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Khreisat A, Xin V, Dado C. Granulomatous Lymphocyte Interstitial Lung Disease: A Rare Complication of Common Variable Immunodeficiency Managed With Azathioprine and Rituximab. Cureus 2024; 16:e59399. [PMID: 38689676 PMCID: PMC11060838 DOI: 10.7759/cureus.59399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
Granulomatous lymphocytic interstitial lung disease (GL-ILD) is a rare, non-infectious pulmonary manifestation of common variable immunodeficiency (CVID). Diagnosing and managing GLILD remains challenging due to its poorly understood pathogenesis and high mortality. We present a complex case of a young female with CVID associated with lung and spinal cord involvement managed with azathioprine and rituximab.
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Affiliation(s)
- Ali Khreisat
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Vickie Xin
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Christopher Dado
- Pulmonary and Critical Care Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
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Meram E, Mansour M, Khreisat A, AlKloub R, Dalal B. Retraction: An Aspirated Tooth Masquerading As Lung Cancer: A Unique Case Report. Cureus 2024; 16:r141. [PMID: 38689669 PMCID: PMC11060665 DOI: 10.7759/cureus.r141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
[This retracts the article DOI: 10.7759/cureus.55890.].
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Affiliation(s)
- Emmanuel Meram
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Meghan Mansour
- Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester Hills, USA
| | - Ali Khreisat
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Roa'a AlKloub
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Bhavinkumar Dalal
- Pulmonary Critical Care Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
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Meram E, Mansour M, Khreisat A, AlKloub R, Dalal B. An Aspirated Tooth Masquerading As Lung Cancer: A Unique Case Report. Cureus 2024; 16:e55890. [PMID: 38463401 PMCID: PMC10924955 DOI: 10.7759/cureus.55890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 03/12/2024] Open
Abstract
Tooth aspiration, while commonly linked to predisposing conditions such as loose teeth, facial surgeries, or injuries, can also affect patients without apparent risk factors. Such small foreign body aspirations may go undiagnosed for many months as patients often tolerate the symptoms, such as chronic cough. However, the protracted course of unaddressed foreign body aspiration has the potential to resemble symptoms of malignancy, including persistent hemoptysis, weight loss, and fatigue. In this report, we detail the case of a 51-year-old man with underlying chronic obstructive pulmonary disease (COPD) whose history and symptoms initially suggested lung carcinoma. Further investigation uncovered an aspirated tooth as the culprit. The sequelae of pulmonary complications arising from endobronchial obstruction, such as post-obstructive pneumonia and atelectasis, as demonstrated in our case, further emphasize the importance of prompt detection and management of tooth aspiration.
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Affiliation(s)
- Emmanuel Meram
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Meghan Mansour
- Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester Hills, USA
| | - Ali Khreisat
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Roa'a AlKloub
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Bhavinkumar Dalal
- Pulmonary Critical Care Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
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Mansour M, Kessler S, Khreisat A, Morton J, Berghea R. Vanishing Lung Syndrome: A Case Report and Systematic Review of the Literature. Cureus 2024; 16:e53443. [PMID: 38314388 PMCID: PMC10838376 DOI: 10.7759/cureus.53443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 02/06/2024] Open
Abstract
Vanishing lung syndrome (VLS), also known as idiopathic giant bullous emphysema, is defined by the emergence of sizable bullae causing compression on healthy lung tissue. The elusive etiology of VLS mandates a diagnosis based on radiographic evidence showcasing giant bullae occupying at least one-third of the hemithorax in one or both lungs. This report presents a case of VLS in a 36-year-old female smoker devoid of any prior medical history. Additionally, we conducted a systematic review to discern the demographics, risk factors, and treatment modalities for individuals diagnosed with VLS.
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Affiliation(s)
- Meghan Mansour
- Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester Hills, USA
| | - Steven Kessler
- Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester Hills, USA
| | - Ali Khreisat
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Jacob Morton
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Ramona Berghea
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
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Khreisat A, Bartosek N, Amal T, Dalal B. Durvalumab-Induced Myocarditis and Dilated Cardiomyopathy in a Patient With Non-small Cell Lung Cancer: A Diagnostic Conundrum. Cureus 2024; 16:e51456. [PMID: 38298285 PMCID: PMC10829531 DOI: 10.7759/cureus.51456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2024] [Indexed: 02/02/2024] Open
Abstract
Immune checkpoint inhibitors have been a therapeutic oncological breakthrough in managing diverse malignancies. We present a 78-year-old male with stage IIIb non-small cell lung cancer (NSCLC) managed by concurrent chemotherapy with carboplatin/pemetrexed and radiotherapy followed by monthly durvalumab injections. He presented to the hospital with shortness of breath and fluid overload after eight months of starting durvalumab. Workup, including laboratory investigations, coronary angiography, and stress myocardial magnetic resonance imaging, increased our suspicion for the diagnosis of durvalumab-induced myocarditis and nonischemic dilated cardiomyopathy. He was managed with aggressive diuresis and pulse dose steroids with an improvement in his symptoms and his cardiac function. This case illustrates an under-reported clinical side effect in the era of advancement in oncological immunotherapy.
