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Italian Journal of Medicine ; 15(3):48, 2021.
Article in English | EMBASE | ID: covidwho-1567590


Background: Available studies suggest that patients treated with monoclonal antibodies therapy (MAT) for CoViD-19 show a significant reduction of the viral load in nasopharinx. Studies are ongoing to better define clinical benefits of this therapy. Materials and Methods:We retrospectively studied the seventeen patients (seven females mean age 71.14 and ten males mean age 63.7) treated with MAT between April and May 2021 in our Internal Medicine ward. We followed the national guidelines for the administration of MAT. All patients were treated within five days after their first positive swab samples (RT-PCR). 10 patients presented hypertensive cardiomiopathy, 4 type 2 diabetes mellitus, 3 asthma, 1 end stage renal disease and 1 Shawcman diamond syndrome. Ten patients were treated with casirivimab/indevimab, six patients with bamlanivimab/etesevimab, one patient with bamlanivimab only. Results: 30 days after MAT, we contacted the patients to evaluate side effects and disease development. The symptoms referred were diarrhea (4 cases), fever (3 cases) and fatigue (2 cases), probably due to CoViD infection more than MAT. The only patient hospitalized for CoViD-19 pneumonia was that one treated with bamlanivimab alone, a 60-year-old man with severe previous conditions such as triple ischemic stroke and triple acute coronaric syndrome. Anyway he underwent non-invasive ventilation and didn't need intensive therapy. Conclusions: Our data suggest that MAT for CoViD-19 infection is safe and can avoid the worsening of symptoms and hospitalization in frail patients with recent infections.

Italian Journal of Medicine ; 15(3):34, 2021.
Article in English | EMBASE | ID: covidwho-1567459


Background: In literature association with CoViD-19 infection and autoimmune diseases like cold agglutinine hemolitic anemia (HA) and immune thrombocytopenia (IT) was observed. Description of the cases: We describe the story of two patients admitted to our ward for SARS-CoV-2 related pneumonia. A 84 yo woman affected by NIDDM, hypertension, ischemic heart disease, colorectal carcinoma (20 years before). Upon the admission HA was reported (Hb 7.6 g/dl, reticulocytes 5.3%, LDH 339 U/l, aptoglobin <8 mg/dl) with direct Coombs test and cold agglutinine positivity. Bone marrow biopsy (BOM) confirmed the suspected diagnosis. TC scan total body excluded a reactivation of colorectal carcinoma or other neoplastic pathology. A 84 yo man on AVK therapy for permanent atrial fibrillation and recent aortic bioprothesis, NIDDM and COPD. He received the first dose of m-RNA antiCoViD- 19 vaccine three weeks before. In this patient too we found a HA, positive direct Coombs test and cold agglutinine associated to a rapide decline in platelet counts up to 5000/mm3. Patient refused BOM. On suspicion of an autoimmune genesis both patients were successfully treated with prednisone. The second one was treated with immunoglobulins too obtaining Hb and platelet values partial correction. Conclusions: Our case reports confirm this cohexistence between HA, IT and CoViD-19. We cannot say if this is a casual relationship but we can hypothesize this like an effect of a dysregulation of the immune system induced by cytokine storm during CoViD-19 infection. Further studies are needed to establish a possible causal link.

Italian Journal of Medicine ; 15(3):19, 2021.
Article in English | EMBASE | ID: covidwho-1567377


Background: Often the onset symptoms of a disease don't easily direct towards the correct diagnosis. Furthermore, the CoViD-19 pandemic has often been an obstacle to obtaining a quick diagnosis. Description of the case: Male 49-year-old patient admitted to emergency room for persistent back pain, asthenia and weight loss. Physical examination revealed a palpable mass in the right gluteal region, chest X ray an enlargement of mediastinum. Nasopharingeal swab for CoViD-19 was positive (even if negative for CoViD-related symptoms);he was so hospitalized in our Internal Medicine CoViD Ward. Blood samples found microcytic anemia (thalassemic trait carrier);high ferritin (1072 ng/ml), aptoglobin (297 mg/dl, nv <200) and B2 microglobulin (3.25 mg/l, nv <2.53);K and L chains normal with K/L serum ratio reduction, increase in urine sample. Lymphocyte subpopulations were indicative of lymphopenia. Suspecting a lymphoproliferative disease, he performed a chest and abdomen CT scan that found: multiple bilateral pulmonary nodules, the largest one 10x9 cm in the left lung;a left renal lesion11x10 cm;a mass 9.5 cm of the sacroiliac left wing and splenomegaly (145 mm). We thus performed a US-assisted biopsy of the mass in the gluteal region. The histological examination allowed to identify metastasis from clear cell renal carcinoma. Conclusions: We report this case to highlight the peculiarity of onset of this renal carcinoma, in absence of genitourinary symptoms. Diagnostic autonomy can be a winning weapon in accelerating the diagnostic process, even more so in times of CoViD-19 pandemic.

