Browsing by Author "Montenegro, John Fernando"
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Item A Vitiligo-like Cutaneous Reaction Induced by Ribociclib in Advanced Breast Cancer: An Unusual Case Report from Colombia(Multidisciplinary Digital Publishing Institute (MDPI), 2025-05-19) Montenegro, John Fernando; Rivas Tafurt, Giovanna Patricia; Vidal Cañas, Sinthia; Diaz Diaz, Miguel Ángel; Bermudez, Cesar Eduardo; Florez, Daniel; Bravo Gustin, Andres Felipe; Liscano, YamilBackground: Cutaneous toxicities associated with CDK4/6 inhibitors are uncommon but may affect treatment adherence. We present the case of a patient with advanced breast cancer who developed vitiligo-like lesions after initiating ribociclib, contributing to the growing evidence of this under-recognized adverse effect. Methods: We present the case of a 72-year-old woman diagnosed in 2007 with early-stage, luminal A, HER2-negative breast cancer, initially treated with surgery and tamoxifen. In 2022, she experienced locoregional recurrence with bone metastases. In January 2023, she began treatment with ribociclib plus letrozole. Two months later, she developed intense pruritus, xerosis, and paresthesia, followed by hypopigmented lesions on her face and upper extremities. Clinical evaluation, supported by photographs and a skin biopsy (led to a diagnosis of ribociclib-induced vitiligo. Management included dose adjustments to the ribociclib and dermatologic treatments, including topical corticosteroids, antihistamines, and short courses of oral prednisone. Results: By September 2024, her skin lesions had stabilized and her pruritus improved with a reduced dose of ribociclib (one tablet per day). However, the hypopigmented patches persisted, mainly on her face and extremities. Despite these cutaneous effects, she maintained an acceptable quality of life and continued effective oncologic treatment.Item Actinomycosis: Mimicking Malignancies in Multiple Anatomical Sites—A Three-Patient Case Series(Multidisciplinary Digital Publishing Institute (MDPI), 2025-02-02) Montenegro, John Fernando; Correa Forero, Vanessa; Liscano, Yamil; Grueso Pineda, Andres; Bonilla Bonilla, Diana Marcela; Ruiz Jimenez, Paola AndreaBackground and Objectives: Actinomycosis is a rare chronic contagion caused by Actinomyces spp. known for its ability to mimic malignant processes across various anatomical locations. Its clinical presentation can often resemble malignancies, Mycobacterium tuberculosis infections, nocardiosis, fungal infections, or other granulomatous diseases. This case series presents three patients diagnosed with Actinomyces spp., highlighting the diagnostic challenges and diverse clinical manifestations of the disease. Materials and Methods: We reviewed the clinical course, diagnostic procedures, and treatment outcomes of three patients with confirmed Actinomyces spp. The first case involved a 51-year-old male with a history of rhabdomyosarcoma in remission who presented with dysphagia. Magnetic resonance imaging identified an irregularly enhancing mass in the tonsil, and subsequent tonsillectomy confirmed Actinomyces spp. The second patient, an 80-year-old female, presented with dysphagia and a sublingual mass initially suspected to be diffuse large B-cell non-Hodgkin lymphoma; however, a histopathological analysis confirmed Actinomyces spp. The third case involved a 72-year-old male with abdominal pain and an ulcerated gastric lesion, where subtotal gastrectomy and histopathological examination confirmed the diagnosis of Actinomyces spp. Results: These three cases highlight the ability of Actinomyces spp. to closely mimic malignant lesions, which significantly complicates the diagnostic process. Although personalized interventions were required for each patient, diagnoses were ultimately confirmed through histopathology. Despite these challenges, timely recognition and appropriate treatment were achieved, underscoring the need to consider Actinomyces spp. in the differential diagnosis of similar presentations. Conclusions: Actinomyces spp. remains a diagnostic challenge due to its ability to mimic a variety of malignant and contagion conditions. This case series emphasizes the need for a thorough histopathological examination and a high index of suspicion when encountering lesions with atypical presentations. Given the potential for misdiagnosis, awareness and consideration of Actinomyces spp. are crucial in the differential diagnosis of chronic contagion and mass lesions. Further studies are warranted to refine diagnostic and therapeutic approaches.Item Postoperative Empyema Due to Leclercia adecarboxylata Following Mesothelioma Surgery: A Case Report(Multidisciplinary Digital Publishing Institute (MDPI), 2025-01-30) Montenegro, John Fernando; Diaz Diaz, Miguel Ángel; Vidal Cañas, Sinthia; Urriago, Gustavo; Correa, Vanessa; Melo Burbano, Luis Álvaro; Liscano, YamilBackground/Objectives: Leclercia adecarboxylata (L. adecarboxylata) is a rare opportunistic pathogen that can cause severe infections like empyema, particularly in immunocompromised individuals. We aim to highlight the importance of the early detection and personalized treatment of L. adecarboxylata infections in patients with comorbidities such as malignant mesothelioma. Methods: We present the case of a 57-year-old man with type 2 diabetes mellitus, hypertension, and malignant mesothelioma who developed a parapneumonic effusion that progressed to empyema. After undergoing pleurectomy and pleurodesis, intraoperative cultures identified L. adecarboxylata. Targeted antibiotic therapy was initiated based on the culture results, and the patient’s response was closely monitored. Results: The patient responded well to targeted antibiotic therapy with ampicillin/sulbactam following the initial empirical treatment with piperacillin/tazobactam. The identification of L. adecarboxylata—a rare finding in empyema cases—was crucial for effective management. The patient recovered fully without complications, highlighting the importance of the early identification and individualized treatment of infections caused by rare pathogens. Conclusions: This case underscores the need to consider L. adecarboxylata in immunocompromised patients presenting with unusual infections. Early detection through advanced diagnostic techniques and personalized antibiotic therapy can improve clinical outcomes and help prevent antimicrobial resistance. Increased clinical awareness and further research into the resistance patterns and treatment approaches for L. adecarboxylata are essential to enhance patient care.