New papulovesicular rash in the course of COVID-19 signaling viral reactivation

SUMMARY Cutaneous manifestations are considered an infrequent presentation of coronavirus disease 2019 (COVID-19) and are mostly described in outpatient settings. Its onset during the course of the severe COVID-19 disease has been poorly described in severe cases. Studies focused on dermatological manifestations mostly described maculopapular or pernio-like lesions and less frequently vesicular or varicella-like eruption. We described the occurrence of a vesiculopapular eruption in three laboratory-confirmed COVID-19 patients associated with severe lung injury in whom the skin findings preceded viral reactivation and recrudescence of hypoxemia. The potential mechanisms for COVID-19-related cutaneous manifestations include immune hypersensitivity, cytokine-release syndrome, deposition of microthrombi, and vasculitis.

Cardiomiopatia de takotsubo: relato de caso / Takotsubo cardiomiopathy: case report

Dor torácica é uma queixa comum na emergência, representando 9-10% das emergências não relacionadas a trauma. Destes, a Síndrome Coronariana Aguda (SCA) conta com 13-23,6% dos casos de dor torácica. No entanto, 1,7-2,2% dos pacientes que tinham suspeita de SCA foram subsequentemente diagnosticados com Cardiomiopatia de Takotsubo. Relatamos o caso de uma paciente do sexo feminino, 78 anos, branca, sem patologias prévias, com queixa de dor torácica em sufocamento de forte intensidade associada à dispneia logo após discussão com vizinhos. A paciente foi submetida à investigação e se chegou ao diagnóstico de Cardiomiopatia de Takotsubo. A paciente foi tratada com sintomáticos e liberada em condições de alta após uma semana, não apresentando episódios de dor torácica durante a internação. A Cardiomiopatia de T akotsubo não é rara, mas sim, subdiagnosticada. Considerar a Cardiomiopatia de Takotsubo no diagnóstico diferencial especialmente em mulheres na pós-menopausa com síndrome coronariana aguda irá prevenir os perigos potenciais do tratamento com agentes trombolíticos (AU)

Chest pain is a common complaint in emergency care, representing 9-10% of non-trauma emergencies. Of these, Acute Coronary Syndrome (ACS) accounts for 13 to 23.6% of cases of chest pain. However, 1.7-2.2% of patients with suspected ACS were subsequently diagnosed with Takotsubo cardiomyopathy. Here we report the case of a white female patient, 78, without prior conditions, complaining of chest pain in suffocation of strong intensity associated with dyspnea after an argument with neighbors. After an investigation Takotsubo cardiomyopathy was diagnosed. The patient was treated symptomatically and discharged after a week, with no significant episodes of chest pain during hospitalization. Although Takotsubo cardiomyopathy is not rare, it is underdiagnosed. Considering Takotsubo cardiomyopathy in the differential diagnosis, especially in postmenopausal women with acute coronary syndrome, will prevent the potential dangers of treatment with thrombolytic agents (AU)