ABSTRACT
Langerhans cell histiocytosis (LCH) is a rare disease that commonly affects the skin and bones and is found mostly in children. Gastrointestinal (GI) involvement in adults is rare and is diagnosed during a routine colonoscopy from the biopsy of polypoid lesions. The pathophysiology of LCH is unclear. We describe an adult patient with LCH in remission who presented with extensive GI involvement after severe acute respiratory syndrome coronavirus 2 infection. This case report identifies severe acute respiratory syndrome coronavirus 2 as a trigger for the worsening of LCH and adds more data to the literature, given this is the first case with fulminant GI involvement.
ABSTRACT
Introduction: The American Gastroenterological Association (AGA) guidelines recommend continuing the use of biologics in those who have not tested positive for COVID-19 and are asymptomatic. 1 This study evaluated the views of patients with IBD on biologics and COVID-19 vaccination during the COVID-19 pandemic. Methods: We surveyed 204 participants through Amazon Mechanical Turk that fulfilled the inclusion criteria of: >18 years old, diagnosed with IBD, and on a biologic. The study was approved by the institutional review board. A five-point Likert scale was used to gauge participants' level of understanding of the risks and benefits of biologics during the pandemic. Participants were also asked what they would do with their biologic if tested positive for COVID-19 and their willingness to accept the COVID-19 vaccine. Descriptive statistics were used to analyze data. Results: Majority of the participants were male (60.1%), under the age of 50 (95.1%), had at least a high school degree/GED (99%), and were insured (90.6%). Participants reported moderate understanding (mean±SD, 2.8±1.1) of the risks and benefits of biologic use for IBD during the COVID-19 pandemic. A remarkable number of participants, 43.6%, reported stopping their biologic due to fear of contracting COVID-19. Also, the majority of participants would “somewhat” agree to be vaccinated against COVID-19 vaccine if the vaccine is available to them (mean±SD, 2.0±1.1) and their attitude toward the vaccination did not change even if their gastroenterologists were to recommend the vaccine (Table 1). Conclusion: Despite recommendations from the AGA to continue one's biologic, a significant number of participants reported either decreasing their dose or stopping their biologic. The participants also reported only a “moderate understanding” of the risks and benefits of using biologics during the pandemic. Most striking, participants' attitude towards receiving a COVID-19 vaccine did not change even if a gastroenterologist were to recommend it. Thus, there is a need to evaluate each patient's biologic compliance and educate patients on the impact of COVID-19 on their treatment plan at their gastroenterology appointments. Further inquiry at appointments is also needed to understand vaccination hesitancy.
ABSTRACT
Elizabethkingia meningoseptica has been considered a rare nosocomial cause of pneumonia, especially in the adult population. Risk factors include immunosuppression, recent hospitalizations, and procedures. We present a rare case of community-acquired Elizabethkingia meningoseptica pneumonia (CAP) in an adult without risk factors. 57-year-old Male, past medical history of hypertension & a solitary kidney presented with one week of generalized weakness, 30-lb weight-loss, productive cough & intermittent fevers. He had no history of malignancy, recent travel, sick contacts nor exposure to pools, bodies of water or fish. He denied any history of lung disease nor tobacco, alcohol, or illicit drug use. Laboratory studies revealed leukocytosis with neutrophilic predominance, lactic acidosis, non-reactive HIV and negative COVID-19 tests. Chest radiograph revealed right apical lung consolidation;computed tomography of the chest revealed a patchy ground-glass opacity in the right upper lobe (RUL). On examination he was found to have diffuse inspiratory and expiratory wheezing and productive cough. The patient was admitted for treatment of CAP with hyperreactive airways. In the ER, the patient was empirically started on methylprednisolone, ceftriaxone and azithromycin. He subsequently underwent a bronchoscopy with washing, protected & cytology brushings of the RUL that revealed multidrug-resistant Elizabethkingia meningoseptica, susceptible to ciprofloxacin and sulfamethoxazole/trimethoprim. Patient was transitioned to ciprofloxacin with improvement of his clinical status as well as the RUL opacity. This case highlights several important factors. First, it allows further investigation on Elizabethkingia meningoseptica, a rare gram-negative, rarely infectious, aerobic bacillus prevalent in natural water sources & soil. Incidence of 5-10 cases per state per year in the US;involving pediatric bacteremia & meningitis, in immunocompromised states (cystic fibrosis). However, it is rarely a cause of CAP or nosocomial pneumonia in adults. This microbe is associated with the intensive care unit (ICU), including mechanical ventilation, insertion of invasive lines/devices, and immunocompromised states. Interestingly, exposure to water sources within hospitals, including bronchoscopy, can be a source. However, our patient presented with clearly defined pneumonia, then had a bronchoscopy. Second, we learn the multidrug resistance of this pathogen (β-lactams, aminoglycosides, carbapenems), and the sensitivities (fluoroquinolones and sulfamethoxazole/trimethoprim) lending to a difficult eradication. Third, CAP from Elizabethkingia meningoseptica highlights the importance of identifying various risk factors for the development of pneumonia. By shedding light to this pathogen, we hope to further improve the identification and treatment of CAP secondary to Elizabethkingia meningoseptica.