Journal of Community Hospital Internal Medicine Perspectives最新文献

{"title":"The Effect of Empiric Initiation of Treatment on Outcomes Among Patients Presenting With Extrapulmonary Mycobacterium Tuberculosis Infection in a Community Hospital Setting.","authors":"Talha Awwal, Faisal R Kh, Hanya Awaba, Waseem Anwar, Jinma Ren, Muhammad A Safdar, Saqib Walayat, John Farrell","doi":"10.55729/2000-9666.1623","DOIUrl":"10.55729/2000-9666.1623","url":null,"abstract":"<p><strong>Background: </strong>Extrapulmonary tuberculosis (EPTB) accounts for ~20% of Mycobacterium tuberculosis infections in Pakistan. Diagnostic delays are common and may worsen outcomes. We evaluated whether empiric treatment initiation improves outcomes among patients with EPTB at a large public hospital in Islamabad, Pakistan.</p><p><strong>Methods: </strong>Retrospective cohort of consecutive EPTB cases at Pakistan Institute of Medical Sciences (January-June 2016). Patients were categorized as clinically diagnosed (symptoms/radiology) or laboratory-supported (histology, microbiology, or biochemical tests). Standard Directly Observed Therapy Short-course (DOTS) based regimens were used. Outcomes were treatment success, failure, loss to follow-up, and mortality; groups were compared using chi-square testing.</p><p><strong>Results: </strong>Of 317 EPTB patients, 275 completed treatment and were analyzed. Mean age was 34.4 years; 57% were male. The most common sites were pleural (28.7%) and lymphatic (20.3%) TB. Clinically diagnosed patients had higher cure rates than laboratory supported diagnosis group patients (87.6% vs. 79.6%; p = 0.221) and significantly lower mortality (5.3% vs. 9.3%; p = 0.041). Among patients who completed treatment, 82.9% achieved treatment success; overall cure rate was 71% including non-completion and loss to follow-up.</p><p><strong>Conclusions: </strong>Early empiric therapy may be associated with improved survival and higher cure rates compared with delaying treatment pending laboratory confirmation. Context-appropriate EPTB guidelines emphasizing prompt clinical treatment are warranted in high burden settings.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 4","pages":"55-61"},"PeriodicalIF":0.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Analysis of Opioid Overdose Hospitalizations Pre- and Post-Pandemic: Insights from the National Inpatient Sample Database.","authors":"Hassan Shakir, Niloy Ghosh, Mohammed A Quazi, Tom Limanovich, Abdul R Awan, Humza Saeed, Adeel Nasrullah, Christopher R Smith, Abu B Sheikh","doi":"10.55729/2000-9666.1632","DOIUrl":"10.55729/2000-9666.1632","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic disrupted healthcare systems, affecting opioid overdose-related hospitalizations. National data examining how demographic and clinical outcomes evolved during this period, particularly by overdose intent, remain limited.</p><p><strong>Methods: </strong>Using the National Inpatient Sample (2018-2021), we identified adult hospitalizations for opioid overdose using ICD-10 codes and categorized cases as intentional, unintentional, or unspecified. Patients were grouped into pre-COVID (2018-2019) and post-COVID (2020-2021) cohorts. Multivariable logistic and linear regression models adjusted for patient- and hospital-level factors evaluated demographic differences, complications, and outcomes.</p><p><strong>Results: </strong>Among 293,810 hospitalizations, intentional overdoses decreased over time, while unintentional overdoses remained predominant. Post-COVID hospitalizations had higher odds of, sudden cardiac arrest (5.53% vs 4.52%; aOR 1.18, 95% CI 1.09-1.27), vasopressor use (aOR 1.12, 95% CI 1.01-1.24), and cardiac dysrhythmias (aOR 1.08, 95% CI 1.02-1.14), with no mortality difference (aOR 1.00, 95% CI 0.92-1.08).Intentional overdoses were more common among younger females and associated with better clinical outcomes. Compared with unintentional overdoses, intentional cases had lower odds of in-hospital mortality (1.86% vs 4.90%; aOR 0.47, 95% CI 0.40-0.55), sudden cardiac arrest (aOR 0.26, 95% CI 0.22-0.31), invasive ventilation (aOR 0.80, 95% CI 0.76-0.85), and anoxic brain injury (aOR 0.41, 95% CI 0.35-0.47).</p><p><strong>Conclusions: </strong>Despite a decline in opioid overdose-related hospitalizations, unintentional overdoses remained the dominant and more severe presentation. The increase in post-COVID complications suggests a shift toward greater clinical acuity, placing additional strain on inpatient healthcare resources.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 4","pages":"62-72"},"PeriodicalIF":0.