COVID‐19 reinfection in a healthcare worker after exposure with high dose of virus: A case report

Eosinophilic fasciitis is a rare connective tissue disease of unknown etiology. Therapeutic options include high-dose corticosteroids and other immunosuppressive drugs. We present a typical eosinophilic fasciitis case, which did not respond to first-line treatment, but improved remarkably after infliximab administration. This report demonstrates that in case of initial treatment failure, infliximab might be a relatively safe and effective way of eosinophilic fasciitis management.

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Nonepileptic Myoclonus in COVID-19: Case Report

The Neurohospitalist ◽

10.1177/19418744211004315 ◽

2021 ◽

pp. 194187442110043

Author(s):

Henly Hewan ◽

Annie Yang ◽

Aparna Vaddiparti ◽

Benison Keung

Keyword(s):

Case Report ◽

Critically Ill ◽

Recovery Phase ◽

Critically Ill Patient ◽

High Dose ◽

The Novel ◽

Neurological Manifestations ◽

Immune Mediated ◽

Novel Coronavirus ◽

Post Infectious

In late 2019, the novel coronavirus, SARS-CoV-2, and the disease it causes, COVID-19, was identified. Since then many different neurological manifestations of COVID-19 have been well reported. Movement abnormalities have been rarely described. We report here a critically ill patient with COVID-19 who developed generalized myoclonus during the recovery phase of the infection. Myoclonus was associated with cyclical fevers and decreased alertness. Movements were refractory to conventional anti-epileptic therapies. There was concern that myoclonus could be part of a post-infectious immune-mediated syndrome. The patient improved fully with a 4-day course of high-dose steroids. Our experience highlights a rare, generalized myoclonus syndrome associated with COVID-19 that may be immune-mediated and is responsive to treatment.

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Acute Tubulointerstitial Nephritis in a Patient on Anti-Programmed Death-Ligand 1 Triggered by COVID-19: A Case Report

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211014745 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110147

Author(s):

Dimitry Buyansky ◽

Catherine Fallaha ◽

François Gougeon ◽

Marie-Noëlle Pépin ◽

Jean-François Cailhier ◽

...

Keyword(s):

Case Report ◽

Severe Acute Respiratory Syndrome ◽

Tubulointerstitial Nephritis ◽

Checkpoint Inhibitor ◽

Checkpoint Inhibitors ◽

High Dose ◽

Programmed Death Ligand 1 ◽

Acute Tubulointerstitial Nephritis ◽

Programmed Death ◽

Kidney Involvement

Rationale: Immune checkpoint inhibitors are monoclonal antibodies used in the treatment of various types of cancers. The downside of using such molecules is the potential risk of developing immune-related adverse events. Factors that trigger these autoimmune side effects are yet to be elucidated. Although any organ can potentially be affected, kidney involvement is usually rare. In this case report, we describe the first known instance of a patient being treated with an inhibitor of programmed death-ligand 1 (anti-PD-L1, a checkpoint inhibitor) who develops acute tubulointerstitial nephritis after contracting the severe acute respiratory syndrome coronavirus 2. Presenting concerns of the patient: A 62-year-old patient, on immunotherapy treatment for stage 4 squamous cell carcinoma, presents to the emergency department with symptoms of lower respiratory tract infection. Severe acute kidney injury is discovered with electrolyte imbalances requiring urgent dialysis initiation. Further testing reveals that the patient has contracted the severe acute respiratory syndrome coronavirus 2. Diagnosis: A kidney biopsy was performed and was compatible with acute tubulointerstitial nephritis. Interventions: The patient was treated with high dose corticosteroid therapy followed by progressive tapering. Outcomes: Rapid and sustained normalization of kidney function was achieved after completion of the steroid course. Novel findings: We hypothesize that the viral infection along with checkpoint inhibitor use has created a proinflammatory environment which led to a loss of self-tolerance to renal parenchyma. Viruses may play a more important role in the pathogenesis of autoimmunity in this patient population than was previously thought.

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Indications for Tonsillectomy in Infectious Mononucleosis

PEDIATRICS ◽

10.1542/peds.48.2.338 ◽

1971 ◽

Vol 48 (2) ◽

pp. 338-339

Author(s):

Edward J. Feroli ◽

Gordon W. Mella ◽

Frank A. Pedreira ◽

Regis T. Storch ◽

Howard P. Gutgesell

Keyword(s):

Case Report ◽

Infectious Mononucleosis ◽

Community Hospital ◽

Nasotracheal Intubation ◽

Benign Disease ◽

Therapeutic Modality ◽

High Dose ◽

High Dose Corticosteroid ◽

Acute Airway Obstruction ◽

Dose Corticosteroid

We read with interest the recent report, "Acute Airway Obstruction in Infectious Mononucleosis."1 Dr. Gutgesell appropriately has called attention to a serious complication of a usually benign disease. He mentions brief, high-dose corticosteroid therapy, tracheotomy, nasotracheal intubation, and IPPB as potential modes of therapy. The following case report suggests an additional therapeutic modality in the management of these patients. A 4-year-old girl was admitted to a community hospital in acute respiratory distress associated with suspected infectious mononucleosis.

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High-Dose Intravenous Vitamin C Treatment of a Child with Neurofibromatosis Type 1 and Optic Pathway Glioma: A Case Report

American Journal of Case Reports ◽

10.12659/ajcr.899754 ◽

2016 ◽

Vol 17 ◽

pp. 774-781 ◽

Cited By ~ 3

Author(s):

Nina Mikirova ◽

Ronald Hunnunghake ◽

Ruth C. Scimeca ◽

Charles Chinshaw ◽

Faryal Ali ◽

...

Keyword(s):

Case Report ◽

Vitamin C ◽

Neurofibromatosis Type 1 ◽

Neurofibromatosis Type ◽

Optic Pathway Glioma ◽

High Dose ◽

Optic Pathway ◽

Intravenous Vitamin

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Case Report. Extracorporeal Membrane Oxygenation in Nivolumab Associated Pneumonitis

The Journal of Critical Care Medicine ◽

10.1515/jccm-2017-0013 ◽

2017 ◽

Vol 3 (2) ◽

pp. 84-88

Author(s):

Thomas-Michael Schneider ◽

Friederike Klenner ◽

Franz Brettner

Keyword(s):

Case Report ◽

Extracorporeal Membrane Oxygenation ◽

Therapeutic Option ◽

High Dose ◽

Great Success ◽

Case Presentation ◽

Computed Tomographic ◽

Rehabilitation Hospital ◽

Membrane Oxygenation ◽

History Of

Abstract Background: Newly approved immunotherapeutic agents, like CTLA-4 inhibitors and antibodies against PD-1, are a promising therapeutic option in cancer therapy. Case presentation: A 74-year-old man, with a history of advanced stage melanoma and treatment with ipilimumab, pembrolizumab and nivolumab, was admitted to the hospital due to respiratory failure with hypoxemia and dyspnoea. He rapidly developed severe acute respiratory distress syndrome (ARDS), which required treatment in the intensive care unit which included mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Computed tomographic imaging (CT) showed signs of a pneumonitis, with an ARDS pattern related to the use of PD-1 antibodies. Treating the patient with high-dose immunosuppressive steroids led to an overall improvement. He was transferred to a rehabilitation hospital and subsequently to his home. Discussion and conclusion: This is a unique case report of a patient suffering a grade 4 adverse event under nivolumab who survived having been treated with ECMO. It highlights the possibility of associated adverse reactions as well as the use of ECMO in palliative care patients. ECMO can be of great success even in patients with malignancies, but careful decision making should be done on a case by case basis.

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