The SARS-CoV-2 pandemic has grown into a major global concern with huge efforts to combat the spread. Exaggerated inflammatory response plays a major role in which was the rationale to use corticosteroids to treat patients. However, multiple studies showed an association between opportunistic and bacterial infections with corticosteroid therapy. We report a case of a 76 year old patient diagnosed with COVID-19 treated with 10 days Dexamethasone and Remdesivir who presented with abdominal symptoms with eosinophilia. Biopsy and stool studies revealed Strongyloides stercoralis larvae. The patient was treated with 2 doses of Ivermectin with significant clinical resolution. Clinician should have high clinical suspicion for Strongloydiasis in patients who have lived or visited endemic areas and for patients with unexplained eosinophilia. Prompt treatment with Ivermectin is crucial for confirmed cases and high risk cases where obtaining a diagnosis is unfeasible.
Antihistamine usage is commonplace for alleviating allergy symptoms, though they are not without side-effects. We present a case of antihistamine use precipitating upper and lower extremity ballismus in a patient. We also discuss other case reports which outline similar dopaminergic dysregulation secondary to antihistamine usage, as well as our recommendations for prevention of these symptoms.
The surgical resection timing of left atrial (LA) myxoma is still controversial in concern for the risk of further embolic phenomena if delayed surgery versus hemorrhagic transformation during early surgery. We describe a case of 60-year-old man without significant past medical history admitted with two-day of double vision and found to have LA myxoma. Multiple factors including clinical aspects and comorbidities should be evaluated to decide the favorable management.
A 29-year-old woman with known sickle cell disease (SCD) and iatrogenic iron overload presented to the emergency department with a recurrent pain crisis and fever. Blood cultures obtained at a recent prior admission for the same complaints grew M avium. Bone marrow biopsy revealed non-caseating granulomas, but stains for mycobacteria and fungi were negative. Disseminated non-tuberculous mycobacterial infections (NTMIs) occur almost exclusively in immunosuppressed patients. SCD is not considered a risk factor for the development of disseminated NTMIs, making diagnosis challenging in this population. However, a number of case reports describing disseminated NTMIs in patients with SCD have been published. This case adds to the current literature, suggesting SCD with iatrogenic iron overload is a possible risk factor for disseminated NTMIs. Potential mechanisms for this increased risk include 1) functional asplenia, 2) iatrogenic iron overload, 3) chronic indwelling central venous catheters, and 4) hydroxyurea use. Further investigation is required to describe the strength and mechanism of the relationship between SCD and disseminated NTMIs.
Treatments for COVID-19 infection have varied widely within the past year. Remdesivir is the only direct-acting antiviral approved by the Food and Drug Administration with demonstrated efficacy in the management of patients with COVID-19.[1] Commonly reported adverse effects include hepatotoxicity and gastrointestinal symptoms such as nausea and diarrhea. Less common adverse effects include respiratory toxicity, cardiovascular toxicity and nephrotoxicity.[2] We report a case of international normalized ratio (INR) prolongation in a COVID-19 patient receiving concomitant warfarin and remdesivir therapy.
