Sinoorbital Mucormycosis Associated with Corticosteroid Therapy in COVID-19 Infection

Background. Mucormycosis is a rare and invasive fungal infection, affecting almost exclusively immunocompromised individuals. Immunosuppressive effects of corticosteroids which are widely prescribed in COVID-19 patients might be a predisposing factor for opportunistic infections even though the other factors should also be considered. Case Presentation. A middle-aged man without any significant past medical history was admitted to the hospital due to a severe COVID-19 infection. He received a high dose of corticosteroids as a part of the treatment. Five days after discharge, he presents with a headache and fever. Eventually, orbital mucormycosis was diagnosed for him and he was treated with antifungal medications. Conclusion. Opportunistic infections should be considered during the current pandemic of COVID-19, during which corticosteroids are widely prescribed.

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Vestibular neuritis caused by severe acute respiratory syndrome coronavirus 2 infection diagnosed by serology: Case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x211013261 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110132

Author(s):

Alexandra Halalau ◽

Madalina Halalau ◽

Christopher Carpenter ◽

Amr E Abbas ◽

Matthew Sims

Keyword(s):

Case Report ◽

Severe Acute Respiratory Syndrome ◽

Medical History ◽

Cranial Nerve ◽

Respiratory Illness ◽

Vestibular Neuritis ◽

Past Medical History ◽

Significant Past Medical History ◽

Eighth Cranial Nerve ◽

Male Physician

Vestibular neuritis is a disorder selectively affecting the vestibular portion of the eighth cranial nerve generally considered to be inflammatory in nature. There have been no reports of severe acute respiratory syndrome coronavirus 2 causing vestibular neuritis. We present the case of a 42-year-old Caucasian male physician, providing care to COVID-19 patients, with no significant past medical history, who developed acute vestibular neuritis, 2 weeks following a mild respiratory illness, later diagnosed as COVID-19. Physicians should keep severe acute respiratory syndrome coronavirus 2 high on the list as a possible etiology when suspecting vestibular neuritis, given the extent and implications of the current pandemic and the high contagiousness potential.

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Sudden onset bilateral lower limb weakness in a female patient with no significant past medical history: answer

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2015.10.014 ◽

2016 ◽

Vol 27 ◽

pp. 180 ◽

Cited By ~ 1

Author(s):

H. Asadi ◽

P. Brennan ◽

A. O’Hare ◽

J. Thornton ◽

S. Looby

Keyword(s):

Medical History ◽

Female Patient ◽

Lower Limb ◽

Sudden Onset ◽

Past Medical History ◽

Significant Past Medical History ◽

Limb Weakness ◽

Lower Limb Weakness ◽

Bilateral Lower Limb

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Sudden onset bilateral lower limb weakness in a female patient with no significant past medical history: question

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2015.10.009 ◽

2016 ◽

Vol 27 ◽

pp. 153

Author(s):

H. Asadi ◽

P. Brennan ◽

A. O’Hare ◽

J. Thornton ◽

S. Looby

Keyword(s):

Medical History ◽

Female Patient ◽

Lower Limb ◽

Sudden Onset ◽

Past Medical History ◽

Significant Past Medical History ◽

Limb Weakness ◽

Lower Limb Weakness ◽

Bilateral Lower Limb

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An unusual suspect for heart failure

Acute Medicine Journal ◽

10.52964/amja.0797 ◽

2020 ◽

Vol 19 (1) ◽

pp. 42-42

Author(s):

Christianne Tan ◽

◽

Hitesh C Patel ◽

Justin Mariani ◽

◽

...

Keyword(s):

Heart Failure ◽

Medical History ◽

Clinical Examination ◽

Venous Pressure ◽

Heart Sounds ◽

Past Medical History ◽

Jugular Venous Pressure ◽

Significant Past Medical History ◽

Chest Auscultation ◽

History Of

A 71-year old retired missionary presented with a 2- week history of increasing dyspnoea, orthopnoea, and peripheral oedema. The patient had no previous significant past medical history. On clinical examination, his heart sounds were dual and his jugular venous pressure was elevated to 7cm. On chest auscultation there were bilateral crepitations at his lung bases.

