Case Report: Short-Term Application of Topical Imiquimod Is Practical for Chromoblastomycosis

Chromoblastomycosis is a chronic cutaneous fungal infection caused by dematiaceous fungi. It is a therapeutic challenge because of the lack of specific treatments. We describe a refractory case of chromoblastomycosis in which the lesion did not respond to initial treatment, but then use of topical imiquimod cured the lesion successfully.

LIVEdoid vasculopathy – benefit of intravenous immunoglobulin in a refractory case

Livedoid vasculopathy is a rare vascular disease which typically manifests as recurrent ulcerative lesions on the lower extremities. It is classified as a vasculopathy, not a true vasculitis, and defined as a vasooclusive syndrome, caused by non-inflammatory thrombosis of the upper and mid-dermal venulae. Main disorders associated with LV include thrombophilias, autoimmune diseases and neoplasia. A triad of clinical features is present in most patients and consist of livedo racemosa (less frequently livedo reticularis), ulcerations and atrophie blanche. Management generally relies on antiplatelet drugs, anticoagulants, vasodilators and fibrinolytic therapy. Some benefit has been observed with intravenous immunoglobulin, colchicine, hyperbaric oxygen, while glucocorticoids are efficient to a lesser extent. This case report highlights a refractory clinical form with no identifiable predisposing condition, which proved responsive only to intravenous immunoglobulin.

Extended pulsed radiofrequency as a part of multimodal pain management in a refractory case of Bernhardt-Roth syndrome

Bernhardt-Roth syndrome (BRS) is a neurological condition characterised by pain, burning or numbness in anterolateral thigh due to entrapment of the lateral femoral cutaneous nerve (LFCN). The possible aetiologies can be mechanical, iatrogenic, neuropathic or idiopathic. After consent for possible publication, we are discussing a case of pain management in a 38-year-old patient with BRS secondary to diabetes. The coherent history, uncontrolled glycaemic status and reduced nerve conduction velocity for LFCN helped reach the diagnosis. Initial treatment with pharmacotherapy, steroid LFCN block and conventional pulsed radiofrequency (PRF) provided moderate temporary pain relief. Extended PRF over 8 min provided significant analgesia without any complications. Physical therapy, adequate glycaemic control and extended PRF provided complete pain relief and improved function over 6 months of follow-up duration. Hence, a cautious multifaceted approach targeting the basic aetiology with extended PRF helped achieve significant analgesia in our refractory case of BRS.

Lenalidomide in Relapsed and Refractory Multiple Myeloma

Improvement in the treatment options in multiple myeloma(MM) makes the survival rate into double during recent years but most of the patient eventually relapses. At the time of relapses, the use of alternative drugs is the current practice. Lenalidomide is an immuno-modulators and it is one of the most versatile drug which is used in several Hematological disease treatment including MM. Several clinical trials have shown a better progression free survival(PFS) and overall survival(OS) with Lenalidomide based regimens. In Pollux study, the regimen with Daratuzumab with Lenalidomide and dexamethasone has shown much better OS and PFS than only Lenalidomide and Dexamethasone. But Some times patients are refractive to Lenalidomides. In that case Pomalidomide or bortezomib based regimen is used. Although Lenalidomide is one of the most promising drug to treat both first line and Relapse-refractory case of MM. Hemato oncology is a challenging topic and its correlated with personalized medicine this days. Different clinical trial are going on with different regimen. In some patient some regimen is showing good result and in some other regimen is giving good prognosis. So its always tough to tell which is the best regimen. In this article we will focus on use of Lenalidomide based regimes and we will see the median OS and median PFS of all these Lenalidomide based regimen. Althrough there is a good room for research on Len refractive cases and personalized treatment in multiple myeloma in both front line and relapsed and refractory cases.