Publications by authors named "Karan Seegobin"

48 Publications

Clinical characteristics, prognostic indicators, and survival outcomes in intravascular lymphoma: Mayo Clinic experience (2003-2018).

Am J Hematol 2022 Jun 17. Epub 2022 Jun 17.

Department of Haematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida, USA.

Intravascular lymphoma (IVL) is a rare extranodal non-Hodgkin lymphoma. We performed a retrospective analysis of 55 IVL patients who were treated at our institution 2003-2018. Median age at diagnosis was 68 years, and 64% were males. The most frequent presenting symptoms were skin rash 43% and weight loss 30%. MRI brain on IVL patients with CNS involvement (CNS-IVL) showed multifocal involvement in 76% (13/17). 89% (17/19) of non-CNS-IVL patients with abnormal FDG-PET had biopsy of an avid lesion resulting in definitive diagnosis. The top diagnostic biopsy site was the bone marrow (45%). 56% had multiorgan involvement. Based on CNS involvement, 36.5% (20/55) had CNS-IVL and 63.5% (35/55) had non-CNS-IVL. CNS-IVL group consists of clinically isolated CNS involvement (CNS-only IVL) (22%;12/55) and mixed clinical CNS and peripheral site involvement (M-IVL) (14.5%; 8/55). Non-CNS-IVL group consists of clinically isolated skin involvement (skin-only IVL) (9%; 5/55) and peripheral IVL with or without skin involvement (P-IVL); (54.5%; 30/55). Skin involvement was predominantly in the lower extremities. Pathologically, 89% (48/54) were B-cell IVL. Rituximab + high-dose methotrexate-based regimen were used in 75% (12/16) of CNS-IVL patients and RCHOP in 60% (17/28) of non-CNS-IVL patients. Estimated 5-year progression free survival (PFS) and overall survival (OS) for the entire cohort were 38.6% and 52%, respectively. Skin-only IVL was associated with excellent survival. Platelet count <150x10 /L, age > 60Y, and treatment without Rituximab were poor prognostic factors. Further research is necessary to identify novel therapies.
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http://dx.doi.org/10.1002/ajh.26635DOI Listing
June 2022

Intravascular Large B Cell Lymphoma with CNS Involvement Successfully Treated with High-Dose Methotrexate and High-Dose Ara-C Based CNS-Directed Chemoimmunotherapy Alternating with Anthracycline Based Chemoimmunotherapy.

Blood Lymphat Cancer 2022 25;12:47-54. Epub 2022 May 25.

Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville, FL, 32224, USA.

Intravascular large B cell lymphoma (IVL) is a rare subtype of diffuse large B cell lymphoma confined to small blood vessels with a predilection for CNS involvement. The prognosis of IVL with CNS involvement (CNS-IVL) is extremely poor. The optimal treatment for CNS-IVL is not well defined. Thus, we report three patients with CNS-IVL successfully treated with a CNS-centric approach consisting of high-dose methotrexate (HDMTX) and high-dose Ara-C (HiDAC) based CNS-directed chemoimmunotherapy (CIT) alternating with anthracycline-based CIT. Our rationale for intensifying the CNS-directed therapy is the presence of intracerebral bleeding in two of our patients which would result in extravasation of lymphoma cells into the cerebral parenchyma with the development of CNS lymphoma. All three patients have achieved excellent therapeutic outcomes. Two patients with intracerebral bleeding have been in complete remission (CR) for about 11 years and 4 years. One patient was successfully induced into CR about 10 months ago and currently is in CR. This unique therapeutic approach should be further explored for CNS-IVL.
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http://dx.doi.org/10.2147/BLCTT.S362736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9148600PMC
May 2022

Coagulopathy following Crotaliπae snakebites in northeast Florida.

Blood Coagul Fibrinolysis 2022 Jun 10;33(4):220-223. Epub 2022 Jan 10.

