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Pandey S, Kashfi S, Hong S, Kalaria A, Kim AS. Onco-Hypertension in Patients with Kidney Disease. Am J Nephrol 2024:000538375. [PMID: 38493776 DOI: 10.1159/000538375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/13/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Cancer, hypertension, and kidney disease are closely interrelated. Knowledge of the potential hypertensive and nephrotoxic effects of antineoplastic medications is critical to minimizing interruptions in cancer treatment. SUMMARY Antineoplastic medications can cause hypertension, proteinuria, and kidney injury, often mediated by common mechanisms. Notably, inhibitors of the vascular endothelial growth factor pathway have the strongest association with both hypertension and proteinuria, typically acute in onset and often reversible after drug discontinuation. The abrupt rise in blood pressure can cause clinically significant hypertensive syndromes and contribute to overall morbidity. Significant proteinuria can herald kidney failure. Close monitoring of blood pressure and renal function during antineoplastic therapy and appropriate hypertension treatment are important. This article reviews available literature and proposes a step-by-step approach to manage cancer patients with concurrent hypertension and kidney disease. KEY MESSAGES For antineoplastic medications with known hypertensive effect, blood pressure should be checked at baseline and serially during cancer treatment. Hypertensive crisis with end-organ damage, significant proteinuria, microscopic hematuria, or unexplained acute kidney injury necessitates drug cessation until further evaluation and resolution. In patients with chronic kidney disease and cancer therapy-related hypertension, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker is the preferred antihypertensive choice. Finally, multidisciplinary collaboration in these patients will yield the best results.
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Khatri S, Epstein S, Kashfi S. Peripheral stent-graft for the management of an ulnar artery pseudoaneurysm. J Clin Imaging Sci 2023; 13:27. [PMID: 37810179 PMCID: PMC10559374 DOI: 10.25259/jcis_80_2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/24/2023] [Indexed: 10/10/2023] Open
Abstract
Penetrating injury can cause pseudoaneurysm which can then affect nerve compression. Although rare, penetrating injuries leading to ulnar artery pseudoaneurysm (UAP) are implicated slightly more frequently than other upper extremity arterial segments. Manual compression, thrombin injections, and surgical reconstruction are typically chosen to effect repair. Conversely, peripheral stent-graft implantation has rarely been reported as an option to exclude upper extremity pseudoaneurysm. We describe a case of a 25-year-old male who was stabbed, presented with signs of ulnar nerve compression, and in whom UAP was instead discovered and treated by stent-graft deployment.
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Affiliation(s)
- Shivam Khatri
- CUNY School of Medicine, New York City, United States
| | - Steven Epstein
- Department of Radiology, St Barnabas Hospital, The Bronx, United States
| | - Simon Kashfi
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, United States
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Khatri S, Epstein S, Kashfi S, Oza P. Iatrogenic subclavian artery rupture: A unique case report on balloon occlusion. Int J Surg Case Rep 2023; 109:108508. [PMID: 37454550 PMCID: PMC10384228 DOI: 10.1016/j.ijscr.2023.108508] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Inadvertent subclavian artery puncture during attempted central venous catheterization can be devastating. Percutaneous stent grafting, closure devices and conventional surgery have been described to effect repair. Balloon occlusion has also been described and often recommended. Numerous publications advise use of balloon expanded to no less than the diameter of the punctured artery. CASE PRESENTATION We describe the case of a 21 year-old male whose right subclavian artery was inadvertently punctured after central-line removal. Our balloon when expanded was purposely slightly smaller than the inner arterial diameter. Balloon occlusion nevertheless alone sufficed to effect closure and repair. CLINICAL DISCUSSION When the expanded balloon surpasses the diameter of the subclavian artery, it is expected that blood flow to the upper extremity will be cut off. Presently, there is a lack of definitive data concerning the maximum duration for balloon inflation that could lead to upper extremity ischemia. However, in this particular case, there was a temporary reduction in vertebral artery flow, while the flow in the carotid and axillosubclavian arteries remained rapid and uninterrupted. To our understanding, only one other case documents the use of a balloon shorter than the vessel diameter. CONCLUSION In specific scenarios, it is advisable to consider the use of smaller balloon diameters to effectively stop extravasation while ensuring adequate perfusion to the brain and hand. While alternative approaches such as open repair, and stent graft procedure have been reported for repairing subclavian artery rupture, balloon tamponade provides interventional radiologists with a distinct technical advantage.
