scholarly journals Glomerular Disease in Temporal Association to SARS-CoV-2 Vaccination - A Series of 29 Cases

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0005372021
Author(s):  
Tiffany N. Caza ◽  
Clarissa A. Cassol ◽  
Nidia Messias ◽  
Andrew Hannoudi ◽  
Randy S. Haun ◽  
...  
Keyword(s):  
De Novo ◽  
Kidney Diseases ◽  
Case Reports ◽  
Glomerular Disease ◽  
Temporal Association ◽  
Disease Flare ◽  
Risk Alleles ◽  
Collapsing Glomerulopathy ◽  
Small Series ◽  
New Onset

Background: Immune responses to vaccination are a known trigger for a new onset of glomerular disease or disease flare in susceptible individuals. Mass immunization against SARS-CoV-2 in the COVID-19 pandemic provides a unique opportunity to study vaccination-associated autoimmune kidney diseases. In the recent literature, there are several case reports demonstrating a temporal association of SARS-CoV-2 immunization and kidney diseases. Methods: Here, we present a series of 29 cases of biopsy-proven glomerular disease in patients recently vaccinated against SARS-CoV-2 and identified patients who developed a new onset of IgA nephropathy, minimal change disease, membranous nephropathy, ANCA-associated glomerulonephritis, collapsing glomerulopathy, and diffuse lupus nephritis diagnosed on kidney biopsies post-immunization, as well as recurrent ANCA-associated glomerulonephritis. This included 28 cases of de novo glomerulonephritis within native kidney biopsies and one disease flare in an allograft. Results: The patients with collapsing glomerulopathy were of African American descent and had two APOL1 genomic risk alleles. A brief literature review of case reports and small series is also provided to include all reported cases to date (n=52). The incidence of induction of glomerular disease in response to SARS-CoV-2 immunization is unknown, however, there was no overall increase in incidence of glomerular disease when compared to the two years prior to the COVID-19 pandemic diagnosed on kidney biopsies in our practice. Conclusions: This suggests that glomerulonephritis in response to vaccination is rare, although should be monitored as a potential adverse event.

scholarly journals Temporal association between SARS-CoV-2 and new-onset myasthenia gravis: is it causal or coincidental?

2021 ◽  
Vol 14 (7) ◽  
pp. e244146
Author(s):  
Y Muralidhar Reddy ◽  
Santhosh Kumar B ◽  
Syed Osman ◽  
Jagarlapudi M K Murthy
Keyword(s):  
Myasthenia Gravis ◽  
Case Reports ◽  
Male Gender ◽  
Temporal Association ◽  
Time Interval ◽  
Myasthenic Crisis ◽  
Ocular Symptoms ◽  
Antiacetylcholine Receptor Antibody ◽  
The One ◽  
New Onset

Several case reports of COVID-19 in patients with myasthenia gravis (MG) have been documented. However, new-onset autoimmune MG following COVID-19 has been reported very rarely. We report one such case here. A 65-year-old man presented to us with dysphagia 6 weeks following mild COVID-19. He was evaluated and diagnosed as antiacetylcholine receptor antibody (AchR) positive, non-thymomatous, generalised MG. He subsequently developed myasthenic crisis and improved after treatment with intravenous immunoglobulin, prednisolone and pyridostigmine. Systematic literature review showed eight more similar cases. Analysis of all cases including the one reported here showed these features: mean age 55.8 years, male gender (5), time interval between COVID-19 and MG (5–56 days), generalised (5), bulbar and/or ocular symptoms (4), anti-AchR antibodies (7) and antimuscle-specific kinase antibodies (2). All have improved with immunotherapy. Although, many hypothesis are proposed to explain causal relationship between the two, it could as well be sheer coincidence.

scholarly journals Nefropatia associata al SARS-CoV-2: cosa sappiamo finora

2020 ◽  
Vol 32 (1) ◽  
pp. 102-106
Author(s):  
Aris Tsalouchos ◽  
Maurizio Salvadori
Keyword(s):  
Kidney Injury ◽  
Drug Induced ◽  
Morphological Alterations ◽  
Risk Alleles ◽  
Collapsing Glomerulopathy ◽  
Ultrastructural Evidence ◽  
Hemostatic Factors ◽  
Kidney Perfusion ◽  
Cytopathic Action ◽  
New Onset

Acute kidney injury (AKI) is a frequent complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) attributable to i) hypotension and decreased kidney perfusion secondary to hemodynamic or hemostatic factors, ii) drug-induced nephrotoxicity, iii) cytokine storm syndrome related to sepsis. However: i) early new-onset proteinuria and hematuria in many patients, ii) the identification of SARS-CoV-2 viral load in precisely defined kidney compartments, iii) ultrastructural evidence of direct viral infection of the kidneys, and most importantly, iv) morphological alterations associated to cytopathic action induced by the virus support the existence of SARS-CoV-2 associated nephropathy. In addition, collapsing glomerulopathy reported in African American patients with underlying APOL1 kidney risk alleles and SARS-CoV-2 infection is the evidence of a distinct form of SARS-CoV-2 associated nephropathy, the APOL1-SARS-CoV2-associated nephropathy.