Division of Hematology & Oncology, Department of Medicine, Hematology & Oncology, University of Louisville, Louisville, Kentucky.

Effects of Crotalinae envenomation vary by geographical areas and research into coagulopathy and effects of antivenom are needed to optimize management. This was a single-center retrospective review with testing on presentation and 4 h after; antivenom administration was noted and data analyzed overall and comparing envenomations. One hundred and nineteen snakebites evaluated with 59 identified as Crotalinae and half receiving antivenom. PT/aPTT was elevated in 20% of water moccasin/copperhead and 21% of rattlesnake bites. DIC-like syndrome occurred in 8% water moccasin/copperhead and 6% rattlesnake bites. Antivenom did not seem to correct PT or aPTT at 4 h follow-up in most cases. Thrombotic microangiopathy was not seen. Coagulopathy was prevalent affecting one in five patients in this cohort and does seem to persist at short interval follow-up, even in those receiving antivenom. We support guidelines recommending clinical monitoring and serial coagulation profiles in such cases. Blood Coagul Fibrinolysis 30:000 - 000 Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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http://dx.doi.org/10.1097/MBC.0000000000001123DOI Listing
June 2022

Leukemic High Grade B Cell Lymphoma is Associated With MYC Translocation, Double Hit/Triple Hit Status, Transformation, and CNS Disease Risk: The Mayo Clinic Experience.

Clin Lymphoma Myeloma Leuk 2022 Aug 14;22(8):e815-e825. Epub 2022 Apr 14.

Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL. Electronic address:

Introduction: Leukemic involvement in high grade B cell lymphoma (L-HGBL) is rare and has been sparsely described in the literature. We report our experience in a large single institution multicenter academic setting.

Materials And Methods: Medical records of patients with HGBL who received care at Mayo Clinic between 2003 and 2020 were reviewed. L-HGBL was confirmed by peripheral blood smear and flow cytometry with corroboration from tissue and bone marrow biopsy findings.

Results: Twenty patients met inclusion criteria. All patients had significant bone marrow involvement by HGBL. Leukemic involvement presented in 11 of 20 (55%) in the de novo and 9 of 20 (45%) in the relapsed setting. Seven of 20 patients had DLBCL, NOS, 6 of 20 had transformation (t-DLBCL), 3 of 20 had transformed double/triple hit lymphoma (t-DHL/THL), 2 of 20 had double hit lymphoma (DHL), and 2 of 20 had HGBL with intermediate features between DLBCL and Burkitt lymphoma. Nine of 15 patients had MYC translocation. Based on Hans criteria, 11 of 20 had germinal center B-cell (GCB) cell of origin (COO) and 9/20 had non-GCB COO. Five of 11 de novo patients experienced CNS relapse/progression. All de novo patients received anthracycline-based chemoimmunotherapy. Eighteen of 20 patients died of progressive disease. Median overall survival was significantly better in the de novo compared to relapsed group (8.9 months vs. 2.8 months, P = .01). COO, MYC status, DHL/THL status, HGBL subtype, or treatment group did not demonstrate a significant effect on overall survival.

Conclusion: L-HGBL carries a poor prognosis and is associated with MYC translocation, DHL/THL status, transformation, and high CNS risk. Novel therapeutic approaches are needed for L-HGBL.
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http://dx.doi.org/10.1016/j.clml.2022.04.009DOI Listing
August 2022

Sinonasal renal cell-like adenocarcinoma arising in von Hippel Lindau (VHL) syndrome.

Oral Oncol 2022 02 5;125:105705. Epub 2022 Jan 5.

Hematology & Oncology, University of Louisville, Louisville, KY, United States.

