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1.
Chest ; 162(4):A1000, 2022.
Article in English | EMBASE | ID: covidwho-2060747

ABSTRACT

SESSION TITLE: Shock and Sepsis in the ICU Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Nocardiosis is a rare bacterial infection, which frequently affects immunocompromised patients. It can present as an acute, subacute, or chronic pulmonary infection with non-specific symptoms, such as fever, cough, dyspnea, weight loss, and hemoptysis. CASE PRESENTATION: A 34-year-old female with a history of chronic granulomatous disease and hidradenitis suppurativa on adalimumab presented to the ED with fever, shortness of breath, and productive cough of 2 days. Her vitals were T 101F, BP 66/48, HR 148, RR 42, and SPO2 94% on room air. On exam, she was cachectic, with bilateral crackles and rales in the right lung base. Extremities were cold, with trace pitting edema was present on bilateral lower extremities. COVID-19 PCR was negative. Despite fluid resuscitation, she remained hypotensive and was started on norepinephrine. Blood cultures were collected, and broad-spectrum antibiotics and an antifungal agent were initiated. Chest CT demonstrated bilateral multifocal consolidation with surrounding ground-glass opacities and complete consolidation of the right lower lobe. Due to worsening respiratory distress and tachypnea, and lack of improvement with non-invasive ventilation, she was intubated, placed on mechanical ventilation, and admitted to the Medical ICU. On hospital day 1, due to the patient's immunosuppression, unresolving shock, and radiographic findings, a bronchoscopy with bronchoalveolar lavage (BAL) was performed. On hospital day 2, a transthoracic echocardiogram showed LV ejection fraction of 20-25% with severe global hypokinesis of the LV. ACS workup had been unremarkable, with mildly elevated troponin and no ischemic changes on EKG. She was initiated on cardiac inotropes. On hospital day 3, BAL culture revealed Nocardia cyriacigeorgica. TMP-SMX and ceftriaxone were started for severe pulmonary nocardiosis. On hospital day 11, she was liberated from mechanical ventilation, and by hospital day 14, she was weaned off all pressors and inotropes. Approximately 4 weeks after admission, repeat TTE showed recovery of LV ejection fraction (55-60%) and she was discharged with a prolonged course of TMP-SMX and IV ceftriaxone, with duration to be determined at outpatient infectious disease follow-up. DISCUSSION: We discuss a unique case of severe pulmonary nocardiosis, presenting with ARDS and cardiogenic shock. To the best of our knowledge, this is the first case of a patient with pulmonary nocardiosis presenting with stress cardiomyopathy reported in the literature. While the pathophysiology is not well understood, theorized mechanisms include catecholamine excess, coronary artery spasm, microvascular dysfunction. CONCLUSIONS: This case highlights the need for a broad differential diagnosis in patients presenting with ARDS and cardiogenic shock and illustrates the value of clinical bronchoscopy in patients with unique presenting features. Reference #1: Lerner PI. Nocardiosis. Clin Infect Dis. 1996 Jun;22(6):891-903;quiz 904-5. doi: 10.1093/clinids/22.6.891. PMID: 8783685. Reference #2: Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, Wu KC, Rade JJ, Bivalacqua TJ, Champion HC. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005 Feb 10;352(6):539-48. doi: 10.1056/NEJMoa043046. PMID: 15703419. Reference #3: Park JH, Kang SJ, Song JK, Kim HK, Lim CM, Kang DH, Koh Y. Left ventricular apical ballooning due to severe physical stress in patients admitted to the medical ICU. Chest. 2005 Jul;128(1):296-302. doi: 10.1378/chest.128.1.296. PMID: 16002949. DISCLOSURES: no disclosure on file for D. Clark Files;No relevant relationships by Nisha Patel No relevant relationships by Meehir Shah

2.
Journal of the American Academy of Dermatology ; 87(3):AB64, 2022.
Article in English | EMBASE | ID: covidwho-2031377

ABSTRACT

Background: Patients with hidradenitis suppurativa (HS) face high psychosocial burden and difficulty in managing their chronic disease. Online support groups and forums are important spaces for patients to share emotional support and management strategies. Objective: To analyze patient-generated online forum posts in Reddit in order to uncover significant HS-related patient concerns and identify HS topics of particular interest to patients. Methods: We collected posts made in the subreddit forum “/r/hidradenitis” between July 1, 2016 to June 30, 2021. Latent derelict allocation (LDA), an unsupervised machine learning model, was applied to split the posts into topics. Keywords for each topic supplied by LDA were used to manually assign topic labels. Results: 61,627 posts by 6948 unique users met inclusion criteria. After applying LDA to the posts, 28 significant topics of conversation emerged that could be organized into 4 major themes: management (56.7%), mental health (20.6%), clinical presentation (13.1%), and logistics (7.6%). The top four topics were support (10.0%), diet (9.5%), wound care (7.3%) and intimate relationships (6.2%). Contemporary topics of interest included biologics (3.5%), COVID-19 (1.2%), and cannabis (1.1%). Limitations: LDA classifies posts into topics based on frequencies of words within the posts without an understanding of the language or context. Conclusions: This LDA-based analysis demonstrated a wide breadth of discussion occurring in an online forum, Reddit, with strong participation. Awareness of popular topics within the HS community can help providers engage with patients and encourage researchers to investigate understudied HS topics that are important to patients.