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation Between Aortic Valve Area Measured by Cardiac Computed Tomography and Transthoracic Echocardiography in Patients with Aortic Stenosis.","authors":"Shehroz Sultan, Neeraj Joshi, Ali Haider Awan, Shabana Kauser, Hafsa Malik Aulakh, Bilal Ghafoor, Muhammad Ammar Ajmal, Abida Perveen, Jahanzeb Malik","doi":"10.55729/2000-9666.1634","DOIUrl":"10.55729/2000-9666.1634","url":null,"abstract":"<p><strong>Background: </strong>Accurate assessment of aortic valve area (AVA) is essential for determining the severity of aortic stenosis (AS) and guiding clinical management. Transthoracic echocardiography (TTE) is the standard first-line imaging modality, while cardiac computed tomography (CT) provides direct anatomical planimetry and may offer complementary information in selected patients.</p><p><strong>Objective: </strong>To evaluate the correlation and agreement between CT-derived and TTE-derived AVA measurements and to examine their association with clinical outcomes in patients with AS.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 1857 consecutive adults with moderate to severe AS who underwent both TTE and cardiac CT at the Rawalpindi Institute of Cardiology between January 2023 and July 2025. Correlation between modalities was assessed using Pearson's coefficient, while agreement was evaluated with Bland-Altman analysis. Associations between AVA thresholds (≤1.0 cm² vs > 1.0 cm²) and adverse clinical outcomes were analyzed using logistic regression and receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>The mean AVA measured by TTE was 0.84 ± 0.19 cm² and by CT was 0.87 ± 0.21 cm². A strong correlation was observed between the two modalities (r =0.82, p < 0.001), with acceptable agreement on Bland-Altman analysis. Patients with AVA ≤1.0 cm² had significantly higher rates of adverse clinical outcomes compared with those with larger valve areas.</p><p><strong>Conclusion: </strong>CT-derived AVA demonstrates strong agreement with TTE and provides complementary information for severity assessment and risk stratification in patients with aortic stenosis. Integrating CT with conventional echocardiography may improve clinical evaluation, particularly in cases with discordant or borderline findings.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 4","pages":"19-25"},"PeriodicalIF":0.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extranodal Marginal Zone Lymphoma of the Breast in a Patient with Chronic Hepatitis C Infection: A Case Report.","authors":"Ravneet K Dhanoa, Bipasha Goyal, Prateek Jain, Marilyn Baird-Howell, Mounika Gangireddy","doi":"10.55729/2000-9666.1619","DOIUrl":"10.55729/2000-9666.1619","url":null,"abstract":"<p><p>Primary breast lymphomas account for less than 1% of all non-Hodgkin lymphomas and 0.04-0.5% of all malignant breast neoplasms. We report a case of breast extranodal marginal zone lymphoma (EMZL) in a 60-year-old woman with chronic hepatitis C virus (HCV) infection. After comprehensive evaluation excluded other known etiologies, chronic HCV infection emerged as the most plausible contributing factor. Epidemiologic and biological evidence supports an association between HCV and B-cell non-Hodgkin lymphomas, particularly marginal zone lymphomas. Our case adds to the limited literature suggesting that HCV should be considered as a potential etiological factor in breast EMZL. We discuss the emerging role of direct-acting antiviral (DAA) therapy in HCV-associated indolent lymphomas and its implications for management.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 4","pages":"105-108"},"PeriodicalIF":0.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review of Randomized Clinical Trials for the Treatment of Long COVID Syndrome.","authors":"Leonardo Tamariz, Dariel Rodriguez, Elizabeth Bast, Nancy Klimas, Morgan Pyne, Maricarmen Cruz-Jimenez, Diana Gomez-Manjarrez, Ana Palacio","doi":"10.55729/2000-9666.1612","DOIUrl":"10.55729/2000-9666.1612","url":null,"abstract":"<p><strong>Background: </strong>There is a critical need for interventions for long COVID. Our aim was to conduct a systematic review on the efficacy and safety of different interventions in patients with long COVID.</p><p><strong>Methods: </strong>We searched the MEDLINE 1965 until August 2024. We included randomized clinical trials that reported a primary outcome. We evaluated the GRADE certainty of the effect measures.</p><p><strong>Results: </strong>Our initial search yielded 2606 potentially relevant studies. We include 43 randomized clinical trials that ultimately included 2878 participants with long COVID. The GRADE criteria found all but one study had low certainty. Eight studies reported on the use of nutraceuticals, 6 tested respiratory muscle training, 7 studies evaluated supervised exercise, 7 studies tested brain stimulation, and 5 studies used FDA regulated medications. The majority of the studies improved the primary outcome and included symptoms, quality of life, and exercise capacity.</p><p><strong>Conclusion: </strong>In randomized clinical trials medications, respiratory cognitive and physical therapy interventions improved outcomes in long COVID patients. However, the studies had low GRADE certainty of the effect measures. Larger and higher quality studies are needed.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 4","pages":"1-12"},"PeriodicalIF":0.