COVID-19 and Pneumocystis jirovecii Pulmonary Coinfection—The First Case Confirmed through Autopsy

Background: Establishing the diagnosis of COVID-19 and Pneumocystisjirovecii pulmonary coinfection is difficult due to clinical and radiological similarities that exist between the two disorders. For the moment, fungal coinfections are underestimated in COVID-19 patients. Case presentation: We report the case of a 52-year-old male patient, who presented to the emergency department for severe dyspnea and died 17 h later. The RT-PCR test performed at his admission was negative for SARS-CoV-2. Retesting of lung fragments collected during autopsy revealed a positive result for SARS-CoV-2. Histopathological examination showed preexisting lesions, due to comorbidities, as well as recent lesions: massive lung thromboses, alveolar exudate rich in foam cells, suprapleural and intra-alveolar Pneumocystisjirovecii cystic forms, and bilateral adrenal hemorrhage. Conclusion: COVID-19 and P.jirovecii coinfection should be considered, particularly in critically ill patients, and we recommend the systematic search for P. jirovecii in respiratory samples.

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Heparin-induced thrombocytopenia presenting as splenic hemorrhage following cardiac surgery: a case report

10.21203/rs.3.rs-34909/v3 ◽

2020 ◽

Author(s):

Joseph F. Ferry ◽

Samuel Youssef ◽

Pierce Wu ◽

Livia Hegerova

Keyword(s):

Emergency Department ◽

Cardiac Surgery ◽

Splenic Vein ◽

Adrenal Hemorrhage ◽

Right Atrial ◽

Splenic Vein Thrombosis ◽

Heparin Induced Thrombocytopenia ◽

Vein Thrombosis ◽

Bilateral Adrenal Hemorrhage ◽

The Right

Abstract Background: Heparin-induced thrombocytopenia with thrombosis (HITT) is a paradoxical prothrombotic complication of anticoagulant therapy. As many as 3% of patients undergoing cardiac surgery develop clinical HIT presenting as thrombocytopenia with or without thrombosis within 5-10 days of heparin exposure. Thrombotic complications associated with HIT carry a mortality rate of 5-10%.Case presentation: We report a case of atraumatic splenic hemorrhage due to splenic vein thrombosis as the main indicator of HIT following cardiac surgery in a 62-year-old woman. She presented to the emergency department on day nine following coronary artery bypass graft surgery with acute weakness, dizziness, and malaise. Her evaluation in the emergency department found anemia and thrombocytopenia. A coagulation profile revealed a markedly elevated d-dimer. She underwent a computed tomography scan of the chest, abdomen and pelvis for suspected bleed and was found to have splenic vein thrombosis, right atrial filling defects consistent with atrial thrombus and mild to moderate hemoperitoneum. Surgical consultation was obtained due to splenic hemorrhage. Hematology was consulted on post-operative day 10, however, she unfortunately developed left sided weakness concerning for stroke. A magnetic resonance imaging scan of the brain demonstrated infarct involving distribution of the right anterior cerebral artery. A transesophageal echocardiogram demonstrated a large immobile thrombus within the right atrium with a second, mobile thrombus arising from the left tricuspid valve annulus. Due to a 4Ts score of 7 and markedly positive platelet factor 4 (PF4) IgG antibody a serotonin release assay was not performed given the high probability of HIT. She was cautiously treated with bivalirudin and was transitioned to warfarin anticoagulation. In the following days her platelet count recovered and 3 months later a transthoracic echocardiogram revealed solution of the intracardiac thrombi.Conclusions: Atraumatic splenic hemorrhage is an unusual presentation of HIT that is reminiscent of the rare bilateral adrenal hemorrhage due to adrenal necrosis that also occurs in HIT. Alternative anticoagulation is the mainstay of therapy for HIT despite hemorrhage, given the underlying acquired hypercoagulability. Despite similarities of the presentation between splenic hemorrhage and bilateral adrenal hemorrhage, splenic hemorrhage is rarely described in the literature. HIT should be considered in patients presenting with thrombocytopenia following cardiac surgery.

