UNASSIGNED: Solid organ transplant recipients are at high risk for developing severe zoster-associated neuralgia, and the pharmaceutic therapies of pain management for these patients with limited organ function are challenging. Intravenous lidocaine infusion showed positive analgesic effects and is used for the management of neuropathic pain. This case series reports the safety and effectiveness of intravenous lidocaine infusion in the treatment of intractable zoster-associated neuralgia in solid organ transplant recipients.
UNASSIGNED: Five solid organ transplant recipients suffering from refractory zoster-associated neuralgia (numeric rating scale 8-10, despite using high doses of antiepileptic drugs or combined with opioids) were enrolled. Intravenous lidocaine (5 mg/kg ideal bodyweight) was administered over 1.5 h with the monitoring of vital signs. Pain intensity, patient satisfaction, adverse events, typical liver, and kidney function were evaluated. All subjects reported high satisfaction with their treatment and effective pain relief at the 6-month follow-up. One patient experienced short and mild numbness in the mouth and dizziness after the therapy, but no major adverse reactions were reported.
UNASSIGNED: This case series provides evidence that intravenous lidocaine infusion provided effective pain relief as an analgesic treatment option for transplant patients with intractable zoster-associated neuralgia.

UNASSIGNED: Intravenous leiomyomatosis (IVL) is a special type of uterine leiomyoma and is rare. Intravenous lipoleiomyomatosis (LPL) is a rare subtype of IVL, distinguished by the presence of adipose tissue. Although histologically benign, this disease exhibits aggressive biological behavior such as local invasion and high recurrence rate. The disease initially presents with no obvious clinical features, and cardiac symptoms may only appear in the later stages. Diagnosis primarily relies on imaging studies, and due to its rarity and atypical clinical presentation, imaging diagnosis can be challenging, leading to misdiagnosis and missed diagnosis. Previously, there was no report on the imaging findings of this disease.
UNASSIGNED: This article reports a case of a 52-year-old patient who presented with lower abdominal discomfort due to IVL, and who underwent surgical resection and had a good recovery.
UNASSIGNED: This is the first time we report the imaging features of a disease of intravenous LPL with an extension of the inferior vena cava (IVC), and its characteristic imaging features [ultrasound shows a mass with high echogenicity, computed tomography (CT) shows low-density signal similar to fat, magnetic resonance imaging (MRI) shows high signal on T1-weighted (T1W) image and low signal on T1W with fat-suppression (T1FS)] can lead to an accurate preoperative diagnosis and guide clinical treatment.

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Retained needles are frequently observed in intravenous drug users. However, an incidental discovery of multiple needles at the neck seldom occurs. These foreign bodies remain either asymptomatic or cause local and central complications that can be fatal. We report the case of a 43-year-old male having a medical record of human immunodeficiency virus and hepatitis C who presented to our department with a 3-day history of a febrile lateral neck swelling. He reported a history of repetitive intravenous drug use and previous abscesses that were surgically drained. We noted a left and tender 8 cm neck swelling with torticollis. Computed tomography scan showed a collected myositis of the sternocleidomastoid muscle in association to multiple metallic foreign bodies at the neck that were compatible with the aspect of broken needles. Imagery also showed a thrombosis of the ipsilateral jugular vein. No central embolism of a foreign body was noted. We performed a surgical drainage of the muscular abscess and managed to retrieve a 1 cm broken needle that was retained at the level of the collection. We did not retrieve the other needles since they were asymptomatic. The patient was placed under intravenous antibiotics for 1 week followed by oral amoxicillin-clavulanate with a total regression of the cellulitis. At the further follow-ups, the rest of the foreign bodies remained asymptomatic. Our study emphasizes on the importance of suspecting a retained foreign body in intravenous drug users to ensure an adequate management of the possible complications and to protect the medical team from incidental needle injuries.

Although it was originally developed and approved for the treatment of various psychiatric conditions, such as schizophrenia and bipolar I disorder, recent studies have identified the role of olanzapine in the treatment of intensive care unit (ICU)-related delirium and nausea and vomiting. Unfortunately, olanzapine is currently only indicated to be administered via the intramuscular (IM) route or enteral route, limiting the opportunity of its use in certain pediatric patients. IM injections are typically avoided in pediatrics whenever possible, and it is not uncommon for pediatric patients, especially those in an ICU setting, to be restricted to nothing by mouth. Studies in the adult population have demonstrated both safety and efficacy for the administration of reconstituted olanzapine powder by the intravenous (IV) route, which would provide an ideal administration route for pediatric patients unable to receive IM or enteral administration. We report a case series of 4 pediatric patients who received at least 1 dose of IV olanzapine. All 4 patients reported a positive response from the medication and no safety concerns were noted.

