ABSTRACT
Background: In winter, you can usually see a picture of Perniosis and/or chilblains. Painful, often itchy, red-to-purple lesions that affect the acrid surfaces of the fngers and toes after contact with the cold, resembling vasculitis, characterize them. Chilblains can be idiopathic and self-limiting or associated with systemic diseases. The diagnosis is usually clinical, but in some circumstances, analytical and microscopic studies of a biopsy sample may be necessary. We present a series of 19 consecutive cases of Pseudoperniosis associated with probable past INFECTION by SARS-CoV-2. Methods: During the winter 2020-21, an unexpected number of cases referred as 'acute arthritis/vasculitis' have been received in our rheumatology section and associated consultations. In the pathochrony of patients, exposure to cold was referred to as the main triggering factor. Initially qualifed as PERNIOSIS. Given the appearance in the current situation of Pandemic by covid-19, we began to request the serology SARS2-COVID19 IgG/IgM. Appreciating an approximate rate of 70% of IgG+ positivity in which it was performed. Results: Characteristics of the clinical data collected evolutionarily in the 19 patients: These are preferably young people, without any other pathology, although there are also people of all ages, with a clinical picture of edema of soft parts preferably of the hands, but also in the feet, with pain and some hemorrhage infusions, including ulcerations in the areas of the knuckles or pressure (PHOTO1-2-3). Despite the overwhelming nature of the picture, they do not associate any other symptoms and the analyses are normal, including acute phase reactants (ESR and PCR), and serological markers of autoimmune disease. Approximately 1/4 of them reported having passed clinical compatible with the covid19 infection and/or having been isolated with some minor symptom, but they had not been performed PCR. The others did not report any symptoms associated with COD19 infection. From the initial diagnosis, about 40 days passed on average. Many of them were being treated with corticosteroids/NSAIDs without improvement. In the ultrasounds performed, only edema of periarticular and paratendinous tissue is appreciated, such as that which can occur after a momentary ischemic picture. All evolved favorably avoiding cold (probable triggering factor), and with antiplatelet agent (infant aspirin). Conclusion: This picture of Pseudoperniosis lacks the typical pruritus of perniosis and the main problem is pain along with edema of the tissues of the hand that leads to make it impossible to use. Similarly, asymmetric lesions similar to perniosis were observed in patients who presented skin manifestations of SARS-CoV-2 infection in a study conducted in Spain (1). We are following these patients to assess if there is any relationship with any other factor that facilitates this unusual incidence, and at the same time indicate the transience of the clinical picture that evolves favorably in a few weeks.
ABSTRACT
Background: It has been more than a year and a half since the WHO announced a pandemic of a new coronavirus infection caused by SARS-CoV-2. The virus belongs to the respiratory group, but it it can damage various organs and tissues of the body. COVID-19 infection is characterized by pathological activation of immunity, violated synthesis of pro-infammatory, immunoregulatory, anti-infammatory cytokines, such as interleukins-1 and-6, tumor necrosis factor α and others. These features contribute to the development of rheumatic diseases and syndromes in people who have had COVID-19. Cellular and humoral immune responses are also of primary importance in the pathogenesis of infammatory myopathies. Objectives: Description of a case of severe dermatomyositis after COVID-19. Methods: The 34-year-old female patient complained of pain and weakness in the proximal muscles of the upper and lower extremities, difficulty swallowing solid and liquid food, rash on the face, neck, chest and arms. In August 2020 she had a mild case of COVID-19. A month later, faky erythematous papules like Gottron's sign appeared on the extensor surfaces of the metacarpophalangeal joints and proximal interphalangeal joints of the hands. Six months later, sore throats, hoarseness of voice, belching of air, choking on solid food and episodes of subfebrility joined. Refux esophagitis, duodenitis was detected by fbrogastroduodenoscopy. After 9 months, there were muscle pains and muscle weakness, erythema