MIS-A associated myocardial injury: The art of diagnosis and follow-up

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Bellony Nzemenoh ◽  
◽  
Arianne C Agdamag ◽  
Valmiki Maharaj ◽  
Victoria Charpentier ◽  
...  
Keyword(s):  
Chest Pain ◽  
Early Identification ◽  
Myocardial Injury ◽  
Clinical Course ◽  
Full Recovery ◽  
Myocardial Inflammation ◽  
Severe Condition ◽  
Healthy Female ◽  
Inflammatory Syndrome

Multisystem inflammatory syndrome in adults (MIS-A) is a rare but severe condition in adults with a clinical course similar to that described in children (MIS-C) following infection with the SARS-CoV-2 virus. Here we describe a case of a 21-year-old, otherwise healthy female who presented with chest pain and signs of sepsis six weeks after recovering from coronavirus disease 2019 (COVID-19). Early identification of MIS-A led to a favorable clinical course and full recovery. Given the highly variable disease presentation yet potentially deadly outcome, providers must remain vigilant to recognize and treat MIS-A early Keywords: MIS-A; myocardial inflammation; SARS-CoV-2; COVID-19 disease.

scholarly journals Spectrum of cardiovascular diseases in children during high peak COVID-19 period infection in Northern Italy: is there a link?

2020 ◽  
Author(s):  
Marianna Fabi ◽  
Emanuele Filice ◽  
Laura Andreozzi ◽  
Francesca Conti ◽  
Liliana Gabrielli ◽  
...  
Keyword(s):  
Myocardial Injury ◽  
Clinical Course ◽  
Myocardial Dysfunction ◽  
Parvovirus B19 ◽  
Northern Italy ◽  
Myocardial Depression ◽  
Positive Serology ◽  
Cross Sectional ◽  
Aggressive Form ◽  
Inflammatory Syndrome

Abstract Background Children with COVID-19 have a milder clinical course than adults. We describe the spectrum of cardiovascular manifestations during a COVID-19 outbreak in Emilia-Romagna, Italy. Methods Cross-sectional multicenter study including all diagnosis of KD, myocarditis and multisystem inflammatory syndrome in children (MIS-C) from February to April,2020. KD patients were compared to those diagnosed before the epidemic. Results KD: 8 patients (6/8 boys, all negative for SARS-CoV-2); complete presentation in 5/8; 7/8 IVIG-responders; 3/8 showed transient coronary lesions (CALs). Myocarditis one 5-year-old girl negative for SARS-CoV-2, positive for Parvovirus B19. She responded to IVIG. MIS-C 4 SARS-CoV-2 positive boys (3 patients with positive swab and serology, 1 patient with negative swab and positive serology). Three presented myocardial dysfunction and pericardial effusion, one developed multicoronary aneurysms and hyperinflammation; all responded to treatment. The fourth boy had mitral and aortic regurgitation that rapidly regressed after steroids. Conclusions KD, myocarditis and MIS-C were distinguishable cardiovascular manifestations. KD did not show a more aggressive form compared to previous years: coronary involvement was frequent, but always transient. MIS-C and myocarditis rapidly responded to treatment without cardiac sequelae despite high markers of myocardial injury at onset suggesting a myocardial depression due to systemic inflammation rather than focal necrosis. Evidence of actual or previous SARS-CoV-2 infection was documented only in patients with MIS-C.

scholarly journals Case report of cardiogenic shock in COVID-19 myocarditis: peculiarities on diagnosis, histology, and treatment

2021 ◽  
Vol 5 (10) ◽  
Author(s):  
Giorgio Fiore ◽  
Francesca Sanvito ◽  
Gabriele Fragasso ◽  
Roberto Spoladore
Keyword(s):  
Cardiogenic Shock ◽  
Clinical Course ◽  
Heart Diseases ◽  
Myocardial Damage ◽  
Case Summary ◽  
Choice Of Treatment ◽  
Inflammatory Syndrome ◽  
Stable Improvement ◽  
Inflammatory Burden

