ABSTRACT
After initial reports of multisystem inflammatory syndrome in children (MIS-C) in April 2020 in Europe, this disease has been known to occur in children with recent history of coronavirus disease 2019 (COVID-19) and most cases have been reported in Europe and the Unites States of America. We report a case of a 14-year-old girl who was diagnosed with MIS-C with acute myocarditis and successfully treated with intravenous immunoglobulin (IVIG), methylprednisolone, and anakinra. At initial presentation, she had persistent high fever, generalized rash, generalized swelling, abdominal pain, and low blood pressure. She showed a remarkably elevated level of inflammation and cardiac enzyme markers and had a previous history of COVID-19 5 weeks before the initial presentation. After extensive work up, other infectious and non-infectious causes were excluded. She was diagnosed with MIS-C and initially treated with IVIG and high-dose methylprednisolone;however, despite treatment, her heart function deteriorated and coronary artery dilatation progressed. Therefore, anakinra, an interleukin-1 receptor antagonist, was administered on hospital day 6, after which her cardiac function exhibited improvement. She was discharged on hospital day 19 without any symptoms, and follow-up echocardiography after 1 month revealed fully recovered heart function with normal coronary arteries. © 2021 The Korean Society of Pediatric Infectious Diseases.
ABSTRACT
Introduction: Lynch Syndrome (LS) is a familial cancer-predisposition syndrome caused by mutations in DNA mismatch repair genes. LS accounts for 3-8% of all new cases of colorectal cancer (CRC), and it increases the lifetime risk of multiple associated cancers. LS is common, occurring in approximately 1 in 200-300 individuals, but remains underdiagnosed. Estimates indicate that less than 1% of individuals with LS are aware of their diagnosis. This represents a missed opportunity for cancer screening and prevention. Case Description/Methods: A 50-year-old healthy woman presented to endoscopy for direct access screening colonoscopy. Family history included in her electronic medical record noted two malignancies in first degree relatives (thyroid and uterine). Colonoscopy revealed 13 tubular adenomas (3- 12mm). Office follow up to discuss genetic testing was delayed due to COVID-19. 10 months later the patient presented for follow up, and family history revealed ureteral and CRC in her father, CRC in her paternal uncle, and uterine cancer in her paternal aunt and paternal grandmother. Germline genetic testing was discussed and sent. While awaiting results, she was found to have atypical endometrial cells on routine pap smear. Colposcopy revealed complex endometrial hyperplasia (CAH) with atypia, bordering on grade 1 endometrioid carcinoma. The following week, genetic results showed a mutation in MSH6. One week later, surveillance colonoscopy revealed 4 sub-cm tubular adenomas. She then underwent total hysterectomy, bilateral salpingo-oophorectomy, and sentinel lymph node biopsy. Pathology showed CAH but no definitive features of endometrioid carcinoma. The patient recovered from her surgery uneventfully, is now in a screening/surveillance program, and cascade testing has begun for her first-degree relatives, including her two adult children. Discussion: This case highlights the importance of obtaining cancer family history during patient contact, so that this underdiagnosed condition can be identified and patients can benefit from appropriate cancer screening..
ABSTRACT
The virus behind the current pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the etiology of novel coronavirus disease (COVID-19) and poses a critical public health threat worldwide. Effective therapeutics and vaccines against multiple coronaviruses remain unavailable. Single-chain variable fragment (scFv), a recombinant antibody, exhibits broad-spectrum antiviral activity against DNA and RNA viruses owing to its nucleic acid-hydrolyzing property. The antiviral activity of 3D8 scFv against SARS-CoV-2 and other coronaviruses was evaluated in Vero E6 cell cultures. Viral growth was quantified with quantitative RT-qPCR and plaque assay. The nucleic acid-hydrolyzing activity of 3D8 was assessed through abzyme assays of in vitro viral transcripts and cell viability was determined by MTT assay. We found that 3D8 inhibited the replication of SARS-CoV-2, human coronavirus OC43 (HCoV-OC43), and porcine epidemic diarrhea virus (PEDV). Our results revealed the prophylactic and therapeutic effects of 3D8 scFv against SARS-CoV-2 in Vero E6 cells. Immunoblot and plaque assays showed the reduction of coronavirus nucleoproteins and infectious particles, respectively, in 3D8 scFv-treated cells. These data demonstrate the broad-spectrum antiviral activity of 3D8 against SARS-CoV-2 and other coronaviruses. Thus, it could be considered a potential antiviral countermeasure against SARS-CoV-2 and zoonotic coronaviruses.