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Health inequities vary along social and economic gradients. The COVID-19 pandemic and nursing home infections have highlighted this fact. Using the Centers for Medicare and Medicaid Services' Nursing Home COVID-19 Public File, Brown University's LTCFocus, Robert Graham Center's Social Deprivation Index, and CMS Nursing Home Payroll Based Journal Staffing Data. We examined the relationship between community resource scarcity, as conceptualized by the Social Deprivation Index (SD) and COVID-19 incidence rates in nursing homes. After controlling for interstate differences, organizational enabling factors, as well as, facility-level resident and community-level characteristics, nursing homes located in communities with medium levels of social deprivation had 4.4% more COVID-19 infection rates (Incidence Rate Ratio [IRR] = 1.04;p < 0.05) and communities with high levels of social deprivation had 7.5% higher COVID-19 infection rates (Incidence Rate Ratio [IRR] = 1.07;p < 0.01) as compared to nursing facilities located in areas of low social deprivation. From a policy perspective, nursing homes, that are located in socially deprived communities, may need additional resources, such as, funding for staffing and personal protective equipment in the face of the pandemic. The COVID-19 pandemic has sharpened the focus on healthcare disparities and societal inequalities in the delivery of long-term care.
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Remote meetings have become the norm for most students learning synchronously at a distance during the ongoing coronavirus pandemic. This has motivated the use of artificial intelligence in education (AIED) solutions to support the teaching and learning practice in these settings. However, the use of such solutions requires new research particularly with regards to the human factors that ultimately shape the future design and implementations. In this paper, we build on the emerging literature on human-centredAIED and explore students' experiences after interacting with a tool that monitors their collaboration in remote meetings (i.e., using Zoom) during 10 weeks. Using the social translucence framework, we probed into the feedback provided by twenty students regarding the design and implementation requirements of the system after their exposure to the tool in their course. The results revealed valuable insights in terms of visibility (what should be made visible to students via the system), awareness (how can this information increase students' understanding of collaboration performance), and accountability (to what extent students take responsibility of changing their behaviours based on the system's feedback);as well as the ethical and privacy aspects related to the use of collaboration analytics tools in remote meetings. This study provides key suggestions for the future design and implementations of AIED systems for remote meetings in educational settings.
ABSTRACT
Health inequities vary along social and economic gradients. The COVID-19 pandemic and nursing home infections have highlighted this fact. Using the Centers for Medicare and Medicaid Services Nursing Home COVID-19 Public File, Brown University's LTCFocus, Robert Graham Center's Social Deprivation Index, and CMS Nursing Home Payroll-Based Journal Staffing Data. We examined the relationship between community resource scarcity, as conceptualized by the Social Deprivation Index (SD), and COVID-19 incidence rates in nursing homes. After controlling for interstate differences, organizational enabling factors, as well as, facility-level resident and community-level characteristics, nursing homes located in communities with medium levels of social deprivation had 4.4% more COVID-19 infection rates (Incidence Rate Ratio [IRR] = 1.04;p < 0.05) and communities with high levels of social deprivation had 7.5% higher COVID-19 infection rates (Incidence Rate Ratio [IRR] = 1.07;p < 0.01) as compared to nursing facilities located in areas of low social deprivation. From a policy perspective, nursing homes, that are located in socially deprived communities, may need additional resources, such as funding for staffing and personal protective equipment in the face of the pandemic. The COVID-19 pandemic has sharpened the focus on healthcare disparities and societal inequalities in the delivery of long-term care. © 2021 Aspen Publishers Inc.. All rights reserved.
