scholarly journals Case Report of 78-Year-Old Man With Meningitis, Pulmonary Thromboembolism and SARS-Coronavirus-2 Infection

2021 ◽  
Author(s):  
Minoosh Moghimi ◽  
Samad Ghodrati ◽  
Zahra Abbaspourrad ◽  
Amirhossein Moghtader Mojdehi ◽  
Sattar Jafari ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Clinical Symptoms ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Transverse Myelitis ◽  
Cns Infection ◽  
Rt Pcr ◽  
Pcr Test

The novel coronavirus infection involves both the Central and Peripheral Nervous systems. Some of the presentations include acute cerebrovascular disease, impaired consciousness, transverse myelitis, encephalopathy, encephalitis, and epilepsy. Our patient was a 78-year-old man with dementia and diabetic nephropathy who was admitted two times for possibly COVID-19 infection. At the first hospitalization, the patient is treated with hydroxychloroquine and Kaletra based on clinical symptoms and initial laboratory findings due to suspicion of COVID-19. After the negative RT-PCR test of the nasopharyngeal sample for COVID-19 and evidence of aspiration pneumonia in CT scan, the patient was discharged with oral antibiotics. Five weeks later, he was rehospitalized with loss of consciousness, fever, and hypoxemia in the physical exam; he had neck stiffness in all directions, So the central nervous system (CNS) infection was suspected, the cerebrospinal fluid (CSF) sample was in favor of aseptic meningitis and second RT-PCR test of nasopharyngeal sample for COVID-19 was positive, but Brain MRI just showed small vessel disease without evidence of encephalitis. In the second hospitalization, he had acute renal failure, which was treated with supportive care, and also suffered from pulmonary embolism with cavitary lesions in his lungs. Meningitis with pulmonary embolism and acute renal failure have not yet been reported. Our patient is the first one, so we decided to share it. This case showed a different presentation of COVID-19 without typical lung involvement. So, we must pay attention to any signs and symptoms in a patient suspected of having a COVID-19.

scholarly journals Case Report of 78 –year-old man with meningitis, Pulmonary Thromboembolism & SARS-Coronavirus-2 infection

2020 ◽  
Author(s):  
Minoosh Moghimi ◽  
Samad Ghodrati ◽  
Zahra Abbaspourrad ◽  
Amirhossein Moghtader Mojhdehi ◽  
Sattar Jafari ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Clinical Symptoms ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Transverse Myelitis ◽  
Cns Infection ◽  
Rt Pcr ◽  
Pcr Test

Abstract The novel corona virus infection involve both Central & Peripheral Nervous System . Some of the presentations include: acute cerebrovascular disease, impaired consciousness, transverse myelitis, encephalopathy, encephalitis and epilepsy. Our patient was 78 year –old man with dementia and diabetic nephropathy which was admitted two times for possibly COVID19 infection. At the first hospitalization, the patient is treated with hydroxychloroquine and kaletra based on clinical symptoms and initial laboratory findings due to suspicion of COVID19 . After the negative RT-PCR test of nasopharyngeal sample for covid19 and evidence of aspiration pneumonia in CT scan, the patient was discharged with oral antibiotics. Five weeks later, he was rehospitalized with loss of consciousness, fever and hypoxemia in physical exam he had neck stiffness in all directions, So the CNS infection was suspected, the CSF sample was in favor of aseptic meningitis and second RT-PCR test of nasopharyngeal sample for COVID19 was positive but Brain MRI just showed small vessel disease without evidence of encephalitis. In the second hospitalization, he had acute renal failure, which was treated with supportive care, and also suffered from pulmonary embolism with cavitary lesions in his lungs. Meningitis with pulmonary embolism and acute renal failure have not yet reported. Our patient is the first one, so we decided to share it. This case showed different presentation of COVID19 without typical lung involvement. So we must pay attention to any sign & symptoms in a patient suspected of having a COVID19 .

scholarly journals Delayed pulmonary embolism after COVID-19 pneumonia: a case report

2020 ◽  
Author(s):  
Mohamad Kanso ◽  
Thomas Cardi ◽  
Halim Marzak ◽  
Alexandre Schatz ◽  
Loïc Faucher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Index Hospitalization ◽  
Rt Pcr ◽  
Moderate Severity ◽  
Respiratory Status ◽  
Case Summary ◽  
Pcr Test

