Carly C. Barron

An adult man with low-volume liver metastases from grade 3 rectal neuroendocrine tumor (Ki67 index of 25%) sequentially underwent multiple systemic therapies. Gallium (88Ga)-DOTATATE scan showed avid metastases, including a scalp deposit (Figure A, B). He received lutetium (177Lu)-DOTATATE, 200 mCi times 3 cycles. The scalp metastasis was excised 8 days after cycle 3 of 177Lu therapy. Histopathologic evaluation was consistent with a metastasis of his neuroendocrine tumor (Figure C).

To the Editor: Adrenal insufficiency (AI) is characterized by inadequate cortisol production. AI is due to either primary dysfunction of the adrenal cortex or a secondary process leading to decreased central adrenocorticotropic hormone (ACTH) production. The most common cause of secondary AI is iatrogenic suppression of the hypothalamic–pituitary–adrenal (HPA) axis due to prolonged use of supraphysiologic doses of oral or intravenous glucocorticoids.

We report a case series of patients presenting with features of oral allergy syndrome (OAS) with clinical symptoms ranging from gastrointestinal upset to anaphylaxis. This highlights the possibility that OAS may present not only as local irritation of the oropharynx, but can also manifest as more serious symptoms such as gastrointestinal upset, and even anaphylaxis.