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Heparin-induced thrombocytopenia presenting as splenic hemorrhage following cardiac surgery: a case report

10.21203/rs.3.rs-34909/v1 ◽

2020 ◽

Author(s):

Joseph Frank Ferry ◽

Samuel Youssef ◽

Pierce Wu ◽

Livia Hegerova

Keyword(s):

Emergency Department ◽

Cardiac Surgery ◽

Splenic Vein ◽

Adrenal Hemorrhage ◽

Right Atrial ◽

Splenic Vein Thrombosis ◽

Heparin Induced Thrombocytopenia ◽

Vein Thrombosis ◽

Bilateral Adrenal Hemorrhage ◽

The Right

Abstract Background Heparin-induced thrombocytopenia with thrombosis (HITT) is a paradoxical prothrombotic complication of anticoagulant therapy. As many as 3% of patients undergoing cardiac surgery develop clinical HIT presenting as thrombocytopenia with or without thrombosis within 5–10 days of heparin exposure. Thrombotic complications associated with HIT carry a mortality rate of 5–10%. Case presentation: We report a case of atraumatic splenic hemorrhage due to splenic vein thrombosis as the main indicator of HIT following cardiac surgery in a 62-year-old woman. She presented to the emergency department with acute weakness, dizziness, and malaise. Her evaluation in the emergency department found anemia and thrombocytopenia. A coagulation profile revealed a markedly elevated d-dimer. She underwent a computed tomography scan of the chest, abdomen and pelvis for suspected bleed and was found to have splenic vein thrombosis, right atrial filling defects consistent with atrial thrombus and mild to moderate hemoperitoneum. Surgical consultation was obtained due to splenic hemorrhage. Hematology was consulted on post-operative day 10, however, she unfortunately developed left sided weakness concerning for stroke. A magnetic resonance imaging scan of the brain demonstrated infarct involving distribution of the right anterior cerebral artery. A transesophageal echocardiogram demonstrated a large immobile thrombus within the right atrium with a second, mobile thrombus arising from the left tricuspid valve annulus. Due to a 4Ts score of 7 and markedly positive platelet factor 4 (PF4) IgG antibody a serotonin release assay was not performed given the high probability of HIT. She was cautiously treated with bivalirudin and was transitioned to warfarin anticoagulation. In the following days her platelet count recovered and 3 months later a transthoracic echocardiogram revealed solution of the intracardiac thrombi. Conclusions Atraumatic splenic hemorrhage is an unusual presentation of HIT that is reminiscent of the rare bilateral adrenal hemorrhage due to adrenal necrosis that also occurs in HIT. Alternative anticoagulation is the mainstay of therapy for HIT despite hemorrhage, given the underlying acquired hypercoagulability. Despite similarities of the presentation between splenic hemorrhage and bilateral adrenal hemorrhage, splenic hemorrhage is rarely described in the literature. HIT should be considered in patients presenting with thrombocytopenia following cardiac surgery.

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Transient benign hyperphosphatasemia due to COVID-19: the first case report

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2020-0503 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Tugba Erat ◽

Müge Atar ◽

Tugba Kontbay

Keyword(s):

Polymerase Chain Reaction ◽

Alkaline Phosphatase ◽

Case Report ◽

Rt Pcr ◽

Chain Reaction ◽

Benign Condition ◽

Case Presentation ◽

Normal Ranges ◽

First Case ◽

Polymerase Chain

AbstractObjectivesCoronavirus disease (COVID-19) rapidly spread worldwide in a few months and was declared as a worldwide pandemic by WHO in March 2020. Transient benign hyperphosphatasemia (THI) is a benign condition associated with marked elevation of alkaline phosphatase (ALP) without any other kidney, bone, and liver pathologies.Case presentationHerein, we report a previously healthy 16-month-old female patient who developed a secondary transient benign hyperphosphatasemia associated with SARS-CoV-2. Patient whole family’s SARS-CoV-2 real-time reverse transcription-polymerase chain reaction (RT-PCR) results were positive. Since THI is a diagnosis of exclusion, other reasons that may cause ALP elevation should be ruled out. ALP activity decreased and turned to normal ranges within the following month. THI has been reported to be in association with various conditions. Its relationship with many viruses has been reported previously.ConclusionsIf ALP elevation is detected in patients with COVID 19 due to the increasing number of infections, THI should be considered if there is no other accompanying pathology.