Sinonasal renal cell-like adenocarcinoma (SNRCLA) is a rare and relatively novel diagnosis. Hereditary and somatic genomic signatures are not well defined in this disease. We report the case of a 35-year-old African-American male with von Hippel Lindau (VHL) syndrome who developed SNRCLA. He underwent surgical resection followed by adjuvant radiation and has no recurrence one year from diagnosis. A review of the literature yielded two similar cases in the setting of VHL. In our case with associated VHL syndrome, next generation sequencing detected MST1R mutation, a possible driver. SNRCLA is an emerging tumor associated with VHL syndrome and it is hoped that future studies shed light on the underlying biology of this unique tumor.
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http://dx.doi.org/10.1016/j.oraloncology.2021.105705DOI Listing
February 2022

Immunotherapy in Non-Small Cell Lung Cancer With Actionable Mutations Other Than .

Front Oncol 2021 1;11:750657. Epub 2021 Dec 1.

Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, United States.

While first line targeted therapies are the current standard of care treatment for non-small cell lung cancer (NSCLC) with actionable mutations, the cancer cells inevitably acquire resistance to these agents over time. Immune check-point inhibitors (ICIs) have improved the outcomes of metastatic NSCLC, however, its efficacy in those with targetable drivers is largely unknown. In this manuscript, we reviewed the published data on ICI therapies in NSCLC with , , , , , , , and alterations. We found that the objective response rates (ORRs) associated with ICI treatments in lung cancers harboring the (0-54%), (12-49%), and (18.7-66.7%) alterations were comparable to non-mutant NSCLC, whereas the ORRs in fusion NSCLC (less than10% in all studies but one) and fusion NSCLC (0%) were relatively low. The ORRs reported in small numbers of patients and studies of fusion, fusion, and mutant NSCLC were 0-17%, 50% and 7-23%, respectively, making the efficacy of ICIs in these groups of patients less clear. In most studies, no significant correlation between treatment outcome and PD-L1 expression or tumor mutation burden (TMB) was identified, and how to select patients with NSCLC harboring actionable mutations who will likely benefit from ICI treatment remains unknown.
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http://dx.doi.org/10.3389/fonc.2021.750657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8671626PMC
December 2021

Macrophage Activation Led Acute Heart Failure Managed Successfully with Immunosuppression.

J Blood Med 2021 7;12:1037-1043. Epub 2021 Dec 7.

Department of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, 32224, USA.

Macrophage activation leading to multi-organ dysfunction/failure has been described in various hematologic disorders like hemophagocytic lympho-histiocytosis (HLH), also known as macrophage activation syndrome (MAS) and macrophage activation like syndrome (MALS). Congestive heart failure (CHF) appears to be an uncommon manifestation of macrophage activation. This novel entity of macrophage activation-associated cytokine-mediated CHF has not been well reported in the medical literature. We report two young female patients with acute CHF secondary to macrophage activation-associated cytokine storm. An extensive diagnostic workup was negative for other etiologies, such as ischemia, myocarditis, or infections. Their clinical, laboratory, and pathologic findings did not meet the diagnostic criteria for hemophagocytic syndrome (HPS)/MAS. However, both had laboratory and pathologic findings which were consistent with macrophage activation and cytokine storm. One patient met criteria for MALS. Therapeutically, our patients were promptly treated with steroids with or without anti-cytokine therapy with rapid restoration of cardiac function. Macrophage activation-induced disease may not always fulfil the diagnostic criteria for the currently known macrophage activation disorders. We suggest that markers of macrophage activation and cytokine levels should be part of the diagnostic workup in patients with otherwise unexplained acute CHF. Additional research is warranted to further elucidate the underlying mechanism of this disorder.
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http://dx.doi.org/10.2147/JBM.S340361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8667193PMC
December 2021

Role of Immune Checkpoint Inhibitor Therapy in Advanced -Mutant Non-Small Cell Lung Cancer.

Front Oncol 2021 16;11:751209. Epub 2021 Nov 16.

Division of Hematology and Oncology, Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, United States.

