Immune therapies have transformed the landscape of oncology. Immune checkpoint inhibitors are group of medications, which activate T-Cells to fight against cancer cells. Acute tubulointrestitial nephritis is the most common form of kidney immune-related adverse event. With more use of ICPIs, renal immune related side effects are being recognized more. Here we present a case of renal tubular acidosis with acute kidney injury in a patient with squamous cell carcinoma of the skull who was on Cemiplimab.

A 72-year-old man with a history of metastatic melanoma and hypertension presented to the hospital with a 2-week duration of weakness and fatigue. He also reported poor appetite and decreased oral intake but no weight loss. He denied shortness of breath, lightheadedness, syncope, nausea, vomiting, or diarrhea. He also denied headache, confusion, polyuria, or polydipsia.Home medications included amlodipine 10 mg once a day, lisinopril 10 mg once a day, and pembrolizumab 200 mg intravenously every 3 weeks. The latter was started 3 months prior to admission and he had recently completed 3 cycles of therapy.On admission, he had blood pressure of 118/78 mm Hg and heart rate of 62 beats per minute. Initial work-up was notable for hyponatremia with serum sodium level of 120 mg/dL and metabolic acidosis with total CO 2 of 16 mmol/L. Other laboratory results are shown in Table 1. A spot urinary protein-creatinine ratio was 0.12 mg/mg, and urine pH was 6.0. Urine analysis did not show any microscopic hematuria or pyuria. There was no glycosuria.Computed tomography scan of the abdomen was normal. Other laboratory studies including titers of serum antinuclear antibody, anti-neutrophil cytoplasmic antibody, and anti-SSA/SSB; tests for hepatitis B and C virus; and levels of C3 and C4 were all unrevealing.

Cholangiocarcinoma (CC) is one of the main crucial hepatic malignancies; hence CC is the prime cause for cancer death occurred due to bile duct cancer. A wide range of studies showed that the expression of intracellular proteins associated with the progression of tumor process might be a response of autoantibody. Unlike intracellular components, autoantibodies can appear in cancer patients long before clinical appearance of the cancer. Apparently, CC autoantibodies can appear at any point in the transformation of chronic liver disease; those autoantibodies may not apparent in erstwhile non-transformation phases, lead to a significant increase in the quantity of patients with CC positive for the presence of autoantibodies. The aim of present study was to detect the cellular proteins involved in bile duct cancer process by the use of immunoblotting technique and to predict the future biomarkers of CC. SERPA technique was applied to detect the differentially expressed proteins from nine CC patients’ sera adopting standard protocol. 2-D maps revealed a number of protein spots after gels staining. Proteins of interest were observed between pH 5 and pH8 having molecular mass range between 20 and 90 kDa. Comparative analysis of blots indicated four common immunoreactive spots in CCSW1 cell lines. These cancer specific proteins might be used for CC diagnosis at early stage.  

Cutaneous leishmaniasis is a neglected protozoan disease caused by a phlebotomine sand fly that inserts a parasite into the host bloodstream by biting to expose the area of the body. These parasites cause lesion which is very painful and ulcerated. The disease is quite common like a fever in the province of Balochistan Pakistan due to the neighboring border of Afghanistan where the travelers and refugees migrate and transfer this disease into this area of Pakistan. The purpose of our study is to find out the cases and the intensity of disease in different areas of Balochistan. A study was conducted at the rural health centers in areas such as Winder, Uthal, and Lasbela in the province of Balochistan Pakistan. Where fifty patients from each area were diagnosed by sampling their lesions after taking their consent-on-consent form. From the above study, it was observed that the Cutaneous leishmaniasis was dominant in all three areas of Balochistan because its hot weather is likely to be suitable for the growth of parasite-holding sandflies. Most of the patients were male with multiple lesions and aged between 11-40 years who work in fields. No proper treatment is seriously available, desperately poor patients must face this infectious disease as their daily routine. The frequency of Cutaneous leishmaniasis is increasing to its full ultimate due to less awareness and being deprived of the proper treatment, and lack of preventive measures. To overwhelm the situation some emergency steps should be taken for this common neglected disease.