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Giant Nodular Fasciitis Originating From The Humeral Periosteum: A Diagnostic Challenge

10.21203/rs.3.rs-86216/v1 ◽

2020 ◽

Author(s):

Shili Yu ◽

Jian Li ◽

Meng Jia ◽

Ping-Li Sun ◽

Hongwen Gao

Keyword(s):

Gene Rearrangement ◽

Molecular Detection ◽

Histopathological Examination ◽

Low Grade ◽

Superficial Fascia ◽

Nodular Fasciitis ◽

Diagnostic Challenge ◽

Case Presentation ◽

First Case

Abstract Background: Nodular fasciitis (NF) is a self-limiting, benign, fibroblastic, and myofibroblastic tumor that mostly occurs in the subcutaneous superficial fascia, although there are reports of NF occurrences at atypical sites, such as intraneural and intra-articular locations. However, NF originating from the appendicular periosteum is extremely rare, and NF lesions usually are smaller than 4 cm. A large NF lesion of periosteal origin can be misdiagnosed as a malignant bone tumor and may cause overtreatment.Case presentation: This case report presents a large NF that originated from the humeral periosteum in an adult and was initially diagnosed intraoperatively as low-grade sarcoma, but later diagnosed as NF after post-resection histopathological evaluation. Furthermore, fluorescence in situ hybridization analysis revealed a USP6 gene rearrangement that confirmed the diagnosis. To the best of our knowledge, this is the first case of NF in the humeral periosteum.Discussion and Conclusions: NF poses a diagnostic challenge especially occurrences at rare sites as it is often mistaken for a sarcoma. Postoperative histopathological examination of whole sectionscan be combined with immunohistochemical staining and, if necessary, the diagnosis can be confirmed by molecular detection, and thus help avoid overtreatment.

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Heparin-induced thrombocytopenia presenting as splenic hemorrhage following cardiac surgery: a case report

10.21203/rs.3.rs-34909/v4 ◽

2021 ◽

Author(s):

Joseph F. Ferry ◽

Samuel Youssef ◽

Pierce Wu ◽

Livia Hegerova

Keyword(s):

Emergency Department ◽

Cardiac Surgery ◽

Splenic Vein ◽

Adrenal Hemorrhage ◽

Right Atrial ◽

Splenic Vein Thrombosis ◽

Heparin Induced Thrombocytopenia ◽

Vein Thrombosis ◽

Bilateral Adrenal Hemorrhage ◽

The Right

Abstract Background: Heparin-induced thrombocytopenia with thrombosis (HITT) is a paradoxical prothrombotic complication of anticoagulant therapy. As many as 3% of patients undergoing cardiac surgery develop clinical HIT presenting as thrombocytopenia with or without thrombosis within 5-10 days of heparin exposure. Thrombotic complications associated with HIT carry a mortality rate of 5-10%. Case presentation: We report a case of atraumatic splenic hemorrhage due to splenic vein thrombosis as the main indicator of HIT following cardiac surgery in a 62-year-old woman. She presented to the emergency department on day nine following coronary artery bypass graft surgery with acute weakness, dizziness, and malaise. Her evaluation in the emergency department found anemia and thrombocytopenia. A coagulation profile revealed a markedly elevated d-dimer. She underwent a computed tomography scan of the chest, abdomen and pelvis for suspected bleed and was found to have splenic vein thrombosis, right atrial filling defects consistent with atrial thrombus and mild to moderate hemoperitoneum. Surgical consultation was obtained due to splenic hemorrhage. Hematology was consulted on post-operative day 10, however, she unfortunately developed left sided weakness concerning for stroke. A magnetic resonance imaging scan of the brain demonstrated infarct involving distribution of the right anterior cerebral artery. A transesophageal echocardiogram demonstrated a large immobile thrombus within the right atrium with a second, mobile thrombus arising from the left tricuspid valve annulus. Due to a 4Ts score of 7 and markedly positive platelet factor 4 (PF4) IgG antibody a serotonin release assay was not performed given the high probability of HIT. She was cautiously treated with bivalirudin and was transitioned to warfarin anticoagulation. In the following days her platelet count recovered and 3 months later a transthoracic echocardiogram revealed solution of the intracardiac thrombi. Conclusions: Atraumatic splenic hemorrhage is an unusual presentation of HIT that is reminiscent of the rare bilateral adrenal hemorrhage due to adrenal necrosis that also occurs in HIT. Alternative anticoagulation is the mainstay of therapy for HIT despite hemorrhage, given the underlying acquired hypercoagulability. Despite similarities of the presentation between splenic hemorrhage and bilateral adrenal hemorrhage, splenic hemorrhage is rarely described in the literature. HIT should be considered in patients presenting with thrombocytopenia following cardiac surgery.