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COVID-19 patients have a high incidence of acute kidney injury (AKI) and a notable increase in mortality once AKI has developed. The goal of this study is to help identify critically ill COVID-19 patients who are at higher risk of developing severe AKI and renal failure in hopes that earlier identification can lead to improved outcomes. We performed a retrospective study of COVID-19-positive patients in the intensive care unit (ICU) at a major Southwest United States quaternary hospital from March 20 to November 26, 2020whohad a Nephrocheck® test, an FDA-approved lab test that allows for assessment of AKI risk. Patients who met the criteria were put into risk groups based on theirNephrocheck®value: low-risk (<0.3), intermediate-risk (0.3-2.0), and high-risk (>2.0). Patients in the study were evaluated for outcomes of mortality, ICU length of stay, need for renal replacement therapy, urinary output, and degree of AKI. Univariate analysis, primarily Fisher's exact test, was used to compare the groups. In total, 38 COVID-19 patients with Nephrocheck® values were identified. Of the 38 COVID-19 patients who had a Nephrocheck® lab obtained, 5 were low risk, 19 were intermediate risk, and 14 were high risk. The intermediate-risk (OR = 18, 95% CI =. 7540547 -1019.974, P = 0.0441) and thehigh-risk (or = 19.5, 95% CI =. 8208219 - 1098.472, P = 0.0374) groups had higher odds of developing stage 3 AKI by creatinine compared to the low-risk group.Also, the high-risk group had higher odds of developing stage 3 AKI by urinary output compared to the intermediate-risk (OR = 8.1, 95% CI = 0.97 - 97.06, P = 0.0419) and low-risk (lower limit of 95% CI of OR = 2.22, P = 0.0275;exact CI not possible with zero count cells) groups. Mortality, ICU length of stay, and need for renal replacement therapy were not statistically different between the three risk groups. Our findings suggest that Nephrocheck® is able to identify and risk stratify COVID-19 patients in the ICU who are at increased risk of developing a severe AKI. These results are limited by the small sample size and the non-uniform timing of the Nephrocheck® labs being drawn for each patient.
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Introduction: Renal arterial thrombosis and infarction is an under-recognized condition due to its rarity and ability to mimic other disease processes. It can lead to secondary hypertension, acute kidney injury, and chronic kidney disease. Clinical manifestations include nausea, vomiting, flank pain, and sudden elevations in blood pressure. Here, we present a case of a patient with previous normal kidney function presenting with a severe AKI due to an acute renal arterial thrombus. Case Description: A 58-year-old woman with previously normal kidney function (baseline Cr of 0.8 mg/dL) presented with complaints of nausea and vomiting and was found to have a stage 3 AKI with a creatinine of 4.65 mg/dL. Her creatinine level continued to rise, peaking at 8.5 mg/dL, despite volume expansion. Her urinalysis showed moderate blood and moderate protein. Her FeNa was calculated to be 6.5% and the P/creatinine was found to be 4.56 grams. Renal ultrasound revealed right renal atrophy and a normal appearing left kidney. She remained non-oliguric with good urine output and initially did not meet requirements for renal replacement therapy. Due to the unknown etiology of her AKI, a left kidney biopsy was performed which revealed fulminant acute cortical necrosis. Subsequently, an MRA revealed complete occlusion of the left renal artery. No angioplasty or stent placement was performed, and she eventually required renal replacement therapy. Hypercoagulable testing revealed protein S deficiency. Other serologic work up was negative. She was tested multiple times for COVID19 infection during her hospital stay and each test was negative. Discussion: The majority of renal thromboembolisms originate as emboli from the heart. Much less commonly, thrombi may form in the renal arteries themselves, especially in those with a hypercoagulable state such as this patient. In light of the recent global COVID19 pandemic, renal artery thromboembolism has gained increased recognition and prevalence. As such, our patient tested negative multiple times for COVID19 as a potential explanation for her hypercoagulable state. Acute renal artery thrombosis should be considered as an explanation for AKI of unknown etiology, especially in those who have underlying risk factors. In the appropriate context, imaging studies should be obtained promptly to prevent permanent kidney injury.
