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Background: Hypertriglyceridemia is a medical condition defined as fasting triglyceride level more than 150 mg/dl. It could be due to either familial or acquired cause as in obesity, metabolic syndrome, diabetes mellitus type 2, alcohol consumption, decrease exercise or drug affects. Drugs such as corticosteroids rarely induced hypertriglyceridemia, for that we are reporting this case. Case presentation: We are reporting a 35 years old pregnant lady diagnosed with immune thrombocytopenia and started on prednisolone 1mg/kg per oral once a day. Two months later, while on 20 mg of prednisolone, she presented to the emergency department with epigastric pain, nausea and vomiting for 15 days. Physical examination showed dry mucosa, new xanthelasma over both eyelids and epigastric tenderness with palpable suprapubic gravida uterus; otherwise, was unremarkable. Blood samples were highly lipemic, and laboratory investigations showed high triglycerides (TG) of greater than 73 mmol/L, mild diabetic keto acidosis with normal other chemistry including hepatic, renal, and pancreatic panel. She was treated by diet restriction, insulin infusion, Fenofibrate, and Omega 3 as well as rapid tapering down of prednisolone. Conclusion: Corticosteroid-induced hypertriglyceridemia is an uncommon condition and could be fatal, especially in high-risk cases. Unfortunately, no guidelines support a regular screening for lipid profile prior to initiating steroid therapy. However, we are suggesting a further study and creating a recommendation to mandate screening for lipid profile along with fasting blood sugar prior to initiating steroid therapy, especially in high-risk cases as in pregnancy.
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BACKGROUND: Sickle cell disease (SCD) is a group of hereditary diseases, inherited as autosomal recessive disorder, which causes mutation in the ß-globin gene. As a result, there is a change in the sixth amino acid from glutamic acid to valine. The affected red blood cell is then prone to polymerization and sickling crisis under conditions of low oxygen tension. One of the major causes of mortality in SCD is acute chest syndrome (ACS). On the other hand, coronavirus disease 2019 (COVID-19) is a pandemic disease that carries significant mortality and morbidity worldwide with unknown outcomes in the affected SCD population. This study was created for that reason. MATERIALS AND METHODS: We report a case series of ten SCD patients who were affected by COVID-19 and required admission between May 1, 2020, and October 30, 2020, at a tertiary care hospital in Dhahran, eastern region of Saudi Arabia. Historical data were obtained retrospectively from electronic records. MS Excel was used for data entry, and SPSS version 23 was used for data analysis. RESULTS: The mean age of the patients involved in the study was 32 years, and the mean duration of symptoms was 5.7 days. None required critical care admission, and there was no mortality. All patients were discharged from hospital in good condition with no requirement of home oxygen. CONCLUSION: Although we expected a fatal outcome of SCD patients affected by COVID-19 infection, our limited case series showed favorable disease behavior and outcome, with a suspicion of underlying unclear protective mechanism from serious complications. However, further studies are required to better understand COVID-19 behavior in SCD patients.
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Chronic neutrophilic leukaemia is a very rare disease with diagnosis based on persistent leucocytosis >25×103/µl and monocytes <1×103/µl. The revised WHO criteria 2016 included CSF3R gene mutations as a diagnostic finding. We report the case of a 77-year-old man who was found to have asymptomatic persistent mature neutrophilic leucocytosis with monocytosis. Molecular study confirmed the presence of a CSF3R gene mutation in the absence of morphological or genetic features of myelodysplasia or other forms of myelodysplastic syndrome. The patient's medical history was significant for coronary artery disease, hypertension, chronic obstructive pulmonary disease, bilateral cystic bronchiectasis, moderate pulmonary hypertension, tuberculosis treated 27 years previously, hypothyroidism, and a thyroid nodule. He had hepatosplenomegaly but no lymphadenopathy, and no other malignancy was seen on computed tomography (CT) scanning. At the time of evaluation, he was free of symptoms and had no evidence of infection or drug-induced leucocytosis. The patient was referred to an oncology centre and treated with hydroxyurea and subsequently azacitidine. However, he developed pancytopenia with bone marrow aplasia. He died with neutropenia sepsis. The presence of persistent monocytosis in this case created a diagnostic dilemma as to whether the disease was a variant of chronic neutrophilic leukaemia or was reactive monocytosis. LEARNING POINTS: The presence of a CSF3R gene mutation is diagnostic for chronic neutrophilic leukaemia (CNL).The monocytosis in this patient might have been a new variant of CNL.
