According to several cases earlier reported by Gandhi
According to several cases earlier reported by Gandhi et al, the median time of acute pancreatitis occurring is 12 days (range: 9–16 days), from the last administration of BV, and most events occurred in the first course of BV treatment. One patient experienced recurrent pancreatitis in the fifth course, after pancreatitis occurred in the second course of BV treatment. All patients experienced at least grade 3 pancreatitis, and two patients expired because of acute pancreatitis with multiple organ dysfunction.
Unintended targeting of BV to the pancreatic carboxypeptidase with low-level CD30 expression is a possible etiology of such acute pancreatitis after BV treatment, and significantly higher expression of low-level CD30 in pancreatic cells of human than mouse immunoglobulin controls has been noted. The expression of low-level CD30 in pancreatic cells is detected not only in the pancreas from the patient with pancreatitis after BV treatment, but also in the pancreas from normal controls; nevertheless, acute pancreatitis only occurs in a few patients who have received BV treatment. Maybe some other factors, such as BV dose, gene, minimal lymphoma infiltration of pancreas and underlying state of pancreas, can catalyze such unintended targeting of BV and determine the chance of acute pancreatitis.
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Introduction Venous gangrene is a type of wet gangrene that develops rapidly because of the blockage of venous drainage and subsequent saturation of the tissue with stagnant blood, which impedes arterial blood flow. Venous gangrene includes two different syndromes of microthrombosis-associated ischemic limb injury. First, thrombocytopenic disorders are closely associated with deep-vein thrombosis. Microthrombosis in these patients can sometimes be complicated with acute large-vein thrombosis in the same limb, leading to acral ischemia; typically only one limb is involved. Second, symmetric peripheral gangrene in two or all limbs can also be associated with acral limb ischemic necrosis but usually without deep-vein thrombosis. Limb necrosis is often symmetric, particularly in the cases with lower limb involvement. The clinical presentation of nonacral tissue necrosis is termed purpura fulminans, which is observed in patients with cardiogenic or septic shock. These two syndromes show characteristics similar to the pathophysiological characteristics of microthrombosis complicated with an unbalanced procoagulant–anticoagulant state.
Case report A 65-year-old male with colorectal cancer cT3N2M0 received concurrent chemoradiotherapy, and surgery and post-operative chemoradiotherapy for colorectal cancer ypT3N2M0 at the end of treatment in 2003. During follow-up visits at open-patient department in 2004, cystorectal fistula was suspected based on the complaints of terminal dribbling and gas passage from the urethra. Abdominal computed tomography (CT) scan revealed pericecal soft tissue infiltration into the presacral and retrovesical spaces, with extension to the posterior wall of the urinary bladder and thickening of the rectal wall in 2005 (Fig. 1). Pathological examination of the biopsy material obtained by colonoscopy showed tubular adenoma. Abdominal CT and colonoscopy were repeated twice during 2006–2007 with no diagnosis of a definitive malignancy. Positron emission tomography (PET)/CT scan in 2007 revealed a lesion with irregularly increased fluorodeoxyglucose (FDG) activity in the presacral space which appeared to be urine leaking from the cystorectal fistula; however, the possibility of concomitant malignancy (local recurrence) still could not be ruled out. In 2008, the patient developed bilateral hydronephrosis and percutaneous nephrostomy (PCN) was performed. PET/CT scan in 2015 revealed areas with intensely increased FDG uptake in the pelvis, with increased standardized uptake values in the delayed study; these findings were highly suspicious of rectal cancer. In addition, the patient\'s carcinoembryonic antigen (CEA) level was increased from 7.9 ng/ml in Apr 2015 to 18.1 ng/ml on August 25, 2015. Furthermore, urine drainage to bilateral PCNs was observed. These findings, contrary to previous evaluations, provided strong evidence for rectal cancer diagnosis. However, the patient refused biopsy and agreed to receive chemotherapy (see Fig. 2).