RESUMO
Non-typhoidal salmonella (NTS) is most commonly associated with self-limiting enterocolitis. However, in extremes of age and immune compromised patients, it can cause invasive and disseminated infection, including bacteremia and localized extraintestinal infections. Pneumonia and vertebral osteomyelitis are rare manifestation of NTS, with only a few cases reported worldwide. Our case describes a young man with sickle cell anemia, who developed multifocal invasive NTS infection with pulmonary involvement, vertebral osteomyelitis, and epidural abscess. He was treated with a six-week course of antibiotics and surgical drainage of the abscess. This case report highlights an atypical presentation of NTS infection that is associated with high morbidity and mortality, that can be reduced with early diagnosis and appropriate treatment.
RESUMO
BACKGROUND: Celiac disease, an immune-mediated inflammation of the small intestine, occurs in genetically predisposed individuals, and is caused by sensitivity to dietary gluten and related proteins. The global prevalence is approximately 1%. Celiac disease is frequently associated with extra-intestinal manifestations, including iron deficiency anemia, dermatologic eruptions, type 1 diabetes mellitus, thyroid disease, and connective tissue disorders, but is rarely associated with cardiomyopathy. CASE PRESENTATION: Our case describes a 33-year-old woman, who presented with exertional dyspnea and fatigue, and was diagnosed with severe iron deficiency anemia and dilated cardiomyopathy, secondary to celiac disease. CONCLUSION: High clinical suspicion is needed to identify celiac disease in patients diagnosed with dilated cardiomyopathy, as an improvement in cardiac function has been reported with strict adherence to a gluten-free diet.
RESUMO
SARS-CoV-2 is the cause of COVID-19. Since the outbreak and rapid spread of COVID-19, it has been apparent that the disease is having multi-organ system involvement. Still its effect in the endocrine system is not fully clear and data on cortisol dynamics in patients with COVID-19 are not yet available. SARS-CoV-2 can knock down the host's cortisol stress response. Here we present a case of a 51-year-old man vomiting for 10 days after having confirmed COVID-19 infection. He had hypotension and significant hyponatraemia. Work-up was done including adrenocorticotropic hormone stimulation test. He was diagnosed as suffering from adrenal insufficiency and started on steroids with subsequent improvement in both blood pressure and sodium level. COVID-19 can cause adrenal insufficiency. Clinicians must be vigilant about the possibility of an underlying relative cortisol deficiency in patients with COVID-19.