Calcium gluconate solutions are an essential part of the intensive care medication armamentarium. Calcium-related extravasations are not an infrequent occurrence. However, occult extravasation presenting solely as an isolated mass lesion with no preceding cutaneous manifestation is rare. Calcinosis cutis is an extraosseous collection of calcium deposits in the skin and subcutaneous tissues. Multiple etiopathogenetic factors play a role in its manifestations. We illustrate a case of a seven-week-old infant diagnosed with pseudo-hypoaldosteronism with a mysterious swelling on the left leg during the third week of hospitalization, which was attributed to occult iatrogenic calcinosis cutis.

OBJECTIVE: This case series would like to highlight hypophosphatemia related to ferric carboxymaltose and its adverse clinical consequences.
BACKGROUND: Intravenous iron supplementation is a good alternative to oral iron replacement in iron deficiency anaemia due to its ability to correct iron deficit with minimal infusions without incurring the gastrointestinal side effects of oral iron replacement. Ferric carboxymaltose is one common formula for intravenous iron supplementation. However, an increasingly recognised adverse side-effect of intravenous ferric carboxymaltose is hypophosphatemia. There has been increasing reports and studies highlighting hypophosphatemia related to intra-venous iron therapy. Though initially thought to be transient and asymptomatic, recent studies have shown that persistent hypophosphatemia in iron therapy can result in debilitating disease including myopathy, fractures and osteomalacia.
METHODS: A retrospective analysis of all patients who had ferric carboxymaltose was performed.
RESULTS: We highlight 3 cases where hyposphatemia affected the clinical outcomes.
CONCLUSIONS: With the increased use of IV iron it is important to be aware of the high potential for hypophosphatemia secondary to ferric carboxymaltose.

Congenital nephrogenic diabetes insipidus (CNDI) is a rare disease that results in polyuria due to decreased responsiveness to the antidiuretic hormone in the collecting ducts of the kidney. Without compensation by drinking large amounts of water, dehydration and hypernatremia can rapidly develop. We present a case of a patient originally diagnosed with CNDI who required surgery and a fasting period due to adhesive bowel obstruction. The patient was a 46-year-old man who was originally diagnosed with CNDI. He was prescribed trichlormethiazide but self-discontinued treatment in the process. His normal urine output was about 7,000-8,000 mL/day. He underwent robot-assisted radical cystectomy and uretero-cutaneostomy for bladder cancer. Two years later, he was hospitalized due to adhesive bowel obstruction. A 5% glucose solution was infused, and the dose was adjusted according to the urine volume and electrolytes. An adhesiotomy was performed due to recurrent bowel obstruction in a short period of time. A 5% glucose solution was used as the main infusion during the perioperative period. Once drinking water was resumed after surgery, urinary output and electrolytes were easily controlled. In conclusion, patients with CNDI should be given a 5% glucose solution as the primary infusion, and the infusion volume should be adjusted by monitoring daily urine output, electrolytes, and blood glucose levels. Infusion management is easier if oral intake is initiated as early as possible.

UNASSIGNED: Intravenous injections are an everyday practice in the health-care sector and are also frequently abused by drug abusers. One rare complication of intravenous injections is venous intraluminal breakage of the needle, which is a matter of concern due to the possible embolization of needle fragments in the body.
UNASSIGNED: We report our case of an intravenous drug abuser with an intraluminal breakage of a needle presenting within 2 h of the incidence. The broken needle fragment was retrieved successfully at the local injection site.
UNASSIGNED: Intraluminal intravenous needle breakage should be treated as an emergency, and a tourniquet should be applied as soon as possible.

Topiramate (TPM) is widely used in focal and generalized epilepsies. It is commercially available as tablets and sprinkles capsules for oral treatment. Previous studies comparing intravenous (IV) to oral TPM in healthy adults showed more rapid pharmacodynamic effects in cases of IV administration. Despite promising findings, no clinical application in humans followed. We present a case of a pregnant woman with idiopathic generalized epilepsy who experienced a generalized tonic-clonic seizure in the third trimenon due to low TPM levels attributed to pregnancy followed by repeated prolonged absences. We applied a new meglumine-based solution (1%) of TPM (10 mg/ml) in two IV infusions of 200 mg each under EEG monitoring over a total duration of 1 hour. The infusion was well tolerated and led to a rapid increase in plasma TPM levels. A clinical as well as electroencephalographic improvement was documented within the first hours. To the best available knowledge, this is the first reported case where IV TPM was used therapeutically for seizure treatment in humans. It is also the first time that the new meglumine-based solution was used in a human with epilepsy. The advantages of IV route delivery and the solution\'s quick preparation, high tolerability, and low toxicity make it ideal for use in many clinical settings and high-care patients. IV TPM seems to be a reasonable adjunctive option for adults with seizures, previously stabilized on oral TPM, who need rapid plasma concentration boosting. Although our experience was successful in using injectable TPM in seizure emergencies, randomized controlled clinical trials are required to make recommendations for the use of IV TPM on patients with epilepsy. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022 in Salzburg, Austria.