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Affiliation(s)
- Shivam Khatri
- CUNY School of Medicine, New York, NY 10031, United States of America.
| | - Steven Epstein
- Interventional and Vascular Radiologist, Department of Radiology, St. Barnabas Hospital, Bronx, NY 10457, United States of America
| | - Simon Kashfi
- Division of Internal Medicine, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, United States of America
| | - Parind Oza
- Division of Vascular Surgery, Department of Surgery, St. Barnabas Hospital, Bronx, NY 10457, United States of America
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Khatri S, Teferi A, Kashfi S, Chamay S, Sharma S. Vancomycin-Resistant Enterococcus Endocarditis Complicated by Splenic Infarction and Embolic Stroke. Cureus 2023; 15:e40633. [PMID: 37476117 PMCID: PMC10355228 DOI: 10.7759/cureus.40633] [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: 04/03/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Infective endocarditis (IE) is a serious condition associated with high morbidity and mortality rates. The risk factors for IE include underlying heart disease, intravenous drug use, cardiac surgery, and interventional procedures. Enterococci are a common cause of IE, and vancomycin-resistant enterococci (VRE) infections are becoming increasingly prevalent. In this report, we present the case of an 88-year-old female patient with multiple cardiac comorbidities who developed VRE endocarditis with splenic infarction and embolic stroke. The patient was successfully treated with a combination of antibiotics and anticoagulation therapy. This report highlights the importance of recognizing the potential complications of VRE endocarditis and the need for appropriate management to prevent adverse outcomes. To the best of our knowledge, only one other case of VRE endocarditis with multiple systemic complications has been documented so far.
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Affiliation(s)
- Shivam Khatri
- Medicine, The City University of New York School of Medicine, New York, USA
| | - Adisalem Teferi
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
| | - Simon Kashfi
- Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - Salomon Chamay
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
| | - Shorabh Sharma
- Medicine, The City University of New York School of Medicine, New York, USA
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
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Khatri S, Kashfi S, Griffin S. Primary Mucosal Melanoma of the Lip With GNA11 Mutation in a 23-Year-Old Pregnant Woman. Cureus 2023; 15:e38581. [PMID: 37284406 PMCID: PMC10239609 DOI: 10.7759/cureus.38581] [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: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Mucosal melanoma represents a small proportion of all melanoma cases and is associated with a worse prognosis. Primary malignant melanoma of the lip (PMML) is far less common, and only a few cases have been reported since 1997, most commonly in China, Japan, Uganda, and India. Most of these cases have been associated with the gene C-KIT. As a result, treatment guidelines surrounding mucosal melanoma are unclear, especially in complicated populations such as pregnant women. Mutations in theGNAQ and GNA11 genes have been found to be associated with uveal melanoma, while they are rarely associated with mucosal melanoma. We present the case of a 23-year-old pregnant woman who was found to have likely primary malignant melanoma of the lip that metastasized to the left jaw, neck, breast, lungs, and ovaries and was found to be positive for both the BRAF-MLL3 and GNA11 mutation.
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Affiliation(s)
- Shivam Khatri
- Medical School, City University of New York (CUNY) School of Medicine, New York City, USA
| | - Simon Kashfi
- Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - Stephanie Griffin
- Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
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Kashfi S, Pierce M. Multisystem Inflammatory Syndrome Causing Mixed Cardiogenic Shock in a 34-Year-Old With Influenza A. Cureus 2023; 15:e36417. [PMID: 37090278 PMCID: PMC10115191 DOI: 10.7759/cureus.36417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/22/2023] Open
Abstract
Multisystem inflammatory syndrome in adults (MIS-A) is a sequela of COVID-19 and can cause mixed cardiogenic and vasodilatory shock. We present the case of a 34-year-old female who presented with mixed cardiogenic and vasodilatory shock and was found to be influenza A positive while also meeting criteria for MIS-A. She responded well to treatment with steroids and intravenous immunoglobulin (IVIG).
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Khatri S, Alom M, Kashfi S, Atallah J, Goswami G. Simultaneous Presentation of Secondary Adrenal Insufficiency and Primary Hypothyroidism due to Pembrolizumab: A Case Report. J Investig Med High Impact Case Rep 2023; 11:23247096231194401. [PMID: 37642143 PMCID: PMC10467221 DOI: 10.1177/23247096231194401] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/31/2023] Open
Abstract
Checkpoint inhibitors have gained increased traction in recent years as they have improved prognosis in various malignancies. Pembrolizumab, an anti-programmed cell death protein (PD-1) monoclonal antibody, has become a first-line chemotherapeutic agent for stage II non-small cell lung cancer since 2019. Although much more common with nivolumab, several immune-related adverse effects, particularly endocrinopathies, have been linked with pembrolizumab. We describe a case of a 59-year-old man with a history of unspecified lung cancer who presented with severe hyponatremia later attributed to secondary adrenal insufficiency and accompanying primary hypothyroidism secondary to pembrolizumab. Diagnosing adrenal insufficiency in patients on immune checkpoint inhibitors like pembrolizumab can be challenging due to nonspecific symptoms, making it crucial to rule out other causes of hyponatremia. Immunotherapy is known to cause thyroid immune-related adverse events, and anti-thyroid antibodies may not always be present in the diagnosis of hypothyroidism. Although there are some reported cases of pembrolizumab-induced adrenal insufficiency, the link between immunotherapy and endocrine disorders remains unclear. To our knowledge, no case reports exist that describe both primary hypothyroidism and secondary adrenal insufficiency after taking pembrolizumab, although such cases have been documented with axitinib. Timely diagnosis and treatment of adrenal insufficiency is crucial to prevent adverse effects, especially in patients with cancer receiving immunotherapy, as highlighted in this case.