Abstract Background The year 2020 was dramatically characterized by SARS-CoV-2 pandemic outbreak. COVID-19-related heart diseases and myocarditis have been reported. Case summary A 45-year-old healthy male was admitted to the intensive care unit of our hospital because of cardiogenic shock. A diagnosis of COVID-19 infection and myocarditis was done. We present here several peculiarities about diagnostic workup, myocardial histological findings, choice of treatment, and the patient clinical course at 3 and 8 months of follow-up. Discussion COVID-19 myocardial damage and myocarditis are mainly linked to the cytokine storm with mild myocardial inflammatory infiltrate and very unusual platelet microclots in the setting of the microvascular obstructive thrombo-inflammatory syndrome. Counteracting the inflammatory burden with an interleukine-1 inhibitor appeared safe and led to a dramatic and stable improvement of cardiac function.

scholarly journals Myocarditis: Which Role for Genetics?

2021 ◽  
Vol 23 (6) ◽  
Author(s):  
Chiara Baggio ◽  
Giulia Gagno ◽  
Aldostefano Porcari ◽  
Alessia Paldino ◽  
Jessica Artico ◽  
...  
Keyword(s):  
Genetic Background ◽  
Clinical Course ◽  
Risk Profile ◽  
Myocardial Inflammation ◽  
Genetic Defects ◽  
Prognostic Role ◽  
Clinical Presentations

Abstract Purpose of Review Myocarditis is a polymorphic disease, both in its presentation and clinical course. Recent data suggests that the genetic background, interacting with environmental factors, could be diriment both in the susceptibility and evolution of myocarditis in different clinical presentations. The aim of this paper is to expose the current available evidences and the evolving concepts on this topic, in order to provide insight for improving the clinical management of those patients. In this regard, the main goal is an optimal characterization of each patient’s risk, with the purpose of individualizing the treatment and the follow-up. Recent Findings The latest research highlights the possible prognostic role of some pathogenic mutations that could create a vulnerable myocardium prone to myocardial inflammation and also to the development of a long-lasting cardiomyopathy. Summary The identification of these genetic defects and of myocarditis patients requiring genetic testing is emerging as a challenge for the future. In fact, identifying a possible genetic background responsible for a particularly high-risk profile could be of extreme importance in improving management of myocarditis. This and many other aspects in the genetics of myocarditis remain uncovered, and further studies are expected based to refine our daily clinical practice.

Nine-year follow-up of panic disorder in chest pain patients: clinical course and predictors of outcome

2008 ◽  
Vol 30 (2) ◽  
pp. 138-146 ◽  
Author(s):  
Christine B. Bringager ◽  
Svein Friis ◽  
Harald Arnesen ◽  
Toril Dammen
Keyword(s):  
Chest Pain ◽  
Panic Disorder ◽  
Clinical Course ◽  
Predictors Of Outcome ◽  
Pain Patients

Cardiac Imaging Phenotype in Patients with Coronavirus Disease 2019: Rationale, design and protocol of the COCARDE study (Preprint)

2020 ◽  
Author(s):  
Olivier Lairez ◽  
Virginie Blanchard ◽  
Laurent Balardy ◽  
Fanny Vardon-Bounes ◽  
Stéphanie Cazalbou ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Myocardial Injury ◽  
Myocardial Function ◽  
Clinical Course ◽  
Demographic Data ◽  
Cardiac Injury ◽  
University Hospital ◽  
Geriatric Ward ◽  
Improve Patient

