COVID-19-Associated Nephropathy: A Devastating Complication.

With the rapid emergence and prevalence of SARS-CoV-2 worldwide, cases of COVID-19-associated nephropathy (COVAN) from collapsing focal segmental glomerulosclerosis (cFSGS) have been reported, and the associations between the two are actively being studied. Creating appropriate treatment guidelines for COVAN requires further understanding of the pathophysiology of this type of kidney injury. This case report outlines the case of a 77-year-old patient admitted to the hospital for COVID-19 infection with a subsequent renal biopsy indicating cFSGS, adding to the data exploring the relationship between COVID-19 infections, cFSGS and the associated risk factors. Current guidelines on the treatment of COVAN are similar to those of other causes of cFSGS but continue to have poor outcomes and resistance to treatments. Further research needs to be done on both the clinical assessment and pathophysiology of COVAN to provide timely and life-saving interventions.

Methotrexate-Induced Lymphoproliferative Disorder Complicating Into Spontaneous Tumor Lysis Syndrome and Disseminated Intravascular Coagulation.

Lymphoproliferative disorder (LPD) is a severe adverse outcome of methotrexate (MTX) administration in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). The immunosuppression caused is attributed to pathogenesis. Hence, discontinuation is the treatment. Reports on spontaneous tumor lysis with cessation of MTX are rare. We report a case of a female in her 50s with methotrexate-associated lymphoproliferative disease (MTX-LPD) following treatment for rheumatoid arthritis. Methotrexate was discontinued immediately. She presented two months later with severe disseminated intravascular coagulation (DIC) and spontaneous tumor lysis syndrome (STLS). Although tumor lysis syndrome responded well to rasburicase therapy, DIC was a challenge. MTX-LPD has various complications and highly variable presentation. RA/SLE patients receiving MTX should be regularly monitored, and MTX should be immediately stopped in suspicion of MTX-LPD. Although many patients respond to MTX cessation, some patients head to remission and relapse. At the same time, some worsen with complications such as DIC and tumor lysis syndrome, as described above. This case reiterates the need for regular monitoring following MTX therapy cessation for early identification and treatment of these complications to improve prognosis.

Constipation in transverse myelitis.

Transverse myelitis is an extremely rare neuroinflammatory disorder. About half of the affected patients develop paraplegia associated with urinary and bowel dysfunction. The bowel dysfunction is thought to be benign and is usually managed with dietary management and laxatives. We report a case of a man in his 60s presenting with transverse myelitis and the acute disease course complicated with treatment refractory intestinal dysfunction resulting in intestinal perforation, eventually leading to his death. Thus, this case helps us weigh the fact that intestinal dysfunction in the case of transverse myelitis is not always benign but can lead to deadly outcomes as well.