Abstract Background  Since the onset of the COVID-19 pandemic, several cardiovascular manifestations have been described. Among them, venous thromboembolism (VTE) seems to be one of the most frequent, particularly in intensive care unit patients. We report two cases of COVID-19 patients developing acute pulmonary embolism (PE) after discharge from a first hospitalization for pneumonia of moderate severity. Case summary  Two patients with positive RT-PCR test were initially hospitalized for non-severe COVID-19. Both received standard thromboprophylaxis during the index hospitalization and had no strong predisposing risk factors for VTE. Few days after discharge, they were both readmitted for worsening dyspnoea due to PE. One patient was positive for lupus anticoagulant. Discussion  Worsening respiratory status in COVID-19 patients must encourage physicians to search for PE since SARS-CoV-2 infection may act as a precipitant risk factor for VTE. Patients may thus require more aggressive and longer thromboprophylaxis after COVID-19 related hospitalization.

scholarly journals Management of cardiac tamponade due to contrast nephropathy: A case report

2019 ◽  
pp. 11-14
Author(s):  
Nihat M Hokenek ◽  
Mehmet O Erdogan ◽  
Davut Tekyol ◽  
Hakan Hançer ◽  
Ergul A Kozan ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Urine Output ◽  
Clinical Symptoms ◽  
Vital Signs ◽  
Contrast Nephropathy ◽  
Volume Load ◽  
Load Increase

Pericardial effusion secondary to contrast nephropathy is a very rare clinical condition. Patients have a volume load increase secondary to acute renal failure. In such a case, the progression of pericardial effusion with tamponade may follow a very rapid course contrary to what is believed. In this case, a 78-year-old male patient with diabetes mellitus and hypertension was admitted to the emergency department with complaints of decreased urine output, nausea, and vomiting. The patient was diagnosed with acute renal failure secondary to contrast nephropathy. Pericardial effusion amount was found to be 2 cm by thorax tomography. As the patient who had no urine output when his vital signs were stable became unstable during dialysis preparation and manifested clinical symptoms of cardiac tamponade, immediate pericardiocentesis was performed. Following that, he became stable and was transferred to the intensive care unit. In current guidelines regarding indications for pericardiocentesis, it is stated that drainage should be performed when the amount of effusion is more than 2 cm in the absence of tamponade, suspected bacterial infection or neoplastic etiology. However, in contrast to the standard approach to patients with acute renal failure, our suggestion is that the indications for pericardiocentesis may be broader in the presence of pericardial effusion.

scholarly journals Risk Factors of BK Virus Cystitis in Haematopoietic Stem Cell Transplantation-a Retrospective Monocentric Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3361-3361
Author(s):  
Eléonore Kaphan ◽  
Raphaele Germi ◽  
Martin Carre ◽  
Claude-Eric Bulabois ◽  
Sebastien Bailly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cells ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Stem Cell ◽  
Acute Gvhd ◽  
Clinical Symptoms ◽  
Bk Virus ◽  
Post Transplantation ◽  
Peripheral Stem Cells