on the face, neck and chest, the patient lost 11 kg. She was hospitalized in the rheumatology department with suspected dermatomyositis. Results: On objective examination: proximal myopathy, erythematous rashes on the face, neck, chest, Gottron's erythema on the hands. In the analyses: clinical analysis of blood and urine without pathology, ANA 1:1280, creatinkinase 5370 IU/l, with an increase in dynamics up to 9260 IU/l, CRP 0.03 mg/dl, LDH 1023 IU/l, rheumatoid factor and anti-ds DNA were negative. Nasal regurgitation was detected during radiography of the pharynx with contrast. Instrumental examination revealed no signs of a tumor process. Fibrogastroduodenoscopy-superfcial refux-esophagitis, duodenitis, Chest CT-interstitial pneumonitis, abdominal ultrasound without pathology, ECG-sinus rhythm, normal EOS position, accelerated A-V conduction, echocardiography-minor separation of pericardial leaves (up to 5 mm), colonoscopy-dolichosigma. The patient was diagnosed with idiopathic dermatomyositis of high activity. Because of progressive myopathy and increasing dysphagia, pulse therapy with methylpredniso-lone500 mg for 3 days and rituximab 1000 mg was performed. She also received metipred 48 mg per day orally, methotrexate 15 mg per week subcutaneously and folic acid 5 mg per week. Against the background of therapy, positive dynamics was noted: swallowing normalized, the severity of myopathy decreased, after 10 days CKdecreased to 2049 IU/l. After 6 months during the control examination: there are no skin rashes, muscle strength is restored, CK 300 IU/l. The dose of methylprednisolone is reduced to 10 mg per day, the patient continues injections of methotrexate 15 mg per week. Conclusion: COVID-19 may be a trigger for the development of infammatory myopathy. In this clinical case there are features of the course and therapy of infammatory myopathies in patients after coronavirus infection.
ABSTRACT
The metacarpophalangeal (MCP) joint is surrounded by various structures critical to its stability and function. Though the ligamentous injury to the digits is common, rupture of the metacarpophalangeal collateral ligament and a sagittal band of the same finger is not well represented in the literature. We report a chronic case of a concurrent metacarpophalangeal collateral ligament and sagittal band injury. Though surgery would have been the most appropriate treatment soon after the injury, restrictions on elective procedures due to the COVID-19 pandemic precluded surgical treatment. The patient was alternatively treated with buddy tape, and a close follow-up was done. This is the first reported case of a concurrent metacarpophalangeal collateral ligament, and sagittal band injury successfully treated using nonoperative management.
ABSTRACT
Background: The coronavirus disease or COVID-19 pandemic is the major global health crisis of the present time. Various rheumatological manifestations have been reported during or after COVID-19 infection, but data are scarce. In this observational study, we have tried to analyze the clinical characteristics of COVID-19 associated arthralgia/arthritis. Methods: We have collected the clinical data of 14 patients over the past 6 months who have developed arthralgia or arthritis during or after symptomatic COVID-19 infection, proven by a positive reverse transcription-polymerase chain reaction test from nasopharyngeal swab. Results: The most common symptoms during COVID-19 infection in the 14 patients were fever and myalgia, being present in 92.8% and 64.3% patients, respectively. Arthralgia/arthritis occurred at a mean interval of 20 days (range: 0-60 days). Knee was the most commonly involved joint (78.6%), followed by the wrist and metacarpophalangeal joints (each in 57.1%). Enthesitis was documented in 21.4% patients. The mean duration of COVID-19 associated arthralgia or arthritis was 53.9 days (range: 7-210 days). In 85.7% patients, joint pains improved within 2 months;in only a small proportion of patients (14.3%), joint pains persisted after 6 months. Nonsteroidal anti-inflammatory drugs (NSAIDs) (given in 64.3% patients) and corticosteroids (in 50%) were the most commonly prescribed and effective treatment options. Conclusion: COVID-19 infections mostly caused reactive arthritis, though acute and chronic arthritis is also seen. In the majority of cases, arthritis started about 3 weeks after COVID-19 infection and subsided within 2 months. NSAIDs and corticosteroids are the most effective treatment options.
