Otitis with Aspergillus niger in a patient with SARS-CoV-2 and multiple comorbidities

Introduction. COVID-19 is associated with a significant incidence of bacterial and fungal superinfections and with the exacerbation of pre-existing infections, representing a diagnostic and therapeutic challenge. Case presentation. A 64-year-old woman, confirmed with COVID-19 by the SARS-CoV-2 antigen test, is hospitalized accusing fatigue, nausea, watery stools, cough and vertigo started 10 days ago, aggravated 4 days before the presentation. It also reports recurrent episodes of otalgia and otorrheic pluriantibiotic treatment in the last 2 months. From the personal pathological antecedents we remember: hypothyroidism, dyslipidemia, hypertension, ischemic heart disease, history of deep vein thrombosis (DVT) and secondary pulmonary thromboembolism, in chronic anticoagulant treatment. Pathological clinical signs at admission: bilateral basal crackling rales. Biologically, inflammatory syndrome is detected, and radiologically, interstitial-alveolar infiltrates in the lower lung fields. On day 3 of hospitalization, the patient shows purulent secretion in the right external auditory canal and the ENT consultation confirms chronic suppurative otitis media in acute onset. Bacteriological examination of otic secretion reveals Aspergillus niger. Antiviral treatment with Remdesivir is initiated, antibiotic therapy initiated at home with Azithromycin is continued for one day, then escalated to Ceftriaxone i.v. (in the context of clinical-paraclinical aggravation), systemic corticotherapy, anticoagulation with Dalteparin in the prophylactic regime of DVT, systemic treatment with Voriconazole p.o. (according to the antifungal program) and topical (local) with a slow favorable evolution. Conclusions. The association of COVID-19 with otitis with Aspergillus is a rare and particular clinical picture.

Management of a hepatic hydatid cyst ruptured into the retroperitoneum and the abdominal wall muscles: A case report

Introduction. Hydatid disease is a zoonosis caused by the tapeworm Echinococcus granulosus. The liver is the most commonly involved organ, followed by lungs. The most common complications of hepatic hydatid cyst are rupture into the biliary tract and secondary bacterial infection. However, rupture into the retroperitoneum and the abdominal wall muscles is exceptional. Case presentation. We describe an unusual case of a 27-year-old female who was referred to our department for right flank pain for four months. Abdominal ultrasound and CT scan revealed a huge hydatid cyst in liver segment VI fistulizing to the retroperitoneum and the lateral and posterior abdominal wall muscles, causing anterior displacement of the right kidney, with two other cysts in segment II and VIII. Surgery was performed associated with perioperative antiparasitic chemotherapy. The cysts were unroofed and a resection of the protruding domes was performed. The hydatid material in the retroperitoneum and the muscles were completely evacuated by aspiration. Follow-up showed no recurrence. Discussion. Hepatic hydatid cyst rupture usually occurs into biliary tract, pleural cavity, bronchial tree and intraperitoneal cavity. Rupture into the retroperitoneum and the lateral and posterior abdominal wall muscles is exceptional. To our knowledge, this complication has never been documented before. The hydatid disease may involve insidiously for a long time to lead to such a complication. Surgery was inevitable in our case. It allowed to treat both the hydatid cyst and its complication. Conclusions. A rupture into the retroperitoneum and the abdominal wall muscles as a complication of a liver hydatid cyst is exceptional. In this presentation, we noticed that hydatid cysts can reach an extremely large size while remaining for a long time asymptomatic. We aim to highlight the significance of preventive measures and public health education to fight against the hydatid disease in endemic areas.

COVID-19 in a child with multiple comorbidities

A female child, 1 year-old and 2 months, diagnosed with multiple neurological conditions, including myelomeningocele and operated hydrocephalus, was diagnosed with SARS-CoV-2 in October 2020 and hospitalized in our clinic. At the time of the onset of the disease, the patient had a febrile episode, laboratory blood tests showed a slightly increased biological inflammatory syndrome, and mixed pneumonia was described radiologically. Thus, antibiotic treatment was initiated, with laboratory tests and control imaging within normal limits after several days of admission. Being an institutionalized child, according to the epidemiological recommendations of that time, she was hospitalized in our clinic during the 14 days of the illness. Thus, on the 15th day of the disease she was discharged, with negative SARS-CoV-2 control RT-PCR, with good general condition, afebrile over 10 days.

Child with SARS-CoV-2 infection and acute lymfoblastic leukemia

Introduction. Coronavirus disease 2019 (COVID-19) frequently leads to asymptomatic or mild infectious disease evolution in children. Case presentation. We present the case of a 3 year old girl, known with acute lymphoblastic leukemia in chemotherapy treatment at that time. She had an asymptomatic form of COVID-19 but with important paraclinical changes. The evolution was favorable under the treatment initiated with antibiotics, corticotherapy, gastric protector and symptomatic treatment if necessary. Conclusion. Management of children with COVID-19 and other comorbidities remains a challenge given the few data currently in the literature.