Over the last decade, the treatment of advanced non-small cell lung cancer (NSCLC) has undergone rapid changes with innovations in oncogene-directed therapy and immune checkpoint inhibitors. In patients with epidermal growth factor receptor (EGFR) gene mutant (m) NSCLC, newer-generation tyrosine kinase inhibitors (TKIs) are providing unparalleled survival benefit and tolerability. Unfortunately, most patients will experience disease progression and thus an urgent need exists for improved subsequent lines of therapies. The concurrent revolution in immune checkpoint inhibitor (ICI) therapy is providing novel treatment options with improved clinical outcomes in wild-type (wt) NSCLC; however, the application of ICI therapy to advanced m NSCLC patients is controversial. Early studies demonstrated the inferiority of ICI monotherapy to EGFR TKI therapy in the first line setting and inferiority to chemotherapy in the second line setting. Additionally, combination ICI and EGFR TKI therapies have demonstrated increased toxicities, and EGFR TKI therapy given after first-line ICI therapy has been correlated with severe adverse events. Nonetheless, combination therapies including dual-ICI blockade and ICI, chemotherapy, and angiogenesis inhibitor combinations are areas of active study with some intriguing signals in preliminary studies. Here, we review previous and ongoing clinical studies of ICI therapy in advanced m NSCLC. We discuss advances in understanding the differences in the tumor biology and tumor microenvironment (TME) of NSCLC tumors that may lead to novel approaches to enhance ICI efficacy. It is our goal to equip the reader with a knowledge of current therapies, past and current clinical trials, and active avenues of research that provide the promise of novel approaches and improved outcomes for patients with advanced m NSCLC.
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http://dx.doi.org/10.3389/fonc.2021.751209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634952PMC
November 2021

Successful Non-Transplant Treatment of Double Hit Richter Transformation with Long-Term Remission.

Blood Lymphat Cancer 2021 22;11:67-72. Epub 2021 Sep 22.

Department of Hematology and Medical Oncology, Mayo Clinic Hospital, Jacksonville City, FL, 32224, USA.

Richter transformation (RT) is defined as the transformation of chronic lymphocytic leukemia (CLL) to a high-grade B cell lymphoma. It usually carries a dismal prognosis and represents an unmet need for novel therapeutic interventions. We report a case of an 80-year-old male who developed double-hit (DH) RT with translocations of MYC and BCL6 after 5 years of watchful waiting for standard-risk CLL. He was treated with induction therapy consisting of 4 cycles of anthracycline-based chemoimmunotherapy (CIT) and 2 cycles of platinum-based CIT with intrathecal methotrexate for CNS prophylaxis followed by continuous maintenance therapy with ibrutinib. He achieved complete remission after the induction therapy. At the time of writing, four and a half years after the diagnosis with DH-RT, he remains in complete remission without evidence of RT or CLL. The novel therapeutic approach used in successful treatment of this patient should be further explored.
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http://dx.doi.org/10.2147/BLCTT.S330008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8474063PMC
September 2021

Successful treatment of IgG4-related hypertrophic pachymeningitis with induction rituximab and dexamethasone followed by maintenance rituximab.

Clin Case Rep 2021 Mar 27;9(3):1610-1614. Epub 2021 Jan 27.

Department of Pathology Mayo Clinic Jacksonville Florida Jacksonville FL USA.

IgG4-related disease (IgG4RD) with intracranial involvement is rare. We report a 56-year-old male who had an excellent response to rituximab and dexamethasone after going undiagnosed for 5 years. After 3 years of rituximab maintenance, he has no evidence of disease on brain MRI.
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http://dx.doi.org/10.1002/ccr3.3855DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981770PMC
March 2021

Systemic ALK-positive anaplastic large cell lymphoma with bilateral optic neurolymphomatosis resulting in permanent blindness.

Clin Case Rep 2020 Dec 14;8(12):2629-2633. Epub 2020 Aug 14.

Department of Pathology Mayo Clinic Jacksonville Florida.