Abstract Background: BK virus (BKV) is a human polyomavirus. Reactivation occurs during deep immunosuppression as in hematopoietic stem cell transplantation (HSCT) and renal transplantation, leading to hemorrhagic cystitis (HC) and nephropathy respectively. In HSCT, systematic PCR for BKV in urine is positive for 50 to 100% of patients (pts), but only 5 to 40% develop a BKV HC. Thus, BKV PCR is usefull to confirm a diagnostic of BKV HC but not to predict its occurrence. Several risk factors to develop BKV HC have been studied, especially mismatched HLA and haploidentical HSCT. Objectives: The aim of this retrospective study was to ascertain the risk factors to develop BKV HC. Methods: A retrospective study was performed by considering data from Grenoble University Hospital in the national retrospective register ProMISe, from the SFGM-TC. The period of the study covered from January 2014 to January 2018. PCR BKV in urine was performed when pts presented hematuria grade 2 or higher with clinical symptoms of cystitis. Viral nucleic acid was extracted from the urine samples with the EasyMag platform (Biomérieux) and the qPCR with BK Virus R-GENE®kit (ARGENE) on a LightCycler 480 (ROCHE). BKV HC is defined by the association of clinical symptoms of cystitis, haematuria grade 2 or higher and a BKV viruria >7 log10 copies/mL. Univariable and multivariable logistic regression model were used to identify risk factors for BK cystitis. Results: 188 HSCT were performed during the study period. After exclusion of 13 pts for early mortality (<30 days) and 4 for engraftment failure, 171 pts were finally considered for analysis, from whom 43 (25.1%) developed a BKV HC. The median age of patients presenting with BKV HC was 44 years (23-62) and males represented 67.4 %. Acute leukemia was the most common indication of HSCT (74.4%), followed by myelodysplastic syndromes (9.3%), lymphoma (6.9%), myeloproliferative neoplasms (4.7%) and aplastic anemia (4.7%). In most cases, pts were not in complete response at transplant (51.2%). First autologous or allogenic HSCT had previously been performed for 30.2% of pts. The majority of pts had a transplant with peripheral stem cells as graft source (76.6%), and had a transplant with mismatched HLA (9/10, n=9, 20.9%) or haploidentical donors (n=13, 30.2%). Twenty-nine pts (67.4%) received reduced-intensity conditioning and twenty-two pts (51.2%) received cyclophosphamide post allograft to prevent Graft Versus Host Disease (GVHD). BKV HC prophylaxis relied on hyperhydratation and mesna during the conditioning regimen. The median time to develop HC was 42 days post-transplantation (30-55) mainly with a grade 3 HC (53.5%). The median viruria was 9 log (9-10). Cidofovir was administered as curative treatment to 20 pts (46.5%) and 25 pts (58%) needed bladder irrigation and forced diuresis. The median level of platelets at diagnosis was 58 G/L (29-123). At diagnosis of BKV HC, 32.6% of pts presented a bacterial cystitis and 62.8% an acute renal failure. Allogenic HSCT was complicated by an acute GVHD in 88.4% of pts and 69.8% were treated by corticosteroids. CMV reactivation was observed in 39.5% of pts, and HHV6 in 18.6%. In univariate analysis, post-transplant cyclophosphamide (p<0.001), age below 40 years (p<0.001), history of previous auto or allograft (p=0.007), allograft with mismatched HLA (9/10 and haploidentical) (p<0.001), use of peripheral stem cells (p=0.047), engraftment of platelets >100 days (p=0.016), acute GVHD (p=0.007), corticotherapy (p<0.001), co-infection by HHV6 (p=0.006), association to bacterial cystitis (p=0.002), acute renal failure (p=0.009) and platelets below 50G/L (p<0.001) were significantly associated with increased risk of BKV HC. After logistic regression, the risk factors associated with BKV HC were reduced to: exposition post-transplantation to cyclophosphamide (OR 4.1, 1.5-10.7, p=0.004), age below 40 years (OR 4.1, 1.6-10.9, p=0.004), corticosteroids therapy (OR 3.9, 1.6-9.5, p=0.033), acute renal failure (OR 3.8, 1.5-9.6, p=0.0056), bacterial cystitis (OR 3.3, 1.2-8.7, p=0.0175), and platelets below 50G/L (OR 3.8, 1.382-10.486, p=0.097). Conclusion: BKV HC was observed in 25.1% of patients. Exposition to cyclophosphamide, young age, corticosteroids therapy and bacterial cystitis are potential risk factors of BKV HC. Surprisingly, young age was not expected as risk factor. Disclosures No relevant conflicts of interest to declare.

scholarly journals Acute renal failure due to lymphomatous infiltration of the kidneys.

1997 ◽  
Vol 8 (8) ◽  
pp. 1348-1354
Author(s):  
G T Obrador ◽  
B Price ◽  
Y O'Meara ◽  
D J Salant
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Clinical Symptoms ◽  
Tumor Lysis Syndrome ◽  
Sudden Onset ◽  
Moderate Degree ◽  
Rapid Improvement ◽  
Kidney Size ◽  
Unusual Manifestation ◽  
Pulse Steroid

Acute renal failure (ARF) is an unusual manifestation of lymphomatous infiltration of the kidneys. In this article, a patient whose initial presentation of lymphoma was the sudden onset of painless hematuria and ARF is described. The absence of other causes of ARF, together with massively enlarged unobstructed kidneys on renal ultrasonography, strongly suggested an infiltrative process. Renal biopsy established the diagnosis of non-Hodgkin's lymphoma. Pulse steroid therapy was associated with rapid improvement of renal function and kidney size, but a moderate degree of tumor lysis syndrome ensued. Further recovery followed with chemotherapy. Whereas widespread infiltration of the kidneys is present in almost one third of patients with lymphoma at autopsy, this rarely causes clinical symptoms. Nevertheless, because it often responds to therapy, lymphomatous infiltration should be suspected in any patient presenting with unexplained ARF and enlarged kidneys, especially in the setting of widespread lymphoma.

scholarly journals Artificial intelligence-enabled rapid diagnosis of COVID-19 patients

2020 ◽  
Author(s):  
Xueyan Mei ◽  
Hao-Chih Lee ◽  
Kai-yue Diao ◽  
Mingqian Huang ◽  
Bin Lin ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Clinical Symptoms ◽  
False Negative ◽  
Clinical History ◽  
Alternative Methods ◽  
Ct Scans ◽  
Rt Pcr ◽  
Negative Results ◽  
Radiologic Findings ◽  
Pcr Test

