ABSTRACT
Basal cell carcinoma (BCC) is the most common cutaneous malignancy in the world, and the incidence of pulmonary metastasis is exceedingly rare. We present a case of middle-aged male with findings consistent with BCC with metastasis to the lungs managed with surgical resection and the use of targeted therapy using the hedgehog pathway inhibitor with improvement.
ABSTRACT
Introduction. Legionella is a frequent cause of bacterial pneumonia in patients with AIDS. While multiple organisms have been associated with cavitary pneumonia in this population, Legionella has not. Clinical Case. A middle-aged woman with HIV-AIDS and severely depressed CD-4 count presented with one month of progressively worsening productive cough and dyspnea. Serial imaging showed focal consolidations which multiplied and cavitated over the subsequent days. Legionella urine antigen was positive, and appropriate treatment was continued for 3 weeks total. The patient recovered quickly, and follow-up imaging 8 weeks later showed near-resolution of all lesions. Discussion. Cavitary pneumonia secondary to Legionella has been seldom described, traditionally in the context of immunosuppressive therapy. Patients with AIDS and severely depressed CD4 counts have significantly compromised cell-mediated immunity. This case highlights the importance of consideration for legionellosis in rapidly progressing cavitary pneumonia, especially in patients with severely compromised cell-mediated immunity, including those with HIV-AIDS.
ABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) has affected millions of people worldwide, and considerable effort is focused on identifying certain populations at increased risk. ABO blood types have been associated with disease susceptibility; however, evidence remains limited. Our aim was to determine the association between ABO/Rh blood type with disease susceptibility and mortality among admitted COVID-19 patients. METHODS: A retrospective analysis of patients with COVID-19 requiring admission was undertaken. Demographics and pertinent medical history were analyzed with respect to ABO/Rh blood type: between the cases and a control population; as well as with respect to mortality in the COVID-19 population in univariate analysis. Potential confounding factors were evaluated by multivariate models. The main outcomes were disease susceptibility by comparison of blood type prevalence between populations, and mortality within the COVID-19 population. RESULTS: A total of 825 cases (admitted with confirmed COVID-19 infection by reverse transcriptase-polymerase chain reaction (RT-PCR)) and 396 controls (seen at the same institution during the calendar year of 2019) were included. The COVID-19 population was older with male predominance. It was heavily represented by blood types O-positive (53%) and A-positive (23%), while lower representation was observed in groups B-positive (odds ratio (OR): 0.61, P = 0.013) and AB-positive (OR: 0.46, P = 0.014). Neither relationship remained significant in pairwise analysis. Within the COVID-19 population, no mortality difference was appreciated between ABO groups (P = 0.312), but higher mortality was observed in Rh negative group (P = 0.01). The latter of which was significantly confounded by age (P < 0.001), sex (P = 0.022), body mass index (BMI) (P = 0.001), and hemoglobin A1c (HbA1c) (P < 0.001) in multivariate analysis. CONCLUSIONS: While type A blood appears to be weakly more prevalent with respect to B and AB types in hospitalized patients, strong confounders of age and sex dilute this significance. Rh-negative patients appear to have a higher mortality, although this too is strongly confounded. Overall, ABO and Rh blood types do not have a significant relationship with susceptibility and mortality with COVID-19 infection in our population.
ABSTRACT
Acutely decompensated dilated cardiomyopathy in a middle-aged patient without the typical risk factor profile presents a clinical dilemma. While cardiomyopathy is a known aspect of systemic lupus erythematosus (SLE), initial clinical presentation as decompensated dilated cardiomyopathy (DCM) is exceedingly rare in the literature. We share the case of a 49-year-old African-American female with no past medical history who presented with overt heart failure of 4 weeks evolution. Workup showed acute onset decompensated dilated cardiomyopathy, with a serologic profile compatible with SLE. She responded well to immunosuppressive steroid therapy. Literature review for SLE presenting as dilated cardiomyopathy with acute heart failure revealed a paucity of clinical evidence and consensus. Therefore, a comprehensive review of case reports was undertaken. A total of 10 cases were identified. Patients were 90% female and averaged 31 years of age. Dyspnea was the most common clinical presentation, and dilated cardiomyopathy with severely compromised left ventricular function was universally appreciated. Clinical presentation to diagnosis averaged 2 weeks. Immunosuppressive therapy regimens were universally employed; however, the regimens varied significantly. High-dose steroid therapy was most commonly used, and clinical and functional recovery was reported in 90% of individual case reports. Within the limited evidence and experience of therapeutic approaches, the efficacy of different singular or combined therapy is based solely on anecdotal case reports. Given the near-complete response to a short course of high-dose steroid therapy as much in the clinical recovery as in the resolution of DCM, the limited evidence based on review of these observational case studies and series supports the initial use of high-dose steroid therapy in acute lupus myocarditis.
ABSTRACT
Legionella pneumophilia is a multi-systemic disease primarily affecting the pulmonary, gastrointestinal, and to a lesser extent, renal systems. We present a case of Legionella pneumonia, which after resolution of respiratory compromise, was complicated by the development of autoimmune hemolytic anemia (AIHA) as determined by a positive Coombs test, and negative workup of other causes. Steroid immunosuppression was initiated, and red cell counts subsequently improved. While AIHA has only been anecdotally described in one prior case, the separation in time of the development and resolution of respiratory symptoms with the development of anemia most likely makes this an under-appreciated entity. An in vitro mechanism has been suggested; however in vivo causation has yet to be proven. Given the prolonged deleterious clinical consequences associated with the development of AIHA and the increase in recognition of Legionella outbreaks, greater recognition of this potential complication and research into the pathophysiology is warranted for the future.
ABSTRACT
Chagas cardiomyopathy (CCM) is traditionally considered a disease restricted to areas of endemicity. However, an estimated 300,000 people living in the United States today have CCM, of which its majority is undiagnosed. We present a case of CCM acquired in an endemic area and detected in its early stage. A 42-year-old El Salvadoran woman presented with recurrent chest pain and syncopal episodes. Significant family history includes a sister in El Salvador who also began suffering similar episodes. Physical exam and ancillary studies were only remarkable for sinus bradycardia. The patient was diagnosed with symptomatic sinus bradycardia and a pacemaker was placed. During her hospital course, Chagas serology was ordered given the epidemiological context from which she came. With no other identifiable cause, CCM was the suspected etiology. This case highlights the underrecognized presence of Chagas in the United States and the economic and public health importance of its consideration in the etiological differential diagnosis of electrocardiographic changes among Latin American immigrants. While the United States is not considered an endemic area for Chagas disease, the influx of Latin American immigrants has created a new challenge to identify at-risk populations, diagnose suspected cases, and provide adequate treatment for this disease.
