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Lan is a high prevalence red blood cell antigen present in the majority of the populations that belong to the Lan (Langereis) blood group system. Anti-Lan antibody is an immunoglobulin G (IgG) antibody that is known to cause delayed hemolytic transfusion reactions in adults as well as hemolytic disease in fetuses and newborns, however with variable clinical significance ranging from mild to severe. We present a 58-year-old woman with diffuse abdominal pain and a large gastric ulcer causing gastric outlet obstruction. She underwent antrectomy and Billroth I reconstruction surgery without complications. The patient’s hemoglobin upon presentation was 10g/dL and dropped acutely post-operatively to 6.4 g/dL requiring blood transfusion. The patient developed acute respiratory distress within minutes of starting a packed red blood cell (pRBC) transfusion, requiring discontinuation. Laboratory testing demonstrated pan-reactivity with additional reference testing demonstrating an anti-Lan antibody. The rarity of Lan negative pRBC units is a challenge in managing such patients requiring blood transfusions. Autologous blood donation or donation by a compatible family member is another option to consider in these rare cases.

A 24-year-old male with metastatic desmoplastic round cell tumor was admitted for fatigue and weakness after chemotherapy. The patient was found to be hypotensive, pancytopenic, and bacteremic. Early treatment with intravenous antibiotics and fluids was efficacious. The hospital course was complicated by recurrent hypoglycemia that was refractory to the standard hypoglycemia protocol. Initial workup revealed low serum insulin and normal C-peptide. Further evaluation revealed elevated IGF-II levels consistent with non-islet cell tumor-induced hypoglycemia. Euglycemia was subsequently achieved with aggressive and continuous infusion of intravenous 10% dextrose.

We present a case of a 55-year-old lady with intermittent twitching of the left side of her face, involving her left eyelid and the angle of the mouth, ongoing for two years. She failed multiple trials of botulinum toxin injections as well as oral anti-spasmodic medications. The patient was diagnosed with an ectatic left vertebral artery, causing a compression of cranial nerve VII on the same side on magnetic resonance imaging (MRI) of the brain. She underwent neurosurgery with a microvascular decompression of the ectatic artery with a resolution of hemifacial spasms. However, her postoperative course was complicated by headaches and low-grade fevers. She also had leukocytosis on a laboratory evaluation. The postoperative computed tomography (CT) scan of her head was normal. The patient had a lumbar puncture done, which showed an elevated white cell count in cerebrospinal fluid (CSF) analysis and the CSF culture was positive for methicillin-resistant Staphylococcus aureus (MRSA) bacteria. She was diagnosed with MRSA meningitis as a postoperative complication following microvascular decompression. The patient had a revision surgery of the decompression site, including wound debridement and did well postoperatively.