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Clinical Spectrum of COVID-19 in a Pediatric Mexican Population

10.21203/rs.3.rs-81586/v3 ◽

2020 ◽

Author(s):

Edgar Bustos-Cordova ◽

Daniela Castillo-García ◽

Magdalena Cerón-Rodriguez ◽

Nadia Soler-Quiñones

Keyword(s):

Emergency Department ◽

Pediatric Patients ◽

Care Center ◽

Tertiary Care ◽

Signs And Symptoms ◽

Clinical Spectrum ◽

Tertiary Care Center ◽

Rt Pcr ◽

Excessive Crying ◽

Pcr Test

Abstract ObjectiveFrom the beginning of the COVID-19 pandemic, it has become evident that the spectrum of manifestations in children is different from those seen in adults. In this study, we aimed to describe a broader clinical spectrum of COVID-19 in children.MethodsIn this descriptive, prospective study, we included confirmed pediatric patients with COVID-19 who presented to the emergency department of a pediatric tertiary care center from April to July 2020. All patients were confirmed by the SARS-CoV-2 RT-PCR test, and we analyzed 24 symptoms and 25 signs.ResultsWe analyzed 50 patients with COVID-19. From the evaluated signs and symptoms, the most common symptoms were fever, excessive crying and dry cough, digestive symptoms were frequently found (24%), and the most common signs were pharyngeal erythema and irritability.ConclusionClinicians should recognize that the clinical spectrum of COVID-19 in children is wider than previously described, often with nonspecific signs and symptoms, and digestive symptoms should raise suspicion.

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Changes in RT-PCR test results and symptoms during the menstrual cycle of a female individual infected with SARS-CoV-2: a case report

10.21203/rs.3.rs-25303/v1 ◽

2020 ◽

Author(s):

Hua Zheng ◽

Juan Tan ◽

Ke Ma ◽

Weihua Meng

Keyword(s):

Menstrual Cycle ◽

Hospital Discharge ◽

Disease Susceptibility ◽

Menstrual Period ◽

Test Results ◽

Rt Pcr ◽

Case Presentation ◽

Management Protocol ◽

History Of ◽

Pcr Test

Abstract Background: The implications of the menstrual cycle for disease susceptibility, development, and severity of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are largely unknown.Case presentation: We report a 37-year-old woman infected with SARS-CoV-2 who showed a 16-day incubation period. She developed a fever on the first day of her menstrual period, and again on the first day of her next menstrual period after hospital discharge. RT-PCR test results were positive during the first menstrual period before admission, turned negative during hospitalization, and then positive again during the second menstrual period after hospital discharge.Conclusions: This case indicates sex hormones may play an important role in SARS-CoV-2 infection. For women with history of exposure to SARS-CoV-2, the management protocol should include assessment of the menstrual status.

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Neuroendocrine tumor arising from the greater omentum treated with laparoscopic tumor resection: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01217-4 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Taichi Terai ◽

Kenji Nakagawa ◽

Kota Nakamura ◽

Shunsuke Doi ◽

Kohei Morita ◽

...