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Introduction: IgA dominant infectious related glomerulonephritis (IGAD-IRGN) is an uncommon variant of IRGN. It has been mostly associated with S.aureus infections. In the COVID Era, thre has been one case of IGAD-IRGN related to COVID. This is a case of IGA-IRGN in a patient infected with COVID-19. Case Description: 51 y/o male with no previous medical history who presented with a 3 day history of generalized swelling. Patient had no known medical problems and was not taking any medications. He reported drinking 3 beers daily. Denied any recent illness or sick contacts. At ED, the patient was found with anasarca and uncontrolled blood pressure. Initial blood tests showed normal renal function with hypoalbuminemia (2.9g/dL). U/A showed active sediments and nephrotic range proteinuria of about 4 g/ day. Proteinuria workup was done, including serologic workup. Labs were remarkable for elevated ESR (105), low C4 (12), normal C3 (95) and elevated RF (44). ANA, HIV, HCV, light chain ratio, cryoglobulins and ANCA were negative. UPIEP showed faint IgG kappa. CXR showed hazy interstitial opacities with a perihilar distribution. Pre-biopsy COVID molecular testing came back positive. He was diuresed aggressively and received losartan for BP control. A kidney biopsy was performed and revealed MPGN pattern with IF strongly positive for IgA in addition to weaker staining for C3, and IgG. EM showed subendothelial humps with few mesangial and subepithelial deposits. The diagnosis of IgA-dominant immune complex-mediated glomerulonephritis consistent with IRGN was made. Discussion: IGA-IRGN is a rare variant of IRGN that has been mostly associated with S. aureus infections. In this case, the recent COVID-19 infection in this patient could reasonably explain the finding of IGAD-IRGN on kidney biopsy. IGAD-COVIDrelated GN has been reported only once in the literature. Up until recently, most cases of COVID related kidney injury have been associated to ATN and collapsing FSGS. A immunohistochemistry test for COVID in kidney tissue was sent, which is pending at the time of this submission. If confirmed positive, this could be the second confirmed case COVID related IGAD-IRGN. It is important for nephrologists to include IGAD-IRGN in the differential diagnosis in a COVID patient with nephrotic syndrome. Renal Biopsy is of utmost importance for diagnosis.
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Introduction: Lupus nephritis is a well-described entity. The simultaneous presence of ANCA abs is rare and is related to poor prognosis. Positive patients usually have MPOANCA. We present a case of biopsy-proven Class IV/V Lupus nephritis with PR3-ANCA and decreased ADAMTS 13 activity in an AA man. Case Description: This 46-year-old AA man with no known past medical history presented to the ED for two weeks of SOB, leg, and scrotal swelling. He denies any associated symptoms. He denies using any other OTC medications and illegal drugs. On exam, vital signs were stable. He had 2+ pitting edema in LE bilaterally, scrotal and penile edema. Other systems were unremarkable. Labs were significant for Hg 5.1, Platelets 106, K 6.9, CO2 9, BUN 78, Cr 10.2, and Albumin 2.4. UA showed dysmorphic RBCs and proteinuria, and Urine protein/creatinine of 9. COVID-19 testing was negative. HIV1&2, RPR titer, hepatitis panel, rheumatoid factor, ASO screen were all negative. Renal U/S showed normal-sized kidneys and no hydronephrosis. ANA, ANA titer, and anti-dsDNA returned elevated at >10,1:640 and 9.9IU, respectively. PR3-ANCA was also positive, but MPO-ANCA negative. C3 and C4 at 0.4g/L and 0.14g/L, respectively. ADAMTS-13 activity decreased to 40%. The rest of the work-up was negative. Kidney biopsy confirmed lupus nephritis, Class IV, and V, with ∼50% cellular crescents. Moderate to advanced interstitial fibrosis and tubular atrophy ∼50%. EM showed two globally sclerotic glomeruli. IF showed a full-house with IgG, IgA, C3, C1q, kappa, and lambda. Unfortunately, kidney function did not recover, and hemodialysis was started, and he was treated with MMF, Methylprednisolone, and with plasma exchange. Discussion: ANCA positivity, although not common, is a well-described entity but not understood in lupus nephritis patients. Most of these patients present with MPO-ANCA rather than PR3-ANCA. This subset of patients usually presents clinically differently with distinct histopathological features. Long-term follow-up in these patients is also needed to better understand this disease process in lupus nephritis patients.
