ABSTRACT
We report a patient with seronegative rheumatoid arthritis diagnosed with Whipple's disease following treatment of tumour necrosis factor inhibitor (TNFI) therapy. Whipple's disease should be considered in patients with seronegative rheumatoid arthritis and other unexplained multisystem illness. The TNFI therapy and immunosuppressive therapies can unmask latent Whipple's disease.
Subject(s)
Arthritis, Rheumatoid , Whipple Disease , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/drug therapy , Humans , Tumor Necrosis Factor Inhibitors/therapeutic use , Whipple Disease/diagnosis , Whipple Disease/drug therapyABSTRACT
Viral myositis is commonly seen with influenza and COVID-19 infections. While it has been described with acute viral hepatitis, concomitant involvement of the peripheral nerves causing a neuromyopathy has not been reported. A 67-year-old man with acute hepatitis B infection developed a severe myalgia and lower limb weakness around 1 month into his illness. Investigations revealed a neuromyopathy and rhabdomyolysis. MRI whole body with short tau inversion recovery sequences showed scattered muscle hyperintensities in the upper and lower limbs. He was treated with intravenous immunoglobulin and improved. This is the first report of an acute neuromyopathy associated with acute hepatitis B viral infection and demonstration of muscle MRI abnormalities in this condition.
Subject(s)
COVID-19 , Hepatitis B , Myositis , Neuromuscular Diseases , Aged , Hepatitis B/complications , Hepatitis B/drug therapy , Humans , Male , SARS-CoV-2ABSTRACT
Patients with COVID-19 may be asymptomatic or present with extrarespiratory symptoms, such as liver injury. It has been reported that 22.5%-46.2% of patients have moderate elevation of liver enzymes. To our knowledge, acute hepatitis has never been described as an isolated symptom of COVID-19 in a previously healthy patient. We report the case of a 53-year-old patient with COVID-19 whose first clinical presentation was acute icteric hepatitis, several days before the development of others symptoms. During the pandemic, we suggest that patients with acute hepatitis be considered as COVID-19 suspects, tested and isolated.
Subject(s)
COVID-19 , Hepatitis , Jaundice , Acute Disease , Hepatitis/diagnosis , Humans , Middle Aged , SARS-CoV-2ABSTRACT
This case represents a rare fulminant course of fried-rice associated food poisoning in an immunocompetent person due to pre-formed exotoxin produced by Bacillus cereus, with severe manifestations of sepsis, including multi-organ (hepatic, renal, cardiac, respiratory and neurological) failure, shock, metabolic acidosis, rhabdomyolysis and coagulopathy. Despite maximal supportive measures (continuous renal replacement therapy, plasmapheresis, N-acetylcysteine infusion and blood products, and broad-spectrum antimicrobials) and input from a multidisciplinary team (consisting of infectious diseases, intensive care, gastroenterology, surgery, toxicology, immunology and haematology), mortality resulted. This case is the first to use whole genome sequencing techniques to confirm the toxigenic potential of B. cereus It has important implications for food preparation and storage, particularly given its occurrence in home isolation during the COVID-19 pandemic.