Massive pericardial effusion as the first manifestation of childhood non‐Hodgkin's lymphoma: A case report

Although one of the serious manifestations of advanced malignancies is pericardial involvement, pericardial involvement of lymphoma is extremely rare. We present a case of a 6‐year‐old girl arriving at the hospital with dyspnea and pleuritic chest pain, which is eventually diagnosed with massive pericardial effusion due to mediastinal non‐Hodgkin lymphoma.     

Pharmacologic management of neuropsychiatric lupus

Neuropsychiatric lupus affects above 50% of patients with systemic lupus erythematosus and may span from mild symptoms to acute devastating life-threatening ones. Owing to the clinical variability, most pharmacological data rely on small, uncontrolled trials and case reports. The mainstay of therapy relies on immune-suppression by glucocorticoids, in adjunction with cyclophosphamide or anti-B-cell therapy, in moderate to severe cases. In selected scenarios (e.g., chorea) intravenous immunoglobulin or plasmapheresis may be effective. Anticoagulation is warranted if anti-phospholipid antibodies are present. In parallel there may be a need for symptomatic treatment such as anti-epileptic or anti-depressive treatments, etc. In the future, more studies addressed to assess pathogenesis and preferred treatments of specific manifestations are needed in order to personalize treatments.     

Management of unexpected cerebrospinal fluid fistulae during endoscopic sinus surgery

BACKGROUND: The aim of this study was to determine the incidence and perioperative management of patients with cerebrospinal fluid (CSF) fistulas during endoscopic sinus surgery (ESS) in New York State. METHODS: A questionnaire was mailed to otolaryngologists in New York State who were registered with the American Academy of Otolaryngology, Head and Neck Surgery in November 2005. Questions addressed the incidence and perioperative care of patients with successful closure of unexpected CSF fistula during ESS. RESULTS: Twenty-five percent of respondents have experienced at least one episode of unexpected CSF fistula during ESS over the prior 5 years, with a calculated incidence of 0.16%. Surgeons most often (46%) observed patients for 1-2 days. Antibiotics were used in 93% of patients. A lumbar drain was most commonly not used. Repair techniques most often used an intranasal flap or graft (92%). CONCLUSION: The incidence of unexpected CSF fistula during ESS may be lower than previously reported. A majority of surgeons use an intranasal flap or graft in repair with antibiotic use, with no consensus regarding use of lumbar drain or inpatient observation. More study is needed to determine consensus algorithms for management of CSF leaks during ESS.     

Is autoimmunology a discipline of its own? A big data-based bibliometric and scientometric analyses

Autoimmunology is a super-specialty of immunology specifically dealing with autoimmune disorders. To assess the extant literature concerning autoimmune disorders, bibliometric and scientometric analyses (namely, research topics/keywords co-occurrence, journal co-citation, citations, and scientific output trends – both crude and normalized, authors network, leading authors, countries, and organizations analysis) were carried out using open-source software, namely, VOSviewer and SciCurve. A corpus of 169,519 articles containing the keyword “autoimmunity” was utilized, selecting PubMed/MEDLINE as bibliographic thesaurus. Journals specifically devoted to autoimmune disorders were six and covered approximately 4.15% of the entire scientific production. Compared with all the corpus (from 1946 on), these specialized journals have been established relatively few decades ago. Top countries were the United States, Japan, Germany, United Kingdom, Italy, China, France, Canada, Australia, and Israel. Trending topics are represented by the role of microRNAs (miRNAs) in the ethiopathogenesis of autoimmune disorders, contributions of genetics and of epigenetic modifications, role of vitamins, management during pregnancy and the impact of gender. New subsets of immune cells have been extensively investigated, with a focus on interleukin production and release and on Th17 cells. Autoimmunology is emerging as a new discipline within immunology, with its own bibliometric properties, an identified scientific community and specifically devoted journals.     

Tacrolimus-associated Diffuse Gastrointestinal Ulcerations and Pathergy: A Case Report

Tacrolimus is a common immunosuppressive modality with a range of therapeutic applications, including for rheumatologic disease, nephrotic syndrome, and inflammatory bowel disease. The medication also plays an integral role in organ transplantation. However, tacrolimus has a significant side effect profile, which commonly includes nephrotoxicity, neurotoxicity, infection risk, and anemia. We describe an unusual case of tacrolimus toxicity in a cardiac transplant patient, manifesting as diffuse gastrointestinal ulcerations and pathergy. Our goal was to further characterize the toxicity of tacrolimus to include this rare presentation.