Parálisis de Bell y enfermedad por Coronavirus 2019: dos casos y revisión de la literatura / Bell’s palsy and Coronavirus disease 2019: two cases and literature review

Since the first description of the new Coronavirus disease 19 (COVID 19), the number of associated manifestations described in literature haveincrease exponentially. The spread of virus to extrapulmonary tissues, especially to central and peripheral nervous system, concerns the physiciansand suspicious of disease even in the absence of respiratory symptoms had a major impact preventing it’s spread. The authors report two cases ofBell’s palsy in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), describing the clinical manifestations, evolutionand treatments. Both patients had a mild course of COVID 19, without respiratory symptoms reported and complete resolution of facial palsy. Theauthors postulate an association between isolated facial palsy and SARS-CoV-2 infection reviewing the reported cases in literature and the mechanism of neuroinvasion. The authors highlights the importance of suspecting SARS-CoV-2 infection when a patient presents with isolated facial palsy.(AU)

Severe Acute Liver Injury Related to Heat Stroke.

Heat stroke (HS) is a life-threatening condition characterized by hyperthermia and multiple organ failure. Mild to moderate hepatocellular injury is a well-documented complication but severe liver injury and acute liver failure are rare. There are neither established criteria nor optimal timing for liver transplantation and conservative management seems to be the cornerstone treatment. The authors report a case of a patient with severe liver injury related to HS who recovered completely under conservative treatment. LEARNING POINTS: Hyperthermia, neurologic dysfunction and recent exposure to hot weather or physical exertion should raise the suspicion of heat stroke (HS).Fast and effective cooling is the cornerstone of treatment, along with support of organ dysfunction. Antipyretics have no role in HS management.Conservative treatment has been described as being successful in the management of patients with HS that manifest severe acute liver injury (ALI) and acute liver failure (ALF). However, early referral to a liver transplantation centre is essential to guide treatment.

Cardiopulmonary Resuscitation Induced Consciousness A Case Report in an Elderly Patient.

Cardiopulmonary resuscitation-induced consciousness is a rarely described and often misunderstood phenomenon, although it can be encountered. High quality cardiopulmonary resuscitation (CPR) may lead a patient to recover consciousness while in cardiac arrest. The authors present the case of an 89-year-old male patient who received CPR after a cardiac arrest. Spontaneous movements during CPR were noted and prompted several CPR interruptions. These movements immediately stopped during chest compression pauses. Physical restraint was used in order to be able to continue with the CPR algorithm, but sedation may be the best approach. Guidelines on how to identify and manage these cases need to be developed. LEARNING POINTS: Although rare, cardiopulmonary resuscitation-induced consciousness is a phenomenon that physicians should be aware of, given the implications it may have during resuscitation manoeuvres.Cardiopulmonary resuscitation-induced consciousness can readily be recognised by the presence during cardiac arrest of spontaneous and purposeful patient movements that immediately cease after stopping chest compressions.The use of sedative and analgesic drugs such as ketamine may be the best choice to manage cardiopulmonary resuscitation-induced consciousness, as an alternative to physical restraint.

An Acute Blue Finger: A Case of Achenbach's Syndrome.

Achenbach's syndrome, also known as paroxysmal finger haematoma, is a rare condition that results in spontaneous bruising and pain in one or more fingers. Despite its benign and self-limiting course, the remarkable clinical presentation can suggest serious vascular and haematological disease leading to unnecessary referrals and invasive investigations. The authors present the case of a 60-year-old woman with an acute painful and bruised finger. All other physical findings and investigations were normal, except for autoimmune thyroiditis. Based on the clinical presentation and course, the diagnosis of Achenbach's syndrome was made and the symptoms resolved without treatment. LEARNING POINTS: Achenbach's syndrome is a rare and benign condition characterized by recurrent episodes of sudden pain, bruising and swelling of one or more fingers.It is a self-limiting condition and the diagnosis is essentially based on history and clinical examination.It is important to recognize this rare syndrome in order to address patient concerns and avoid unnecessary referrals or invasive investigations.

Mycoplasma pneumoniae-associated Mucositis: A Recently Described Entity.

Mycoplasma pneumoniae (MP) is a common cause of respiratory infections and can be associated with extrapulmonary complications. MP mucositis has recently been described as a distinct endemic clinical entity called Mycoplasma pneumoniae-induced rash and mucositis (MIRM). The authors present the case of a 46-year-old man with atypical pneumonia associated with exuberant mucositis, conjunctival hyperaemia and positive serological assays for MP IgM. The patient was treated with azithromycin and systemic corticosteroid therapy. Supportive care including pain management, intravenous hydration and mucosal care was also given. There was complete resolution of the pneumonia and mucositis. The presence of atypical pneumonia with mucosal involvement without cutaneous lesions and a favourable clinical evolution led to the diagnosis of MIRM. LEARNING POINTS: Mycoplasma pneumoniae infection can be associated with mucocutaneous lesions. A new entity called Mycoplasma pneumoniae-induced rash and mucositis (MIRM) has been recently described. The mucocutaneous involvement associated with MIRM is predominantly mucositis with scarce or absent cutaneous expression.The clinical presentation, pathophysiology and disease outcomes of MIRM distinguish it from Stevens-Johnson syndrome/toxic epidermal necrolysis and erythema multiform.MIRM has an overall favourable prognosis as the majority of patients recover without sequalae and recurrence is rare.