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Objectives: To describe the incidence and severity of COVID-19 disease in Spondyloarthritis patients in Argentina. Methods: Patients with axial spondyloarthritis (AxSpA) radiological (AS) and non-radiological (AxSpA-nr) and peripheral spondyloarthritis (according to ASAS criteria, SpAp) and Psoriatic arthritis (PsA) (according to CASPAR criteria) were included. The patients were followed up by phone or in person on a monthly basis. Data were collected from 1/4/2020 to 20 / 9/2020. Descriptive statistics were performed with mean and standard deviation (SD) and median and 25-75 percentile according to distribution, and the cumulative incidence (CI) of the disease was calculated. Results: 320 patients were included, of which 55%were male, with a mean age of 50 (SD 13), 21.6% had a diagnosis of AS, 6.9% AxSpA-nr, 6.9% SpAp and 64.7% PsA. The duration of the disease was 11 (5-16), BASDAI 3.65 (3), BASFI 3 (1.5-9), PASI 0.3 (0-7), BSA 0.2 (0-6). Fourteen patients with a diagnosis of COVID-19 (4.4%) were reported, of which 10 diagnoses were by positive PCR and 4 by symptoms associated with positive close contact. Thirteen (93%) cases were patients from the Province of Buenos and Ciudad Autónoma de Buenos Aires (CABA) and 1 patient from Santiago del Estero. The total CI of the country was 0.04, the CI of the Province of Buenos Aires + CABA 0.04, and the CI of the rest of the provinces 0.01. Of the 14 patients with COVID-19: 50% were men;4 have a diagnosis of AS, 1 of SpAax-nr, 9 (64.3%) PsA. All of them in urban areas, 79% have social work, 2 (14%) have hypertension, 1 (7%) diabetes mellitus, 4 (28.6%), hypothyroidism, 1 (7%) Chronic Obstructive Pulmonary Disease, 2 (14%) Depression o Anxiety. Regarding the treatments: 4 (28.6%) were in treatment with anti TNF (3 with Adalimumab, 1 with certolizumab pegol), 4 (28.6%) with Anti IL17 (3 with Secukinumab and 1 with Ixekizumab), 8 (57%) methotrexate and 2 (14%) Leflunomide, 1 (7%) were under treatment with Enalapril, 1 (7%) with Losartan. 10 (71.4%) stayed at home, 3 (21.4%) hospitalized in the common room and 1 (7) in the intensive care unit. No patients died due to COVID-19. Conclusion: An incidence of 4.4% of COVID-19 was found in this SpA population, most of the cases occurred in the Province of Buenos Aires and CABA, most of them suffered mild symptoms and no deaths were reported.