ABSTRACT
Myxoma (mx) is the most frequent adult cardiac tumour, that often poses a difficult diagnostic challenge due to the variety and aspecifity of presenting clinical signs. Alongside the more typical clinical onset caused by intracardiac obstruction and systemic embolization, mainly at cerebral level, a mx may initially manifest itself with nonspecific systemic symptoms such as fever, weight loss, fatigue, skin rash, myalgia and arthralgia. We present the case of a 58-year-old woman diagnosed in December 2018 with idiopathic, serum-negative arthritis of the metacarpophalangeal joint of the first finger of the right hand, treated with methotrexate (Reumaflex 10 mg/week s.c.), hydroxychloroquine sulphate (Paquenil 200 mg/day per os) and corticosteroids cycles;in January 2021, this therapy was suspended by the patient (pt) as ineffective. In April 2021, pt was admitted for bilateral SARS-CoV-2 pneumonia. As dyspnoea and fatigue persisted during moderate physical activity (NYHA class II), the pt underwent a cardiological examination on 13 August, when echocardiographic diagnosis of a left atrial mass with the appearance of a mx was made. Interleukin-6 (IL-6) was assayed for a suspected relationship between the cardiac tumour and rheumatic symptoms and was found to be elevated (490 pg/m)l. On 23 August, cardiac surgery was performed to remove the left atrial mass by right minithoracotomy. Histopathological examination confirmed that the 3.5 x 2.5 x 1.5 cm neoformation was a mx. On 1 September, strong attenuation of joint pain and IL-6 reduction to 107 pg/ml was detected. On 9 October, resolution of rheumatic symptoms and normalisation of IL-6 to 3.7 pg/ml (N.V < 7) occurred. This clinical case is emblematic of the long time that sometimes can elapse between the first clinical manifestation and the diagnosis of mx. Also the widespread use of echocardiography did not significantly reduce the diagnostic delay when cardiac symptoms are absent. In a large number of cases, onset symptoms mimicking autoimmune connective tissue disease are reported for 5% (“Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases” Medicine (Baltimore) 2001 May;80(3):159-729). The monoarticular localisation we describe is however unusual. Finally, our observation confirms that the association between mx and systemic symptoms is most likely due to IL-6 synthesis by tumour cells. (Figure Presented).
ABSTRACT
Introduction: A novel coronavirus (COVID-19), caused a series of acute atypical respiratory syndrome termed as SARS CoV-2. It has a varying degrees of symptoms like headache, high fever, dizziness, generalized weakness, diarrhoea and vomiting. But primarily it affects the respiratory system causing breathlessness and sometimes may be fatal. People recovered from the illness had variety of physical and mental illness. Aims: To find the effectiveness of virtual therapeutic exercises and mindfulness programme among the subjects recovering from COVID-19. Materials and methods: A total number of 32 male subjects aged between (55 - 70) years were included in this study. The subjects were included based on the prescription of a medical officer/ Curved length of Aortic Knuckle (AKC), total length of Left Heart Border (LHBT) and Aortic Knuckle Index (AKI) were measured. Statistical analysis was carried out with the help of IBM-SPSS (IBM Corporation) and Microsoft Excel. Results: AKC and AKI were measured,and correlated with total lenght of LHBT. A positive correlation between AKC, AKI and LHBT was noted. Conclusion: Simple measurement of aortic knob in PA chest x-ray may help in predicting cardiovascular disorder. pulmonologist. The duration of the study was eight weeks. Fitness assessment scale, hamilton stress anxiety scale and modified respiratory assessment scale was used. The study was conducted in the Symbiosis Medical College for Women, Pune. Results: The statistical analyses were done using the SPSS software version 18 executed at a 95% confidence interval. A paired t-test was done to find the effectiveness of the therapeutic exercises. The level of significance in all tests was set to p < 0.05. Positive changes were observed in health-related fitness among the subjects. Conclusion: This study reports about finding that virtual therapeutic training also provides the best results in physical and mental health among the patients recovering from COVID-19.