiculated left lung lesion along with mediastinal lymphadenopathy. Fine-needle aspiration from the mediastinal lymph node confirmed metastatic squamous cell lung carcinoma. Carboplatin with gemcitabine was initiated, and significant response was seen within 3 days of chemotherapy. The skin lesions continued to remain in remission even after stopping the chemotherapy.
Conclusion
Although there are still controversies regarding paraneoplastic etiology of bullous pemphigoid, this case presents a temporal association. It is the first case report showing a remarkable response with the use of a carboplatin-based regimen.
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