UNSTRUCTURED Background – The effects of SARS-Cov-2 (COVID-19) on the myocardium and their role in the clinical course of infected patients are still unknown. The severity of SARS-Cov-2 is driven by hyperinflammation and the effects of SARS-Cov-2 on the myocardium may be significant. The present study proposes to use bedside observations and biomarkers to characterize the association COVID-19 with myocardial injury. Objectives – The aim of the study is to describe the myocardial function and its evolution over the time in patients infected with SARS-COV-2; and to investigate the link between inflammation and cardiac injury. Design – This prospective, monocentric observational study will enroll 150 patients with suspected or confirmed SARS-COV-2 infection at Toulouse University Hospital, Toulouse, France. Patients admitted in intensive care unit, regular cardiologic ward as well as geriatric ward of our tertiary university hospital will be included during the pandemic period. Blood sampling, electrocardiography, echocardiography, as well as morphometric and demographic data will be prospectively collected. Implications – A better understanding of the effects of COVID-19 on myocardia function and the links with inflammation would improve patient follow-up and care. Trial registration – Clinicaltrials.gov NCT04358952

COVID-19 in children: Pathogenesis and current status

2020 ◽  
Author(s):  
Lawrence Frenkel ◽  
Fernando Gomez ◽  
Joseph A Bellanti
Keyword(s):  
Respiratory Disease ◽  
Respiratory Symptoms ◽  
Distress Syndrome ◽  
Clinical Course ◽  
Current Status ◽  
Current Evidence ◽  
Initial Description ◽  
Relationship Of ◽  
Inflammatory Syndrome ◽  
The Relationship

Background: Since its initial description in December 2019 in Wuhan, China, coronavirus disease 2019 (COVID-19) has rapidly progressed into a worldwide pandemic, which has affected millions of lives. Unlike the disease in adults, the vast majority of children with COVID-19 have mild symptoms and are largely spared from severe respiratory disease. However, thereare children who have significant respiratory disease, and some may develop a hyperinflammatory response similar to thatseen in adults with COVID-19 and in children with Kawasaki disease (KD), which has been termed multisystem inflammatory syndrome in children (MIS-C).Objective: The purpose of this report was to examine the current evidence that supports the etiopathogenesis of COVID-19 in children and the relationship of COVID-19 with KD and MIS-C as a basis for a better understanding of the clinical course, diagnosis, and management of these clinically perplexing conditions.Results: The pathogenesis of COVID-19 is carried out in two distinct but overlapping phases of COVID-19: the first triggered by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) itself and the second by the host immune response. Children with KD have fewer of the previously described COVID-19–associated KD features with less prominent acute respiratory distress syndrome and shock than children with MIS-C.Conclusion: COVID-19 in adults usually includes severe respiratory symptoms and pathology, with a high mortality. Ithas become apparent that children are infected as easily as adults but are more often asymptomatic and have milder diseasebecause of their immature immune systems. Although children are largely spared from severe respiratory disease, they canpresent with a SARS-CoV-2–associated MIS-C similar to KD.

THYROID TYPE CARCINOMA ARISING IN STRUMA OVARII. SIX CLINICAL CASES AND REVIEW

2018 ◽  
Vol 64 (6) ◽  
pp. 708-715
Author(s):  
Natalya Severskaya ◽  
Andrey Rodichev ◽  
Aleksey Ilin ◽  
Dmitriy Semin ◽  
Pavel Isaev ◽  
...  
Keyword(s):  
Radioiodine Therapy ◽  
Clinical Course ◽  
Case Reports ◽  
Thyroid Tissue ◽  
Follicular Carcinoma ◽  
Complete Response ◽  
Pelvic Surgery ◽  
Ovarian Teratoma ◽  
Struma Ovarii

Struma ovarii is a rare variant of the mature ovarian teratoma composed of more than 50% thyroid tissue. Thyroid type carcinoma can occur in 5% of struma ovarii. Given the rarity of this pathology, as well as the different clinical course, approaches to the treatment of this disease are controversial. The proposed approaches to treatment vary from ovarian resection to total hysterectomy with bilateral salpingo-oophorectomy and adjuvant therapy. We present here 6 case reports of thyroid type carcinoma in struma ovarii and outcome of patients treated in our clinic. All patients had pelvic surgery of different extent, followed by thyroidectomy and radioiodine therapy. The incidence of metastasis is 67% (4/6), 2 - intraperitoneal metas-tases, 2 - bone metastases. Among patients with metastases, 2 have reached a complete response, one with a good response continues treatment, one had progression. The follow-up period is 1 to 15 years (median 4 years). One patient with follicular carcinoma died of progression 8 years after diagnosis. The remaining patients are alive.

