scholarly journals COVID-19 pneumonia in a patient with granulomatosis with polyangiitis on rituximab: case-based review

Author(s):  
Alicia Rodriguez-Pla ◽  
Holenarasipur R. Vikram ◽  
Vanood Khalid ◽  
Lewis J. Wesselius

AbstractA 77-year-old man with past medical history of granulomatosis with polyangiitis (GPA) on rituximab and prednisone, presented to the hospital with worsening cough and shortness of breath. He had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by nasal swab polymerase chain reaction (PCR) while asymptomatic, 6 weeks earlier. He started with cough and shortness of breath 2 weeks after his initial positive test. After developing symptoms, he tested negative twice by nasal swab PCR, but the PCR of his bronchioloalveolar lavage was positive for SARS-CoV-2. He did not develop antibodies against coronavirus. Prednisone 15 mg daily was continued, and he received remdesivir, and convalescent plasma with quick recovery. We reviewed the literature to search for similar cases. Our case suggests that SARS-CoV-2 infection in patients on rituximab may have an atypical presentation and the diagnosis may be delayed due to negative PCR testing in the nasal swab. Patients may benefit from treatment with convalescent plasma.

2020 ◽  
Vol 11 ◽  
pp. 215013272098564
Author(s):  
Huda Anwar ◽  
Anwaar Al Lawati

Coronavirus disease 2019 (COVID-19) has become an urgent global health priority. Although most patients with COVID-19 manifest with fever and respiratory tract symptoms, COVID-19 infections may also involve other organs and extrarespiratory manifestations, including cardiac, gastrointestinal, hepatic, renal, and neurological symptoms. This case describes a 16-year-old boy who presented with fever, sore throat, myalgia, and subsequently with shortness of breath. A diagnosis of COVID-19 was confirmed by polymerase chain reaction. His condition deteriorated and he died within 3 days of admission. An evaluation of his past medical history confirmed an episode of viral illness which had progressed to myositis and rhabdomyolysis 1 year prior. Clinicians should be aware of this complication and maintain a high index of suspicion in cases of COVID-19 presenting with extrapulmonary symptoms.


2021 ◽  
Vol 18 (4) ◽  
pp. 323-325
Author(s):  
Aleksandra Młodożeniec ◽  
◽  
Paulina Szul ◽  
Agnieszka Gala-Błądzińska ◽  
◽  
...  

Introduction. The coronavirus disease 2019 (COVID‑19) is an acute infectious disease of the respiratory system caused by severe acute respiratory syndrome coronavirus (SARS‑CoV‑2). Most patients present with typical, respiratory symptoms. Common signs include cough, fever, dyspnea and shortness of breath. In this case we provide atypical indications of COVID-19, which may occur earlier than respiratory symptoms. Aim. This case is an example of an unusual course of SARS-CoV-2 infection. Description of the case. This article describes a case of a 63-year-old man and his wife, a 60-year old woman who were admitted to the emergency department with a few days’ history of gastrointestinal symptoms. Both patients presented with the digestive symptoms of nausea, diarrhea and loss of appetite. They denied abdominal pain and the loss of smell or taste. Due to suspicion of SARS-CoV-2 infection a nasopharyngeal swabs of both patients was taken. The results of real- time reverse transcriptase-polymerase chain reaction were positive. When the final diagnosis of COVID-19 was established they were transported to another hospital. Conclusion. COVID-19 may manifest with atypical indications such a nausea and diarrhea. An atypical indications of COVID-19 may occur earlier than respiratory symptoms. It is important for clinicians to remain alert.


Author(s):  
Lotfollah Davoodi ◽  
Leila Faeli ◽  
Rogheye Mirzakhani ◽  
Rozita Jalalian ◽  
Tahereh Shokohi ◽  
...  

Background and Purpose: Coronavirus disease 2019 (COVID-19) and Candida prostatic valve endocarditis present various clinical manifestations which may overlap;hence, discrimination between them is extremely difficult. Case report: The case was a 66-year-old man with a past medical history of mitral and aortic valves replacement one year before COVID-19 co-infection. He was admitted with fever (for 7 days), shortness of breath, cough, seizure, lethargy,headache, and 85% oxygen saturation. Transesophageal echocardiography revealed multiple large-sized, highly mobile masses on both sides of the mechanical mitral valve highly suggestive of vegetation. Chest computed tomography scanning showed simulating scattered COVID-19 peripheral ground-glass opacities confirmed by reverse-transcription polymerase chain reaction. The set of blood cultures yielded yeast colonies that were identified as Candida tropicalis. The patient died of septic shock shortly after receiving antifungal therapy. Conclusion: This case emphasized the importance of early diagnosis and implementation of antifungal treatment, particularly in patients with prosthetic cardiac valves, to reduce their unfavorable outcomes in COVID-19 patients. 


