ABSTRACT
Background: Atypical presentation of calcinosis cutis in the context of COVID-19 infection complicated by acute renal failure has not been described in literature. We report a case of severe COVID-19 infection and its associated uncommon skin manifestation. It is a rare condition and its association with different diseases has been established in the past. However, to the authors' knowledge, calcinosis cutis has not yet been described in relation to COVID-19 infection complicated by acute renal failure. Case Presentation: Here we describe a case of a 55-year-old gentleman admitted to the intensive care unit with severe COVID-19 infection whose hospital stay was complicated by acute renal failure and development of hypocalcemia which was treated with oral and intravenous calcium. Subsequently, he developed an atypical fleshy lesion on his left ankle during his in-patient stay which was histologically proven calcinosis cutis. It was successfully treated with topical medications. Conclusion: This case highlights the importance of considering a wide differential of skin lesions including calcinosis cutis in patients who are critically unwell with COVID-19 or any other severe infections and develop isolated skin lesions in the setting of impaired renal functions and abnormal calcium phosphate metabolism with calcium administration. [ FROM AUTHOR] Copyright of European Journal of Medical Case Reports is the property of Discover STM Publishing Ltd 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.)
ABSTRACT
OBJECTIVES: To investigate inequalities in stillbirth rates by ethnicity to facilitate development of initiatives to target those at highest risk. DESIGN: Population-based perinatal mortality surveillance linked to national birth and death registration (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK). SETTING: UK. PARTICIPANTS: 4 391 569 singleton births at ≥24+0 weeks gestation between 2014 and 2019. MAIN OUTCOME MEASURES: Stillbirth rate difference per 1000 total births by ethnicity. RESULTS: Adjusted absolute differences in stillbirth rates were higher for babies of black African (3.83, 95% CI 3.35 to 4.32), black Caribbean (3.60, 95% CI 2.65 to 4.55) and Pakistani (2.99, 95% CI 2.58 to 3.40) ethnicities compared with white ethnicities. Higher proportions of babies of Bangladeshi (42%), black African (39%), other black (39%) and black Caribbean (37%) ethnicities were from most deprived areas, which were associated with an additional risk of 1.50 stillbirths per 1000 births (95% CI 1.32 to 1.67). Exploring primary cause of death, higher stillbirth rates due to congenital anomalies were observed in babies of Pakistani, Bangladeshi and black African ethnicities (range 0.63-1.05 per 1000 births) and more placental causes in black ethnicities (range 1.97 to 2.24 per 1000 births). For the whole population, over 40% of stillbirths were of unknown cause; however, this was particularly high for babies of other Asian (60%), Bangladeshi (58%) and Indian (52%) ethnicities. CONCLUSIONS: Stillbirth rates declined in the UK, but substantial excess risk of stillbirth persists among babies of black and Asian ethnicities. The combined disadvantage for black, Pakistani and Bangladeshi ethnicities who are more likely to live in most deprived areas is associated with considerably higher rates. Key causes of death were congenital anomalies and placental causes. Improved strategies for investigation of stillbirth causes are needed to reduce unexplained deaths so that interventions can be targeted to reduce stillbirths.