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Background: Access to high-cost treatments is especially limited in low-resource countries. This issue is becoming stronger today given the health and economic crisis caused by the SARS-CoV2 pandemic. There are no reports in our country on limitations to access and adherence to treatment in patients with Spondyloarthritis (SpA) during social preventive and mandatory isolation. Objectives: Evaluate access and adherence to treatment in patients with Spondyloarthritis during social preventive and mandatory isolation. Methods: Patients with axial spondyloarthritis (axSpA) radiological (r-axSpA), non-radiological (nr-axSpA) and peripheral spondyloarthritis (pSpA), according to ASAS criteria and psoriatic arthritis (PsA) according to CASPAR criteria, were included. Sociodemographic data, comorbidities, disease activity and treatments were collected at baseline. Data on treatment discontinuation, medical attention for suspected COVID-19 disease, RT-qPCR for SARS-CoV-2 detection and outcome of COVID-19 disease were collected from April to September 2020. Numerical variables were summarized as means and standard deviations (SD) or as medians and interquartiles 25-75 (IQ 25-75). Results: 320 patients were included, 55% were male, with a mean age of 50 years (SD 13), 21.6% had diagnosis of r-axSpA, 6.9% nr-axSpA, 6.9% pSpA, and 64.7% PsA. Disease duration was 11 (IQ 5-16) years and activity parameters were as follow: BASDAI 3.65 (SD 3), BASFI 3 (1.5-9), PASI 0.3 (0-7), BSA 0.2 (0-6). 14 (4.4%) patients with COVID-19 disease were reported, 10 were confirmed by positive RT-qPCR and 4 by symptoms and history of close contact with SARS patients. 4 (28.6%) received anti TNF (3 adalimumab, 1 certolizumab), 4 (28.6%) anti IL17 (3 secukinumab and 1 ixekizumab), 8 (57%) methotrexate (MTX) and 2 (14%) leflunomide (LF). Among the 320 patients included, 59 (18.4%) discontinued at least one treatment during follow-up. The discontinued medications were: adalimumab (16), MTX (15), secukinumab (9), etanercept (6), certolizumab(4), ustekinumab (3), NSAIDs (2), apremilast (1), golimumab (1), ixekuzumab (1), LF (1), MTX plus LF (1). The main reason for treatment discontinuation was drug shortage: 36 (62%), followed by patient's decision: 12 (21%) and medical indication: 11 (17%). Of the 36 patients who discontinued due to shortage, 11 received adalimumab, 8 secukinumab, 5 MTX, 3 etanercept, 3 certolizumab, 3 ustekinumab, 2 NSAIDs and 1 golimumab. Conclusion: In our Argentinian cohort of patients with SpA, drug shortage was the main reason for treatment discontinuation. The SARS-CoV2 pandemic exposed limitations to access to treatment for patients with SpA.
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Background: There are limited data worldwide on the behavior of SARSCOV2 in patients with Spondyloarthritis (SpA). Objectives: To describe the incidence and severity of COVID-19 disease in patients with SpA in Argentina. Methods: Patients with axial spondyloarthritis (AxSpA) radiological (EA) and non-radiological (AxSpA-nr) and peripheral spondyloarthritis (according to ASAS criteria) and psoriatic arthritis (PsA) (according to CASPAR criteria) were included. Sociodemographic data, comorbidities, disease activity and treatments were collected at baseline. The patients were followed up by phone or in person monthly. Data were collected from 1/4/2020 to 9/20/2020. Descriptive statistics were performed with mean and standard deviation (SD) and median and quartile 25-75 according to distribution, and the cumulative incidence (AI) of the disease was calculated. Results: 320 patients were included, of which 55% were male, with a mean age of 50 SD 13, 21.6% had a diagnosis of AS, 6.9% SpAax-nr, 6.9% SpAp, and 64.7% PsA, BASDAI 3.65 (3), BASFI 3 (1.5-9), PASI 0.3 (0-7), BSA 0.2 (0-6). Fourteen patients with a diagnosis of COVID-19 (4.4%) were reported, of which 10 diagnoses were by positive PCR and 4 by positive symptoms and close contact. 93% (13) of the cases were patients from the Province of Buenos and CABA and 1 patient from Santiago del Estero. The total IA for the country was 0.04. Of the 14 patients with COVID-19, 7 (50%) were men, 4 had a diagnosis of AS, 1 of SpAax-nr, 9 (64.3%) PsA. 100% live in urban areas, 2 (14%) have hypertension, 1 (7%) DBT, 1 (7%) COPD, 2 (14%) depression or anxiety, 11(97%) had received influenza vaccine 2020, 13 (93%), Antineumoccic 23, 14 (100%) Antineumoccic 13. Regarding the treatments: 4 (28.6%) were in treatment with anti TNF (3 with Adalimumab, 1 with certolizumab pegol), 4 (28.6%) with Anti IL17 (3 with Secukinumab, 1 with Ixekizumab), 8 (57%) with methotrexate and 2 (14%) with Leflunomide. Place of follow-up of the disease: 10 (71.4%) at home, 3 (21.4%) in the common room and 1 (7) in the intensive care unit. Treatments received for COVID-19: 1 (7%) antiretroviral, 1 (7%) antibiotic and 1 (7%) steroids. None of the patients died from COVID-19. Conclusion: An incidence of 4.4% of COVID-19 was found in this population with SpA and most of the patiend had mild symptoms and no deaths were reported. .
