Background: Renal adverse drug reactions (ADRs) associated with tyrosine kinase inhibitors (TKIs) in the treatment of chronic myeloid leukemia (CML) are relatively rare, and there is currently no standardized protocol for their management. Therefore, this study aimed to summarize renal ADRs related to TKIs use in CML and propose an evidence-based approach to monitor and manage these ADRs. Methods: A systematic literature review was performed to identify renal ADRs associated with TKIs in CML. Two authors screened the search results and extracted data from 37 eligible studies. These findings were then used to develop a scheme for clinicians to monitor and manage these ADRs. Results: Overall, imatinib seemed to be significantly linked to renal adverse events compared to other TKIs, and switching to dasatinib or nilotinib significantly improved renal function. Similar events were reported with bosutinib, although they were not statistically significant. However, most of the renal events reported on dasatinib were described as nephrotic syndrome that resolved with switching to imatinib. Few cases were reported with nilotinib that described tumor lysis syndrome (TLS)-related kidney injury. Conclusions: Recommendations include monitoring for progressive decline in the estimated glomerular filtration rate with imatinib, nephrotic syndrome with dasatinib, and TLS with nilotinib. Additionally, holding the offending TKI and managing renal ADRs according to local guidelines were adopted more frequently than reducing the TKI dose.

Chronic myeloid leukemia (CML), while traditionally a disease of the elderly, has recently risen in incidence among younger patients. Hence, fertility concerns have emerged considering the disease process and treatments, especially with the current scarce and conflicting recommendations. This review explores the impact of CML treatments including the first-line tyrosine kinase inhibitors (TKIs) and other treatments on male fertility in chronic myeloid leukemia (CML) patients. The aim of this review was to compile the available evidence on male fertility to ultimately tailor treatment plans for male CML patients for whom fertility and future chances for conception pose a concern. The data available on the conventional and newer TKIs to address fertility concerns were reviewed, particularly the potential long- and short-term effects. Also, the possible side effects on subsequent generations were a crucial focus point of this review to reach a more comprehensive CML management approach. We found and compared the evidence on TKIs approved to treat CML. We also reported the effects of hydroxyurea, interferon, and transplantation, which are considered second-line treatments. Our findings suggest that these drugs might have an undiscovered effect on fertility. More research with larger sample sizes and longer follow-up periods is essential to solidify our understanding of these effects.

Background: COVID-19 infection is caused by a novel coronavirus. It was identified initially in late 2019 as the cause of a cluster of pneumonia cases in Wuhan, China. It spread worldwide causing a pandemic. Since the start of the COVID-19 pandemic, multiple complications have been linked to COVID-19 infections, one of them being pleural effusion. To the best of our knowledge, only a few case reports have discussed the incidence of candida empyema in COVID-19 patients 1,2 . Case Presentation: This work is reporting on a case of COVID-19 pneumonia, in a 52-year-old previously healthy male patient, who developed ARDS 2 days after diagnosis of COVID-19 pneumonia and was attached to mechanical ventilation. Unfortunately, he continued to progress with refractory hypoxemia despite the maximum support. Ultimately, the patient required veno-venous ECMO with ultra-protective lung ventilation until the gas exchange in his lungs has normalized. The patient received multiple treatments based on our local protocol that have immunosuppressive effects. Due to worsening pneumonia, bronchoscopy was done. The Bronchoalveolar lavage (BAL) showed Candida Albicans, which was complicated with left-sided candida empyema. The later was treated by antifungal, chest tube insertion, and finally with decortication. However, despite the maximum interventions, the patient has unfortunately passed away 2 weeks after the decortication due to sepsis and multi-organ failure, while he was on ECMO during the whole period. Recommendation: Given the immunosuppressive effect of many of the medications used for the treatment of COVID-19 infection, atypical and opportunistic infections should be carefully considered within the clinical context. Conclusion: Candida pneumonia/empyema is not very common in a healthy host, however, it is a serious and rare condition, commonly seen in immunocompromised patients and associated with a high mortality rate 3 . The immunosuppressive therapies that are used in COVID-19 are not completely safe and more atypical infectious agents have been considered as not suitable in several typical locations causing adverse outcomes.