3.
Journal of Investigative Dermatology ; 142(8):S40, 2022.
Article in English | EMBASE | ID: covidwho-1956215

ABSTRACT

Background: Hidradenitis suppurativa (HS) can severely impact quality of life. However, its specific impact on participation in social activities is not well studied. Objective: To assess HS’s interference with social activities in relation to disease severity. Methods: We recruited patients with a clinical diagnosis of HS (ICD-10 code L73.2) from clinic (n=30) and mail (n=123) to complete a survey. Respondents reported the extent to which HS interfered with social activities (none, a little, a lot). Disease severity was assessed using a validated self-assessment tool. Differences in disease severity were compared to degrees of interference with social activities using Chi-squared analysis. Results: A total of 67 completed responses were received and analyzed. Respondents were 22% Hurley Stage 1, 35% Hurley Stage 2, and 43% Hurley Stage 3 disease severity. Most reported HS interfered with their ability to go out (53%), engage in hobbies (57%), participate in sports or recreational activities (68%), go out socially or to a special event (65%), and go to parties (52%), with no significant differences by Hurley stage (p=0.31-0.68), though going out socially or to a special event (p=0.12) approached significance. Conclusion: Most patients in our cohort, regardless of disease severity, reported HS interfered with their social activities. HS is a physically and socially debilitating disease. Given social distancing policies during the COVID-19 pandemic, HS patients may be even more prone to isolation. Interventions to help HS patients with their social support structure may be helpful in improving their quality of life.

4.
Acta Dermato-Venereologica ; 102(SUPPL 222):27, 2022.
Article in English | EMBASE | ID: covidwho-1917139

ABSTRACT

Purpose: The burden of different dermatoses may vary with ensuing different degrees of sensitivity to stress. Thus, we compared the stress and health-related quality of life (HRQoL) before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and the subsequent societal lockdown. Methods: The study cohort was the Danish Blood Donor Study. Overall, 12,798 participants completed a baseline questionnaire before the pandemic, between June 2018 and December 2019, and a follow-up questionnaire during the pandemic, between May and July of 2020. The classification of dermatoses was based on responses in the baseline questionnaire and hospital diagnoses. Logistic and linear regression determined the association between the dermatoses and the outcomes. Results: Overall, 1,168 (9.1%) participants had hyperhidrosis, 363 (2.8%) hidradenitis suppurativa and 402 (3.1%) psoriasis. At follow-up, hyperhidrosis was associated with a worse mental HRQoL (adjusted coefficient -0.59 [95% confidence interval -1.05, -0.13]) and hidradenitis suppurativa with a worse physical HRQoL (adjusted coefficient -0.74 [95% confidence interval -1.21, -0.27]) independent of the baseline HRQoL. Hyperhidrosis was also associated with moderate-to-severe stress (adjusted odds ratio 1.37 [95% confidence interval 1.13, 1.65]) independent of the baseline stress level. No association with psoriasis was observed. Conclusions: Individuals with hyperhidrosis and hidradenitis suppurativa may have been particularly affected during the SARSCoV- 2 pandemic and the societal lockdown. This indicates that individuals with these dermatoses may be especially susceptible to external stress in general.