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Villi to Alveoli: Lung Involvement in Celiac Disease - A Narrative Review.","authors":"Mateusz Marzec, Patrycja Cecha","doi":"10.55729/2000-9666.1615","DOIUrl":"10.55729/2000-9666.1615","url":null,"abstract":"<p><strong>Background: </strong>Celiac disease (CD) is a chronic, immune-mediated enteropathy triggered by gluten that affects about 1% of the population and may present with extraintestinal manifestations. Pulmonary complications are considered rare and are poorly characterized. Lane-Hamilton syndrome is the best described lung manifestation, but data suggests a broader spectrum of respiratory involvement.</p><p><strong>Methods: </strong>We performed a narrative review with structured search strategy of PubMed and Embase (January 1, 1970-December 1, 2025) using the terms <i>celiac</i>/<i>coeliac</i> and <i>lung</i>, <i>pulmonary</i>, <i>respiratory</i>, <i>hemoptysis</i>, <i>hemosiderosis</i>, <i>alveolar hemorrhage</i>, <i>interstitial lung disease</i>, <i>alveolitis</i>, <i>bronchiectasis</i>, <i>bronchiolitis</i>, <i>asthma</i>, <i>pneumonia</i>, <i>pneumococcal</i>, <i>sarcoidosis</i> and <i>histiocytosis</i>. We analyzed all available data describing patients with CD and respiratory disorders.</p><p><strong>Results: </strong>Pulmonary involvement in CD appears to represent one of its extraintestinal manifestations, alongside hematologic, dermatologic, neurologic, hepatic, and skeletal. LHS is well defined: several systematic reviews identified dozens of pediatric and adult cases. Increased risk of pneumonia (especially pneumococcal) is demonstrated in observational studies and described in systematic reviews. Moreover, CD has been associated with interstitial lung disease, bronchiectasis, asthma, chronic obstructive pulmonary disease, and chronic cough.</p><p><strong>Conclusions: </strong>Pulmonary involvement in CD is uncommon but clinically important. For hospital internists, a bidirectional approach is suggested: to screen for CD in selected pulmonary presentations, and to systematically assess respiratory symptoms in patients with CD.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 4","pages":"81-88"},"PeriodicalIF":0.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Piperacillin-Induced Immune Hemolytic Anemia Masked by Intestinal Failure-Associated Liver Disease: A Case Report with Three Serial Exposures.","authors":"Stephanie Ammari, Nawras Ibrahim, Khalid Mahmood","doi":"10.55729/2000-9666.1617","DOIUrl":"10.55729/2000-9666.1617","url":null,"abstract":"<p><strong>Background: </strong>Drug-induced immune hemolytic anemia (DIIHA) secondary to piperacillin has an estimated incidence of 0.01-0.10% [1,2]. In patients with intestinal failure-associated liver disease (IFALD), chronic conjugated hyper-bilirubinemia obscures typical hemolytic markers [3,4].</p><p><strong>Case presentation: </strong>A 27-year-old woman with traumatic short bowel syndrome requiring total parenteral nutrition for 6 months, IFALD (baseline total bilirubin 2.5 mg/dL), and chronic kidney disease experienced three piperacillin-tazobactam exposures over two months. First exposure (12 days): hemolysis developed after drug discontinuation (primary sensitization). Second exposure: severe hemolysis occurred within 3 days (anamnestic response) with hemoglobin declining to 5.8 g/dL, undetectable haptoglobin, elevated LDH, reticulocytosis, and strongly positive DAT (IgG 3+, C3d negative). Total bilirubin remained stable at 9.7 mg/dL despite severe hemolysis. Peripheral smear showed spherocytes and polychromasia without schistocytes. Naranjo score was 10 (definite causality) [5]. Treatment included drug discontinuation, corticosteroids, and transfusion with resolution within 8 days. Third exposure (6 days): no hemolysis occurred. At 5-month follow-up, hemoglobin returned to baseline at 9.7 g/dL.</p><p><strong>Conclusions: </strong>When baseline cholestasis masks unconjugated bilirubin elevation, diagnosis requires non-bilirubin hemolytic markers, peripheral smear, and positive IgG DAT. Immediate drug discontinuation is essential, with favorable prognosis in most cases.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 4","pages":"109-114"},"PeriodicalIF":0.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Cardiac and Renal Amyloidosis with Nephrotic Syndrome in a Patient with a Remote History of Partial Nephrectomy for Renal Cell Carcinoma.","authors":"Gaurav Bector, Prateek Jain, Mahyar Toofantabrizi, Christopher J Haas","doi":"10.55729/2000-9666.1620","DOIUrl":"10.55729/2000-9666.1620","url":null,"abstract":"<p><strong>Background: </strong>Primary AL amyloidosis is a rare systemic disorder caused by deposition of misfolded immunoglobulin light chains, leading to multi-organ dysfunction. Renal cell carcinoma (RCC) is common, with an age-adjusted incidence of 16.4 per 100,000 persons per year in the US (2017-2021). Post-partial nephrectomy, mild proteinuria may occur, but progressive glomerular disease such as AL amyloidosis years later is rare.