Reactive synovitis of the knee joint after COVID-19 vaccination: The first ultrastructural analysis of synovial fluid.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus 2019 disease (COVID-19) have spread all around the world since 2019 and have affected millions of people. The development of COVID-19 vaccines helped to decelerate the spread of the virus. However, as in the case of vaccines against other infectious diseases, adverse events can also present with COVID-19 vaccines. CASE PRESENTATION: We report here a rare case of a 53-year-old man with knee-joint synovitis, after the first dose of messenger RNA vaccine, with no fever and a negative COVID-19 reverse transcription polymerase chain reaction test. During a clinical examination the suspicion of pyogenic arthritis was excluded by blood tests and by a complex joint effusion examination, including a microbiological and cytological-energy analysis of the synovial fluid. The treatment received by our patient consisted of 3 doses of dexamethasone administered intravenously over a period of 3 days. All the symptoms improved after this therapy, and in the 3-week follow-up period we recorded full recovery with no consequences. CONCLUSION: Case reports on patients undergoing COVID-19 vaccination should be examined in order to detect rare and long-term side-effects. This is the first report to present the outcomes of an ultrastructural analysis of post-vaccination synovitis.

Safety and Systemic Exposure of Hydroxychloroquine in Healthy Volunteers After Inhalation Administration

The anti-inflammatory and antiviral effects of hydroxychloroquine have not been demonstrated in clinical trials for the treatment of COVID-19. A possible reason for the failure is low local exposure in the lungs after p.o. or i.v. administration. In the Phase 1 study, the aim was to test the pharmacokinetics and safety of inhaled hydroxychloroquine after nebulization. In 6 healthy volunteers, we determined the pharmacokinetics after a single administration of 10 mg hydroxychloroquine from 19 blood samples collected at the following times: before nebulization and 2, 5, 10, 15, 20, 25, 30, 45, and 60 min, and 1:15, 1:30, 2:00, 2:30, 3:00, 4:00, 8:00, 12:00, and 24:00 hr after the start of nebulization. On Day 5, we determined the pharmacokinetics after repeated administration of 20 mg once daily from 12 samples taken at the following times: before nebulization and 5, 10, 20, 30, 45, and 60 min, and 2, 4, 8, 12, and 24 hr after the start of nebulization. Safety was assessed by observing biochemical parameters, blood count, and clinical parameters including ECG and blood pressure. After a single administration, the mean ± SD Cmax, T1/2, and AUC0-24 values were 5633.6 ± 2924.8 pg/ml, 11.7 ± 1.3 hr, and 6588.4 ± 1252.2 pg/ml*hr, respectively. After repeated administration on Day 5 the respective values were 4807.7 ± 1708.7 pg/ml, 14.83 ± 3.41 hr, and 26801.0 ± 8217.8 pg/ml*hr. We found no significant difference between the pretreatment and posttreatment values of safety parameters and they did not deviate outside the physiological range. We observed only minor adverse events related to the bitter taste of hydroxychloroquine. There were no systemic or respiratory adverse reactions. We have demonstrated acceptable safety of the inhaled route of administration of hydroxychloroquine in this dose group. [ FROM AUTHOR] Copyright of Acta Facultatis Pharmaceuticae Universitatis Comenianae is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Toxocariasis as a Rare Parasitic Complication of a Transthoracic Spine Surgery Procedure.

Human toxocariasis is a helminthozoonosis caused by the migration of Toxocara species larvae through an organism. The infection in humans is transmitted either by direct ingestion of the eggs of the parasite, or by consuming undercooked meat infested with Toxocara larvae. This parasitosis can be found worldwide, but there are significant differences in seroprevalence in different areas, depending mainly on hot climate conditions and on low social status. However, the literature estimates of seroprevalence are inconsistent. Infected patients commonly present a range of symptoms, e.g., abdominal pain, decreased appetite, restlessness, fever, and coughing. This manuscript presents a case report of a polytraumatic patient who underwent a two-phase spinal procedure for a thoracolumbar fracture. After the second procedure, which was a vertebral body replacement via thoracotomy, the patient developed a pathologic pleural effusion. A microscopic cytology examination of this effusion revealed the presence of Toxocara species larvae. Although the patient presented no specific clinical symptoms, and the serological exams (Enzyme-linked immunosorbent assay (ELISA), Western blot) were negative, the microscopic evaluation enabled a timely diagnosis. The patient was successfully treated with albendazole, with no permanent sequelae of the infection.