Leishmaniasis, a protozoan parasitic pathology, is caused by infection with a parasite known as Leishmania donovani, which is transmitted to humans through the bite of a sand fly. The disease has various manifestations, including cutaneous leishmaniasis, visceral leishmaniasis (VL), and disseminated cutaneous leishmaniasis. Visceral leishmaniasis (VL), also known as kala-azar, is mostly seen in the Asian and African regions and can be deadly if left untreated. We present the case of a 10-month-old male infant who was brought to the office with the chief complaints of recurrent fever for the past one month, along with generalized fatigue and poor feeding. A comprehensive history, detailed physical examination, and laboratory testing, including bone marrow aspiration, were performed, and visceral leishmaniasis was diagnosed.

Supraventricular tachycardia (SVT) refers to the narrow complex tachycardia originating at or above the bundle of His. Several risk factors are associated with the development and recurrence of SVT, but its association with gastric problems, especially dyspepsia, is relatively rare. We report the case of a 54-year-old female who presented to the emergency room (ER) with palpitations, which were diagnosed as an episode of paroxysmal supraventricular tachycardia (PSVT). She had a history of PSVT in the past, along with hypertension and dyspepsia. After thorough history and examination, dyspepsia was identified as the common trigger of her PSVT episodes, pointing towards the likelihood of gastrocardiac symptoms. Therefore, an appropriate regimen of beta-blockers, proton pump inhibitors (PPIs), and anti-foaming agents (simethicone) was prescribed to manage her symptoms with the plan to perform a catheter ablation later.

Introduction: Isatuximab (ISA) is an anti-CD38 monoclonal antibody that has shown benefit in patients with relapsed/refractory multiple myeloma (RRMM) in combination regimens. This study focuses on the clinical utility and tolerability of ISA based therapies in patients with ISS stage III disease. Methods: Literature search on PubMed, EmCare, Clinicaltrials.gov, Cochrane, and Google Scholar was performed from inception to July 1, 2020, for the use of ISA in MM patients. A total of five clinical trials, including phase Ib/II and phase III trials, were selected for a systematic review out of 109 studies (n=556 patients). Results: The median age was 61-71 years. The addition of ISA to pomalidomide-dexamethasone (PD) in previously treated patients was evaluated by Attal et al. (2019). International Staging System (ISS) stage III disease was present in 28% of the study population at baseline. Patients treated with ISA-PD had a meaningful increase in progression-free survival (PFS) (11.53 versus 6.47 months, P = 0.001, Hazard Ratio (HR): 0.596; 95% confidence interval (CI): 0.436-0.814. PFS benefit was maintained in subgroup analysis based on renal involvement, refractoriness to lenalidomide, and proteasome inhibitors. However, PFS benefit was not statistically significant in ISS stage III disease (HR: 0.64; CI: 0·36-1·11). Martin et al. (2017) evaluated the addition of ISA to lenalidomide and dexamethasone in 57 patients. 22% of the patients had ISS stage III disease. Mikeal et al. also included 9% and 37.1% of patients with ISS stage III MM in their phase Ib and II trials, respectively. All studies demonstrated a significant prolongation of PFS in patients refractory to lenalidomide with ISA administered at 10 mg/kg weekly/every two weeks. Iida et al. (2019) also reported statistically significant improvement in PFS with ISA monotherapy in heavily pretreated Japanese patients (PFS 4.7 months; 95% CI 3.75-NC). In patients with newly diagnosed MM, Ocio et al. (2017) showed encouraging results with an ISA based regimen in 17 patients. ISS stage III disease was present in 88% of the population. At the time of data cut-off, the overall response to treatment was 87%, and 82.4% continued to remain on treatment (see Table 1). Conclusion: ISA as monotherapy and in combination therapy improved surrogate endpoints without increased toxicity in patients refractory to previous lines of treatment. Limited data suggest an improvement in PFS for ISS stage III disease. Long-term results on efficacy in MM with high-risk cytogenetics are awaited. Disclosures Anwer: Incyte, Seattle Genetics, Acetylon Pharmaceuticals, AbbVie Pharma, Astellas Pharma, Celegene, Millennium Pharmaceuticals.: Honoraria, Research Funding, Speakers Bureau.

Isotretinoin is an analog of vitamin A, used to treat severe, recalcitrant nodular acne, psoriasis and disorders of keratinization. However, its benefits come with a broad range of serious side effects, including ocular adverse effects. We report and describe a rare case of bilateral myopia in a female patient treated with oral isotretinoin for acne vulgaris. A female patient, 29-year old, presented to the office for blurry vision. The patient was treated with oral isotretinoin for four weeks. She had a past medical history of myopia precisely corrected with laser-assisted in situ keratomileusis without any residual refractive error. After a thorough examination and laboratory workup, isotretinoin was thought to be the causative agent of her current complaint, so it was immediately stopped. The follow-up showed no further decrement of visual acuity in the patient. However, the vision loss acquired as an adverse effect of oral isotretinoin persisted.

Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease caused by the novel coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Initially, it was reported in December 2019 and became a global pandemic in March 2020, with many presentations and after-effects. We report the case of a 68-year-old female patient who presented to the emergency room with the chief complaint of a skin rash and itching all over her body, developing within a few minutes of insulin injection. The patient had tested positive for COVID-19 almost eight days ago and was self-quarantined. She was a known diabetic for the past 28 years. Her blood glucose levels were maintained within the normal range by a combination regimen of oral anti-diabetic drugs and subcutaneous humulin 70/30 (70% neutral protamine Hagedorn (NPH) insulin and 30% regular human insulin) injections. After careful examination and thorough history taking, a newly acquired insulin allergy was diagnosed in the patient, attributed to her disrupted immune system due to the recent COVID-19 infection.