Lung transplantation is a life-saving alternative for patients with end-stage lung disease. The procedure itself has a high risk of bleeding. Jehovah’s Witness patients refuse to accept blood products due to religious beliefs. A 48-year-old Jehovah’s Witness woman presented with an 8-year history of cough, dyspnea along with progressive worsening of her functional class and quality of life. A diagnosis of autoimmune interstitial lung disease was made, for which cyclophosphamide was administered without improvement of symptoms, and the patient was accepted as a transplant candidate. Transplantation was performed without complications, nor blood products requirement, intraoperative cell salvage was performed, and pharmacological agents were used preoperatively for bleeding prevention. The patient only developed anemia after administration of immunosuppressor therapy, which was treated with erythropoietin in the outpatient setting.

Background/Objectives: Carbapenem-resistant Enterobacterales (CRE) infection is associated with a higher mortality rate. The purpose of this study was to evaluate the effect of ceftazidime avibactam (CZA) for treating bacteremia caused by CRE compared to the best available therapy in an area where these microorganisms are endemic. Methods: A retrospective cohort study of patients with CRE bacteremia was conducted. We included adults with CRE bacteremia who were treated with CZA or the best available therapy (BAT) for more than 48 h, and the hospitalization time was recorded. The outcomes included death during hospitalization, relapse, and microbiological cure. Confounders were adjusted using propensity score-derived stabilized inverse probability of treatment weighting (IPTW). Results: A total of 169 patients with CRE bacteremia were included. About 72.6% of isolates had a class A serin carbapenamase, and 20.4% had metallo-β-lactamase co-production. A total of 107 patients were treated with CZA, 63% in monotherapy and 32% with aztreonam (ATM). Crude mortality during hospitalization was 36 (34.5%) in patients treated with CZA and 21 (33.2%) with BAT. No difference was observed between death rates (HR 0.86: IC 95% 0.40–1.83), microbiological cure (OR 1.31 IC 95% 0.46–3.67), clinical response (OR 1.39 IC 95% 0.35–5.43), acute kidney injury (OR 0.56 IC 95% 0.11–2.80) or relapse (OR 0.99 IC 95% 0.17–5.51) during the hospitalization after the adjustment. Conclusions: Among adult patients with CRE, no differences were observed between treatments with CZA and BAT after adjustment with IPTW.

Introducción: actualmente la colangiopancreatografía retrógrada endoscópica (CPRE) constituye el procedimiento estándar para el tratamiento de condiciones pancreatobiliares, lo que ha aumentado las CPRE y, por tanto, un incremento en las complicaciones descritas (pancreatitis, sangrado, perforación, entre otros). La pancreatitis aguda pos-CPRE es la complicación más frecuente, y aunque la mayoría de casos pueden ser leves, en algunos casos pueden ser graves y, en muy raras ocasiones, complicarse con lesión bilateral de los cuerpos geniculados laterales, como en este caso. Reporte de caso: se trata de una mujer de 28 años con antecedente de obesidad, que presentó colangitis aguda por coledocolitiasis y fue llevada a una CPRE con extracción de un cálculo biliar y derivación con stent plástico. A las 48 horas después del procedimiento presentó pancreatitis grave pos-CPRE y, concomitantemente, hemianopsia binasal incongruente con evidencia de lesión bilateral de los cuerpos geniculados laterales (CGL) en la resonancia magnética cerebral. Se descartaron causas isquémicas, infecciosas, hidroelectrolíticas y autoinmunes. La evolución clínica de la paciente fue favorable. Discusión: aunque los mecanismos por los cuales se pueden lesionar los cuerpos geniculados laterales no están totalmente esclarecidos, en el presente caso se postula como posible etiología la pancreatitis aguda grave pos-CPRE, y el compromiso multiorgánico por la respuesta inflamatoria sistémica subyacente.

Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, life-threatening adverse drug reaction that causes multiorgan involvement characterized by rash, fever, lymphadenopathy, and eosinophilia. Only one case of fenofibrate-associated DRESS syndrome has been reported in the literature. Case presentation: A 70-year-old man with hypertension and hypertriglyceridemia presented to the emergency department of a university hospital in Bogotá (Colombia) with a generalized erythematous rash, intermittent fever (38.6°C), diarrhea, nausea, and palpitations over the preceding 3 days. The patient reported initiating fenofibrate (160 mg/day) 2 weeks prior for hypertriglyceridemia management. Admission laboratory tests revealed eosinophilia and elevated transaminases. The patient scored 4 according to RegiSCAR criteria, consistent with a probable case of fenofibrate-associated DRESS syndrome, so he was admitted. The drug was immediately discontinued, and IV methylprednisolone (250 mg/day) was initiated for 3 days, followed by oral prednisolone (1 mg/kg/day) with a planned taper. On hospital day 7, following favorable clinical progress (progressive improvement of skin lesions and normalization of eosinophil count), he was discharged with instructions to continue oral prednisolone on a gradual 8-week taper, during which no relapses or adverse events occurred. Conclusion: This case highlights the importance of timely recognition of DRESS syndrome clinical manifestations and prompt identification of the suspected drug, even when rarely implicated, such as fenofibrate. It is still worth noting that, based on the RegiSCAR score, this represents a probable, rather than a definitive, case of fenofibrate-associated DRESS syndrome.

Acute generalized exanthematous pustulosis is a severe skin reaction, Usually begins in the first 48 hours after exposure to the culprit drug, however it can occur a few days after exposure. Its usually associated to beta-lactam antibiotics, macrolides, and quinolones, but few cases have been associated with oral antidiabetic drugs. Herein