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Affiliation(s)
- Ali Khreisat
- Internal Medicine, Beaumont Hospital, Royal Oak, USA
| | | | - Tanya Amal
- Internal Medicine, Beaumont Hospital, Royal Oak, USA
| | - Bhavinkumar Dalal
- Pulmonary Critical Care Medicine, Corewell Health William Beaumont Hospital, Royal Oak, USA
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Khreisat A, Amal T, Howell DM, Timmis S. An Undifferentiated Primary Mediastinal Carcinoma Compressing the Main Pulmonary Artery: A Rare Cause of Right Ventricular Strain. Cureus 2024; 16:e52789. [PMID: 38268992 PMCID: PMC10806412 DOI: 10.7759/cureus.52789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 01/26/2024] Open
Abstract
Undifferentiated carcinoma (or poorly differentiated carcinoma) of the mediastinum is a relatively rare pathological variant of anterior mediastinal tumors. Pathologists usually use the term to describe an epithelial tumor with no histological features that enable the identification of its site of origin. Invasion of adjacent vital cardiopulmonary structures is among the most problematic complications of anterior mediastinal masses. We report a case of a 60-year-old male presenting with easy fatiguability, significant weight loss, and chest pain. A CT scan of the chest revealed a large anterior mediastinal mass, compression of the main pulmonary artery, and a large pericardial effusion. The patient underwent pericardiocentesis, emergent radiotherapy, and platinum-based chemotherapy. His condition dramatically improved, and he was subsequently discharged home for further follow-up.
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Affiliation(s)
- Ali Khreisat
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Tanya Amal
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - David M Howell
- Internal Medicine, Beaumont Health, Royal Oak, USA
- Internal Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, USA
| | - Steven Timmis
- Cardiovascular Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
- Cardiology, Beaumont Health, Royal Oak, USA
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Khreisat A, Bateman J, Kozyk M, Strubchevska K. Spontaneous Celiac Artery Pseudoaneurysm in a Patient With Viral Myocarditis: Coincidence or Consequence? Cureus 2023; 15:e48970. [PMID: 38106727 PMCID: PMC10725737 DOI: 10.7759/cureus.48970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Abstract
Spontaneous pseudoaneurysm formation in the celiac artery is a very infrequent occurrence in the absence of trauma or descending aortic dissection. If it continues to progress, it can lead to visceral organ infarction or life-threatening hemoperitoneum. Management is conservative in select cases; however, most patients require an endovascular or surgical approach. The definitive etiology of spontaneous celiac artery pseudoaneurysm remains unclear. We present an intriguing case of a 67-year-old female who presented to the hospital with sudden chest pain preceded by viral prodromal symptoms. She was discharged as a case of viral myocarditis and was re-admitted the same day with acute abdominal pain. Computed tomography with intravenous contrast showed an enlarging eight-millimeter celiac artery pseudoaneurysm managed with endovascular coil embolization. This case report demonstrates spontaneous celiac artery pseudoaneurysm workup and management. We are also investigating whether a unifying diagnosis exists to explain both viral myocarditis and celiac artery pseudoaneurysm or if both conditions are sporadic occurrences.