Keyword(s):

Neuroendocrine Tumor ◽

Histopathological Examination ◽

Tumor Resection ◽

Ventral Side ◽

Greater Omentum ◽

Preoperative Imaging ◽

Ki 67 ◽

Case Presentation ◽

First Case ◽

Omental Tumor

Abstract Background Primary omental tumors are extremely rare. Herein, we report the first case of a primary omental neuroendocrine tumor (NET). Case presentation A 59-year-old woman was referred to our hospital for the treatment of an 18-mm tumor located at the ventral side of the duodenum. No other tumor was detected. The preoperative imaging diagnosis was omental tumor. A laparoscopic tumor resection was performed. Histopathological examination revealed that the tumor consisted of cuboidal cells with eosinophilic, granular cytoplasm showing trabecular or ribbon architecture. No other component was seen. The mitotic count was of 5 per 10 high-power fields. Immunohistochemical staining was positive for chromogranin A, synaptophysin, and CD56. Her Ki-67 index was 5%. These results led to the diagnosis of grade 2 omental NET. The patient was discharged on the 3rd postoperative day without any complications and did not develop any recurrence for 3 years. Conclusions We encountered a very rare case of omental NET. Complete resection is recommended with minimally invasive surgery for the diagnosis of NET.

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Clinical Spectrum of COVID-19 in a Pediatric Mexican Population

10.21203/rs.3.rs-81586/v2 ◽

2020 ◽

Author(s):

Edgar Bustos-Cordova ◽

Daniela Castillo-García ◽

Magdalena Cerón-Rodriguez ◽

Nadia Soler-Quiñones

Keyword(s):

Emergency Department ◽

Pediatric Patients ◽

Care Center ◽

Tertiary Care ◽

Signs And Symptoms ◽

Clinical Spectrum ◽

Tertiary Care Center ◽

Rt Pcr ◽

Excessive Crying ◽

Pcr Test

Abstract ObjectiveFrom the beginning of the COVID-19 pandemic, it has become evident that the spectrum of manifestations in children is different from those seen in adults. In this study, we aimed to describe a broader clinical spectrum of COVID-19 in children.MethodsIn this descriptive, prospective study, we included confirmed pediatric patients with COVID-19 who presented to the emergency department of a pediatric tertiary care center from April to July 2020. All patients were confirmed by the SARSCoV-2 RT-PCR test, and we analyzed 24 symptoms and 25 signs.ResultsWe analyzed 50 patients with COVID-19. From the evaluated signs and symptoms, the most common symptoms were fever, excessive crying and dry cough, digestive symptoms were frequently found (24%), and the most common signs were pharyngeal erythema and irritability.ConclusionClinicians should recognize that the clinical spectrum of COVID-19 in children is wider than previously described, often with nonspecific signs and symptoms, digestive symptoms should raise suspicion.

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Atypical Meningioma in the Medulla Oblongata Parenchyma

10.21203/rs.3.rs-112925/v1 ◽

2020 ◽

Author(s):

Qiushi Xu ◽

Ziang Pan ◽

Meidan Hou ◽

Fang Peng

Keyword(s):

Magnetic Resonance Imaging ◽

Medulla Oblongata ◽

Preoperative Diagnosis ◽

Histopathological Examination ◽

Atypical Meningioma ◽

Resonance Imaging ◽

Case Presentation ◽

First Case ◽

History Of ◽

Atypical Meningiomas

Abstract Background: Glioma is the most common tumor occurring in the brainstem. A primary intraparenchymal meningioma located in the brainstem without dura attachment is rare. Meanwhile, atypical meningiomas that occur in the medulla oblongata parenchyma, and without dura coverage, are extremely rare. In this study, we report the first case of atypical meningioma in the medulla oblongata parenchyma and review the existing literature.Case presentation: A 38-year-old female was admitted at our hospital with a 2-week history of progressive neck and occipital pain. Magnetic resonance imaging revealed a presence of a 1.5x0.9cm mass lesion, located in the left side of the medulla oblongata, which was hypointense on T1-weighted and hyperintense on T2-weighted images, and with inhomogeneous enhancement following gadolinium-diethylenet-riamine pentaacetic acid (Gd-DTPA) administration. The initial preoperative diagnosis was glioma or angioblastoma. The patient underwent a total surgical resection of the left medulla oblongata tumor and the histopathological examination indicated that the lesion was an atypical meningioma. The patient returned to normal life after surgery.Conclusions: Although glioma is the most common tumor occurring in the brainstem parenchyma, the possibility of meningioma cannot be ruled out in this area.

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