MyMedR

Fulltext Intrapleural alteplase and DNase for complex tuberculous pleurisy: a medical approach

Cheong XK, Abdul Hamid MF

Respirol Case Rep, 2021 Feb;9(2):e00706.

Tuberculous pleurisy is extra-pulmonary tuberculosis caused by Mycobacterium tuberculosis (MTB), which is one of the main cause of pleural effusions in developing countries. Intercostal chest catheter is useful for drainage of infected pleural fluid and facilitates sepsis control. However, management might be challenging in complex tuberculous pleural effusion as the septations within the effusion hinder pleural drainage. Intrapleural fibrinolysis therapy improved infected fluid drainage and septic parameter in parapneumonic effusions; however, there seems to be little data on its use in tuberculous pleurisy. In our case series of seven patients with complex tuberculous pleurisy, the use of intrapleural alteplase and deoxyribonuclease (DNase) facilitated fluid drainage which resulted in clinical and radiological improvement. These medications should not be confined to bacterial aetiology only as our case series highlights that in complex tuberculous pleurisy, intrapleural alteplase and DNase may be used as an adjunctive treatment which are proven to be successful and safe.

Fulltext Short-course modified regimen intrapleural alteplase and pulmozyme (DNase) in pleural infection

Faisal M, Farhan R, Cheong XK, Ng BH, Nuratiqah N, Andrea Yl B

Respir Med Case Rep, 2020;31:101168.

PMID: 32714827 DOI: 10.1016/j.rmcr.2020.101168

Pleural infection is a common clinical condition leading to hospitalisation. In the last decade, advances in pleural research have led to a paradigm shift in the treatment of complex effusion from a surgical approach to a less invasive non-surgical approach using a combination of intrapleural fibrinolytics and pulmozyme (DNase). We report 3 patients with pleural infection. Intercostal chest catheter failed to drain the complex effusion. They were subsequently treated with a modified short-course regimen of alteplase and DNase. They received 3 cycles of 16 mg alteplase with 5 mg DNase each within 24 hours and all three had a favourable outcome with no adverse effects. This modified regimen appears effective with good safety profile and adds to the current literature on the safety and effectiveness of different dose combinations of alteplase and DNase.

Fulltext "Black box warning" rash with entecavir - case report

Cheong XK, Wong Z, Nor NM, Lee BR

BMC Gastroenterol, 2020 Sep 18;20(1):305.

PMID: 32948126 DOI: 10.1186/s12876-020-01452-3

BACKGROUND: Hepatitis B infection is a significant worldwide health issue, predispose to the development of liver cirrhosis and hepatocellular carcinoma. Entecavir is a potent oral antiviral agent of high genetic barrier for the treatment of chronic hepatitis B infection. Cutaneous adverse reaction associated with entecavir has rarely been reported in literature. As our knowledge, this case was the first case reported on entecavir induced lichenoid drug eruption.

CASE PRESENTATION: 55 year old gentlemen presented with generalised pruritic erythematous rash on trunk and extremities. Six weeks prior to his consultation, antiviral agent entecavir was commenced for his chronic hepatitis B infection. Skin biopsy revealed acanthosis and focal lymphocytes with moderate perivascular lymphocyte infiltration. Skin condition recovered completely after caesation of offending drug and short course of oral corticosteroids.

CONCLUSION: This case highlight the awareness of clinicians on the spectrum of cutaneous drug reaction related to entecavir therapy.

A case of lupus nephritis flare-up in severe COVID-19 infection

Yusuf AS, Cheong XK, Rozita M, Periyasamy P, Ruslinda M

Med J Malaysia, 2021 09;76(5):757-761.

