Tumor lysis syndrome following trastuzumab and pertuzumab for metastatic breast cancer: a case report

Background

Tumor lysis syndrome is a rare and potentially fatal complication of oncologic treatments, especially in solid tumors. To the best of our knowledge, tumor lysis syndrome has never been reported after trastuzumab and pertuzumab combination therapy. Knowledge of risk factors and active prevention proceedings is of utmost importance to avoid fatal outcomes.

Case presentation

We present the case of a chemo-naive 58-year-old Belgian woman developing hypovolemic shock and multiple organ failure due to tumor lysis syndrome after a single dose of trastuzumab and pertuzumab in the context of the treatment of a metastatic breast cancer and resulting in fatal outcome despite optimal management.

Conclusions

Considering that targeted cancer therapies become increasingly effective, oncologists should be extremely cautious when treating patients at high risk of tumor lysis syndrome, even if they are not treated with cytotoxic chemotherapy, and determine appropriate prophylaxis.

Measles elimination efforts and 2008-2011 outbreak, France

Although few measles cases were reported in France during 2006 and 2007, suggesting the country might have been close to eliminating the disease, a dramatic outbreak of >20,000 cases occurred during 2008–2011. Adolescents and young adults accounted for more than half of cases; median patient age increased from 12 to 16 years during the outbreak. The highest incidence rate was observed in children <1 year of age, reaching 135 cases/100,000 infants during the last epidemic wave. Almost 5,000 patients were hospitalized, including 1,023 for severe pneumonia and 27 for encephalitis/myelitis; 10 patients died. More than 80% of the cases during this period occurred in unvaccinated persons, reflecting heterogeneous vaccination coverage, where pockets of susceptible persons still remain. Although vaccine coverage among children improved, convincing susceptible young adults to get vaccinated remains a critical issue if the target to eliminate the disease by 2015 is to be met.

[Measles in France]

From January 2008 to May 2012, over 22,000 cases of measles were reported in France. The highest incidence rate was observed in children below one year of age. Over 50% of cases were reported in young adults. Almost 5,000 patients were hospitalised including 1,023 with severe pneumonia, 27 with encephalitis and/or myelitis : 10 died. This situation is linked to insufficient and heterogeneous vaccination coverage with pockets of susceptible people allowing virus circulation. Although the vaccine coverage in children has now improved for both doses, the issue of convincing young susceptible adults to catch up for measles vaccination remains critical, if the elimination target is to be met, and in order to protect the most vulnerable population unable to benefit from this vaccination (children below 1 year, immunodeficient people, pregnant women).

Epidemiology, surveillance and control of infectious diseases in the European overseas countries and territories, 2011

The 25 European overseas countries and territories (OCTs) are closely associated with the European Union (EU) through the four related UE Member States: Denmark, France, the Netherlands and the United Kingdom. In 2008 and 2009, these four EU Member States, in association with the European Centre for Disease Prevention and Control (ECDC), reviewed the OCTs’ needs, with the objectives of documenting their capacity to prevent and respond to infectious diseases outbreaks, and identifying deficiencies. This Euroroundup is based on the review’s main findings, and presents an overview of the OCTs’ geography and epidemiology, briefly introduces the legal basis on which they are linked to the EU and describes the surveillance and infectious disease response systems. As a result of their diversity the OCTs have heterogeneous epidemiological profiles. A common factor, however, is that the main burden of disease is non-communicable. Nevertheless, OCTs remain vulnerable to infectious diseases outbreaks. Their capacity for surveillance, early detection and response to such outbreaks is generally limited, with laboratory capacity issues and lack of human resources. Avenues for capacity strengthening should be explored by the OCTs and the related EU Member States, in collaboration with ECDC and regional public health networks where these exist.

Epidemiology, surveillance and control of infectious diseases in the European overseas countries and territories, 2011

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Influenza A(H1N1)2009 in the French Pacific territories: assessment of the epidemic wave during the austral winter

The three French territories in the Pacific (New Caledonia [NC], French Polynesia [FP] and Wallis and Futuna [WF]) have been affected by an outbreak of influenza A(H1N1)2009 during the austral winter of 2009. This wave of influenza-like illness was characterized by a short duration (approximately 8 weeks) and high attack rates: 16-18% in NC and FP, 28% in Wallis and 38% in Futuna. The number of infected patients requiring hospitalization in critical care services and the number of deaths were, respectively, 21 and 10 in NC and 13 and 7 in FP (none in WF). Diabetes, cardiac and pulmonary diseases, obesity in adults, neuromuscular diseases in children, and Oceanic origin were frequently observed among severe cases and deaths. A significant proportion of the population remains susceptible to A(H1N1)2009, making the occurrence of a second wave likely. A state of preparedness and control efforts must be implemented, based on preventive measures (immunization), as well as combined clinical and virological surveillance and health organization.

[Deep venous thrombosis of the upper limb complicated by pulmonary embolism. Apropos of a case]

Venous thrombosis of the upper limb is classically rarely complicated by pulmonary embolism. The authors report a case of phlebitis of the upper limb in a 46-year-old woman with a thoracic outlet syndrome complicated by multiple and recurrent pulmonary emboli. Analysis of recent data from the literature would appear to bring into question the classically accepted harmless nature of this condition regarding the risk of embolic complications.