5.
British Journal of Haematology ; 197(SUPPL 1):153, 2022.
Article in English | EMBASE | ID: covidwho-1861243

ABSTRACT

We present the case of a 39-year-old female who presented to University Hospitals of Leicester 14 days after the second dose of ChAdOx1 nCov-19 vaccine. Her presenting symptoms included skin rash, nausea, intermittent abdominal pain and occasional episodes of dizziness. Her past medical history included Type 2 Diabetes Mellitus and hidradenitis suppurativa. The first dose of ChAdOx1 nCov-19 vaccine had been administered on 27th February 2021, following which the patient reported flu like symptoms that resolved after four days and did not require further medical input. Following this, a preplanned surgical procedure to incise and drain a vulval abscess was performed on 17th May 2021. Preoperative testing performed on 13th May 2021 showed a normal platelet count of 219 × 10 9 /l. The second dose of ChAdOx1 nCov-19 vaccine was subsequently administered on 23rd May 2021. On presentation, examination revealed mild epigastric tenderness and features of classical thrombocytopenic rash affecting all limbs with no other associated bleeding. Initial blood results confirmed thrombocytopenia of 11 × 10 9 /l, with D-Dimer 14.26 μg/ml and fibrinogen 2.1 g/l. Blood film microscopy revealed an occasional schistocyte and microangiopathic haemolysis was considered. Treatment with plasmapheresis of 1.5 x plasma volume using Octaplas was administered. Subsequent abdominal computed topography imaging identified extensive thrombotic events. This included bilateral pulmonary embolism, superior mesenteric vein non-occlusive thrombus and multiple soft atheromas lining the abdominal aorta causing moderate infrarenal stenosis. In view of the recent history, vaccine associated thrombosis and thrombocytopenia (VITT) was considered. Subsequent testing showed a normal ADAMTS13 level. Treatment for VITT with intravenous immunoglobulin along with oral steroids and anticoagulation using Argatroban was commenced in line with national guidance. Anti-PF4 antibody, tested using the Asserachrom HPIA ELISA assay, was positive at a level of 1.298 OD units confirming the diagnosis of VITT;the first case we are aware of in the UK following second dose administration. Given high-risk presentation, Rituximab therapy was given as an inpatient with good clinical response. Prior to discharge, anticoagulation was switched to oral apixaban with a platelet count on discharge of 170 × 10 9 /l. Subsequent follow-up has shown ongoing clinical remission with consistently negative Anti-PF4 antibody titres. This report outlines the first known definite case of VITT identified following administration of the second dose of ChAdOx1 nCov-19 vaccine in the United Kingdom. The subsequent clinical course was similar to those of patients presenting after their first dose but the atypical presentation mimicking that of Thrombotic Thrombocytopenia is noted..

6.
Journal of Crohn's and Colitis ; 16:i482-i483, 2022.
Article in English | EMBASE | ID: covidwho-1722341

ABSTRACT

Background: Immunomodulators (IMM) and Targeted Immune-Modulating Therapies (TIMT) such as anti-TNF, anti-interleukins and Janus Kinase inhibitors, for treatment of Immune Mediated Inflammatory diseases (IMID) could theoretically interfere with the cytokine storm and humoral immune response against COVID19 infection and vaccination. We investigate seroprevalence and evolution of SARS-CoV2 antibodies in relation to previous vaccination and/or exposure to COVID19 and ongoing IMID-treatment in a Belgian, reallife population of IMID patients. Methods: A cross-disciplinary, prospective, observational cohort study was set up at two university hospitals. All patients with IMIDs of the gut (Crohn's disease, ulcerative colitis), joints (rheumatoid, psoriatic or spondyloarthritis) and skin (psoriasis, hidradenitis suppurativa, atopic dermatitis) visiting the respective clinics were asked to participate. Patients had to fill out an electronic survey (REDCap®, based on WHO-ISARIC) and blood samples were drawn for serology testing (anti-Spike(S) and antiviral Nucleocapsid(N) protein antibody IgG, Abbott). Results at baseline, prior to the national vaccination program and at 6 months follow-up are presented. R version 4.0.2 was used for statistical analyses. Results: At baseline 2165 IMID patients consented to take part. In 3.2% SARS-CoV2 anti-N seroconversion was confirmed. Of the anti-N seroconverted patients 72.9% reported a positive PCR test prior to inclusion. At 6-months follow-up, data of 1853 IMID patients was collected. Of these, 81.7% were fully and 14.4% partially vaccinated. Seroconversion for anti-N antibodies was confirmed in 2.5% of all participants and seroconversion for anti-S antibodies in 90.8%. In 5.1% (61/1483) of fully vaccinated IMID patients no seroconversion in anti-N nor anti-S antibodies was found. Chi Square analyses show, at 6-months follow-up, no significant association between anti-S seroconversion rate and treatment with systemic steroids (RiskRatio 1.22, 95%CI 0.38-3.9, P=0.99), TIMT (RiskRatio 0.57, 95% CI 0.3-1.1, P=0.12), IMM (RiskRatio 1.65, 95% CI 0.85- 3.19, P=0.19) or combination treatment IMM/TIMT (RiskRatio 1.60, 95% CI 0.75-3.4, P=0.32). Appearance of COVID19 symptoms followed the epidemiological curve in Belgium (Fig1). Conclusion: In this real-life IMID cohort, the number of COVID19 cases confirmed by PCR prior to vaccination was low. Seroconversion rate for anti-N antibodies was lower at 6-months follow-up, suggesting decrease in antibody titre over time. Full COVID19 vaccination led to a high anti-S antibody seroconversion rate. Nonetheless, 5.1% of fully vaccinated patients showed no antibody seroconversion. So far, no significant association between anti-S antibody seroconversion and IMID treatment was noted.

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