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Affiliation(s)
- Shivam Khatri
- City University of New York School of Medicine, New York City, USA
| | | | - Simon Kashfi
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Khatri S, Chacko S, Chamay S, Kashfi S, Sharma S. Delayed-Onset Losartan-Induced Pancreatitis Secondary to an Overdose: A Case Report. J Investig Med High Impact Case Rep 2023; 11:23247096231165737. [PMID: 37052072 PMCID: PMC10102932 DOI: 10.1177/23247096231165737] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Acute pancreatitis is defined as inflammation of the pancreas and is most commonly caused by gallstones and alcohol use. Less commonly, acute pancreatitis can be drug induced from medications that are divided into 5 subgroups (classes Ia-V). The subgroups are determined based on the cases reported, reaction with rechallenge and a consistent period of latency. We describe a case of a 34-year-old female who overdosed on losartan pills in a suicide attempt but developed symptoms of drug-induced acute pancreatitis nearly a week later without gallstones, alcohol involvement, or other drug toxicity.
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Kashfi S, Farhan Nasser M, Soleiman A, Sharma S, Sandeep Koripalli V, Sharma S. Clot In Transit in a Patient with Protein S Deficiency. Eur J Case Rep Intern Med 2022; 9:003355. [PMID: 35774736 PMCID: PMC9239027 DOI: 10.12890/2022_003355] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 11/05/2022] Open
Abstract
Clot in transit (CIT) is a rare condition in which a venous thromboembolism becomes lodged in the right heart. It is seen in up to 18% of patients with massive pulmonary embolism, and if left untreated, mortality rates are between 80% and 100%. The identification and management of CIT are crucial. However, there are no current guidelines for the treatment of CIT. We present the case of a 44-year-old woman who was found to have CIT that was ultimately treated with medical management.
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Affiliation(s)
| | - Mohamed Farhan Nasser
- Heart and Vascular Center, MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | | | - Sapna Sharma
- St. Barnabas Hospital Health System, Bronx, NY, USA
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Kashfi S, Sharma S. Hair Spray Induced Cardiomyopathy. Eur J Case Rep Intern Med 2022; 9:003313. [PMID: 35520369 PMCID: PMC9067417 DOI: 10.12890/2022_003313] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022] Open
Abstract
Inhalants are common drugs of abuse. Hydrocarbons, the active ingredient in most inhalants, exert depressant effects on the central nervous system, causing a ‘high’. In the heart, hydrocarbon toxicity can predispose patients to arrhythmias and heart failure through increased sympathetic susceptibility. We present the case of a 28-year-old female who developed dilated cardiomyopathy in the setting of chronic inhalant abuse.
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Abstract
Mucosal melanomas represent about 1% of all melanoma cases. Primary malignant melanoma of the esophagus (PMME) is a rare and deadly condition, with only about 339 cases reported in the literature. Esophageal melanoma usually presents with progressively worsening dysphagia, and patients often present late in the disease course. Esophageal melanoma can be treated with surgical resection, chemotherapy, targeted therapy, or immunotherapy depending on the stage and tumor mutations. However, due to the rarity of the disease, no trials have been performed to deliver a gold standard of treatment. We present the case of a 76-year-old female who was diagnosed with metastatic primary malignant melanoma of the esophagus and underwent treatment with nivolumab, a PD-1 receptor antagonist.
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Kashfi S, Loloi J, Statnii I, Arifi B, Sharma S. Gabapentin-Induced Priapism. Cureus 2022; 14:e21241. [PMID: 35174036 PMCID: PMC8841069 DOI: 10.7759/cureus.21241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 11/12/2022] Open
Abstract
Priapism is defined as an erection that lasts longer than four hours, is unrelated to sexual interest or stimulation, and is unrelieved by orgasm. The ischemic subtype is a urologic emergency and is often caused by medication side effects, most notably selective serotonin reuptake inhibitors and trazodone. We present the case of ischemic priapism thought to be caused by the recent initiation of gabapentin.
