STEMI in a patient with recent intracranial hemorrhage.

A 63-year-old male patient with a history of hypertension presented to the emergency department with a one-day history of dizziness, nausea, and vomiting.

Outcomes associated with SARS-CoV-2 reinfection in individuals with natural and hybrid immunity.

BACKGROUND: Studies comparing SARS-CoV-2 reinfection outcomes among individuals with previous infection (natural immunity) and previous infection plus vaccination (hybrid immunity) are limited. METHODS: Retrospective cohort study comparing SARS-CoV-2 reinfection among patients with hybrid immunity (cases) and natural immunity (controls) from March 2020 to February 2022. Reinfection was defined as positive PCR> 90 days after initial laboratory-confirmed SARS-CoV-2 infection. Outcomes included time to reinfection, symptom severity, COVID-19-related hospitalization, critical COVID-19 illness (need for intensive care unit, invasive mechanical ventilation, or death), length of stay (LOS). RESULTS: A total of 773 (42%) vaccinated and 1073 (58%) unvaccinated patients with reinfection were included. Most patients (62.7%) were asymptomatic. Median time to reinfection was longer with hybrid immunity (391 [311-440] vs 294 [229-406] days, p < 0.001). Cases were less likely to be symptomatic (34.1% vs 39.6%, p = 0.001) or develop critical COVID-19 (2.3% vs 4.3%, p = 0.023). However, there was no significant difference in rates of COVID-19-related hospitalization (2.6% vs 3.8%, p = 0.142) or LOS (5 [2-9] vs 5 [3-10] days, p = 0.446). Boosted patients had longer time to reinfection (439 [IQR 372-467] vs 324 [IQR 256-414] days, p < 0.001) and were less likely to be symptomatic (26.8% vs 38%, p = 0.002) compared to unboosted patients. Rates of hospitalization, progression to critical illness and LOS were not significantly different between the two groups. CONCLUSIONS: Natural and hybrid immunity provided protection against SARS-CoV-2 reinfection and hospitalization. However, hybrid immunity conferred stronger protection against symptomatic disease and progression to critical illness and was associated with longer time to reinfection. The stronger protection conferred by hybrid immunity against severe outcomes due to COVID-19 should be emphasized with the public to further the vaccination effort, especially in high-risk individuals.

Infliximab-Induced Lupus in a Patient With Psoriatic Arthritis Who Presented With Cardiac Tamponade: A Case Report.

Psoriatic arthritis (PsA) is a chronic, immune-mediated inflammatory condition, and the proinflammatory cytokine tumor necrosis factor-α (TNF-α) plays a major pathogenic role in the development and progression of PsA. Anti-TNF-α therapies, such as the monoclonal antibody infliximab, are used to treat patients whose PsA has not responded favorably to conventional anti-rheumatic drugs. However, exposure to anti-TNF-α therapeutics can lead to drug-induced lupus erythematosus (DILE), which may rarely be accompanied by cardiac manifestations. Here, we describe a rare case of drug-induced lupus erythematosus secondary to infliximab therapy for PsA and psoriasis in a patient who presented with life-threatening acute pericarditis and cardiac tamponade. Newly developed skin rashes, newly elevated autoimmune indicators, and punch biopsy results indicating subacute cutaneous lupus collectively supported a DILE diagnosis within the context of infliximab use. Pericardiocentesis, colchicine, and corticosteroids alleviated symptoms, and infliximab was replaced with alternate therapy. This case highlights the importance of early recognition of the possible serious and uncommon adverse reactions from infliximab therapy. Prompt initiation of appropriate treatment and discontinuation of the offending agent are critical in cases of drug-induced lupus erythematosus, particularly when rare cardiac complications occur.