A case of Francisella tularensis meningitis in a 64-year-old man treated with quinolones

We report a French case of tularemic meningitis - the second to be thoroughly described - and discuss the existing literature. The patient is a 64-year-old man with no medical history, who developed fever, cutaneous symptoms, and swollen lymph nodes within a week after a hunt. He was then diagnosed with meningitis caused by Francisella tularensis subsp. holarctica. Healing was quickly achieved ad integrum within 3 weeks with a course of ciprofloxacin. We discuss the existing literature about this specific issue, and try to shine a light on the superior efficacy and lesser toxicity of quinolones compared to the historical treatment.

[Effectiveness of erlotinib in Critical Care Unit in patients with non-small cell lung cancer with EGFR mutation]

INTRODUCTION

The search for mutations epidermal growth factor receptor (EGFR) has changed the therapeutic approach and prognosis of non-small cell lung cancer (NSCLC). The effectiveness of tyrosine kinase inhibitors (TKI) has been demonstrated orally in patients with EGFR mutation. We report the case of a patient for whom treatment with TKI was started effectively in a Critical Care Unit.

OBSERVATION

A patient of 59 years is followed for a stage IV lung adenocarcinoma with metastases in liver, brain, adrenal, lung and pleura. After a first course of chemotherapy (cisplatin-gemcitabine), the patient presents a multi-factorial acute respiratory distress. Due to an EGFR mutation, transfer to intensive care is decided then orotracheal intubation with mechanical ventilation. It is decided to initiate treatment with erlotinib via nasogastric tube. The evolution will be marked by a tumor response leading to a favorable issue.

CONCLUSIONS

This case shows the value of initiate TKI despite hospitalization in Intensive Care Unit and highlights the question of the transfer in ICU patients with EGFR mutation.

[Severe hyponatremia during chemotherapy for small cell carcinoma]

INTRODUCTION

The small cell lung cancer (SCLC) is a rapidly progressive malignancy with a poor prognosis. Its chemosensitivity mandates prompt treatment. Hyponatremia occurs frequently in patients with small cell lung cancer due to the syndrome of inappropriate antidiuretic hormone (SIADH). We report a case of severe hyponatremia induced by chemotherapy that required management in intensive care.

OBSERVATION

A 68-year-old patient was undergoing treatment for small cell cancer, invading the right lung. On the second day of the first cycle of treatment (cisplatine-vepeside), the patient became comatose and required transfer to an intensive care unit. The coma was due to severe hyponatremia (107 mmol/L) and improved with specific treatment. The patient had similar episodes on the second day of each chemotherapy treatment but with less and less severe clinical manifestations. Hyponatremia due to chemotherapy in SCLC is not commonly known; a relation between hyponatremia intensity and the tumor size is suspected.

CONCLUSION

This clinical case highlights the possibility of severe hyponatremia during small cell lung cancer chemotherapy. Hyponatremia may be related to the reduction in tumor size. Monitoring of electrolytes on day 2 of chemotherapy is advised.