Differential Immune Checkpoint and Ig-like V-Type Receptor Profiles in COVID-19: Associations with Severity and Treatment.

Identifying patients' immune system status has become critical to managing SARS-CoV-2 infection and avoiding the appearance of secondary infections during a hospital stay. Despite the high volume of research, robust severity and outcome markers are still lacking in COVID-19. We recruited 87 COVID-19 patients and analyzed, by unbiased automated software, 356 parameters at baseline emergency department admission including: high depth immune phenotyping and immune checkpoint expression by spectral flow cytometry, cytokines and other soluble molecules in plasma as well as routine clinical variables. We identified 69 baseline alterations in the expression of immune checkpoints, Ig-like V type receptors and other immune population markers associated with severity (O2 requirement). Thirty-four changes in these markers/populations were associated with secondary infection appearance. In addition, through a longitudinal sample collection, we described the changes which take place in the immune system of COVID-19 patients during secondary infections and in response to corticosteroid treatment. Our study provides information about immune checkpoint molecules and other less-studied receptors with Ig-like V-type domains such as CD108, CD226, HVEM (CD270), B7H3 (CD276), B7H5 (VISTA) and GITR (CD357), defining these as novel interesting molecules in severe and corticosteroids-treated acute infections.

Cardiac involvement in Adult Multisystemic Inflammatory Syndrome related to COVID-19. Two case reports.

In this article we describe two cases that presented with persistent fever and a hyperinflammatory state in association with severe acute respiratory syndrome-coronavirus-2 infection with various negative reverse transcription-polymerase chain reaction results. These cases subsequently developed myocarditis with cardiogenic shock that required vasoactive drugs and had a good response to corticosteroid treatment. All cases met criteria for a definitive case of multisystemic inflammatory syndrome in adults, a recently described entity associated with coronavirus disease 2019, which has a good response to immunomodulators and a good prognosis in most cases. .

Autoimmune pancreatitis / Pancreatitis autoinmunitaria

We report the case of a 70-year-old male with chronic abdominal pain, who presented with increased intensity of the pain, and was initially diagnosed and treated for acute biliary pancreatitis. However, the symptoms persisted after hospital discharge, and he was subsequently studied with cholangio-MRI, abdominal CT scan, and ERCP, which revealed dilation of the biliary tract and a mass in the head of the pancreas. An excisional biopsy of the lesion showed chronic inflammation with severe sclerosing fibrosis and a lymphoplasmacytic infiltrate. A diagnosis of autoimmune pancreatitis was made, and the patient was initiated on azathioprine with good clinical response.

Presentamos el caso de un varón de 70 años con dolor abdominal crónico, que se presenta con aumento de este; se le diagnostica y se lo trata inicialmente como cuadro de pancreatitis biliar. A pesar del manejo inicial, los síntomas persisten después de la primera hospitalización, y se estudia con tomografía computarizada de abdomen, colangiorresonancia y colangiopancreatografía retrograda endoscópica, estudios en los cuales se detecta dilatación de la vía biliar y masa en la cabeza del páncreas. Se llevó a cabo biopsia excisional, que demuestra inflamación crónica con intensa fibrosis e infiltrado linfocitario. Se hace diagnóstico de pancreatitis autoimmunitaria y se inicia azatioprina, con adecuada respuesta.

Histoplasma capsulatum en paciente con dermatopolimiositis / Histoplasma capsulatum in patient with dermatopolymiosytis

Se presenta el caso de una paciente de 67 años, natural y procedente de Santa Ana (Boyacá), con dermatopolimiositis, en la ciudad de Tunja (Boyacá, Colombia), con inmunosupresores, Prednisolona, Metotrexate. A los tres meses del diagnóstico presenta un cuadro infeccioso pulmonar catalogado como neumonía necrotizante de lóbulo superior derecho, la cual progresivamente lleva a la paciente a falla ventilatoria hipercápnica y sepsis de origen pulmonar. Se realiza lavado bronco-alveolar demostrando la presencia de Histoplasma capsulatum; de manera posterior la paciente desarrolla shock cardiogénico y fallece.

We present a case of a 67 years old woman with dermatopolymiosytis that after initiated the inmunosupresor treatment develops a necrotizing pneumonia. Histoplasma capsulatum was identified. She received antimycotic treatment but then after develops cardiogenic shock and die.