Eur Rev Med Pharmacol Sci ; 25(19): 5904-5912, 2021 10.
Article in English | MEDLINE | ID: covidwho-1478932


OBJECTIVE: Liver injury has been reported in patients with COVID-19. This condition is characterized by severe outcome and could be related with the ability of SARS-CoV-2 to activate cytotoxic T cells. The purpose of this study is to show the histological and scanning electron microscopy features of liver involvement in COVID-19 to characterize the liver changes caused by the activation of multiple molecular pathways following this infection. PATIENTS AND METHODS: Liver biopsies from 4 patients (3 post-mortems and 1 in vivo) with COVID-19 were analyzed with histology and by scanning electron microscopy. RESULTS: The liver changes showed significant heterogeneity. The first case showed ground glass hepatocytes and scattered fibrin aggregates in the sinusoidal lumen. The second evidenced intra-sinusoidal thrombi. The third was characterized by sinusoidal dilatation, atrophy of hepatocytes, Disse's spaces dilatation and intra-sinusoidal aggregates of fibrin and red blood cells. The fourth case exhibited diffuse fibrin aggregates in the dilated Disse spaces and microthrombi in the sinusoidal lumen. CONCLUSIONS: In COVID-19-related liver injury, a large spectrum of pathological changes was observed. The most peculiar features were very mild inflammation, intra-sinusoidal changes, including sinusoidal dilatation, thrombotic sinusoiditis and diffuse intra-sinusoidal fibrin deposition. These findings suggested that a thrombotic sinusoiditis followed by a local diffuse intra-vascular (intra-sinusoidal) coagulation could be the typical features of the SARS-CoV-2-related liver injury.

Blood Coagulation Disorders/pathology , COVID-19/pathology , Liver Diseases/pathology , Liver/pathology , Thrombosis/pathology , Aged , Autopsy , Biopsy , Erythrocytes/pathology , Fibrin , Hepatocytes/pathology , Humans , Male , Microscopy, Electron, Scanning , Middle Aged , Thrombosis/complications , Young Adult
Italian Journal of Medicine ; 14(SUPPL 2):18-19, 2020.
Article in English | EMBASE | ID: covidwho-984167


Background: Acute eosinophilic pneumonia (AEP) is a raredisease. Patients can develop hypoxemic respiratory failure andsometimes require mechanical ventilation.Case report: Woman 20 years old with frequent episodes ofhyperpyrexia and dry cough mostly nocturnal which improved withspray bronchodilators. The patient went to the pulmonologist whofound whistles, hisses and blood sputum. The spirometry showedpositive bronchodilatation. The Physician diagnosed asthma andprescribed steroid and bronchodilators. Because of symptomsworsening, the patient went to the hospital and she was admittedto our department. The chest ultrasound and x-ray showed diffusebilateral infiltrates and interstitial syndrome. Laboratory testsrevealed eosinophils 16500, IgE 7953 IU / ml, PCR slightlyincreased. We started with steroid, antibiotic and antifungaltherapy. On second day the symptoms and the laboratory testimprove. After one week the patient was discharged.Conclusions: Diagnosis of AEP is based on clinical criteria, ipere- osinophilia in the blood and at bronchoalveolar lavage, the exclusion of other causes of pulmonary eosinophilia. Lung biopsy israrely necessary. Differential diagnosis with cases detected inChina of coronarovirus infection (2019-nCoV) has recently beenvery interesting. Initial management includes supportive care, empiric antibiotics and systemic glucocorticoid therapy. If the patientdoes not respond to steroid or there is contraindication to its use,he could be treated with immunosuppressive or biological drugs.

Italian Journal of Medicine ; 14(SUPPL 2):120, 2020.
Article in English | EMBASE | ID: covidwho-984166


Background: COVID19 pneumoniae presented, especially at thebeginning of pandemia, diagnostic difficulties dues to the frequentswabs negativity (in contrast with clinic and imaging) and the notwidespread availability or doubtful interpretation of serologicaltests. Clinical case: 52 years old man with cough and fever for a week,admitted to our Medical Ward for acute respiratory failure onMarch 24, 2020. Positive history of epidemiological contact, obesity and hypertension. Laboratory tests showed an increase in PCR,LDH and ferritin. EGA showed pO2 62%, pCO2 37% and P/F 298and oxygen therapy was started (Venturi mask 6 l/min). Chest Xray was positive for interstitial pneumonia. Lung ultrasound showeddiffuse B lines (especially in posteral basal fields) and irregularpleural line with small subpleural thickenings. Despite a first negative swab, we considered the patient affected by Covid19 pneumoniae and started therapy: hydroxychloroquine 600 mg die,azithromycin 500 mg die and fondaparinux 2.5 mg die for 7 dayswith rapid clinical improvement. Swab repeated after a week wasnegative but COVID19 search in sputum was doubtful two times.Diagnosis was definitely confirmed three weeks after discharge,when our laboratory was finally able to perform serological testsfor COVID 19 on blood samples collected at the admission. BothIgM and IgG were high titer positive.Conclusions: This case report highlights how COVID19 pneumoniae diagnosis needs combination of epidemiology, clinical manifestations, laboratory tests, imaging and how swab negativity can'texclude it.