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Acute xerostomia in head and neck radiotherapy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20190757 ◽

2019 ◽

Vol 5 (2) ◽

pp. 262

Author(s):

Dalya S. A. Al-Nuaimi ◽

Khudair J. Al-Rawaq ◽

Ali G. M. Noori ◽

Marwa A. N. Fattah

Keyword(s):

Head And Neck ◽

Salivary Glands ◽

Medical History ◽

Associated Factors ◽

High Dose ◽

Past Medical History ◽

Common Complaint ◽

The Mean ◽

Head And Neck Radiotherapy ◽

High Chance

Background: Xerostomia is a common complaint experienced with radiotherapy to the head and neck and it is caused by salivary glands dysfunction. Methods: Xerostomia is a common complaint experienced with radiotherapy to the head and neck and it is caused by salivary glands dysfunction. Results: The mean age was 51.69±13.7 years; 67% were men and 33% were women. Nasopharyngeal tumor and larynx cancer were the common tumors diagnosed (29% and 28% respectively), 78% of the tumors were squamous cell carcinoma and 53% of them in stage III. Most patients didn’t take chemotherapy during radiotherapy (90%), while 68% of them have previously received chemotherapy. The mean dose of radiotherapy used was 63.2±9.65 Gray. Post radiotherapy, the highest proportion diagnosed with xerostomia grade I (37%), while 21% of them were free of xerostomia. Female, negative past medical history, site, stage and dose of radiation were associated factors that increased prevalence of xerostomia. Conclusions: After radiotherapy, there is a high chance for developing xerostomia. Females, negative past medical history, advanced stage of tumor, high dose of radiation and site of tumor (oral, nasopharyngeal, and parotid) were significantly associated factors. Tumor site was a significant factor associated with the grade of xerostomia.

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First Case of Nocardia pseudobrasiliensis Causing Primary Cutaneous Nocardiosis in an Immunocompetent Patient

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709620938228 ◽

2020 ◽

Vol 8 ◽

pp. 232470962093822

Author(s):

Shraddhadevi Makadia ◽

Ishan Patel ◽

Ivan Soosaipillai ◽

Aneta Tarasiuk-Rusek

Keyword(s):

Medical History ◽

Causative Agent ◽

Immunocompetent Patient ◽

Causative Organism ◽

Immunocompromised Patients ◽

Past Medical History ◽

Significant Past Medical History ◽

Common Cause ◽

First Case ◽

Disseminated Disease

Nocardia brasiliensis is the most common cause of cutaneous nocardiosis. Nocardia pseudobrasiliensis is an emerging species responsible for invasive and disseminated disease in immunocompromised patients. We describe a case of a 67-year-old immunocompetent patient without significant past medical history diagnosed with primary cutaneous nocardiosis with N pseudobrasiliensis as the causative organism. In our opinion, we report the first case of primary cutaneous nocardiosis in an immunocompetent patient with N pseudobrasiliensis being the causative agent.

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Native aortic valve endocarditis with Morganella morganii in a patient with multiple myeloma and valvular amyloidosis: a case report

BMC Infectious Diseases ◽

10.1186/s12879-019-4511-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Renée van Bentum ◽

Judith Nieken ◽

Esther de Waal ◽

Mels Hoogendoorn

Keyword(s):

Multiple Myeloma ◽

Aortic Valve ◽

Opportunistic Infections ◽

Hemodynamic Instability ◽

High Dose ◽

Al Amyloidosis ◽

Morganella Morganii ◽

Case Presentation ◽

Native Aortic Valve ◽

Urinary Culture

Abstract Background Patients with multiple myeloma (MM) are known to be immune incompetent and experience higher incidences of infectious diseases. However, infective endocarditis (IE) is rarely observed in patients with MM and Morganella morganii (M. morganii) has rarely been associated with IE. Case presentation A 72-year-old female receiving 4th line treatment for MM presented with fever and concomitant confusion. Urinary culture revealed growth of Escherichia coli, wherefore broadspectrum penicillin and high-dose corticosteroids were initiated. However, blood cultures showed growth of M. morganii. Fluoroquinolone was added due to penicillin-resistance of the Morganella species. Two days after admission, the patient acutely deteriorated with hemodynamic instability. Gentamicin and high dose corticosteroids were added. Echocardiography showed marked aortic valve vegetation with severe aortic valve regurgitation, leading to the diagnosis of bacterial endocarditis of the native aortic valve. Shortly after diagnosis, the patient died. At autopsy, vegetation with gram-negative rods in the native aortic valve was observed, confirming the diagnosis of M. morganii-endocarditis. Additional staining for amyloid confirmed advanced light-chain (AL) amyloidosis with extensive amyloid depositions of the aortic valve and valvular damage as complications of her MM. Conclusions Our case suggests that IE with M. morganii was facilitated by the combination of the cardiac amyloidosis with valvular impairment and the profound immune deficiency caused by the several chemo-immunomodulatory treatment lines and the MM itself. This case further illustrates that awareness for rare opportunistic infections in an era with growing potential of combined chemoimmunotherapy is warranted.

