Severe inflammatory disorder in trisomy 8 without myelodysplastic syndrome and response to methylprednisolone:A case report

BACKGROUND Patients with trisomy 8 consistently present with myeloid neoplasms and/or auto-inflammatory syndrome.A possible link between myelodysplastic syndromes(MDS)with trisomy 8(+8-MDS)and inflammatory disorders is well recognized,several cases having been reported.However,inflammatory disorders in patients without MDS have been largely overlooked.Generally,Behçet's disease is the most common type in+8-MDS.However,inflammatory disorders with pulmonary involvement are less frequent,and no effective treatment has been established.CASE SUMMARY A 27-year-old man with recurrent fever,fatigue for>2 mo,and unconsciousness for 1 day was admitted to our emergency department with a provisional diagnosis of severe pneumonia.Vancomycin and imipenem were administered and sputum collected for metagenomic next-generation sequencing.Epstein–Barr virus and Mycobacterium kansasii were detected.Additionally,chromosomal analysis showed duplications on chromosome 8.Two days later,repeat metagenomic next-generation sequencing was performed with blood culture.Cordyceps portugal,M.kansasii,and Candida portugal were detected,and duplications on chromosome 8 confirmed.Suspecting hematological disease,we aspirated a bone marrow sample from the iliac spine,examination of which showed evidence of infection.We added fluconazole as further antibiotic therapy.Seven days later,the patient’s condition had not improved,prompting addition of methylprednisolone as an anti-inflammatory agent.Fortunately,this treatment was effective and the patient eventually recovered.CONCLUSION Severe inflammatory disorders with pulmonary involvement can occur in patients with trisomy 8.Methylprednisolone may be an effective treatment.

Survival of a patient who received extracorporeal membrane oxygenation due to postoperative myocardial infarction: A case report

BACKGROUND Cardiac arrest after noncardiac surgery is a dangerous complication that may contribute to mortality.Because of the high mortality rate and many complications of cardiac arrest,it is very important to identify and correct a reversible etiology early.By reporting the treatment process of this case,we aimed to broaden the diagnosis and treatment of cardiac arrest after noncardiac surgery and describe how cardiopulmonary resuscitation using extracorporeal membrane oxygenation(ECMO)can improve a patient’s chance of survival.CASE SUMMARY A 69-year-old man visited our hospital complaining of low back pain on July 12,2021.Magnetic resonance imaging showed lumbar disc herniation.Two hours after lumbar disc herniation surgery,the patient developed cardiac arrest.Cardiopulmonary resuscitation was performed,and ECMO was started 60 min after the initiation of cardiopulmonary resuscitation.Regarding the etiology of early cardiac arrest after surgery,acute myocardial infarction and pulmonary embolism were considered first.Based on ultrasound evaluation,acute myocardial infarction appeared more likely.Coronary angiography confirmed occlusion of the left anterior descending branch,and coronary artery stenting was performed.Pulmonary artery angiography was performed to exclude pulmonary embolism.Due to heparinization during ECMO and coronary angiography,there was a large amount of oozing blood in the surgical incision.Therefore,heparinfree ECMO was performed in the early stage,and routine heparinized ECMO was performed after hemorrhage stabilization.Eventually,the patient was discharged and made a full neurologic recovery.CONCLUSION For early postoperative cardiac arrest,acute myocardial infarction should be considered first,and heparin should be used with caution.