ALK-positive ALCL can lead to rapid irreversible destruction of the optic pathway. Early treatment should be instituted in patients with CNS involvement or those at increased CNS risk.
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http://dx.doi.org/10.1002/ccr3.3231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752471PMC
December 2020

Patients with high-grade alectinib-induced skin rash: How do we desensitize these patients? A case report and review of literature.

SAGE Open Med Case Rep 2020 24;8:2050313X20966895. Epub 2020 Oct 24.

Department of Medicine, Division of Hematology and Oncology, Mayo Clinic Jacksonville, FL, USA.

With the advent of targeted therapy for non-small-cell lung cancer, there are many new available treatment options for patients whose cancer harbors an actionable mutation or alteration. These new medications come with numerous side effects, for some of which, the management is not well defined. Alectinib is a second-generation tyrosine kinase inhibitor approved for stage-IV lung adenocarcinoma with anaplastic lymphoma kinase gene rearrangement. Severe (⩾Grade 3) skin rash is a rare side effect of alectinib. Reintroducing alectinib in patients with severe skin rash is not well defined in the medical literature. While other case reports have outlined their approach and desensitization protocol, the maximum dose that patients were titrated up to in a desensitization protocol was 300 mg twice daily. Here, we report a case of Grade 3 skin rash secondary to alectinib, and our experience in managing the rash and reintroducing alectinib with a unique desensitization protocol to a max of 600 mg twice daily (full dose). This case could provide further guidance to oncologists managing patients with this adverse event and may aid in reducing concerns to both patients and physicians about recurrence of skin rash at the maximum dose.
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http://dx.doi.org/10.1177/2050313X20966895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586266PMC
October 2020

In Reply: Trousseau sign and syndrome: Erroneous terms.

Cleve Clin J Med 2020 10 1;87(10):586. Epub 2020 Oct 1.

James Graham Brown Cancer Center, University of Louisville School of Medicine Louisville, KY.

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http://dx.doi.org/10.3949/ccjm.87c.10003DOI Listing
October 2020

Mönckeberg medial sclerosis.

Cleve Clin J Med 2020 06 30;87(7):396-397. Epub 2020 Jun 30.

Department of Medicine, University of Louisville School of Medicine, Louisville, KY

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http://dx.doi.org/10.3949/ccjm.87a.19085DOI Listing
June 2020

Trousseau syndrome.

Cleve Clin J Med 2020 Apr;87(4):199-200

James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY.

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http://dx.doi.org/10.3949/ccjm.87a.19086DOI Listing
April 2020

Metastatic ductal adenocarcinoma of the breast presenting with pericardial effusion-Challenges in the diagnosis of breast cancer.

Clin Case Rep 2019 Dec 24;7(12):2384-2387. Epub 2019 Oct 24.

Division of Rheumatology and Clinical Immunology Department of Medicine University of Florida College of Medicine Jacksonville FL USA.

Breast cancer is a common entity that can be difficult to diagnose. This case demonstrates the limitations of breast cancer diagnostics. Particularly, how the available imaging techniques and even biopsy can potentially miss a malignancy. It exemplifies the role immunohistochemistry staining plays in the diagnosis of cancers of unclear origin.
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http://dx.doi.org/10.1002/ccr3.2497DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935662PMC
December 2019

Sarcoidosis presenting with facial swelling (Heerfordt syndrome).

Clin Case Rep 2018 Oct 5;6(10):2023-2024. Epub 2018 Sep 5.

Department of Internal Medicine University of Florida College of Medicine Jacksonville Florida.

Sarcoidosis is one of the "great masqueraders" of medicine and can present with atypical facial swelling. Imaging and biopsy confirm the diagnosis.
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http://dx.doi.org/10.1002/ccr3.1741DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186866PMC
October 2018

Temporality of heparin-induced antibodies: a retrospective study in outpatients undergoing hemodialysis on unfractionated heparin.

Exp Hematol Oncol 2018 14;7:23. Epub 2018 Sep 14.

