Heterotopic pregnancy (HP) is a rare phenomenon. Despite its rarity, there has been a notable increase in its incidence in recent decades due to the greater use of in vitro fertilization (IVF). However, information about the relation between ovarian stimulation and HP is scarce. We report a case of HP after ovarian stimulation using clomiphene citrate. A 26-year-old pregnant woman presented to the emergency department with mild vaginal bleeding, and abdominal pain. She had a history of pelvic inflammatory disease (PID) and left salpingectomy due to a previous ectopic pregnancy. She had undergone ovarian stimulation with clomiphene citrate three months earlier. Transvaginal ultrasound revealed an eight-week-old ruptured tubal pregnancy with an intrauterine ten-week-old gestational sac confirming superfetation HP. An urgent laparoscopic right salpingectomy was performed and the extrauterine pregnancy was successfully removed with the preservation of the intrauterine embryo. The course of the intrauterine pregnancy was uneventful and the patient gave birth to a healthy boy via cesarean section. Women receiving ovarian stimulation are at an increased risk of developing HP especially when they also have other predisposing factors for HP. Thus, close monitoring using transvaginal ultrasound with extra attention to the adnexa is required for a timely diagnosis and management of HP.

Delayed diagnosis of common variable immunodeficiency (CVID) remains a serious problem. We investigated whether some diseases diagnosed during out-patient visits or admission to hospitals could act as indicator conditions for CVID diagnosis.
In this nested case-control study, we identified 128 cases diagnosed with CVID in Denmark (1999-2013) and 640 age-, gender-, and region-matched controls. We obtained data on diseases diagnosed at hospitals in the five years before CVID diagnosis from The National Hospital Registry. We grouped hospital diagnoses in 33 major disease categories and 210 subcategories. We used conditional logistic regression to calculate the odds ratios (OR) and 95% confidence intervals (CI) to estimate associations between disease exposure and subsequent CVID.
During the five years preceding a CVID diagnosis, cases had four times as many hospital contacts as the controls (p < 0.001). A diagnosis in 18 major disease categories showed a significant OR for subsequent diagnosis of CVID. The most substantial association with a subsequent CVID diagnosis was a diagnosis of lower respiratory tract infections (OR: 29.9; 95% CI: 14.2-63.2) and lung diseases (35.1; 15.0-82.5). We observed a similar association when we removed the last year before diagnosis from analysis and overall, in the years < 1, ≥ 1-3, and ≥ 3-5 before diagnosis, although the absolute number of exposures was small. Twenty-eight specific diseases displayed an at least 3-fold risk of subsequent CVID diagnosis.
Targeted screening for antibody deficiency in patients diagnosed with specific diseases associated with CVID may lead to earlier CVID diagnosis and treatment and thereby potentially reduced morbidity and mortality.

Progressive multifocal leukoencephalopathy is a rare opportunistic infection of the brain by John Cunningham polyomavirus in immune-compromised patients. In cases where no overt option for immune reconstitution is available [e.g., in patients with primary immunodeficiency (PID)], the disease is lethal in the majority of patients. Immune checkpoint inhibition has been applied in recent years with mixed outcomes. We present four novel patients and the follow-up of a previously published patient suffering from progressive multifocal leukoencephalopathy (PML) due to PID and/or hematologic malignancy who were treated with the immune checkpoint inhibitor pembrolizumab. In two patients with PID, symptoms improved and stabilized. One patient died because of worsening PML another of intracranial hemorrhage which was unrelated to PML or its treatment with pembrolizumab. The fifth patient suffered from PID and died of a pre-existing immune dysregulation, possibly exacerbated by pembrolizumab. The long-term follow-up of the first patient provides support for therapeutic decisions during this therapy and is the longest published clinical course of a patient with checkpoint inhibition for PML. We conclude that pembrolizumab can control PML symptoms long term in a subgroup of patients with PID, in our cases for 21 and 36 months. However, therapy must be started early because symptoms are only partially reversible. In light of severe adverse events, application of pembrolizumab is only justified if the prognosis for the individual patient is very poor.

Pelvic inflammatory disease (PID), a serious infection in sexually active women, is one of the reasons for which females seek care in emergency departments and therefore represents an important public health problem. PID is the result of an endocervical infection with different microorganisms, which then ascend to the endometrium and fallopian tubes. Symptoms of PID may be mild and aspecific, making its diagnosis difficult. However, this clinical condition requires effective antibiotic treatment to reduce incidence of complications and late sequelae. We describe here a case of peritonitis as a complication of pelvic inflammatory disease (PID) due to Neisseria gonorrhoeae infection in a 49-year-old woman who presented at the Emergency Department with acute abdominal pain.

Child Sexual Abuse (CSA) is a crime against children. It is largely underreported and commonly goes unpunished in our society as it is commonly perpetrated by close ones including family relations. Victims are left with the adverse sequelae associated with it sometimes for life. This report highlights the management of a case of PID in a child as a result of incest perpetrated by her father. It also brings to fore the problems and challenges of child sexual abuse in Nigeria. The patient was a 17 year old 100 level university student who lost her mother at the age of 14 and was living with her father alone. The father sexually abused her repeatedly for two years. She became pregnant and had the pregnancy illegally terminated at seven weeks gestation via dilatation and curettage. The procedure was complicated by Pelvic Inflammatory Disease (PID) which necessitated her presentation at the clinic where she was treated. The case brings to the fore the problem of child sexual abuse in Nigeria and its attendant sequelae. The health care providers should have a high index of suspicion for CSA when attending to minors and address sexual problems including CSA where present.

OBJECTIVE: To determine the association between a history of asthma and a diagnosis of selective IgA deficiency (sIgAD)/common variable immunodeficiency (CVID).
METHODS: This population-based case-control study included residents of Olmsted County, Minnesota, who met the Pan-American Group for Immunodeficiency/European Society for Immunodeficiencies diagnostic criteria for sIgAD/CVID between January 1, 1964, through December 31, 2008. Each case had 4 age- and sex-matched controls (2 from the community and 2 from a list of individuals who had undergone an immune work-up). We ascertained asthma status by applying predetermined criteria for asthma.
RESULTS: We identified 39 cases: 26 (66.7%) had sIgAD and 13 (33.3%) had CVID. Of the 39 cases, 51.3% were men (n=20) and 97.1% were white (33 of 34 patients). The mean age at the index date (the time when criteria were met) of sIgAD/CVID was 34.2 years. Of the 39 cases, 9 (23.1%) had a history of asthma before the index date of sIgAD/CVID; of the 156 controls, 16 (10.3%) had a history of asthma before the index date (odds ratio, 2.77; 95% CI, 1.09-7.06; P=.03). A history of asthma (before or after the index date of sIgAD/CVID) was more prevalent in sIgAD/CVID cases (30.8%; n=12) than in matched controls (11.5%; n=18) (odds ratio, 3.57; 95% CI, 1.50-8.51; P=.01).
CONCLUSIONS: Asthmatic patients are more likely to have a diagnosis of sIgAD/CVID than nonasthmatic individuals. This association may potentially account for the increased risks of bacterial infections in some individuals with asthma.