Catastrophic Antiphospholipid Syndrome as a Complication of COVID-19 Infection.

COVID-19 infection has been found to precipitate hypercoagulability and transiently increase antiphospholipid antibodies. However, it is yet to be determined how likely these transient changes contribute to thrombotic events and antiphospholipid syndrome. We present a case in which antiphospholipid antibodies were detected in the presence of significant thromboses. The patient was subsequently treated for suspected catastrophic antiphospholipid syndrome following COVID-19 infection.

T-Cell Large Granular Lymphocyte Leukemia in a Patient With Rheumatoid Arthritis.

Large granular lymphocyte leukemia (LGL) is a clonal, lymphoproliferative disorder with an indolent disease course. T-cell LGL (T-LGL) is the most common type of LGL driven from T-cell lineage (85%). The coexistence of T-LGL with several types of autoimmune disorders, mostly rheumatoid arthritis (RA), has been reported. Felty's syndrome (FS) is defined by splenomegaly, low neutrophil count, and destructive arthritis and is usually seen in <1% of patients with RA. About 30% to 40% of patients with FS have been reported to have an expansion of large granulated lymphocytes in the circulation. FS and T-LGL are similar in terms of clinical manifestations, response to immunosuppressive therapy, their smoldering course, and immunogenetic findings, proposing FS and T-LGL with RA might be different aspects of a single disease spectrum. In this article, we present a case with long-standing RA who had never been on DMARD (Disease Modifying Anti-Rheumatic Drugs) treatment found to have constitutional symptoms, neutropenia, and splenomegaly, and the patient was diagnosed with T-LGL.

A Case of Aortic Dissection Presenting with Atypical Symptoms and Diagnosed with Transthoracic Echocardiography.

We present a case of an extensive aortic dissection (AD) identified in a woman with atypical symptoms. Transthoracic echocardiography (TTE) allowed the identification of an intimal flap in multiple locations and resulted in rapid diagnosis and treatment. In most cases, CT angiography is the imaging modality of choice for diagnosis of AD. TTE is rapid and accurate and can be used in kidney failure. Our case highlights the important role of bedside echocardiography in the diagnosis of AD, especially in the patient with a typical symptoms in whom this diagnosis of AD may not be entertained and actually missed leading to negative and possibly deadly consequences.

Correlation Between Subclinical Hypothyroidism and Dyslipidemia.

BACKGROUND & OBJECTIVE: Thyroid hormones have an important role in the regulation of lipid metabolism. Subclinical hypothyroidism (SCH), defined as a mild increase in thyroid-stimulating hormone (TSH) and normal level of thyroxine (T4), could be associated with altered lipid profile. The current study aimed at assessing the association between SCH and changes in lipid profile. METHODS: Data of 53 patients with SCH and 53 euthyroid cases were collected from Besat Hospital in Hamadan, Iran, in 2013. The age range of the cases was 18 to 60 years, and the groups were matched in terms of gender, age, and body mass index (BMI). SCH was defined as a TSH value of 4.2 to 10 mU/L, and normal T4 as 0.8 to 2.8 ng/dL. Control cases had a normal TSH ranging from 0.5 to 4.2 mU/L. The total serum cholesterol (TCHOL), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride (TG) levels in both groups were examined and the results were recorded. RESULTS: Participants with SCH had significantly higher LDL and lower HDL levels than the control group regardless of age group and gender (P-value <0.001), but there was no difference in TG and TCHOL levels (P-value <0.05). The prevalence of dyslipidemia and SCH was only significant in females (P-value =0.009). Totally, there was significant correlation between the prevalence of dyslipidemia and SCH regardless of gender (P-value =0.04). CONCLUSION: SCH is associated with dyslipidemia, and biochemical screening for thyroid dysfunction is recommended in all patients with dyslipidemia.