International Journal of Medical and Pharmaceutical Case Reports

B-Cell Acute Lymphoblastic Leukemia Associated with Isolated and Recurrent Central Nervous System Relapse with a Novel t(6;19)(q21;p13) Translocation: A Case Report

Heloísa Zorzi Costa — 2026-09-16

B-cell acute lymphoblastic leukaemia (B-ALL) is a haematological malignancy characterised by the clonal proliferation of B-lymphoid precursors. Cytogenetic and molecular alterations are central to B-ALL classification and diagnosis according to the 2024 World Health Organization (WHO) guidelines. Although recurrent abnormalities are well characterised, rare chromosomal alterations may provide insights into leukaemogenesis and prognosis. Here, we report the case of a 33-year-old woman diagnosed with B-ALL. Bone marrow flow cytometry identified 82% blasts expressing CD19, CD79a, CD22, and CD10, with partial cytoplasmic IgM and nuclear TdT expression and absence of CD34, consistent with B-precursor ALL. BCR::ABL1 p190 and p210 transcripts were negative by nested RT-PCR. Cerebrospinal fluid (CSF) flow cytometry detected 4.9% immature B cells with a phenotype similar to bone marrow blasts, confirming central nervous system (CNS) involvement at diagnosis. Conventional cytogenetics revealed 46,XX,t(6;19)(q21;p13). The patient received Hyper-CVAD chemotherapy and intrathecal therapy, achieving complete bone marrow remission with undetectable measurable residual disease and a normal karyotype. Subsequent CSF assessments were negative for leukaemic involvement. Three isolated CNS relapses occurred at 7, 11, and 17 months after diagnosis, with 82.7%, 95.9%, and 5.1% leukaemic cells in the CSF, respectively, despite treatment with intrathecal chemotherapy and CNS radiotherapy. The patient died 20 months after diagnosis. This case expands knowledge of rare cytogenetic abnormalities in B-ALL and highlights the need for further studies to clarify the biological and potential prognostic implications of t(6;19)(q21;p13).

Neuroleptic Malignant Syndrome with Suspected Lithium Toxicity Following Combined Lithium and Antipsychotic Overdose, Complicated by Rhabdomyolysis and Fatal Acute Kidney Injury: A Case Report

Saraswathi Yashaswini — 2026-09-23

Neuroleptic malignant syndrome (NMS) and lithium toxicity are life-threatening complications of psychotropic medication exposure with substantially overlapping clinical manifestations, potentially delaying recognition when they occur together. We report a fatal case of a 40-year-old man with bipolar affective disorder who presented seven days after intentional ingestion of lithium, lorazepam, olanzapine, divalproex, and quetiapine. He developed persistent high-grade fever, altered sensorium, generalised rigidity, seizures, respiratory failure, rhabdomyolysis, stage 3 acute kidney injury (AKI), hyperkalaemia, transaminitis, and mixed metabolic and respiratory acidosis. NMS with suspected concomitant lithium toxicity was diagnosed clinically. Management included immediate withdrawal of psychotropic agents, bromocriptine, aggressive hydration, active cooling, correction of electrolyte abnormalities, peritoneal dialysis followed by continuous renal replacement therapy (CRRT), and multidisciplinary care involving nephrology, neurology, and psychiatry. Despite treatment, the patient developed refractory hyperthermia, worsening acidosis, refractory hypotension, and cardiac arrest with pulseless ventricular tachycardia progressing to asystole. This case highlights the diagnostic overlap between NMS and lithium toxicity, the potentially catastrophic consequences of delayed presentation after deliberate self-poisoning, and the importance of early recognition and appropriate renal replacement therapy in critically ill patients with severe AKI.

Incidentally Detected Supraventricular Tachycardia in a Preterm Neonate: A Case Report of Successful Medical Management and Follow-up

Lere P. Oluwadare — 2026-10-17

The neonatal or newborn period is defined as the time interval between birth and the twenty-eighth day of life. Supraventricular tachycardia, a cardiac emergency, is characterised by a heart rate between 200 and 300 beats per minute (bpm), often ≥220 bpm. We present the case of a 2-week-old moderately preterm male neonate whose heart rate was found to be persistently above 220 bpm (250–260 bpm) during the second week of life. There was no preceding fever or other clinically significant antecedent. Investigation findings were essentially normal except for the initial limited echocardiogram, which showed sinus venous venosus atrial septal defect. Ice packs were initially applied to the face for vagal stimulation, but there was no satisfactory response. Intravenous adenosine was subsequently administered, with minimal reduction in the heart rate, which remained between 185 and 200 bpm. Oral propranolol was thereafter commenced as a maintenance regimen. The heart rate plateaued between 160 and 170 bpm until the end of the first month of life. The child was discharged home at the beginning of the fifth week of life. He was reviewed at specific intervals in the neonatology outpatient department after hospital discharge. Tapering of propranolol was commenced when the child was 4 months old, and the medication was finally discontinued after the sixth outpatient clinic visit, when the child was 6 months old. The heart rate had stabilised between 120 and 140 bpm. Repeat surface electrocardiographic (ECG) findings at 6 months of life showed normal sinus rhythm, while repeat definitive echocardiograms at 3 and 6 months of life showed normal structural intracardiac and functional findings.