Treatment of MDA5-positive dermatomyositis complicated by gangrenous cholecystitis with tofacitinib.

BACKGROUND: Dermatomyositis is a rare idiopathic inflammatory disease with diverse presentations that can have varying degrees of cutaneous and systemic involvement. This phenotypic heterogeneity makes DM a therapeutic challenge. Some therapeutic drugs, such as hormones and immunosuppressants, have poor therapeutic effects. In recent years, tofacitinib has been reported to be effective in the treatment of dermatomyositis. CASE PRESENTATION: We report a case of anti-MDA5 antibody-positive dermatomyositis that was relieved after treatment with tofacitinib, during which gallbladder gangrene and suppurative cholecystitis occurred. After cholecystectomy, we continued to use tofacitinib and achieved a good therapeutic effect. CONCLUSIONS: Tofacitinib is effective in the treatment of anti-MDA5 antibody-positive dermatomyositis, but the risk of infection is increased. It can still be used after infection control. Close follow-up should be performed during the use of tofacitinib.

The SARS-CoV-2 first wave impact in the acute inflammatory surgical pathologies.

Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP-appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. This was a multicentre, comparative study, whereby ASIP cases from 2019, 2020 and 2021 (March 14th to May 2nd) were analyzed. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain). The number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020 and 835 in 2021. This 1/3rd reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. Surgical standards suffered a step back during the first wave: Lower laparoscopic approach and longer length of stay. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances. Luckily these standards improved again in 2021. The positive COVID-19 status itself did not have a direct impact on mortality. Strikingly, none of the 33 surgically treated COVID positive patients during both years died postoperatively. This is an interesting finding which, if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services.

Acute portal vein thrombosis in mild cholecystitis. A consequence of coronavirus disease 2019 infection?

La infección por el virus SARS-CoV-2 provoca, además de cuadros respiratorios graves, episodios trombóticos en múltiples localizaciones debido a una mala regulación de la respuesta inmune. Presentamos el caso de un paciente con colecistitis incipiente que desarrolló trombosis portal aguda sin ningún otro antecedente salvo haber pasado de forma asintomática una infección por COVID-19. Dado que esta complicación es extremadamente infrecuente en pacientes sin factores predisponentes ni infecciones graves, consideramos que la infección por COVID-19 pudo ser un factor desencadenante de la trombosis portal y debemos de tenerlo en cuenta de cara al manejo y tratamiento de futuros casos similares.Severe acute respiratory syndrome coronavirus 2019 infection causes, in addition to severe respiratory symptoms, thrombotic episodes in multiple locations due to dysregulation of the immune response. We present the case of a patient with incipient cholecystitis who developed acute portal thrombosis with no other antecedents except having passed an asymptomatic coronavirus disease 2019 (COVID-19) infection. Since this complication is extremely rare in patients without predisposing factors or serious infections, we consider that COVID-19 infection could be a triggering factor for portal thrombosis and we must take it into account in the management and treatment of future similar cases.