A Jarisch–Herxheimer reaction is a body’s response to endotoxin-like substances released when bacteria are killed during antibiotic treatment. It’s been linked to syphilis, Lyme disease, leptospirosis, and relapsing fever. It usually happens 1 to 12 hours after the first antibiotic dose and doesn’t happen again with subsequent treatments. Symptoms include feeling tired, fever, redness, and a fast heartbeat. This can sometimes lead to low blood pressure because the blood vessels in the extremities dilate.

Procaine penicillin can cause a serious reaction if accidentally given IV instead of IM. It’s like a sudden rush of fear, with delusions and hallucinations. Patients might need help restraining themselves. The reaction usually goes away within 20 minutes. Sometimes, patients might have a seizure, which should be stopped with IV or PR diazepam.

• Purpuric rash • Raynaud’s • Polyarthralgia • Positive rheumatoid factor (RF) • Low C4 • Suggestive of
cyroglobulinaemia

The 2019 revised International Prognostic Scoring System for Waldenström’s Macroglobuinaemia (IPSSWM) allows risk stratification of patients with WM
according to the following factors:
• age < 65 years (0 point)
• age 66–75 years (1 point)
• age > 75 years (2 points)
• beta-2 microglobulin > 4 mg/l (1 point)
• lactate dehydrogenase (LDH) level > 250 IU/l (1 point)
• serum albumin < 35 g/l (< 3.5 g/dl) (1 point).
Risk groups are defined as (with points needed and 5-year survival rate in brackets): very low risk (0 points; 95%); low risk (1 point; 86%); intermediate risk (2 points; 78%); high risk (3 points; 47%); and very high risk (4–5 points; 36%). This patient can be stratified as being intermediate risk due to beta-2 microglobulin and LDH levels.

Mucosa-associated lymphoid tissue lymphoma (MALToma), also known as marginal zone lymphomas, are low-grade lymphomas that predominantly affect the stomach. They exhibit a unique association with chronic inflammation of one of the following types:

- Stomach: Chronic H. pylori gastritis
- Eyes: Sjögren syndrome
- Thyroid: Hashimoto’s thyroiditis
- Intestine: Crohn’s disease or coeliac disease

Treatment against H. pylori is effective and leads to regression in 90% of low-grade gastric MALTomas. Given the significance of establishing H. pylori diagnosis, if the tumor biopsy is negative for H. pylori, non-invasive testing such as stool antigen testing or urea breath test for H. pylori should be performed. In the event of a positive non-invasive test result, the patient should be initially managed with triple therapy.

Teduglutide
is a special medicine that helps the small intestine grow. It’s especially helpful for people with short bowel syndrome caused by many surgeries for Crohn’s disease. After six months of taking Teduglutide, people with short bowel syndrome who needed extra nutrition through a tube (TPN) saw a big drop in how much TPN they needed. Some people needed 20% less, while others needed 100% less!