AbstractFor diagnosis of COVID-19, a SARS-CoV-2 virus-specific reverse transcriptase polymerase chain reaction (RT-PCR) test is routinely used. However, this test can take up to two days to complete, serial testing may be required to rule out the possibility of false negative results, and there is currently a shortage of RT-PCR test kits, underscoring the urgent need for alternative methods for rapid and accurate diagnosis of COVID-19 patients. Chest computed tomography (CT) is a valuable component in the evaluation of patients with suspected SARS-CoV-2 infection. Nevertheless, CT alone may have limited negative predictive value for ruling out SARS-CoV-2 infection, as some patients may have normal radiologic findings at early stages of the disease. In this study, we used artificial intelligence (AI) algorithms to integrate chest CT findings with clinical symptoms, exposure history, and laboratory testing to rapidly diagnose COVID-19 positive patients. Among a total of 905 patients tested by real-time RT-PCR assay and next-generation sequencing RT-PCR, 419 (46.3%) tested positive for SARSCoV-2. In a test set of 279 patients, the AI system achieved an AUC of 0.92 and had equal sensitivity as compared to a senior thoracic radiologist. The AI system also improved the detection of RT-PCR positive COVID-19 patients who presented with normal CT scans, correctly identifying 17 of 25 (68%) patients, whereas radiologists classified all of these patients as COVID-19 negative. When CT scans and associated clinical history are available, the proposed AI system can help to rapidly diagnose COVID-19 patients.

scholarly journals SARS-CoV-2 Detection in Fecal Sample from a Patient with Typical Findings of COVID-19 Pneumonia on CT but Negative to Multiple SARS-CoV-2 RT-PCR Tests on Oropharyngeal and Nasopharyngeal Swab Samples

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 290
Author(s):  
Barbara Brogna ◽  
Carlo Brogna ◽  
Mauro Petrillo ◽  
Adriana Modestina Conte ◽  
Giulio Benincasa ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Clinical Symptoms ◽  
Nasopharyngeal Swab ◽  
Upper Respiratory Tract ◽  
Rt Pcr ◽  
Chain Reaction ◽  
Negative Results ◽  
Upper Respiratory ◽  
Polymerase Chain ◽  
Pcr Test

Reverse transcriptase polymerase chain reaction (RT-PCR) negative results in the upper respiratory tract represent a major concern for the clinical management of coronavirus disease 2019 (COVID-19) patients. Herein, we report the case of a 43-years-old man with a strong clinical suspicion of COVID-19, who resulted in being negative to multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR tests performed on different oropharyngeal and nasopharyngeal swabs, despite serology having confirmed the presence of SARS-CoV-2 IgM. The patient underwent a chest computed tomography (CT) that showed typical imaging findings of COVID-19 pneumonia. The presence of viral SARS-CoV-2 was confirmed only by performing a SARS-CoV-2 RT-PCR test on stool. Performing of SARS-CoV-2 RT-PCR test on fecal samples can be a rapid and useful approach to confirm COVID-19 diagnosis in cases where there is an apparent discrepancy between COVID-19 clinical symptoms coupled with chest CT and SARS-CoV-2 RT-PCR tests’ results on samples from the upper respiratory tract.

scholarly journals COVID-19 pneumonia in a 66-year old Honduran female with false negative RT-PCR but typical tomography pattern

2020 ◽  
Vol 9 (1) ◽  
pp. 14
Author(s):  
Carlos Aguilar ◽  
Nora Maradiaga ◽  
Nelson Menocal ◽  
Suyapa Sosa ◽  
Wendy Moncada ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Respiratory Distress ◽  
Pulmonary Thromboembolism ◽  
False Negative ◽  
Ground Glass ◽  
Rt Pcr ◽  
History Of ◽  
Pcr Test ◽  
Rule Out

During the first weeks of the SARS-CoV-2 pandemic in Honduras, a 66-year-old female patient was admitted to the ICU with a 5-day history of cough, fever, and respiratory distress. She had contact with a COVID-19 patient in previous days. The chest radiograph showed signs of bilateral ground-glass opacities (A). Since the RT-PCR was negative, a computed tomography angiography was done at day 7 to rule out a pulmonary embolism. This showed a diffuse, patchy, bilateral increase in density with ground-glass opacities, poorly defined edges, and slight predominance in subpleural regions (B and C). There was no evidence of a pulmonary thromboembolism. The swab test was repeated at day 7, resulting positive. In this case, the clinical and CT findings were highly suggestive before RT-PCR confirmed the diagnosis. This is the first COVID-19 case with a false negative PCR test in our hospital. She recovered fully.

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