PMID: 34508391

The novel Coronavirus disease 2019 (COVID-19) had rapidly spread and became a worldwide pandemic since its detection in Wuhan, China. The disease has caused significant morbidity and mortality, particularly among patients with comorbidities. The current treatment involves supportive management alongside antiviral therapy and immunosuppressant therapy in severely affected patients. We describe a case of a patient with underlying lupus nephritis (LN) who presented with severe COVID-19 infection and concomitant LN flare with acute kidney injury (AKI). The patient was treated with antiviral therapy, Favipiravir, considering his risk of developing severe COVID-19 infection. As the patients would usually have AKI alongside LN flare, we administered initial steroid therapy at a lower dose (Methylprednisolone 50mg daily) and oral hydroxychloroquine despite the initial concerns on immunosuppressant usage in COVID-19 infections. Although our patient recovered relatively well from COVID- 19 infection, he continued to have positive reverse transcriptase-polymerase chain reaction (RT-PCR) nasopharyngeal swab for COVID-19 up to 29 days of illness. His kidney function stabilised despite having persistent nephrotic range proteinuria. Hence, the attending team decided to pulse the patient with a high dose steroid (IV Methylprednisolone 250mg OD for three days) after two weeks of illness despite the persistent positive swab. The patient's condition continued to improve, and this case illustrates an approach in treating COVID-19 with concomitant active immune-mediated glomerulonephritis. We find that it is safe to institute high dose immunosuppressant in recovered COVID-19 patients two weeks after the illness.

Fulltext Acute Thoracolumbar Myelitis Secondary To Intrathecal Chemotherapy

Cheong XK, Ng CF, Tan HJ, Remli R

J Neurosci Rural Pract, 2021 Oct;12(4):815-816.

PMID: 34737525 DOI: 10.1055/s-0041-1735246

Massa intermedia: an innocent bystander?

Tan JK, Cheong XK, Khoo CS, Nair N, Tangaperumal A

Acta Neurol Belg, 2023 Dec;123(6):2341-2343.

PMID: 37432611 DOI: 10.1007/s13760-023-02330-x

Fulltext Short-course intrapleural alteplase and DNase in complex effusion with bleeding risk

Cheong XK, Yu-Lin Ban A, Abdul Hamid MF

Respirol Case Rep, 2020 Oct;8(7):e00648.

PMID: 32864139 DOI: 10.1002/rcr2.648

Pleural infection is an important clinical problem with significant morbidity. In poorly draining complex pleural effusions, the current management favours a less invasive image-guided placement of smaller bore catheters and adjunctive intrapleural fibrinolysis therapy (IPFT). We describe our experience of using IPFT in three patients with different bleeding risks with complex pleural effusions. The first was a 30-year-old with transfusion-dependent β-thalassemia with haemoglobin of 7.8 g/dL; second was an 87-year-old on dabigatran with haemoglobin of 10 g/dL; and the third was an 80-year-old with diffuse large B-cell lymphoma with haemoglobin of 8.6 g/dL. All three patients received three doses of alteplase and deoxyribonuclease (DNase) without any adverse effects of bleeding and had resolution of the effusion. This case series is an addition to the current literature on the safety of IPFT and we highlight the use of IPFT in patients with low baseline haemoglobin and on anticoagulation therapy.

Multiple Cystic Brain Infection: A Diagnostic Dilemma of Neurocysticercosis and Intracranial Tuberculoma

Chew JX, Tan JK, Cheong XK, Ho WC, Mohamed Arifin N, Chinnasami S, et al.

Cureus, 2024 Aug;16(8):e66231.

PMID: 39238702 DOI: 10.7759/cureus.66231

Neurocysticercosis (NCC) is a central nervous system infection caused by Taenia solium or pork tapeworm. It affects millions worldwide and represents a leading cause of epilepsy in developing countries. NCC may be challenging to distinguish from intracranial tuberculomas, with tuberculosis being highly prevalent in developing countries. We highlight the importance of clinical history, including exposure history and neuroimaging, in obtaining an accurate diagnosis to enable prompt treatment. This report presents the case of a 26-year-old man diagnosed with NCC and presenting with acute giddiness and headache. Otherwise, there was no history of fever or constitutional symptoms. Neuroimaging demonstrated multiple cerebral lesions over both hemispheres, with degenerating scolex on brain MRI. He recovered well following a combination of oral albendazole, praziquantel, and corticosteroids. This case highlights the salient features that distinguish NCC from intracranial tuberculoma. Early and precise diagnosis will ensure that patients receive optimal treatment, expedite recovery, and prevent further complications.

Fulltext Correction: Modified regimen intrapleural alteplase with pulmozyme in pleural infection management: a tertiary teaching hospital experience

Cheong XK, Ban AY, Ng BH, Abeed NNN, Ismail NAN, Fuad NFN, et al.

BMC Pulm Med, 2022 Nov 23;22(1):440.

PMID: 36418993 DOI: 10.1186/s12890-022-02251-0

Displaying all 9 publications