2020 ◽  
Vol 9 (1) ◽  
pp. 49-57
Author(s):  
Sutaryono Sutaryono ◽  
Sholikhah Deti Andasari ◽  
Heru Subaris Kasjono

COVID-19 has experienced an increase in 2,995,758 positive cases and 204,987 deaths, in distribution areas of more than 213 countries. This research using a systematic literature review, policy brief, and internet-based questionnaire with the aim of finding out the diagnosis and epidemiology of Coronavirus (COVID-19) outbreak in Indonesia. The cases in Indonesia have reached 9,771 and killed 784 people, possibly as many as 19 cases are asymptomatic but can be carriers of the virus. The diagnosis is carried out by rapid testing and using a polymerase chain reaction (PCR). Most of the patients diagnosed were aged 30-49 years (38.91%), the highest accompanying diseases were hypertension (34.85%), diabetes mellitus (25.76%), and cardiac disease (17.05%). The most signs and symptoms are that the patient has a cough, shortness of breath, and has a history of internal medicine and fever. Based on sex mostly experienced by men (58.94%) compared to women (41.06%), 60.4% of the community is still active outside the home. The Government of Indonesia is making efforts to reduce the COVID 19 outbreak by implementing a health protocol and a Large-scale Social Restrictions or “Pembatasan Sosial Berskala Besar (PSBB)” policy.


2021 ◽  
pp. 101053952110110
Author(s):  
Salma Abbas ◽  
Aun Raza ◽  
Ayesha Iftikhar ◽  
Aamir Khan ◽  
Shahzaib Khan ◽  
...  

Health care personnel (HCP) are at high risk for coronavirus disease-2019 acquisition. Serum antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) indicate past infection. Our institution offered SARS-CoV-2 antibody testing to HCP. We surveyed HCP with positive test results to explore past exposure to SARS-CoV-2, details of symptoms during the preceding 6 months, and a history of SARS-CoV-2 polymerase chain reaction testing. A total of 2162 HCP underwent antibody testing. Eight hundred fifty-seven (39.6%) employees tested positive and, of these, 820 (95.7%) participated in the survey. When adjusted for age, males had higher odds of testing positive for SARS-CoV-2 antibodies compared with females (OR = 1.68; 95% CI = 1.37-2.05; P = .00) and clinical staff had higher odds of SARS-CoV-2 seropositivity compared with nonclinical staff (OR = 1.273; 95% CI = 1.06-1.53; P = .01). Implementation of effective infection control measures is essential to protect HCP from coronavirus disease-2019.


2021 ◽  
pp. 175114372110507
Author(s):  
Sarah Burgess

A 76-year-old lady was found on the floor following a fall at home. She was uninjured, but unable to get up, and had been lying on the floor for roughly 18 hours before her son arrived. She had been unwell for the past 3 days with a cough and shortness of breath. She had a past medical history of diabetes, hypertension, hypercholesterolaemia and atrial fibrillation (AF). On examination, she was alert but distressed, clinically dehydrated, febrile and tachycardic. She was treated for community acquired pneumonia with co-amoxiclav and was fluid resuscitated with Hartmann’s solution. Her hyperkalaemia was treated with 50 mL of 50% glucose containing 10 units of rapid-acting insulin. Her creatinine kinase (CK) on admission was 200,000, and she had an acute kidney injury (AKI). Urine dipstick was positive for blood. However, her renal function continued to deteriorate over the succeeding 48 h, when she required renal replacement therapy (RRT) due to fluid overload and anuria.


1996 ◽  
Vol 8 (2) ◽  
pp. 181-185 ◽  
Author(s):  
Patricia K. Holyoake ◽  
Gary F. Jones ◽  
Peter R. Davies ◽  
Dennis L. Foss ◽  
Michael P. Murtaugh

A polymerase chain reaction (PCR) assay was used to confirm the presence of ileal symbiont (IS) intracellularis in 3 swine herds with a history of proliferative enteritis (PE). Two pooled fecal specimens, each comprising 5 individual stool samples, were collected from pen floors to screen for the presence of IS intracellularis and determine the age range of pigs shedding the organism. IS intracellularis was detected in the feces of clinically normal 10–25week-old grower/finisher pigs, indicating that this age range of pigs was the main source of infection for younger nursery pigs. Shedding continued without clinical disease when 10–100 g/ton of tylosin or 10 g/ton of chlortetracycline was added to the feed. PCR testing of pooled fecal samples can be used to identify groups of pigs affected with PE. The results of this study indicate that this PCR assay has the potential to accurately assess the IS intracellularis infection status of swine herds and the association of IS intracellular-is with PE and growth performance.


2019 ◽  
Vol 7 (19) ◽  
pp. 3262-3264
Author(s):  
Taher Felemban ◽  
Abdullah Ashi ◽  
Abdullah Sindi ◽  
Mohannad Rajab ◽  
Zuhair Al Jehani

BACKGROUND: Having hoarseness of voice as the first clinical manifestation of tuberculosis is rare. This atypical presentation causes some confusion since other more common conditions, such as laryngeal carcinoma, present similarly and might require more invasive tests to confirm the diagnosis. CASE PRESENTATION: A 38-year-old male presented to the otorhinolaryngology clinic with a four-month history of change in voice. Laryngoscopy demonstrated a right glottic mass, raising suspicion of laryngeal cancer. The computed tomography showed a mass and incidental finding of opacities in lung apices. Chest x-ray demonstrated findings suggestive of tuberculosis. Polymerase chain reaction and culture of sputum samples confirmed the diagnosis and the patient was started on anti-tuberculosis treatment. CONCLUSION: Despite accounting for only 1% of pulmonary tuberculosis cases and having a similar presentation to laryngeal carcinoma, we recommend considering laryngeal tuberculosis when evaluating hoarseness of voice in endemic areas.


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