PATH-23. OLIGOSARCOMA, IDH-MUTANT IS A DISTINCT AGGRESSIVE TYPE

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi119-vi120
Author(s):  
Abigail K Suwala ◽  
Marius Felix ◽  
Dennis Friedel ◽  
Damian Stichel ◽  
Daniel Schrimpf ◽  
...  
Keyword(s):  
De Novo ◽  
Case Reports ◽  
Distinct Type ◽  
Proteomic Profiling ◽  
Tert Promoter ◽  
Small Series ◽  
Idh Mutations ◽  
Number Variation ◽  
Grade 3 ◽  
Promoter Mutations

Abstract Oligodendrogliomas are defined by IDH-mutations and the co-deletion of chromosomal arms 1p and 19q. In the past, case reports and small series described gliomas with sarcomatous features arising from oligodendrogliomas, so called oligosarcomas. Here, we report a group of 23 IDH-mutant oligosarcomas that form a distinct methylation group. The tumors were recurrences from prior oligodendrogliomas or developed de novo. Precursor tumors of 11 oligosarcomas were histologically and molecularly indistinguishable from conventional oligodendrogliomas. Tumor cells were embedded in a reticulin fibers network in all oligosarcomas, frequently showing p53 accumulation, positivity for SMA, and regain of H3K27me3 as compared to primary lesions. In 5 oligosarcomas no 1p/19q co-deletion was detectable, even though it was present in the primary lesions. Oligosarcomas harbored an increased chromosomal copy number variation load with frequent CDKN2A/B deletions. Proteomic profiling demonstrated oligosarcomas to be highly distinct from conventional grade 3 oligodendrogliomas with consistent evidence for smooth muscle differentiation. Expression of several tumor suppressors including NF1 and STAG2 was lost whereas oncogenic YAP1 was aberrantly overexpressed in oligosarcomas. Panel sequencing revealed mutations in TP53 and NF1 along with IDH1/2 and TERT promoter mutations. Survival of patients was significantly poorer for oligosarcomas as for grade 3 oligodendrogliomas but comparable to grade 4 IDH-mutant astrocytomas. These results establish oligosarcoma as a distinct type of IDH-mutant glioma differing from conventional oligodendrogliomas on the histologic, epigenetic, proteomic, molecular and clinical level. Diagnosis can be based on the characteristic DNA methylation profile or the combined evidence of sarcomatous histology, IDH-mutation and TERT promoter mutation with or without 1p/19q co-deletion.

Immunsuppression nach Nierentransplantation

2020 ◽  
Vol 24 (03) ◽  
pp. 103-103
Author(s):  
Volker Aßfalg
Keyword(s):  
Diabetes Mellitus ◽  
De Novo ◽  
Onset Diabetes ◽  
Ciclosporin A ◽  
Unerwünschte Nebenwirkungen ◽  
New Onset

Der Goldstandard der Immunsuppression nach Nierentransplantation gemäß aktuellen KDIGO-Empfehlungen 1 besteht nach wie vor aus einem Calcineurininhibitor (CNI), Mycophenolsäure und Steroiden – der sog. Tripel-Therapie. Der große Durchbruch in der Langzeitüberlebensrate von Nierentransplantaten gelang erst in den 1990er-Jahren mit dem Einsatz von Ciclosporin A. Mit Einführung des ähnlich wirkenden, aber potenteren Tacrolimus 2 wurde dieser CNI in die Empfehlungen der KDIGO als Erstlinienpräparat in der de novo Immunsuppression aufgenommen 1. Vonseiten des Nebenwirkungsprofils zeigen die CNI jedoch unerwünschte Nebenwirkungen wie z. B. Nephrotoxizität, die im Rahmen der sog. CNI-Toxizität die Transplantatlangzeitfunktion einschränken und limitieren kann. Darüber hinaus findet sich ein erhöhtes Risiko für Hypertonie, Fettstoffwechselstörungen und insbesondere für Tacrolimus die Auslösung eines Post-Transplantations-Diabetes (NODAT: New Onset Diabetes After Transplantation) oder Aggravierung eines bestehenden Diabetes mellitus.

scholarly journals Granulomatous interstitial nephritis in a patient with SARS-CoV-2 infection