1Division of Hematology and Medical Oncology, Department of Internal Medicine, University of Florida College of Medicine-Jacksonville, UF Health Jacksonville, 653 W 8th St, Jacksonville, FL 32209 USA.

Background: Heparin-induced antibodies (HIA) are responsible for causing heparin-induced thrombocytopenia and thrombosis. Research has shown that the temporality of heparin-induced antibodies does not follow the classic immunologic response. The immunobiology of HIA generation remains unclear with varying in vitro and in vivo data. Outpatients undergoing hemodialysis (HD) are exposed to heparin chronically. The HIA immune response can therefore be investigated in vivo in this population.

Methods: We examined the time between the start of HD using unfractionated heparin and HIA levels in 212 outpatients during a 6-year period. Antibodies were detected on enzyme-linked immunosorbent assay. HIA levels were analyzed to determine significance of the trend over time. HIA subgroups were also analyzed for correlation with subsequent thrombotic events and platelet count during follow up.

Results: Overall, the HIA response in HD was found to peak early with waning antibody response despite continued exposure to heparin. The peak prevalence of a strong immune response (optical density > 1.000) was early and short lived, while weaker immune response (optical density 0.400-1.000) persisted for the first 6 months then declined. The mean follow-up time per patient was 2.3 ± 1.4 years. Despite circulating HIA, including high titers, no patients developed HIT in this sample. There was no association between HIA and thrombocytopenia. There was increased incidence of thrombosis in patients with strong HIA compared to other groups, but this did not achieve statistical significance.

Conclusions: The data suggest a significant temporal pattern of HIA in outpatients undergoing HD using unfractionated heparin. Positive HIA was not found to be significantly associated with thrombocytopenia or thrombosis risk in these patients. However, while not achieving statistical significance, subsequent thrombotic events occurred most frequently in the strong positive HIA group (optical density > 1.000). Further research into HIA and risk of thrombosis in this population is needed.
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http://dx.doi.org/10.1186/s40164-018-0115-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137914PMC
September 2018

Coexistent Breast Cancer and Essential Thrombocythemia: How We Addressed the Therapeutic Challenges.

Case Rep Hematol 2018 12;2018:2080185. Epub 2018 Aug 12.

Department of Hematology and Oncology, University of Florida College of Medicine, Jacksonville, FL 32209, USA.

Essential thrombocythemia (ET) occurring with breast cancer is uncommon; the therapeutic approach varies and poses a challenge. A 65-year-old female presented to us after being diagnosed with hormone positive, HER2-negative infiltrating ductal carcinoma. She had a platelet count of 600 thou/cu mm. Her JAK2 mutation was positive. Bone marrow biopsy showed increased megakaryocytes. She was diagnosed with ET in the setting of breast cancer. She underwent breast conservation surgery after which aspirin was resumed. Anticipating thrombocytopenia during chemotherapy and given the absence of data combining hydroxyurea with standard chemotherapy used for breast cancer, we felt it prudent to delay cytoreductive therapy for her ET until after completion of breast cancer treatment. Her average platelet count during chemotherapy was 480 thou/cu mm with the lowest being 377 thou/cu mm. Her platelet count remained at goal between 300 and 350 thou/cu mm after four months of hydroxyurea.
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http://dx.doi.org/10.1155/2018/2080185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109582PMC
August 2018

Flashes of light and floaters: an unusual presentation of urothelial carcinoma.

BMJ Case Rep 2018 Aug 29;2018. Epub 2018 Aug 29.

Division of Hematology and Oncology, Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA.

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http://dx.doi.org/10.1136/bcr-2018-225486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119364PMC
August 2018

Fatal Type B Lactic Acidosis Associated With Metastatic Colorectal Cancer: A Case Report With Review of Literature, Pathogenesis, and Treatment.

J Investig Med High Impact Case Rep 2018 Jan-Dec;6:2324709618788101. Epub 2018 Jul 19.

University of Florida, Jacksonville, FL, USA.

