Unusual source of recurrent Corynebacterium bacteraemia in an immunocompromised patient.

We describe a unique case of a patient with acute myeloid leukaemia (AML), with recurring infections during chemotherapy from chronic nasal carriage of non-diphtherial Corynebacterium, who was eventually diagnosed as she presented with neutropaenic sepsis. Identifying (often multiple) sources of infection in immunocompromised patients is crucial but deciding whether multiple organisms, which in health are considered as commensals, are actually pathogenic during vulnerable states-can be clinically difficult. Our case highlights the efforts to correctly identify the actual source of this rare organism and the recognition of its pathogenic potential when other illnesses present. We also review the literature of Corynebacteria in patients with haematological malignancies but believe this is the first case of AML to be infected with Corynebacterium presenting during the COVID-19 pandemic with a probable incidental positive swab for SARS-CoV-2.

Longitudinal changes in IgG levels among COVID-19 recovered patients: A prospective cohort study.

OBJECTIVES: To quantify SARS-CoV2 IgG antibody titers over time and assess the longevity of the immune response in a multi-ethnic population setting. SETTING: This prospective study was conducted in a tertiary hospital in Abu Dhabi city, UAE, among COVID-19 confirmed patients. The virus-specific IgG were measured quantitatively in serum samples from the patients during three visits over a period of 6 months. Serum IgG levels ≥15 AU/ml was used to define a positive response. PARTICIPANTS: 113 patients were analyzed at first visit, with a mean (SD) age of participants of 45.9 (11.8) years 87.5% of the patients were men. 63 and 27 participants had data available for visits 2 and 3, respectively. PRIMARY OUTCOME: Change in SARS-CoV2 IgG antibody titers over the visits. RESULTS: No mortality or re-infection were reported. 69% of the patients developed positive IgG response within the first month after the onset of symptoms. The levels of IgG showed a consistent increase during the first three months with a peak level during the third month. Increasing trend in the levels of IgG were observed in 82.5%, 55.6% and 70.4% of patients between visit 1 to visit 2, visit 2 to visit 3, and from visit 1 to visit 3, respectively. Furthermore, about 64.3% of the patients showed sustained increase in IgG response for more than 120 days. CONCLUSIONS: Our study indicates a sustained and prolonged positive immune response in COVID-19 recovered patients. The consistent rise in antibody and positive levels of IgG titers within the first 5 months suggest that immunization is possible, and the chances of reinfection minimal.

Perinephric Hematoma Induced by Factor Xa Inhibitor in a Patient with a Vascular Renal Mass.

Perinephric hematomas are known to present in the form of Lenk's triad with acute flank pain, flank mass and hypovolemic shock. Here, we describe a case of perinephric hematoma occurring secondary to the use of anticoagulant therapy in the setting of a renal mass. To the best of our knowledge, this is the first reported case of a perinephric hematoma occurring secondary to the use of Apixaban. The patient was an 80 year old male with a history of the presence of a left sided vascular renal mass discovered seven years ago admitted from a peripheral health center with pneumonia and a dropping hemoglobin along with acute kidney injury. Evaluation of his course revealed the use of a Factor Xa inhibitor, namely Apixaban, for new onset atrial fibrillation. The patient was stabilized with multiple units of packed red blood cell transfusions. An abdominal computed tomography abdomen demonstrated a perinephric hematoma contained in the Gerotas fascia. Due to deranged renal function, the patient was managed conservatively and made a full recovery. This case highlights the challenges associated with the diagnosis of perinephric bleeds. The use of anticoagulation therapy in the setting of a pre-existing vascular lesion remains a dilemma.

A Novel Mutation of PARK-2 Gene in a Patient with Early-onset Parkinson's Disease.

Between 3-5% of all patients with Parkinson's disease (PD) have onset before the age of 40 years, which is likely related to genetic causes. Parkin gene mutations are the most common mutations, which are associated with autosomal recessive early-onset PD. A 34-year-old Emirati female presented with complaints of limb and speech tremor. She had been having difficulties in initiating movement and speech during her job. These problems began two years ago and had become progressively worsened. Her medical history was significant for generalized seizures for the past three years, which was well controlled with prescription medications. She was unaware of any family members with Parkinson's or any genetic disorders. Her examination revealed a reduction in eyelid blinking movement and hypomimia facial appearance. She had severe bilateral upper and lower extremity rigidity, which was more evident on her right side. While resting, the patient exhibited bilateral pin-rolling tremors in both of her upper extremities. Her gait was shuffling in nature with reduced arm swing and abnormal retropulsion. All of her laboratory investigations were normal. Genetic analysis revealed a homozygous 1 base pair insertion in exon 5 of PARK2 gene (c.601_602insA), resulting in a nonsense mutation causing a stop codon instead of a cysteine codon (p. Cys201X). The patient showed an excellent response to treatment. We described a case of early-onset PD in a female, who on genetic analysis, was found to have a previously undescribed homozygous mutation in the PARK2 gene.

Cerebral Venous Sinus Thrombosis in a Patient with Meningococcal Meningitis.

Meningococcal meningitis has a wide range of neurological complications. However, cerebral venous sinus thrombosis (CVST) following infection with Neisseria meningitidis is uncommon. We report a case of CVST in a 42-year-old male admitted with meningococcal meningitis. The patient was managed with antibiotics. Due to altered coagulation parameters observed in fulminant cases of meningococcemia, deployment of anticoagulation therapy, which would otherwise be the treatment of choice for CVST, is a dilemma.