Kaposi Sarcoma Inflammatory Cytokine Syndrome (KICS) is a serious, uncommon disease that occurs in patients who are positive for HIV and human herpesvirus-8 (HHV-8). It is characterized by a constellation of clinical findings, including fever, weight loss, and fluid retention, as well as a lack of multicentric Castleman disease (MCD) features on histopathology and an elevated serum HHV-8 viral load. Diagnosis is often delayed, and treatment options are limited, culminating in high mortality rates. We hereby present a 32-year-old male patient with HIV who was untreated for a few years and came with fever, night sweats, pancytopenia, and widespread adenopathy. A thorough evaluation of opportunistic infections was unremarkable. Clinically MCD was suspected, but lymph node biopsy only showed Kaposi sarcoma (KS) with no characteristic features of MCD. However, with clinical deterioration, KICS was strongly suspected. Kaposi sarcoma immune reconstitution syndrome (KS-IRIS) was also a possibility as the patient was restarted on antiretroviral therapy. Rituximab was commenced, but the patient suffered a cardiac arrest and could not be revived. Alternative diagnosis must be explored in patients with HIV presenting with constitutional symptoms, cytopenia, and adenopathy after opportunistic infections and malignancies are ruled out. If they have KS with HHV-8 positivity and there is a lack of characteristic features of MCD in lymph node biopsy, prompt suspicion of KICS should be made, and treatment with rituximab and/or chemotherapy should be instituted rapidly. KS-IRIS is also possible if patients have recently received antiretroviral therapy and have a rapid decline in viral load and increase in CD4 counts (immunological recovery). HHV8 viral load levels may help to distinguish between these two inflammatory conditions.

Background Pancreatic cancer is one of the main causes of cancer-related deaths, especially pancreatic ductal adenocarcinoma, and it’s characterized by a poor prognosis. The KRAS gene mutation is prevalent in about 85% of pancreatic cancer cases, which is a significant factor in the pathogenesis and development of pancreatic cancer, impacting cellular tumor growth, survival, and metastasis. The targeted disruption of mutant KRAS variants through the application of various CRISPR systems has led to a marked reduction in cell viability and proliferation in vitro, accompanied by significant inhibition of tumor growth in vivo. Method This systematic study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved a comprehensive search of PubMed, Google Scholar, and PLOS One for original research articles published up to June 2024. Studies included those involving CRISPR-Cas9 gene editing targeting KRAS mutations in human or animal models of pancreatic cancer. Data collection and quality assessment were performed independently by two reviewers. Results The review identified numerous studies demonstrating the efficacy of CRISPR-Cas9 in targeting KRAS mutations. Results showed significant reductions in KRAS transcript levels, decreased tumor progression, and improved survival rates in experimental models. However, challenges such as off-target effects and efficient delivery methods were noted. Conclusion CRISPR-Cas9 gene editing shows significant promise as a therapeutic strategy for targeting KRAS mutations in pancreatic cancer. While the technology has demonstrated potential in preclinical studies, further research is needed to address challenges related to specificity, delivery, and long-term effects to facilitate its clinical application.

Rationale: Paraneoplastic syndromes occur in 10% to 20% of all malignancies, with paraneoplastic neurological syndromes in less than 1% of all malignancies. In small cell lung cancer (SCLC), paraneoplastic manifestations are more common, affecting up to 5% of cases. Common manifestations include syndrome of inappropriate antidiuretic hormone secretion, Cushing’s syndrome due to adrenocorticotropic hormone secretion, paraneoplastic cerebellar degeneration, and Lambert-Eaton myasthenic syndrome. Paraneoplastic acute motor and sensory polyneuropathy is an exceptionally rare but severe complication, necessitating timely diagnosis and management. Patient concerns: A 55-year-old male with an 80 pack-year history of smoking presents to the hospital with a 3-week history of fevers, productive cough, dyspnoea, and wheeze. He had no significant comorbidities. Diagnoses: Extensive radiological investigations revealed a large mass at the right hilum compressing on the right lower bronchus with metastatic adrenal deposits. Biochemical investigations confirmed syndrome of inappropriate antidiuretic hormone secretion, and histology identified SCLC. Interventions: Despite initiating a combination chemotherapy with carboplatin and etoposide, the patient developed progressive motor paralysis and sensory loss over 4 days, leading to a diagnosis of paraneoplastic acute motor and sensory polyneuropathy. Outcomes: He deteriorated rapidly and died 14 days after symptom onset due to respiratory failure, underscoring the aggressive nature of paraneoplastic syndromes. Lessons: Paraneoplastic syndromes, particularly in SCLC, pose significant diagnostic and therapeutic challenges. This case highlights the importance of early recognition and prompt multidisciplinary intervention, which may improve outcomes despite the low incidence of these severe complications. Treating cancer with appropriate systemic chemotherapy or suppression of the immune response alleviates neurological symptoms and improves prognosis.

Extramedullary hematopoiesis (EMH) is the development of hematopoietic tissue outside of the bone marrow. In adults, the bone marrow is the main site of hematopoiesis. When this process occurs outside of the bone marrow, it is a sign of disease or deficiency. Clinically, the findings of EMH may be diverse. One rare complication that can arise from EMH is obstructive jaundice. This occurs when there is a blockage of bile flow leading to retention of bilirubin in hepatocytes. Identifying the markers of EMH and obstructive jaundice is important for optimizing positive outcomes. While often asymptomatic, EMH can be deadly if left untreated. In this case, we present a patient with obstructive jaundice secondary to EMH.