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Kashfi S, Radparvar AA, Ventura Y, Sharma S, Sharma S. Bullous Erythema Multiforme Secondary to Trimethoprim-Sulfamethoxazole Use, Treated With Cyclosporine in a 91-Year-Old Male. Cureus 2021; 13:e18239. [PMID: 34712524 PMCID: PMC8542345 DOI: 10.7759/cureus.18239] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Abstract
Erythema multiforme is an acute, immune-mediated, mucocutaneous condition in which 90% of cases are triggered by infection. The second most common cause is drug-induced. It classically presents with itchy, burning targetoid lesions on the skin and mucous membranes. The lesions may be mistaken for other conditions, and thus, rapid and correct diagnosis is crucial. It is most often treated with corticosteroids, though non-responders or those with weakened immune systems may require immunomodulatory therapy. We present the case of a 91-year-old male who developed bullous erythema multiforme after treatment with trimethoprim-sulfamethoxazole who was successfully treated with cyclosporine.
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Affiliation(s)
- Simon Kashfi
- Internal Medicine, CUNY School of Medicine, New York, USA
| | | | | | - Sapna Sharma
- Internal Medicine, Mahatma Gandhi Mission Institute of Health Sciences, Navi Mumbai, IND
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Abstract
Adult-onset Still’s disease is a rare, autoinflammatory disease characterized by spiking fevers, arthritis, salmon-colored skin rash, and leukocytosis. It has been compared to systemic juvenile idiopathic arthritis because of its similar features but is much rarer than its pediatric counterpart. It is usually treated with corticosteroids and disease-modifying anti-rheumatic drugs. However, those with refractory disease are candidates for one of many biological therapies. We present the case of a 28-year-old man who was successfully managed with first-line steroid therapy.
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Affiliation(s)
- Simon Kashfi
- Internal Medicine, City University of New York (CUNY) School of Medicine, New York City, USA
| | - Sapna Sharma
- Internal Medicine, Mahatma Gandhi Mission Institute of Health Sciences, Navi Mumbai, IND
| | | | - Shorabh Sharma
- Medicine, City University of New York (CUNY) School of Medicine, New York City, USA.,Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
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Kashfi S, Sermeno Camacho C, Castro KL. Urinary Incontinence Secondary to Fecal Impaction in a Patient With Likely Undiagnosed Hirschsprung's Disease. Cureus 2021; 13:e16837. [PMID: 34513426 PMCID: PMC8410229 DOI: 10.7759/cureus.16837] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 11/05/2022] Open
Abstract
Hirschsprung's disease is caused by the failure of migration of neural crest cells to the hindgut, causing a lack of development of ganglion cells in the submucosal and myenteric plexuses of the colonic wall. Hirschsprung's disease most often presents in infants with failure to pass meconium in the first two days of life. We present the case of an eight-year-old male with chronic constipation since birth who presented to the emergency department with signs concerning spinal cord compression. To our knowledge, this is the first of such a case presenting with urinary incontinence.
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Affiliation(s)
- Simon Kashfi
- Internal Medicine, City University of New York (CUNY) School of Medicine, New York, USA
| | | | - Karen L Castro
- Pediatrics, St. Barnabas Hospital Health System, Bronx, USA
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Kashfi S, Murdakhayev E, Rehmani R, Sharma S. Post-Embolization Syndrome Complicated by Hypertensive Emergency and Severely Elevated Transaminases. Cureus 2021; 13:e15446. [PMID: 34258113 PMCID: PMC8255082 DOI: 10.7759/cureus.15446] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 11/05/2022] Open
Abstract
Transarterial chemoembolization (TACE) is a procedure reserved for the treatment of hepatocellular cancer that is unresectable through surgery. It combines both embolization and chemotherapy by injecting chemotherapy via a catheter directed at the tumor and then blocking the artery to prevent blood flow to the tumor. We present the case of a 69-year-old man who experienced post-embolization syndrome (PES) with a hypertensive emergency and elevated liver transaminases following his TACE procedure. Imaging combined with clinical assessment was necessary to determine whether the patient was experiencing a ruptured hepatic abscess or PES, as both are potential complications of TACE. The patient was ultimately managed with supportive care and discharged after several days.
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Affiliation(s)
- Simon Kashfi
- Internal Medicine, City University of New York (CUNY) School of Medicine, New York, USA
| | - Elizabeth Murdakhayev
- Internal Medicine, City University of New York (CUNY) School of Medicine, New York, USA
| | - Razia Rehmani
- Radiology, St. Barnabas Hospital Health System, Bronx, USA
| | - Shorabh Sharma
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
- Internal Medicine, Hospitalist, Bronx, USA
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