Type B lactic acidosis associated with malignancy is a life-threatening complication and mostly seen in hematological malignancies but can also be seen in solid tumors. We report a rare case of a 64-year-old female diagnosed with metastatic adenocarcinoma of the colon with liver metastasis associated with severe type B lactic acidosis. We discuss pathophysiology, previously reported cases, and their outcomes. The most widely used therapies are bicarbonate infusion, thiamine supplementation, chemotherapy, and supportive care but is associated with poor outcomes, and no standard treatment recommendations are available. Early chemotherapy administration remains the only intervention that has shown some survival benefit. Physicians should be aware and proactive for early diagnosis and management of this condition with further research needed to guide optimal therapy.
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http://dx.doi.org/10.1177/2324709618788101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053866PMC
July 2018

Pilot study on the occurrence of multiple cancers following cancer-related therapy at the University of Florida, Jacksonville (2011-2016).

J Investig Med 2018 10 6;66(7):1050-1054. Epub 2018 Jun 6.

Hematology and Oncology Department, University of Florida College of Medicine, Jacksonville, Florida, USA.

New primary cancers can occur in patients with a previous cancer. Among the risk factors, therapies such as chemotherapy, radiotherapy, and hormonal therapy have been associated with the development of neoplasms. Second cancers most commonly develop 5-10 years after the initial tumor. We observe the implications of cancer-related therapy in the development of a new tumor. We looked at 602 patients who had their first cancer diagnosed in 2011 and calculated the number of different primary cancers between 2011 and 2016 for each patient. Twenty-four patients had a second cancer within 5 years from the first diagnosis and there were no patients with a third cancer. There was no statically significant difference in the rates of second cancers after exposure to chemotherapy, radiotherapy, hormonal therapy, or any combination of these (p=0.738). Of the second cancers reported after 2011, renal, uterine, cervical, and lung cancers were the most frequently reported. Additionally, there was no statically significant difference among the rates of second cancers in men versus women (p=0.467), as well as among whites versus blacks (p=0.318). We conclude that while new primaries can occur after one cancer, there was no increased risk after exposure to different cancer-related therapies. With increased focus on the primary disease, there is a higher likelihood of missing another primary lesion. This is important as the practical implications of managing multiple primaries are rarely discussed.
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http://dx.doi.org/10.1136/jim-2018-000772DOI Listing
October 2018

Syncope in a middle-aged man.

Emerg Med J 2018 Jun;35(6):395-401

Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA.

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http://dx.doi.org/10.1136/emermed-2017-207381DOI Listing
June 2018

Dynamic right ventricular outflow tract obstruction from a pedunculated cardiac metastasis.

J Echocardiogr 2018 12 25;16(4):185-186. Epub 2018 Apr 25.

Division of Hematology and Oncology, Department of Medicine, University of Florida College of Medicine, Jacksonville, FL, USA.

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http://dx.doi.org/10.1007/s12574-018-0379-3DOI Listing
December 2018

Acute glomerulonephritis secondary to .

BMJ Case Rep 2018 Mar 9;2018. Epub 2018 Mar 9.

Hotz Children's Hospital, Jackson Health Sysrem, Miami, Florida, USA.

is a clinically important pathogen that is emerging globally but remains poorly investigated. Here, we report the first case of acute glomerulonephritis resulting from infection with Glomerulonephritis is typically caused by and reports secondary to other strains including and exist. Infection with in this patient was associated with acute nephritis (haematuria, oedema and hypertension), nephrotic syndrome and progressive azotemia. There was activation of the complement system. The presence of low C1q and elevated anti-C1q binding complexes points to a potential pathogenic role. Testing for streptococcal antigens was strongly positive. Emerging nephritogenic strains of present a significant health concern for both developed and developing countries.
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http://dx.doi.org/10.1136/bcr-2017-223314DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847902PMC
March 2018

Paraneoplastic acral vascular syndrome.

Cleve Clin J Med 2018 Feb;85(2):101-102

Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, FL, USA.