</p><p><strong>Case presentation: </strong>A 73-year-old man with ulcerative colitis, type 2 diabetes, RCC post right partial nephrectomy (10 years prior), and prostate cancer post-prostatectomy (4 years prior) presented with fatigue and bilateral leg edema. Laboratory evaluation revealed acute kidney injury with nephrotic-range proteinuria, hypoalbuminemia, and elevated cardiac biomarkers. Serum and urine protein electrophoresis revealed IgA kappa monoclonal protein. Renal biopsy confirmed AL amyloidosis, and endomyocardial biopsy confirmed cardiac involvement. Bone marrow biopsy showed 10% clonal plasma cells without myeloma-defining events, excluding multiple myeloma. The patient received Dara-CyBorD chemotherapy and hemodialysis. Despite therapy, renal function remained dialysis-dependent, and cardiac and hematologic responses plateaued after one year.</p><p><strong>Discussion: </strong>This case highlights the diagnostic challenges and multi-organ involvement of AL amyloidosis in a patient with prior malignancy. RCC and AL amyloidosis coexist independently, and early recognition is critical for management.</p><p><strong>Conclusion: </strong>AL amyloidosis can occur in patients with a remote history of RCC. Clinicians should maintain high suspicion in patients with nephrotic-range proteinuria and cardiac involvement. Early recognition, staging, and therapy may improve outcomes, although irreversible organ damage may limit recovery.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 4","pages":"120-123"},"PeriodicalIF":0.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rasmussen's Aneurysm: A Rare but Life-Threatening Complication of Pulmonary Tuberculosis - A Case Report.","authors":"Karan Puri","doi":"10.55729/2000-9666.1614","DOIUrl":"10.55729/2000-9666.1614","url":null,"abstract":"<p><p>Rasmussen's aneurysm is a rare but potentially fatal complication of pulmonary tuberculosis. It represents a pseudoaneurysm of a pulmonary arterial branch caused by erosion of the arterial wall secondary to chronic inflammation within a tuberculosis cavity. Although uncommon, especially in non-endemic regions, rupture of this aneurysm can result in massive hemoptysis and carries a high mortality if not promptly recognized and managed. We report a case of a healthcare worker in the United States, a non-endemic region, who presented with massive, life-threatening hemoptysis. She was found to have active pulmonary tuberculosis. Computed tomography angiography demonstrated a 10-mm pseudoaneurysm arising from the apical branch of the left pulmonary artery protruding into a cavitary lesion in the left upper lobe. Four months prior to presentation, she had been diagnosed with latent tuberculosis but had declined treatment. The patient was started on anti-tuberculosis therapy after presenting with hemoptysis. Endovascular embolization of the left upper-lobe subsegmental pulmonary artery was successfully performed, resulting in complete resolution of hemoptysis. Rasmussen's aneurysm, though rare, can occur outside endemic regions and may follow a rapid progression from latent to active tuberculosis. Awareness, early imaging, and prompt endovascular intervention are crucial to reduce morbidity and mortality. Screening and treatment of latent tuberculosis remain essential to prevent progression to active disease and such severe complications.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 4","pages":"134-137"},"PeriodicalIF":0.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Multisystem Toxicity from Combination Ipilimumab and Nivolumab in Metastatic Melanoma: A Case Report.","authors":"Bushra Amer, Sheetal Manerkar","doi":"10.55729/2000-9666.1622","DOIUrl":"10.55729/2000-9666.1622","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICIs) have transformed cancer therapy by enhancing antitumor immunity. Despite their remarkable efficacy in malignancies, particularly metastatic melanomas, the use of ICIs have been linked to life-threatening immune-related adverse events (irAEs) affecting several organ systems. Combination therapy with ipilimumab and nivolumab increases both efficacy and the risk of severe irAEs. We report a rare case of metastatic melanoma treated with combination ipilimumab and nivolumab, complicated by multisystem irAEs. The patient developed hepatitis, cholangitis, ocular toxicity, and neurologic progression, highlighting the severity and complexity of immune-mediated toxicities following dual checkpoint blockade. This case underscores the potential for severe, multisystem irAEs with combination ICIs and the need for vigilant monitoring, early recognition, and multidisciplinary management. Understanding the mechanisms and predictors of these toxicities is essential to optimize treatment outcomes while minimizing life-threatening complications.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 4","pages":"89-93"},"PeriodicalIF":0.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}