February 13, 2022

Immunotherapy is an important treatment modality in cancer, but it can also cause adverse reactions, with skin toxicity being the most common. The increasing number of immune checkpoint in hibitors being used in the clinic will inevitably cause an increase in the rate of adverse skin reactions that markedly affect the patient’s quality of life. A 58-year-old patient with intrahepatic cholangio carcinoma developed bullous pemphigoid (BP) nearly a year after using immune checkpoint inhibitors, which is different from what has been reported in the literature within two weeks of treatment. Pathologically, the skin biopsy diagnosis was epidermal hyper plasia and focal sub-epidermal pustule formation, consistent with drug-induced dermatitis.

Patients with Parkinsonism may present acutely to the ED with serious and even life-threatening conditions. Although falls are a common presentation in advanced Parkinsonism, early presen tations with falls should alert the clinician that the patient might have a Parkinson syndrome other than Parkinson’s disease itself, including autonomic neuropathy causing orthostatic hypotension. Patients may present with neuroleptic malignant syndrome, acute psychosis, marked hypokinesis, freezing gait, aspiration pneumo nia, dysphagia, serotonin syndrome, dopamine dysregulation syn drome and intestinal pseudo-obstruction. An inpatient admission is necessary for investigation and observation of these patients.

V-P shunt is the most common surgery done in paediatric hydro cephalus. Though the surgery remains as ‘minor’ in the arena of Neurosurgery, its complication surpass any boundary. Here we discuss a case of shunt complication which had malfunctioning shunt with both end malposition, cranial end occluded by septum and cortex and peritoneal end invading bowel. Surgery was taking a new course for dramatic appearance of COVID 19.