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Affiliation(s)
- Ali Khreisat
- Internal Medicine, Beaumont Health, Royal Oak, USA
| | | | - Marko Kozyk
- Internal Medicine, Beaumont Hospital, Royal Oak, USA
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Mansour MR, Kessler SA, Khreisat A, Skrzynski JK. Asymptomatic colo-ovarian fistula amidst acute psychosis: a case report. J Surg Case Rep 2023; 2023:rjad525. [PMID: 37901605 PMCID: PMC10602661 DOI: 10.1093/jscr/rjad525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/04/2023] [Indexed: 10/31/2023] Open
Abstract
This paper presents a rare case of an asymptomatic colo-ovarian fistula in a 45-year-old female with acute psychosis and a history of bipolar disorder, seizure disorder and substance misuse. The intricate diagnostic challenges arising from the patient's complex medical history underscore the significance of a multidisciplinary approach. The absence of typical gastrointestinal symptoms and the presence of a tubo-ovarian abscess complicated the diagnosis of acute on chronic sigmoid diverticulitis and colo-ovarian fistula. Surgical intervention, including sigmoid resection, anastomosis and left salpingo-oophorectomy, led to successful resolution. This case highlights the need for further understanding of colo-ovarian fistula pathophysiology, improved diagnostic strategies, and the nuanced interplay between medical and psychiatric conditions in complex clinical scenarios.
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Affiliation(s)
- Meghan R Mansour
- Department of Medical Education, Oakland University William Beaumont School of Medicine, Rochester Hills, MI 48309, United States
| | - Steven A Kessler
- Department of Medical Education, Oakland University William Beaumont School of Medicine, Rochester Hills, MI 48309, United States
| | - Ali Khreisat
- Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48703, United States
| | - Justin K Skrzynski
- Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48703, United States
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Lazar NJ, Khreisat A, AlKloub R, Al-Hillan A, Duffy M. Inappropriate Multi-Target Stool DNA Use for Colorectal Cancer Screening: Risks, Compliance, and Outcomes. Cureus 2023; 15:e40506. [PMID: 37397671 PMCID: PMC10313417 DOI: 10.7759/cureus.40506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/04/2023] Open
Abstract
Background Inappropriate or "off-label" use of multi-target stool DNA (mt-sDNA) tests refers to their use in patients for whom colonoscopy or no testing at all is warranted. Examples include a positive family history of colorectal cancer, a history of inflammatory bowel disease, or medical issues necessitating diagnostic colonoscopy, among others. Current understanding of off-label mt-sDNA use for colorectal cancer screening, its associated risks, and outcomes is lacking. We examined off-label mt-sDNA prescription and compliance with testing in an outpatient setting in southeast Michigan. Aims The primary aims of the study were determining the extent of off-label mt-sDNA testing and compliance, and results of all testing, as well as demographic factors associated with off-label prescriptions. The secondary aims were to examine explanations for incomplete testing and factors contributing to successful completion. Methods Using a retrospective design, we identified mt-sDNA orders from outpatient internal medicine clinics between January 1, 2018, to July 31, 2019, to evaluate the proportion of off-label mt-sDNA, results of testing, and follow-up colonoscopies up to one year after order placement. Patients were categorized as "off-label" if any inappropriate criteria were met. Statistical analysis was performed for primary and secondary outcomes. Results From 679 mt-sDNA orders within the study period, 81 (12.1%) had at least one off-label criterion for testing. In total, 404/679 (59.5%) patients completed testing. Lack of follow-up comprised the majority of incompletions (216/275; 78.6%). Only 52 (70.3%) out of 74 positive results were followed by diagnostic colonoscopy. Retired employment status (OR = 1.87; 95%CI, 1.17-2.98; P = 0.008) and age of 76 years or older (OR = 2.28; 95%CI, 0.99-5.21; P = 0.044) were significantly associated with increased risk of off-label mt-sDNA prescription. Increasing age range was associated with higher test completion (χ2 (5) = 12.085, p = 0.034). Multinomial logistic regression revealed an increasing age range (OR = 1.29; 95% CI, 1.09-1.54; P = 0.004), predictive of a positive mt-sDNA result for both groups. There was no significant difference between off-label or on-label groups in the mean number of resected polyps or pathology scores on follow-up colonoscopy. Conclusions Off-label mt-sDNA use remains a concern in the outpatient setting. Compliance for test completion and follow-up colonoscopy for positive results require further improvement. Our findings shed new light on the factors associated with off-label testing while reiterating its burden. We also describe common reasons for incomplete tests in an attempt to augment future colorectal cancer (CRC) screening initiatives.
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Affiliation(s)
| | - Ali Khreisat
- Internal Medicine, Beaumont Hospital, Royal Oak, USA
| | - Roa'a AlKloub
- Internal Medicine, Beaumont Hospital, Royal Oak, USA
| | | | - Michael Duffy
- Gastroenterology and Hepatology, Beaumont Hospital, Royal Oak, USA
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Khreisat A, Hanna M, Mando R, Allen O, Timmis SB. UNUSUAL CAUSE OF RIGHT VENTRICULAR STRAIN AND DYSFUNCTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03995-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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