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Mexico is a seismically active country. Earthquakes with magnitudes larger than 7.0 happen, on average, every other year. This fact requires a rapid and consistent response from the national monitoring agency, the Servicio Sismológico Nacional, SSN (Mexican National Seismological Service). For this purpose, in 2014, the SSN created a set of procedures for the daily operations and rapid response called “Protocolo de Respuesta Inmediata ante Sismos Amenazantes” (PRISA, protocol of immediate response to threatening earthquakes). This protocol has been triggered for 292 events with a magnitude larger than or equal to 5.0 that occurred between April 2014 and July 2020. Here we present the response of the SSN, based on this protocol, to three significant earthquakes: the 8 and 19 September 2017 events (Mw 8.2 and 7.1, respectively) and the 23 June 2020 (Mw 7.4). The first two quakes caused severe damage in southern and central Mexico, whereas the third occurred during the coronavirus disease 2019 pandemic and confinement in Mexico. Having PRISA in place contributed to the efficient SSN response in the three events, even though some activities for the 2020 earthquake were performed remotely. © Seismological Society of America
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Introduction: Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has become a global pandemic with alarming numbers of morbidity and mortality. COVID-19 primarily presents as a lung infection, with symptoms of fever, cough, myalgia, and fatigue. The severity of the disease may range from a mild upper respiratory infection to severe pneumonia, ARDS, and death. This novel disease can also present with involvement of multiple organ systems including the kidneys. Acute kidney injury (AKI) has been reported in up to 37 % of cases. Here we report a case of a woman with COVID-19 presenting with rhabdomyolysis and AKI. Case Description: A 48 y/o Hispanic woman with history of HTN, hyperlipidemia and DM type 2 who presented to the ED complaining of shortness of breath, fever, cough, and myalgias. Four days before presentation she had been diagnosed with COVID-19 and was self-isolating at home. Her symptoms worsened prompting her visit to the ED. Vital signs showed fever of 103.1 F, pulse 86, respirations 37, blood pressure 106/58 and O2 Sat 85% at room air, 95% with nasal canula at 4 L. PE was normal except for tachypnea and coarse breath sounds bilaterally on lung auscultation. Admission labs were remarkable for AKI and rhabdomyolysis. Serum creatinine was 3.61, BUN 83, and total CK 106,193. U/A with blood, 5-10 RBC, 5-10 WBC and many bacteria. FeNA was 0.3%. Toxicology panel was negative. Respiratory viral panel was negative. Influenza A and B are negative. She initially received 2 L bolus of IV NS and then continued with balanced crystalloid solutions for volume expansion over the next 3 days. She received treatment with hydroxychloroquine, azithromycin and ceftriaxone for COVID-19 pneumonia. Her symptoms improved and serum creatinine and CK gradually decreased until back to normal levels. Discussion: Rhabdomyolysis can be seen associated with viral infections. We presented a patient with COVID-19 and rhabdomyolysis. There are no studies establishing a mechanism for COVID-19 induced rhabdomyolysis. Patients with COVID-19 pneumonia are generally kept with negative fluid balance to avoid overload and worsening of ARDS. On the other hand, volume expansion is mainstay management for rhabdomyolysis. Clinicians should have a high suspicion for rhabdomyolysis in patients with COVID-19 presenting with myalgias and AKI. Early recognition of and appropriate treatment is crucial to improve outcomes.