Prevalence of Asymptomatic Cryptococcal Antigenemia and Association with Follow-up risk of Cryptococcal Meningitis and Mortality among HIV Infected Patients in North West India – A Prospective Cohort Study

2020 ◽  
Vol 18 ◽  
Author(s):  
Rajendra Bhati ◽  
Pramendra Sirohi ◽  
Bharat Sejoo ◽  
Deepak Kumar ◽  
Gopal K Bohra ◽  
...  
Keyword(s):  
Cryptococcal Meningitis ◽  
Morbidity And Mortality ◽  
People Living With Hiv ◽  
Cryptococcal Antigen ◽  
North West ◽  
Cryptococcal Disease ◽  
Increased Risk ◽  
Living With Hiv ◽  
Inflammatory Syndrome

Objective: Cryptococcal meningitis is an important cause of morbidity and mortality in HIV infected individuals. In the era of universal antiretroviral therapy incidence of immune reconstitution inflammatory syndrome (IRIS) related cryptococcal meningitis has increased. Detection of serum cryptococcal antigen in asymptomatic PLHIV (People Living With HIV) and pre-emptive treatment with fluconazole can decrease the burden of cryptococcal disease. We conducted this study to find the prevalence of asymptomatic cryptococcal antigenemia in India and its correlation with mortality in PLHIV. Method and material: This was a prospective observational study. HIV infected ART naïve patients with age of ≥ 18 years who had CD4 counts ≤ 100 /µL were included and serum cryptococcal antigen test was done. These patients were followed for six months to look for the development of Cryptococcal meningitis and mortality. Results: A total of 116 patients were analysed. Asymptomatic cryptococcal antigenemia was detected in 5.17% patients and it correlated with increased risk of cryptococcal meningitis and mortality on follow-up in PLHIV. Conclusion: Serum cryptococcal positivity is correlated with increased risk of Cryptococcal meningitis and mortality in PLHIV. We recommend the screening of asymptomatic PLHIV with CD4 ≤ 100/µL for serum cryptococcal antigen, so that pre-emptive treatment can be initiated to reduce morbidity and mortality.

When fever is more than infection: two cases of vancomycin-induced drug reaction with eosinophilia and systemic symptoms (DRESS)

2021 ◽  
Vol 14 (1) ◽  
pp. e238006
Author(s):  
Mitchell Cox ◽  
Sophie Paviour ◽  
Sophie Gregory ◽  
Rusheng Chew
Keyword(s):  
Drug Reaction ◽  
Cytomegalovirus Reactivation ◽  
First Case ◽  
Metropolitan Hospital ◽  
Orthopaedic Ward ◽  
Systemic Hypersensitivity ◽  
Systemic Symptoms ◽  
Inflammatory Syndrome ◽  
Intravenous Glucocorticoids

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, but serious systemic hypersensitivity reaction associated with a range of medications. We present two cases of vancomycin-induced DRESS, which occurred simultaneously in the orthopaedic ward in an outer metropolitan hospital. These cases demonstrate the complexity in the diagnosis and management of this inflammatory syndrome on the background of known infection as well as evidence for linezolid as an alternative to vancomycin. The first case was managed conservatively, but developed progressive renal and liver injury along with demonstrated cytomegalovirus reactivation and recurrent colitis, and was eventually palliated. The second was commenced on intravenous glucocorticoids and achieved remission, although had ongoing renal dysfunction at the time of discharge from outpatient follow-up.

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