ABSTRACT
Coronavirus disease-2019 (COVID-19) has become a public health concern and global threat with high morbidity and mortality among kidney transplant recipients. However, risk factors and manifestations in this group of patients remain poorly understood. We aimed to study the clinical characteristics, laboratory parameters, and disease course of kidney transplant recipients with COVID-19 pneumonia. We enrolled 35 kidney transplant patients with COVID-19 pneumonia from March 2020 to November 2020 and studied their clinical records, laboratory results, radiological characteristics, and outcome. Their mean age was 44.82 ± 11.69 years (range: 17-65). The most common symptom was fever (94.28%) followed by cough (54.28%), fatigue (48.57%), shortness of breath (34.28%), and diarrhea/nausea/vomiting (22.85%). Leukopenia was seen in two patients (20.8%), and three patients had leukocytosis, while 75% of the patients had a white cell count in the normal range. Lymphopenia (<1100 per mm3) was seen in 23 patients (79%). All patients had elevated levels of C-reactive protein (CRP) with a range of 6-239.9 mg/L. An increase in serum creatinine from the baseline was seen in 25 patients (71.42%) with a mean of 2.62 mg/dL. Computerized tomography scan of the chest of 30 patients (85.71%) showed typical findings of multifocal ground glass shadows in both lung fields. Injection remdesivir was given in 28 patients (80%), and tocilizumab was given to three patients. Mortality was seen in six patients (17.14%), higher in those with O2 saturation <95% on admission (odds ratio: 6.29). Patients with kidney transplants display a high risk of mortality. The presence of multiple coexisting comorbidities, hypoxia at the time of admission, and high level of inflammatory markers (lactate dehydrogenase, CRP, D-dimer, and ferritin) is predictive of poorer outcomes.
Subject(s)
COVID-19 , Kidney Transplantation , Pneumonia , Adult , COVID-19/diagnosis , COVID-19/epidemiology , Humans , India/epidemiology , Kidney Transplantation/adverse effects , Middle Aged , Pneumonia/etiology , Retrospective Studies , SARS-CoV-2 , Transplant RecipientsABSTRACT
Inflammatory myopathies, including polymyositis (PM), may add risk to electroconvulsive therapy (ECT) due to muscle sensitivity to depolarizing neuromuscular agents. In addition, previously published case series have shown elevations in creatine phosphokinase (CPK), an index of PM disease severity, in patients without muscle disease receiving ECT. We report the case of a 74-year-old female who developed initial onset of depression after steroid treatment for biopsy-proven PM. After she failed to respond to trials of antidepressant medications, she was treated with 21 inpatient and outpatient sessions of ECT over 2 years. Each course of treatment was effective for her depression without worsening symptoms of muscle disease activity. Two previous cases have described the use of ECT in patients with inflammatory myopathies, but our case is the first to report maintenance phase treatment with CPK monitoring.
Subject(s)
Creatine Kinase/blood , Depressive Disorder, Major , Electroconvulsive Therapy/methods , Glucocorticoids/adverse effects , Polymyositis/drug therapy , Prednisone/adverse effects , Aged , Depressive Disorder, Major/blood , Depressive Disorder, Major/chemically induced , Depressive Disorder, Major/therapy , Female , Humans , Polymyositis/bloodABSTRACT
Neuromyelitis optica (NMO) is an aggressive disease characteristically affecting the spinal cord and optic nerves that has recently been differentiated from multiple sclerosis. We present a case of a 16-year-old Antiguan female previously diagnosed with NMO who presented with a 1-week history of confusion and agitation. She had symptoms of psychosis, including delusional thinking and auditory and visual hallucinations, and scored 11/23 on the Bush-Francis Catatonia Scale. This case demonstrates an NMO exacerbation that presented with psychotic symptoms and catatonia.
