Management of patients with cystic fibrosis and allergic bronchopulmonary aspergillosis using anti-immunoglobulin e therapy (omalizumab)

Omalizumab is a recombinant DNA-derived humanized immunoglobulin G (IgG) anti-IgE monoclonal antibody approved for use in patients with allergic asthma. However, it is not approved for allergic bronchopulmonary aspergillosis (ABPA). Conflicting reports exist about the effects of omalizumab on ABPA in patients with cystic fibrosis (CF). We report 2 patients with CF treated with omalizumab, in whom frequency of ABPA exacerbations was markedly reduced with treatment. Additionally, hospitalizations were reduced from 5 per year to once in 18 months in the first patient and from twice to once per year in the second patient. Free IgE decreased by 87.9% after 6 months of therapy in the first patient and by 95.6% after 7 months of therapy in the second patient. Neither of the two patients had evidence of asthma. Omalizumab may be useful in treating ABPA in patients with CF, and including free IgE in monitoring the response to therapy will be helpful.

Metastatic adenocarcinoma of the uterine cervix to the thyroid gland

Clinically diagnosed metastasis to the thyroid gland is rare. The authors present the first reported case of metastasis to the thyroid gland from a primary adenocarcinoma of the uterine cervix.

Hydroxyurea-induced fever in cervical carcinoma: case report and review of the literature

This is a case presentation of a rarely seen hydroxyurea-induced fever in a patient with cervical adenocarcinoma receiving oral hydroxyurea given concurrently with external beam radiotherapy to the pelvis. In the fourth week of treatment, the patient developed recurrent febrile episodes, with no obvious etiology. Eventually, hydroxyurea was discontinued with no further recurrence of fever. A review of the medical literature on fever induced by hydroxyurea suggests a mechanism of delayed hypersensitivity. Since hydroxyurea is an often-used chemotherapeutic drug for various malignancies, clinical oncologists need to be aware of this unusual side effect. The diagnosis is by clinical exclusion and by the recurrent pattern of fever on rechallenge of the drug.