Ruptura atraumática del bazo como forma de presentación de la una amilosis AL en un paciente joven / Spontaneous non-traumatic splenic rupture as a presentation form of light chain amyloidosis. Report of one case

We report a 35-year-old sportive man who was admitted to the emergency department for worsening of acute spontaneous abdominal pain appearing at rest. He only referred having lifted a tree trunk the day before, but he was used to perform such physical efforts. The clinical course at the emergency department was marked by the development of severe anemia secondary to a progressive splenic hematoma and acute pulmonary distress. The patient benefited from total splenectomy. Laboratory data showed hypogammaglobulinemia, proteinuria and the anatomopathological examinations of both spleen and kidneys were consistent with light chain amyloidosis.

[Spontaneous non-traumatic splenic rupture as a presentation form of light chain amyloidosis. Report of one case]. / Ruptura atraumática del bazo como forma de presentación de la una amilosis AL en un paciente joven.

We report a 35-year-old sportive man who was admitted to the emergency department for worsening of acute spontaneous abdominal pain appearing at rest. He only referred having lifted a tree trunk the day before, but he was used to perform such physical efforts. The clinical course at the emergency department was marked by the development of severe anemia secondary to a progressive splenic hematoma and acute pulmonary distress. The patient benefited from total splenectomy. Laboratory data showed hypogammaglobulinemia, proteinuria and the anatomopathological examinations of both spleen and kidneys were consistent with light chain amyloidosis.

Cutaneous Complications Secondary to Haemostasis Abnormalities in COVID-19 Infection.

We describe the case of a patient hospitalized for acute decompensated heart failure in a standard medical ward. During hospitalization, he was diagnosed with COVID-19 and transferred to a special unit. The clinical course was marked by worsening of the respiratory disease, the development of right parotiditis and thrombosis of the left internal jugular vein. Therapeutic anticoagulation was initiated and 2 days later, the minimal dermatoporosis lesions previously present in the upper extremities evolved to haemorrhagic bullae with intra-bullae blood clots and dissecting haematomas. Surgical management of the dissecting haematomas was difficult in the context of haemostasis abnormalities. The patient died 29 days after hospital admission. LEARNING POINTS: Single room accommodation should be preferred to double room accommodation in standard wards during the COVID-19 pandemic.Anticoagulation therapy and the presence of lupus anticoagulant may induce cutaneous complications during COVID-19 infection.The discontinuation of anticoagulation therapy did not help improve the management of cutaneous lesions.

Thrombocytopenia in the Course of COVID-19 Infection.

We report three cases of severe thrombocytopenia during COVID-19 infection associated with either cutaneous purpura or mucosal bleeding. The initial investigations ruled out other causes of thrombocytopenia. Two of the patients were treated with intravenous immunoglobulins and eltrombopag, while the third recovered spontaneously. A good clinical and biological response was achieved in all patients leading to hospital discharge. LEARNING POINTS: Immune thrombocytopenia should be considered in COVID-19-infected patients presenting with thrombocytopenia.Coronavirus-related thrombocytopenia can be severe and life-threatening.Despite the severity of coronavirus-related immune thrombocytopenia, recovery may be spontaneous or achieved following immunoglobulin or platelet growth factor administration.

Idiosyncratic Drug-Induced Neutropenia and Agranulocytosis in Elderly Patients.

Agranulocytosis is a rare, but serious and life-threatening hematologic disorder in elderly patients. Idiosyncratic drug-induced agranulocytosis (IDIA) has been classically defined by a neutrophil count below 0.5 × 109/L. The annual incidence of IDIA in Europe is about 1.6-9.2 cases per million inhabitants. Increasing age and female sex have been considered as risk factors for the development of this condition. Besides, it is well known that older people take on average more drugs than younger people. This condition is most often associated with the intake of antibacterial agents, antiplatelets, antithyroids, antipsychotics, antiepileptics and nonsteroidal anti-inflammatory drugs (NSAIDs). Initially, agranulocytosis may present without symptoms, but may quickly progress to a severe infection and sepsis. The causative drug should be immediately stopped. In febrile patients, blood cultures and where indicated, site-specific cultures should be obtained and early treatment with empirical broad-spectrum antibiotics started. Even with adequate treatment, the mortality rate is higher in elderly patients reaching up to 20%. Hematopoietic growth factors have proven to be useful as they shorten the duration of neutropenia. However, data on neutropenia and agranulocytosis in the elderly meeting the criteria of evidence-based medicine are still poor in the literature. This review analyzes the results of our experience as well as other published studies of the universal literature.

Idiopathic CD4+ T-cell Lymphocytopenia: Report of a Case 11 Years after Diagnosis.

We report the case of a 23-year-old woman evaluated for asthenia and lymphocytopenia. Clinical examination was unremarkable but laboratory tests showed the presence of CD4 lymphocytopenia. Secondary causes of CD4 lymphocytopenia were ruled out and a previous diagnosis of idiopathic CD4+ T-cell lymphocytopenia was retained. CD4 lymphocytopenia has persisted for 11 years now but the patient has been clinically asymptomatic. LEARNING POINTS: CD4+ T-cell lymphocytopenia needs to be meticulously evaluated and secondary causes ruled out.The patient has been clinically asymptomatic for 11 years.Measurement of CD4 subsets twice yearly seems to be appropriate.

Anosmia and Dysgeusia in the Absence of Other Respiratory Diseases: Should COVID-19 Infection Be Considered?

We describe two elderly patients evaluated at emergency departments for anosmia/dysgeusia in the absence of any other respiratory symptoms prior to or upon admission. In the current epidemiological context, clinical and biological work-up led to a diagnosis of COVID-19 infection. Unfortunately, one of the patients died during hospitalization, but the other recovered and was discharged. LEARNING POINTS: In the current epidemiological situation, anosmia and dysgeusia in the absence of other respiratory conditions should be carefully evaluated.Special attention should be given to patients with non-classic COVID-19 symptoms in order to reduce transmission and protect health providers.