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Therapy-Associated Immunosuppression and Opportunistic Infections in Multiple Myeloma Patients.

Blood ◽

10.1182/blood.v106.11.5137.5137 ◽

2005 ◽

Vol 106 (11) ◽

pp. 5137-5137

Author(s):

Philipp Schutt ◽

Dieter Brandhorst ◽

Werner Stellberg ◽

Miriam Poser ◽

Peter Ebeling ◽

...

Keyword(s):

Opportunistic Infections ◽

Pneumocystis Carinii ◽

Serum Levels ◽

High Dose Chemotherapy ◽

High Dose ◽

Predisposing Factor ◽

Varicella Zoster ◽

Humoral Immune ◽

Conventional Dose ◽

Immune Parameters

Abstract This study evaluates cellular and humoral immune parameters in myeloma patients focusing on the effect of treatment and the risk of opportunistic infections. Peripheral blood lymphocyte subsets and serum levels of nonmyeloma immunoglobulins (Ig) were analyzed in 480 blood samples from 77 myeloma patients. Untreated myeloma patients exhibited significantly reduced CD4+/45RO+, CD19+, CD3+/HLA-DR+, and natural killer (NK) cells as well as nonmyeloma IgA, IgG, and IgM. Conventional-dose chemotherapy (conv-CTX) resulted in significantly reduced CD4+ and even further decline of CD4+/CD45RO+ and CD19+ cells, most notably in relapsed patients. Patients treated with conv-CTX in combination with thalidomide showed significantly increased counts of monocytes as well as serum levels of nonmyeloma IgA and IgM as compared to patients on conv-CTX without additional thalidomide. Following high-dose chemotherapy (HD-CTX) prolonged immunosuppression was observed. While CD8+, NK, CD19+, and CD4+/CD45RO+ cells recovered to normal values within 60, 90, 360, and 720 days, respectively, CD4+ counts remaining reduced even thereafter. Nine opportunistic infections were observed including 5 cytomegalovirus (CMV) diseases, 1 pneumocystis carinii pneumonia (PCP), and 3 varicella zoster virus (VZV) infections with CMV diseases and PCP occurring exclusively after HD-CTX. Opportunistic infections were correlated with severely reduced CD4+ as well as CD4+/CD45RO+, and CD19+ counts. Thus, myeloma patients display cellular and humoral immunodeficiencies, which increase following conv- as well as HD-CTX and constitute an important predisposing factor for opportunistic infections.

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Just the facts: Hypertonic saline is just as good as (and probably better than) mannitol

CJEM ◽

10.1017/cem.2019.455 ◽

2020 ◽

Vol 22 (2) ◽

pp. 152-154 ◽

Cited By ~ 1

Author(s):

Laurel Murphy

Keyword(s):

Emergency Department ◽

Medical History ◽

Hypertonic Saline ◽

Motor Vehicle ◽

Motor Vehicle Collision ◽

Past Medical History ◽

Significant Past Medical History ◽

Vehicle Collision ◽

Level Of Consciousness ◽

Better Than

A 27-year-old female is brought to the emergency department (ED) by ambulance following a motor vehicle collision at highway speed. She was the belted driver. She has no significant past medical history and is on no medications. Following a prolonged extrication, she is intubated due to decreased level of consciousness before transport.

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Supraventricular tachycardia associated with phentermine use

The Southwest Respiratory and Critical Care Chronicles ◽

10.12746/swrccc.v4i15.291 ◽

2016 ◽

Vol 4 (15) ◽

pp. 70

Author(s):

Pakpoom Tantrachoti ◽

Saranapoom Klomjit ◽

Supannee Rassameehiran ◽

Scott W Shurmur

Keyword(s):

Cardiovascular Risk ◽

Side Effects ◽

Medical History ◽

Supraventricular Tachycardia ◽

Cardiac Arrhythmias ◽

Past Medical History ◽

High Cardiovascular Risk ◽

Significant Past Medical History ◽

Diet Pill ◽

Prevalence Of Obesity

Phentermine, a very popular diet pill, is reportedly associated with tachycardia but rarely with other cardiac arrhythmias. We report a 36-year-old woman with no significant past medical history who developed supraventricular tachycardia after taking phentermine for four months. The supraventricular tachycardia has not recurred after the patient stopped taking the medication. With growing prevalence of obesity, clinicians should be aware of the potential serious side effects of phentermine and people with high cardiovascular risk should avoid using this medication.

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