A case of crescentic glomerulonephritis in a patient with COVID-19 infection: A case report and literature review.

RATIONALE: Kidney involvement with COVID-19 infection is a well-known complication, and the majority of kidney involvement is related to ischemic injury/acute tubular injury. However, there are some cases of glomerulonephritis, the etiology of which is not yet known, but an immune process is likely to be the trigger. PATIENT CONCERNS: A 27-year-old man presented to our hospital with facial puffiness and lower-limb swelling. DIAGNOSIS: Laboratory assessment revealed features of impaired kidney function with proteinuria and hematuria; COVID-19 polymerase chain reaction was positive, which was consistent with pauci-immune crescentic focal segmental glomerulonephritis. INTERVENTION: After renal biopsy, the patient was started on methylprednisolone and rituximab. Due to worsening kidney parameters, he underwent intermittent hemodialysis as needed. OUTCOME: Kidney function tests partially improved; he was discharged on oral steroids with follow-up in the nephrology clinic to observe for the need for further hemodialysis. LESSONS: We conducted a literature review of cases of glomerulonephritis associated with COVID-19 and described numerous types of glomerulonephritis. This report highlights the importance of recognizing emerging glomerulonephritis with COVID-19, the different pathological patterns of renal biopsies, and management interventions and responses.

Rifampicin-Induced Pulmonary Embolism: A Rare Side Effect.

Rifampicin is an established and effective antibiotic and a gold standard in treating tuberculosis (TB). Venous thromboembolism (VTE) events are a rare side effect of rifampicin, which has been reported in a few case reports. The exact mechanism is yet not clear, however, could include immunological and hematological causes. Here, we report a 56-year-old male who presented with pulmonary embolism (PE) three weeks after initiating rifampicin for latent TB management. Comprehensive investigations were done to rule out any other causes of thrombosis, especially malignancy, however, all tests were negative. The patient was treated with anticoagulant agents and rifampicin was switched to isoniazid after rifampicin discontinuation. He remained stable upon discharge and follow-up.

Pulmonary Tuberculosis With Saddle Pulmonary Embolism and Deep Vein Thrombosis: A Rare Case Report.

Pulmonary tuberculosis is a common endemic disease in developing countries but its thrombogenic tendency is not well-studied and established yet. Pulmonary embolism is rarely reported in Mycobacterium tuberculosis infection. There are reports stating the relation of pulmonary embolism (PE) and deep vein thrombosis (DVT) with a severe infection of tuberculosis but no data is available to establish a mutual association between pulmonary tuberculosis and pulmonary thromboembolism. Herein, we report the case of a 51-year-old male who presented with a one-month history of productive cough, shortness of breath, and fever associated with chills and night sweating. He reported an 8 kg weight loss in the last month. He was found to have pulmonary tuberculosis. On further investigations for leg swelling and tachycardia. Deep vein thrombosis and sub-massive saddle bilateral pulmonary embolism were diagnosed, which was treated with thrombolysis therapy (alteplase). He responded well to initial therapy and was discharged on anticoagulation with anti-tuberculous therapy (ATT).

Invasive Klebsiella pneumoniae Syndrome in Qatar: A Case Report.

Klebsiella pneumoniae (K. pneumoniae) is a Gram-negative bacteria that can infect most of the body's organs, from the lungs to the central nervous system. It is notorious for causing pneumonia in alcoholic, diabetic, and hospitalized patients. It is now emerging as a cause of abscesses involving multiple organs. Invasive K. pneumoniae is most commonly observed in the Asian population but has been reported in other geographical areas as well. We present a case of invasive K. pneumoniae. The patient was initially admitted with diabetic ketoacidosis (DKA); further investigations showed multiple abscesses involving the liver, lungs, brain, and muscles. K. pneumoniae was identified in blood and liver abscess cultures. The patient was managed for DKA as per protocol, and was administered broad-spectrum antibiotics with percutaneous drainage of liver abscess for invasive K. pneumoniae syndrome. In this paper, we highlight the invasive nature of K. pneumoniae, which may aid clinicians in diagnosing and managing similar cases, thereby preventing the associated high morbidity and mortality.

Avoidability of drug-induced liver injury (DILI) in an elderly hospital cohort with cases assessed for causality by the updated RUCAM score.

BACKGROUND: Drug-induced liver injury (DILI) represents an increasing morbidity in the general population, but more so in the elderly cohort of patients. Despite this, the concept of its prevention through prospective analysis has largely remained unexamined. We evaluated the utility of recently validated adverse drug reactions (ADR) avoidability tool in a cohort of elderly patients with DILI. METHODS: We examined 38 DILI-drug pairs from n=38 patients in a prospective cohort of patients presenting with adverse drug reactions to a Weill Cornell-affiliated tertiary hospital between February 2019 and January 2020. DILI outcomes were adjudicated by the updated Roussel Uclaf Causality Assessment Method (RUCAM). Two clinical pharmacologists and two general physicians utilized the Liverpool adverse drug reactions avoidability tool (LAAT) and the modified Hallas tools to rate the preventability of DILI-drug pairs. Inter-rater, exact agreement proportions, as well as intraclass correlation coefficients were generated and expressed as ordinal outcomes. RESULTS: The cases examined for the determination of DILI avoidability had probability likelihood of "probable" or "highly probable" by the updated RUCAM scale. Examination of the 38 DILI-drug pairs (n= 38 patients) resulted in a total of 152 ordinal outcome decisions. We found about 32.3% (50/152) and 34.2% (52/152) of DILI-drug pairs were rated as "avoidable" ("probable" or "definite") by the LAAT and the modified Hallas tools respectively. The overall median Krippendorf's kappa with the LAAT was 0.61 (SE 0.12, CI 0.36, 0.85) and for modified Hallas tool was 0.53 (SE 0.18; CI 0.16, 0.89). The inter-rater correlation coefficient (ICC) for the LAAT and modified Hallas were 0.50 [0.32, 0.65] and 0.63 [0.48, 0.76] respectively. Exact pairwise agreement was present in 30/38 (IQR 29.5, 34.5), and 28/38 (IQR 27.5-35.5) of DILI-ADR pairs using the LAAT and modified Hallas tools respectively. CONCLUSION: We found a significant proportion of drug-induced liver injury adjudicated by the updated RUCAM scale in elderly hospitalized cohort of patients were avoidable with significant implication for therapeutic commissioning as well as cost effectiveness interventions in this cohort of patients.