ABSTRACT
Epstein-Barr virus (EBV) belongs to the family of herpesviruses (herpes type 4) and is one of the most common and highly contagious. During the pandemic of a new coronavirus disease, it was found that in patients previously infected with EBV, COVID-19 can cause its reactivation, which is often manifested by the clinic of acute hepatitis. The article presents a clinical case of the development of acute hepatitis in a patient with mixed infection with EBV and SARS-CoV-2 in combination with allergic toxic reaction while taking sulfasalazine prescribed for spondyloarthritis. A feature of this case was the development of severe hepatitis of mixed genesis with a favorable outcome. The importance of adherence to drug monitoring rules for newly prescribed drugs for COVID-19 was emphasized. In severe cases of the disease, the possibility of mixed infection should be taken into account. © 2022, Ima-Press Publishing House. All rights reserved.
ABSTRACT
Introduction. In modern reality postcovid syndrome (PCS) is characterized by clinical heterogeneity and multi-organ involvement, often presenting a differential diagnostic and therapeutic problem. However, in most studies of PCS, stratification of patients taking into account individual comorbid conditions was not performed. Thus, only an extremely small number of studies have been devoted to assessing the course of PCS in rheumatic diseases Purpose. To characterize the features of the course of COVID-19 in patients with rheumatoid arthritis, as well as to conduct a comparative assessment of clinical and demographic parameters in groups of patients with rheumatoid arthritis, differentiated by the presence of PCS. Materials and methods. The material of the questionnaire which contained questions regarding socio-demographic data of respondents, information on rheumatological history, comorbid diseases, data on past COVID-19, including cases of re-infection, and PCS. Results. The study included 32 adult patients (29 women, 90%) with a reliable diagnosis of rheumatoid arthritis. Of the 32 patients who underwent COVID-19, in 23 cases it was possible to form a judgment about the presence or absence of PCS. To study PCS, 23 patients were stratified into two groups: 11 (47.8%) patients developed PCS (Group 1) and 12 patients had COVID-19 without consequences (Group 2). Both groups were represented predominantly by women (90.9% and 91.7%, respectively). In the general group 37.5% of patients with COVID-19 required inpatient treatment. The number of symptoms associated with COVID-19 did not correlate with RA activity, however, patients with higher RA activity were more likely to report increased arthralgia as a symptom of COVID-19. 47.8% of COVID-19 survivors experienced PCS. The average age, the number of comorbid diseases and the severity of RA symptoms at the time of COVID-19 were relatively higher in the group of patients with RA and PKS. Patients with PKS also noted a higher frequency of hospitalizations and a more severe course of COVID-19. Conclusions. A quantitative assessment of the risk of developing PKS is needed, which will serve as a basis for developing a strategy aimed at prevention, timely diagnosis and treatment of this syndrome in patients with RS. To this end, further studies on larger cohorts of patients are required. © 2022, Remedium Group Ltd. All rights reserved.
ABSTRACT
To describe the clinical case of coronavirus disease-2019, in a patient with rheumatoid arthritis. The patient A., 54, woman, was admitted in a rheumatologic hospital on April 27, 2020 due to the exacerbation of RA. The patient has been observed with the diagnosis of RA since 2013. At the time of admission, the patient took selective NSAIDs only. RNA SARS-CoV-2 (April 24, 2020) was negative. Results of the hospital examination (April 28, 2020): body mass index 32.63 kg/m2. CRP 13 mg/l, rheumatoid factor 65.4 IU/ml, MCV antibodies 30.7 U/ml, beta-2-glycoprotein antibodies IgG > 100 U/ml, ESR 35 mm/hour. Hospital treatment was carried out: methylprednisolone in a total dose of 2 grams intravenously drop-by-drop (from April 30 to May 4, 2020), methylprednisolone in tablets 6 mg/day, leflunomide 20 mg/day. On May 5, 2020 the patient presented with fever up to 38.5°C, which lasted two days, weakness, headache, abundant sweating, SpO2 96%, CRP 45 mg/l. CT of chest (May 7, 2020) was performed: numerous seals of pulmonary tissue of the type of "matte glass" with a peribronchial and subpleural localization on both lungs (severe double pneumonia) (Fig. 1). RNA SARS-?oV-2 (May 7, 2020) was positive. The patient was transferred to the infectious clinic. The patient received therapy with Azithromycin, Levofloxacin, Ambroxol, Hydroxychloroquine, Paracetamol, Enoxaparin Sodium, and oxygen therapy. CT of chest (May 11, 2020): 70% reduction in lung damage. The patient was discharged in a satisfactory condition on May 15, 2 020. Currently, the dominant concept is that patients with rheumatic diseases have a higher risk of developing severe forms of COVID-19 than in the general population. The presented data demonstrate a case of undisturbed COVID-19 course in a patient with active rheumatoid arthritis and a risk factor (obesity), who did not have such typical signs as coughing and shortness of breath, as well as a short-term fever course. According to the authors, earlier therapy with glucocorticoids (intravenously and further per os) could facilitate the faster regress of COVID-19.