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Katarzyna Szajek ◽  
Marie-Elisabeth Kajdi ◽  
Valerie A. Luyckx ◽  
Thomas Hans Fehr ◽  
Ariana Gaspert ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Interstitial Nephritis ◽  
Kidney Biopsy ◽  
Kidney Diseases ◽  
Case Reports ◽  
Kidney Injury ◽  
Maculopapular Rash ◽  
Tubular Injury ◽  
Granulomatous Interstitial Nephritis ◽  
First Case

Abstract Background Acute kidney injury (AKI) associated with severe coronavirus disease 19 (COVID-19) is common and is a significant predictor of morbidity and mortality, especially when dialysis is required. Case reports and autopsy series have revealed that most patients with COVID-19 – associated acute kidney injury have evidence of acute tubular injury and necrosis - not unexpected in critically ill patients. Others have been found to have collapsing glomerulopathy, thrombotic microangiopathy and diverse underlying kidney diseases. A primary kidney pathology related to COVID-19 has not yet emerged. Thus far direct infection of the kidney, or its impact on clinical disease remains controversial. The management of AKI is currently supportive. Case Presentation The patient presented here was positive for SARS-CoV-2, had severe acute respiratory distress syndrome and multi-organ failure. Within days of admission to the intensive care unit he developed oliguric acute kidney failure requiring dialysis. Acute kidney injury developed in the setting of hemodynamic instability, sepsis and a maculopapular rash. Over the ensuing days the patient also developed transfusion-requiring severe hemolysis which was Coombs negative. Schistocytes were present on the peripheral smear. Given the broad differential diagnoses for acute kidney injury, a kidney biopsy was performed and revealed granulomatous tubulo-interstitial nephritis with some acute tubular injury. Based on the biopsy findings, a decision was taken to adjust medications and initiate corticosteroids for presumed medication-induced interstitial nephritis, hemolysis and maculo-papular rash. The kidney function and hemolysis improved over the subsequent days and the patient was discharged to a rehabilitation facility, no-longer required dialysis. Conclusions Acute kidney injury in patients with severe COVID-19 may have multiple causes. We present the first case of granulomatous interstitial nephritis in a patient with COVID-19. Drug-reactions may be more frequent than currently recognized in COVID-19 and are potentially reversible. The kidney biopsy findings in this case led to a change in therapy, which was associated with subsequent patient improvement. Kidney biopsy may therefore have significant value in pulling together a clinical diagnosis, and may impact outcome if a treatable cause is identified.

Secukinumab as a potential trigger of inflammatory bowel disease in ankylosing spondylitis or psoriatic arthritis patients

Rheumatology ◽  
2021 ◽  
Author(s):  
Ioana A Onac ◽  
Benjamin D Clarke ◽  
Cristina Tacu ◽  
Mark Lloyd ◽  
Vijay Hajela ◽  
...  
Keyword(s):  
Alternative Explanation ◽  
Drug Withdrawal ◽  
De Novo ◽  
Gastrointestinal Symptoms ◽  
Temporal Association ◽  
Objective Evidence ◽  
Baseline Evaluation ◽  
Biopsy Confirmation ◽  
Potential Trigger ◽  
Inflammatory Bowel

Abstract Objective Real-world secukinumab gastrointestinal-related adverse events (GIRAE) data during treatment for AS and PsA are lacking. We aimed to obtain this through baseline evaluation of pre-existing IBD rates and predictors of GIRAE. Methods Patient electronic and paper records commencing secukinumab from 10 UK hospitals between 2016 and 2019 were reviewed. GIRAE after initiation were defined as: definite [objective evidence of IBD (biopsy proven), clear temporal association, resolution of symptoms on drug withdrawal, no alternative explanation felt more likely], probable (as per definite, but without biopsy confirmation) or possible (gastrointestinal symptoms not fulfilling definite or probable criteria). Results Data for all 306 patients started on secukinumab were analysed: 124 (40.5%) AS and 182 (59.5%) PsA. Twenty-four of 306 (7.8%) experienced GIRAE after starting secukinumab. Amongst patients who developed GIRAE, four (1.3%) had definite, seven (2.3%) probable and 13 (4.2%) possible IBD. All definite cases were patients with AS and stopped secukinumab; two had pre-existing IBD and two (0.7%) were de novo cases of which one required surgical intervention. Seven patients (2.3%) had pre-existing diagnoses of IBD prior to initiation, of which five patients experienced GIRAE. Conclusion Absolute rates of new IBD in patients starting secukinumab are low. The majority of patients developing new GIRAE did not develop objective evidence of IBD or stop therapy. For patients with pre-existing IBD and AS the risk of GIRAE is much higher, and prescribing alternatives should be considered.