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http://dx.doi.org/10.3949/ccjm.85a.17007DOI Listing
February 2018

Coexistent Ipsilateral Internal Carotid Artery Occlusion and Cerebral Venous Thrombosis in Hepatitis C.

J Investig Med High Impact Case Rep 2018 Jan-Mar;6(1):2324709617750179. Epub 2018 Jan 9.

University of Florida, Jacksonville, FL, USA.

A 58-year-old male, known to have hepatitis C virus (HCV), presented with intermittent headaches and left-sided sensorimotor symptoms. There were no focal neurological deficits on examination. Electrocardiogram was unremarkable. Computed tomography angiography head and neck displayed extracranial right internal carotid artery occlusion. Magnetic resonance imaging showed right cortical vein thrombosis, with hemorrhagic infarction. Echocardiography with bubble study was unremarkable. Hypercoagulable workup was significant for protein S deficiency. He was treated with warfarin for 6 months. Repeat protein S levels remained low 9 months later. The coexistence of arterial and venous thrombotic events gives rise to a limited differential. In this case, it may be related to chronic HCV infection. The underlying pathogenesis is not clear; however, it is possible the patient had chronic high-grade internal carotid artery stenosis, which occluded leading to his presenting symptoms. The cortical vein thrombosis is likely an incidental finding here. The extent by which HCV contributed to the cerebral thrombosis and carotid artery occlusion in our case is not clear; however, the hypercoagulable and atherosclerotic properties of the virus cannot be disregarded. The virus can promote carotid atherosclerosis and cerebral venous thrombosis as well as other venous and arterial thromboembolic events. Furthermore, HCV is associated with impaired venous flow and procoagulant properties, which can fuel a hypercoagulable state. Also of note cirrhosis is associated with protein S deficiency. We recommend considering an underlying hypercoagulable state including both arterial and venous thrombosis in HCV infection.
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http://dx.doi.org/10.1177/2324709617750179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768283PMC
January 2018

Severe beta blocker and calcium channel blocker overdose: Role of high dose insulin.

Am J Emerg Med 2018 Apr 10;36(4):736.e5-736.e6. Epub 2018 Jan 10.

Department of Internal Medicine, University of Florida, College of Medicine, Jacksonville, United States.

A 54-year-old female presented after taking an overdose of an unknown amount of hydrochlorothiazide, doxazocin, atenolol and amlodipine. She was initially refractory to treatment with conventional therapy (intravenous fluids, activated charcoal, glucagon 5 mg followed with glucagon drip, calcium gluconate 10%, and atropine). Furthermore, insulin at 4 U/kg was not effective in improving her hemodynamics. Shortly after high dose insulin was achieved with 10 U/kg, there was dramatic improvement in hemodynamics resulting in three of five vasopressors being weaned off in 8 h. She was subsequently off all vasopressors after six additional hours. The role of high dose insulin has been documented in prior cases, however it is generally recommended after other conventional therapies have failed. However, there are other reports that suggest it as initial therapy. Our patient failed conventional therapies and responded well only with maximum dose of insulin. Physicians should consider high dose insulin early in severe beta blocker or calcium channel blocker overdose for improvement in hemodynamics. This leads to early discontinuation of vasopressors. It is important that emergency physicians be aware of the beneficial effects of high dose insulin when initiated early as opposed to waiting for conventional therapy to fail; as these patients often present first to the emergency department. Early initiation in the emergency department can be beneficial in these patients.
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http://dx.doi.org/10.1016/j.ajem.2018.01.038DOI Listing
April 2018

Enterococcal Empyema and Trapped Lung in Systemic Lupus Erythematosus.

J Glob Infect Dis 2017 Oct-Dec;9(4):162-163

Department of Medicine, Eric Williams Medical Sciences Complex, San Fernando, Trinidad and Tobago.

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http://dx.doi.org/10.4103/jgid.jgid_34_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750442PMC
January 2018
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