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Introduction: The Warburg effect is a rare paraneoplastic syndrome seen in patients with hematologic malignancy. The metabolism of cancerous cells converts to aerobic glycolysis and results in type B lactic acidosis. Case Description: The patient is a 62-year-old man with diffuse large B-cell lymphoma and prior hemophagocytic syndrome (HS) diagnosed 6 months prior, on chemotherapy. He presented with several weeks of fever and respiratory symptoms. Clinical exam and diagnostics did not reveal a source of sepsis. Chest radiography and CT chest were without infiltrates. COVID-19 PCR was negative. Labs- WBC 1,500 /mm3, Hemoglobin 8.8 g/dL, Platelets 63,000 /mm3, creatinine 1.1 mg/dL, lactate 2.6 mmol/L, ferritin 417 ng/mL, serum triglycerides 349 mg/dL. Patient was placed on vancomycin and cefepime and volume expanded, but continued febrile with persistent lactic acidosis. Abdominal CT revealed splenomegaly with focal hypodensities, mild descending and sigmoid diverticulosis without diverticulitis. CT mesenteric angiography revealed moderate narrowing of celiac artery and severe narrowing of the inferior mesenteric artery origin. For suspected ischemic colitis, the patient was taken emergently for exploratory laparotomy, but findings did not support ischemia. Creatinine trended up to 2.0 mg/dL with increasing lactate of 11 mmol/L, bicarbonate 13 mmol/L, and serum pH of 7.0. At this point, without septic or ischemic processes identified, the lactate production was attributed to DLBCL, and not HS as ferritin was not substantially elevated. CRRT was initiated for anuric AKI. Lactate continued to trend up to 21.7 mmol/L with bicarbonate 6 mmol/L. Family discussions were held, and the patient was transitioned to palliative care. Discussion: Type B lactic acidosis should be considered in the differential diagnosis in patients with increased anion gap metabolic acidosis and malignancy. One rare and potentially fatal Type B lactic acidosis is due to the Warburg effect, a rare and potentially lethal paraneoplastic syndrome of hematologic malignancies.
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Introduction: During our current pandemic, physicians must exclude COVID-19 in every patient presenting to the hospital with a febrile illness. However, every patient should have a complete work-up done to not miss other disease processes. Here we describe a case of microscopic polyangiitis with symptoms mimicking COVID-19. Case Description: The patient is a 69 yo female with history of HTN who presented with four weeks of polyarthralgia and fevers;this was accompanied by a dry cough and morning stiffness in her shoulders and hips, for which she heavily used ibuprofen. Vital signs were within normal limits. Physical exam showed clear breath sounds with 2+ pitting edema in the lower legs and no rashes. Labs reveled a WBC of 20,000 cells/ microliter, with creatinine of 2.29 mg/dL, bicarbonate of 17 mmol/L, and C-reactive peptide of 204 mg/L. UA showed moderate leukocyte esterase, trace protein, and large blood. Serum C3 and C4 levels were normal, and a spot urine/protein ratio was 600 mg. Urine microscopy had several non-dysmorphic RBCs with occasional RBC and WBC casts. Infectious work-up via COVID-19 screening, blood cultures, hepatitis, and HIV was negative. The patient's creatinine trended up, peaking at 2.8 mg/dL. She was started on empiric solumedrol at a dose of 60 mg TID for possibilities of polymyalgia rheumatica or vasculitis or NSAID-induced acute interstitial nephritis. She had a positive MPO ANCA with titer of 1:320. Kidney biopsy confirmed pauci-immune crescentic glomerulonephritis, with clinical diagnosis of microscopic polyangiitis. She was placed on prednisone 40 mg daily and rituximab 375 mg/m 2 weekly for four weeks and was discharged home in stable condition. Discussion: Systemic vasculitis remains to be a diagnostic challenge, especially in the era of COVID-19, given the overlap in symptoms. The diagnosis is made via clinical history and histopathological findings coupled with positive ANCA. Despite treatment, almost a quarter of these patients will progress to ESRD. In the era of COVID-19, great care must be taken to diagnose the kidney manifestations of systemic vasculitis.