Myocardial calcification is a rare and life-threatening condition. It has been associated with a myriad of causes, including ischaemic heart disease, cardiac surgery, rheumatic fever, and myocarditis. However, this entity is less well recognised in the setting of toxic shock syndrome. Published medical literature is scarce with regard to the pathogenesis and clinical implications of this potential association. We chronicle here the case of a patient with myocardial calcification secondary to toxic shock syndrome from our clinical experience. Furthermore, a systematic literature search of the medical databases PubMed and Google Scholar was conducted. A total of 17 cases fulfilled the inclusion criteria. The data on patients’ characteristics, epidemiology, clinical features, comorbid conditions, diagnosis, clinical course and outcome were collected and analysed. The present review outlines our current understanding of the epidemiology of and risk factors for sepsis-related myocardial calcification, the pathophysiology of this condition and currently available approaches to diagnosis.
A 22-year-old male who presented with complaints of swelling in the right side of neck and cough with mucoid expectoration was diagnosed to have Hodgkin's lymphoma, stage 2B and was started on 6 cycles of ABVD (Adriamycin, Bleomycin, Vincristine, Dacarbazine) regimen from January 2004 to June 2004, followed by IFRT (Involved Field Radiotherapy). Patient was in complete remission post radiotherapy and was kept under regular follow up.After 10 years, he again presented with right inguinal lymphadenopathy and biopsy was suggestive of Hodgkin's lymphoma. Staging evaluation showed involvement of bone marrow and hence was diagnosed as having relapsed Hodgkin's lymphoma stage 4A. He was started on COPP/ABV regimen (Cyclophosphamide, Oncovin, Prednisone, Procarbazine, Adriamycin, Bleomycin, Vinblastine) with the dose of the offending drug Bleomycin being 15 IU in 100ml 0.9% normal saline. Two weeks after the last chemotherapy cycle 4, patient presented with complaints of breathlessness on exertion which was insidious and progressive and hence was admitted in intensive care unit. High Resolution Computed Tomography (HRCT) thorax showed septal thickening with interspersed areas of ground glass attenuation predominantly in basal and pleural aspects with an associated impression of interstitial lung disease [Table/ Fig-1]. In view of above presentation and computed tomography (CT) findings and drop in saturation, patient was started on non-invasive ventilation, steroids
ABSTRACTHodgkin's lymphoma is one of the curable cancers and the standard treatment regimen involves combination chemotherapy involving bleomycin. One of the fatal side effect of bleomycin is pulmonary toxicity. Here we present three cases of Hodgkin's lymphoma treated with ABVD chemotherapy who had pulmonary toxicity. All three developed bleomycin induced pulmonary toxicity in the form of pulmonary fibrosis during treatment of the disease. Mode of treatment, severity of the condition and the treatment outcome varied among the three. Two recovered following treatment and one patient died due to irreversible pulmonary damage. Causality assessment using Naranjo's scale gave a score of 7 for case one and three and a score of 6 for case two, both indicating the adverse drug reaction to be a probable bleomycin induced Lung fibrosis.
Extracorporeal membrane oxygenation (ECMO) is considered a salvage therapy in patients with acute respiratory distress syndrome (ARDS) and refractory hypoxemia (hypoxemia persisting despite lung-protective ventilation). One aspect of ECMO is whether there would be an application of the technology related to the Coronavirus pandemic. The number of people diagnosed with Coronavirus disease (COVID19) has crossed the five million mark on 9 August 2020, with a case fatality rate of 5.2%. Due to this exponential increase in the number of coronavirus disease (COVID19) cases particularly the ones associated with ARDS, experts are evaluating the need for ECMO in intensive care units. Herein, we chronicle a review encompassing the available evidence on ECMO and its potential role in COVID19 ARDS, as we aim for optimal patient care with appropriate resource utilization and conservation.
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