Severe flank pain is a frequent complaint at the emergency department (ED). It is usually associated to other clinical symptoms like fever, dysuria, vomiting, diarrhea or radiation to the groin. Hereby, it may raise a lot of probable differential diagnosis that should be ruled out first depending on laboratory tests and imaging results. However, when flank pain is isolated and radiating to the groin without evidence of urolithiasis on abdominal CT scan, more rare diagnosis should be suggested such as renal vessels thrombosis with or without other vessel thrombosis in the pelvis. Thereafter, thrombophilic studies should be performed to elucidate the underlying etiology. We present the case of a 44-yearold lady having simultaneously acute left renal and ovarian veins thrombosis presenting to ED for severe isolated left flank pain radiating to the left groin and heterozygous factor V Leiden on thrombophilic studies. We would like to stress on the importance of having a high index of suspicion of such diagnosis at ED based on medical history and primary investigations because a good management may result in salvage of organs by minimally invasive techniques, an early effective treatment and convenient anticoagulation in the future to prevent further complications.

Background QTc interval prolongation has been reported when combining fluoroquinolones and triazoles for chemoprophylaxis in cancer patients. Herein, we aimed to identify the prevalence and contributing factors to QTc prolongation in hematopoietic cell transplantation (HCT) recipients who received these agents during the neutropenic phase. Methods This is a retrospective medical chart review conducted at a university hospital in Lebanon from 2017 to 2020. It included all adult HCT inpatients on antimicrobial prophylaxis with fluoroquinolones and triazoles and whose baseline ECG monitoring done prior to chemoprophylaxis administration, then on day-3 and day-6 of therapy, were available. Results Overall, 68 HCT recipients met our inclusion criteria, of which 22% developed QTc prolongation. Based on bivariate analysis, female gender contributed to QTc prolongation ( P = 0.001). There was a trend to QTc prolongation in patients with predisposing thyroid disease ( P = 0.12), grade 2 vomiting and diarrhea ( P = 0.16, P = 0.46, respectively), baseline hypokalemia ( P = 0.18) and hypocalcemia ( P = 0.3), hypomagnesemia on day-3 ( P = 0.21) and day-6 hyponatremia ( P = 0.36). Patients receiving two or more drugs with a known or probable risk of QTc prolongation (other than the fluoroquinolone/ triazole combination) were more prone to experience a prolonged QTc interval ( P = 0.09). None of the patients that had QTc prolongation died or developed serious arrhythmias. Conclusion The prevalence of QTc prolongation was 22% among HCT recipients on fluoroquinolone and triazole prophylaxis, yet we did not identify any independent risk factors for this issue. None of the patients that had QTc interval prolongation died or developed serious arrhythmias.