Journal of Community Hospital Internal Medicine Perspectives最新文献

In this case series, we explore persistent SARS-CoV-2 infection and its resultant pneumonitis within a cohort of immunocompromised patients. We elucidate the complex interplay between immunosuppression and COVID-19 by examining four patients who experienced prolonged viral shedding and recurrent respiratory failure due to their compromised immune systems. This series elucidates the clinical presentation, diagnostic challenges, and therapeutic strategies. We also summarize existing literature regarding persistent SARS-CoV-2 infection in immunocompromised individuals. Our findings support the use of a tailored treatment approach using a proposed diagnostic and management algorithm to standardize care and optimize outcomes.

The Hypothalamus-Pituitary axis (HPA) is a rare location for metastasis of non-Hodgkin's lymphoma. Lymphomas constitute less than 0.5% of reported HPA metastasis. This case is unique in that, in addition to the noted panhypopituitarism; initial diagnostics demonstrated marked hyponatremia, consistent with syndrome of inappropriate antidiuretic hormone (SIADH), which was subsequently complicated by sudden diabetes insipidus (DI), suggesting hypothalamic/stalk infiltration. Despite low sensitivity, CSF cytology/flow cytometry may serve as a less invasive diagnostic measure. Treatment includes systemic chemotherapy with agents that cross the blood-brain barrier. Surgical resection alone or associated radiotherapy did not show an increase in survival. The prognosis remains poor.

Immune thrombocytopenia purpura (ITP) is defined as a platelet count lower than 100 × 10ˆ9/L, in the absence of known abnormalities in white blood cells, normal hemoglobin with generalized purpuric rash: making it a diagnosis of exclusion.1-2 ITP is due to destruction of platelets in the spleen via autoantibodies, resulting in reduced platelet counts.3 Though rare, ITP is linked with spontaneous retrobulbar hemorrhage (SRH). If ITP is identified, prompt treatment is needed to prevent loss of vision. An 80-year-old non-smoking woman with a history of diabetes, hypertension, and alpha thalassemia minor presented with a one-day history of a right occipital lobe headache and right sided ocular dysfunction. Workup showed a very low platelet count of 35,000/mm³, and elevated D-Dimer at 12,485 ng/mL. MRI revealed a new hemorrhage in the retrobulbar area causing right-sided proptosis. MRA showed no arteriovenous shunting, and the right ophthalmic artery was patent. Therapy for seven days with cryoprecipitate, IVIG, and steroids was started, symptoms resolved, and patient was discharged. The relationship between ITP and non-traumatic sub-periosteal orbital hemorrhage (NTSOH) is unclear, but its occurrence in the setting of anemia is often seen. To best of our knowledge this is a rare case of NTSOH in a patient with mild anemia and acute ITP in the absence of other risk factors such as trauma or excessive Valsalva events.

Olfactory dysfunction has emerged as a prominent symptom of COVID-19, persisting in a subset of patients even after recovery. This scoping review aims to explore the potential of intranasal insulin as a treatment modality for persistent post-COVID-19 olfactory dysfunction. A comprehensive literature search was conducted to gather relevant studies examining the role of intranasal insulin in treating olfactory dysfunction, particularly in post-COVID-19 cases. Studies were included investigating intranasal insulin's mechanisms, efficacy, safety, and clinical outcomes. The review synthesizes findings from various studies suggesting the therapeutic potential of intranasal insulin in improving olfactory function. Research highlights the influence of intranasal insulin on neuroprotection, neurogenesis, and synaptic plasticity within the olfactory system, providing insights into its mechanisms of action. Furthermore, preliminary clinical evidence suggests improvements in olfactory sensitivity and intensity following intranasal insulin administration in post-COVID-19 patients with persistent olfactory dysfunction. While initial findings are encouraging, further rigorous investigations, including clinical trials with larger cohorts, are essential to validate these observations, ascertain optimal dosage regimens, and establish the safety and efficacy of intranasal insulin. This review provides a foundation for future research directions aimed at harnessing the therapeutic potential of intranasal insulin in addressing olfactory dysfunction following COVID-19.

Antiphospholipid antibody syndrome, also known as Hughes syndrome, is a multi-system autoimmune disorder characterized by recurrent thrombosis and fetal loss. The most common types of antiphospholipid antibodies include lupus anticoagulants, anticardiolipin antibodies, and anti-beta 2 glycoprotein 1 antibodies. Owing to the prothrombotic nature of this disease, diagnosing and treating the condition as early as possible is necessary. In this case report, we discuss the typical and atypical manifestations of this disease, as well as the current diagnostic and therapeutic options. We present a case of atypical antiphospholipid antibody syndrome in the form of hemi-tongue ischemia.