scholarly journals Small Cell Carcinoma of the Uterine Cervix in a Pregnant Patient Diagnosed with Liquid Based Cytology and Cell Block Immunocytochemistry

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Mawuli F. Attipoe ◽  
Charles D. Sturgis
Keyword(s):  
Cell Carcinoma ◽  
Small Cell Carcinoma ◽  
Uterine Cervix ◽  
Case Reports ◽  
Pregnant Patient ◽  
Small Cell ◽  
Tumor Type ◽  
Cell Block ◽  
Current Case ◽  
Small Series

Definitive cytomorphologic diagnosis of small cell carcinoma of the uterine cervix is possible but can be challenging in routine cervicovaginal cancer screening specimens. Several small series of reported cases of cervical small cell carcinoma have shown this uncommon malignancy to represent fewer than 2% of all invasive cervical cancers. This tumor type is associated with poor prognosis and rapid disease progression and can develop to an advanced stage in the interval between screening visits. Only rare case reports of small cell carcinoma arising in gravid cervices are known. In the current case a 29-year-old, gravida 6, para 2, pregnant (10-week gestation) female presented with postcoital bleeding. A definitive diagnosis of small cell carcinoma of the cervix was made possible by liquid based Pap testing with ancillary cell block preparation allowing for immunocytochemical characterization of the lesional cell population.

scholarly journals Structural brain injury in sports-related concussion

2012 ◽  
Vol 33 (6) ◽  
pp. E6 ◽  
Author(s):  
Scott L. Zuckerman ◽  
Andrew Kuhn ◽  
Michael C. Dewan ◽  
Peter J. Morone ◽  
Jonathan A. Forbes ◽  
...  
Keyword(s):  
Brain Injury ◽  
Literature Review ◽  
Brain Injuries ◽  
Case Reports ◽  
Head Injuries ◽  
Health Concern ◽  
Prevalence Data ◽  
Small Series ◽  
Structural Brain

Object Sports-related concussions (SRCs) represent a significant and growing public health concern. The vast majority of SRCs produce mild symptoms that resolve within 1–2 weeks and are not associated with imaging-documented changes. On occasion, however, structural brain injury occurs, and neurosurgical management and intervention is appropriate. Methods A literature review was performed to address the epidemiology of SRC with a targeted focus on structural brain injury in the last half decade. MEDLINE and PubMed databases were searched to identify all studies pertaining to structural head injury in sports-related head injuries. Results The literature review yielded a variety of case reports, several small series, and no prospective cohort studies. Conclusions The authors conclude that reliable incidence and prevalence data related to structural brain injuries in SRC cannot be offered at present. A prospective registry collecting incidence, management, and follow-up data after structural brain injuries in the setting of SRC would be of great benefit to the neurosurgical community.

Identification of two novel de novo TUBB variants in cases with brain malformations: case reports and literature review

2021 ◽  
Author(s):  
Kazuki Watanabe ◽  
Mitsuko Nakashima ◽  
Satoko Kumada ◽  
Hideaki Mashimo ◽  
Mikako Enokizono ◽  
...  
Keyword(s):  
Literature Review ◽  
De Novo ◽  
Case Reports ◽  
Brain Malformations

scholarly journals Identification of a De Novoc.1000delA ANK1 mutation associated to hereditary spherocytosis in a neonate with Coombs-negative hemolytic jaundice-case reports and review of the literature 

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Lichun Xie ◽  
Zhihao Xing ◽  
Changgang Li ◽  
Si-xi Liu ◽  
Fei-qiu Wen
Keyword(s):  
De Novo ◽  
Hereditary Spherocytosis ◽  
Case Reports ◽  
De Novo Mutation ◽  
Case Presentation ◽  
Important Means ◽  
Genetic Detection ◽  
Membrane Defects ◽  
Severe Jaundice ◽  
Neonates And Infants

Abstract Background To strengthen the understanding of Hereditary Spherocytosis (HS) and determine the disease-causing mutation present with neonatal jaundice. HS is a hemolytic condition resulting from various erythrocyte membrane defects. Many different mutations result in HS, including mutations in ANK1. Case presentation A term neonate presented at ten hours with severe jaundice requiring exchange transfusion. At two months he was hospitalized due to repeated pallor and anemia requiring blood transfusions. Using next-generation sequencing, we discovered the responsible mutation in the proband but not in his parents; a heterozygous nucleotide variation of c.1000delA (p.1334Sfs*6) in ANK1. Thus hereditary spherocytosis was diagnosed. Conclusions Genetic detection is an important means of discovering the cause of hemolytic anemia in neonates and infants where routine diagnostic tests are unrevealing. We found a novel de novo mutation, c.1000delA (p.1334Sfs*6) in ANK1 that might account for other cases of HS in the Chinese population.

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