Antithrombotic treatment in COVID-19 – from theory to practical approach

Although initially considered a strictly respiratory pathology, the novel coronavirus disease-19 (COVID-19) has emerged as a significant prothrombotic trigger, inducing hypercoagulable status and increased risk of thrombotic events. This is due to a plethora of mechanisms, either from inflammation-induced endothelial dysfunction, overexpression of procoagulant molecules doubled by down-regulation of physiological antithrombotic pathways, or from an exagerated response to otherwise normal procoagulant stimuli. This complex association of factors define the concept of immunothrombosis, which can be influenced by several antithrombotic medications. Despite the lack of an „universal” guideline, the general consensus is to recommend antithrombotic treatment in COVID-19 patients, but its administration should take into account the patient’s clinical status, comorbidities or the other previous indications for antithrombotic treatment. This precaution is due to the multiple drug interactions with antivirals or other molecules used in COVID-19. Concerning anticoagulant treatment, heparins are the optimal choice, compared to antivitamins K and direct oral anticoagulants (DOACs), because they exhibit the most protective effects doubled by the least interactions with other substances. Hospitalized patients should receive prophylactic doses of anticoagulation, but not for the prevention of arterial thrombosis, unless they have a previous indication such as atrial fibrillation or prosthetic valve. It is generally recommended that patients on chronic anticoagulant or antiplatelet therapy for other conditions will continue their prescribed medication, here including special categories such as pregnant women. However, non-hospitalized patients with mild forms of the disease should not be initiated anticoagulant and antiplatelet therapy unless they have other indication. Continuation of prophylaxis after discharge is a matter of debate, the existing data suggesting it may be considered in those patients at high risk for venous thromboembolism (VTE) and/or who had a moderate-severe form of the disease, always assessing the bleeding risk. Further data from extensive studies are required in order to standardize the antithrombotic approach in COVID-19 patients.

SARS-CoV-2 infection in a child with Fanconi anemia and determined immunosuppressed status

Introduction. SARS-CoV-2 virus infection affects all age groups. In children, the infection mainly causes asymptomatic or mildly symptomatic forms of the disease, regardless of their immune status. Case presentation. We describe the case of a 7-year-old male child, known to have Fanconi anemia, scheduled for bone marrow transplantation. The patient comes from a family outbreak of COVID-19, which is why he was tested for SARS-CoV-2 infection. He is asymptomatic at the time of admission to our clinic. The clinical examination performed at the time of admission shows a patient in good general condition, afebrile, with pale skin and mucous membranes, without respiratory changes. Paraclinically, severe neutropenia, severe normochromic normocytic anemia and severe thrombocytopenia are detected, for which transfusions of erythrocyte mass and platelet mass are performed. Due to the immunocompromised status, antibiotic therapy is instituted. If necessary, symptomatic treatment is administered. The evolution is favorable, and the SARS-CoV-2 RT-PCR control test is negative on the eighth day of hospitalization. Conclusions. Immunocompromised status is not a major risk factor for severe COVID-19 in children.

Pancytopenia and Kaposi sarcoma indicators of HIV infection diagnosis: A case report

During HIV infection, hematological manifestations are frequently associated with various pathogenic mechanisms, which require a multidisciplinary approach. We present the case of a 57-year-old patient with pancytopenia associated with Kaposi's sarcoma, as indicative manifestations of the acquired immunodeficiency syndrome. The late diagnosis of HIV infection, in the stage of severe immunosuppression, the association of opportunistic neoplasia, delayed oncological therapy and the development of immune reconstruction syndrome after starting antiretroviral therapy have contributed to the severe evolution and death of the patient.

Pulmonary cavitation – an unexpected finding in late stage COVID-19 pneumonia (case report)

The typical CT features of COVID-19 pneumonia include multifocal and bilateral ground-glass opacities with or without consolidation, found in both lungs, predominantly at peripheral, and posterior regions, bronchovascular thickening, crazy pavement appearance (ground-glass opacities with superimposed interlobular septal thickening). Atypical imagistic findings such as lung cavitation were rarely reported. In this report we describe the case of a 42 years old, healthy man with severe COVID-19 pneumonia who developed two pulmonary cavities during recovery. The pulmonary cavitations formed in the aria of the lung where patchy air space opacification was seen in early stages. There were no signs of invasive fungal or bacterial infection and the complementary investigations have ruled out other possible etiology for lung cavitation. Although the pathophysiological mechanism involved in the origin of the pulmonary cavities is not fully known, it could be closely related to diffuse alveolar damage in severe COVID-19 pneumonia.

COVID-19-ASSOCIATED IMMUNE THROMBOCYTOPENIA

The coronavirus disease 2019 (COVID-19) is a contagious respiratory tract infection caused by the betacoronavirus SARS-CoV-2. The World Health Organization declared the COVID-19 outbreak a pandemic on March 11, 2020. Since the COVID-19 pandemic started, more than 166 million patients have been tested positive worldwide with more than 3.4 million related death recorded. COVID-19 has a wide range of signs and symptoms. Hematological changes such as lymphopenia, thrombocytopenia, and coagulation disturbances are not unusual in patients with COVID-19. However, the mechanisms causing these changes are partially comprehended. Immune thrombocytopenia was identified to be among the hematologic autoimmune diseases seen in patients infected with SARS-CoV-2. This review summarizes the evidence on COVID-19-associated immune thrombocytopenia and the underlying mechanisms involved in its development.