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Carroll MB, Kanne JP, Martin Rother MD. Update on Interstitial Pneumonias. Clin Chest Med 2024; 45:419-431. [PMID: 38816097 DOI: 10.1016/j.ccm.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
The American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/Asociación Latinoamericana de Tórax 2018 clinical practice guideline and 2022 update provide recommendations to define and diagnose idiopathic pulmonary fibrosis (IPF) in patients with newly diagnosed interstitial lung disease. The guideline emphasizes recognition of usual interstitial pneumonia (UIP) and probable UIP patterns of fibrosis on high-resolution CT, which can obviate the need for surgical lung biopsy and allow timely initiation of antifibrotic pharmacotherapy citing a high correlation with UIP on histopathology. This article reviews the recent 2022 IPF clinical practice guideline with a focus on the imaging updates.
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Affiliation(s)
- Melissa B Carroll
- Department of Radiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Jeffrey P Kanne
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
| | - Maria Daniela Martin Rother
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
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Gupta R, Kumar M, Ram Dhayal I. COVID-19 and Genitourinary Tract: A Retrospective Study in the Tertiary Care Center. Cureus 2022; 14:e27153. [PMID: 36017292 PMCID: PMC9393072 DOI: 10.7759/cureus.27153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction COVID-19 pandemic has spread across the globe in the last two years and COVID-19 pneumonia is its typical presentation. Coronavirus (SARS-CoV-2) has the potential to affect extrapulmonary sites like the involvement of the urinary tract and male genital organs. Objectives This single institutional retrospective observational study aimed to study the effects of COVID-19 on the lower urinary tract (LUT) and male genital system. Methods COVID-19 effect on the genitourinary tract was studied in a retrospective observational setting in a tertiary care setting from March 2020 to December 2021 consisting of 110 patients. After informed consent from patients, retrospective data collection was included in a repository. Presenting features related to the genitourinary tract were noted and basic biochemical profiles like CBC, RFT, LFT, urine analysis, and urine culture for bacterial sensitivity were performed in all the patients affected by COVID-19. High-resolution ultrasound was sparingly used according to the clinical presentation of these COVID-19 patients. Results A total of 110 patients 95 males and 15 females were included in this study. De novo LUT symptoms were present in 10 (9.09%) patients and acute worsening of these was seen in three patients. Scrotal discomfort was the most common symptom among men found in five (5.26%) patients and frequency of urine was the overall most common symptom found in 13 (12.38%) patients also having two female patients. Among biochemical findings, microscopic hematuria in 68 (61.81%), pyuria in 72 (65.45%), and raised blood urea were observed in 41 (37.27%) patients with COVID-19. Ultrasound findings revealed acute epididymal-orchitis in 3 (3.15 %) and acute orchitis/epididymitis in one (1.05%) case, respectively. Conclusions COVID-19 patients do have the chance of developing the involvement of the urinary tract and male genital system and the clinicians should be aware of this so that they can manage these patients accordingly.
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Luo H, Wang Y, Liu S, Chen R, Chen T, Yang Y, Wang D, Ju S. Associations between CT pulmonary opacity score on admission and clinical characteristics and outcomes in patients with COVID-19. Intern Emerg Med 2022; 17:153-163. [PMID: 34191219 PMCID: PMC8243308 DOI: 10.1007/s11739-021-02795-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022]
Abstract
This study investigated associations between chest computed tomography (CT) pulmonary opacity score on admission and clinical features and outcomes in COVID-19 patients. The retrospective multi-center cohort study included 496 COVID-19 patients in Jiangsu province, China diagnosed as of March 15, 2020. Patients were divided into four groups based on the quartile of pulmonary opacity score: ≤ 5%, 6-20%, 21-40% and 41% +. CT pulmonary opacity score was independently associated with age, single onset, fever, cough, peripheral capillary oxygen saturation, lymphocyte count, platelet count, albumin level, C-reactive protein (CRP) level and fibrinogen level on admission. Patients with score ≥ 41% had a dramatic increased risk of severe or critical illness [odds ratio (OR), 15.58, 95% confidence interval (CI) 3.82-63.53), intensive care unit (ICU)] admission (OR, 6.26, 95% CI 2.15-18.23), respiratory failure (OR, 19.49, 95% CI 4.55-83.40), and a prolonged hospital stay (coefficient, 2.59, 95% CI 0.46-4.72) compared to those with score ≤ 5%. CT pulmonary opacity score on admission, especially when ≥ 41%, was closely related to some clinical characteristics and was an independent predictor of disease severity, ICU admission, respiratory failure and long hospital stay in patients with COVID-19.
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Affiliation(s)
- Huanyuan Luo
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Yuancheng Wang
- Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Songqiao Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Ruoling Chen
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, WV1 1LY, UK
| | - Tao Chen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Yi Yang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK.
| | - Shenghong Ju
- Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
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Abdel Razek AAK, Elmansy M, El-Latif MA, Al-Marsafawy H. CT angiography of anomalous pulmonary veins. CARDIOVASCULAR AND CORONARY ARTERY IMAGING 2022:181-193. [DOI: 10.1016/b978-0-12-822706-0.00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Interobserver agreement of interstitial lung fibrosis Reporting and Data System (ILF-RADS) at high-resolution CT. Emerg Radiol 2021; 29:115-123. [PMID: 34705193 DOI: 10.1007/s10140-021-01993-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the interobserver agreement of interstitial lung fibrosis Reporting and Data System (ILF-RADS) in interpretation and categorization of interstitial lung disease (ILD) at high-resolution CT (HRCT). METHODS Retrospective analysis was performed on 65 consecutive patients (36 male and 29 female), median age 53 years, who were referred to the Radiology Department, Mansoura University, in the period from July 2016 to February 2020. They were expected clinically to have diffuse lung disease and underwent HRCT of the chest. Patients had some investigations like serology, and when required surgical lung biopsy. Image analysis was done by two independent and blinded readers for the pulmonary and extra-pulmonary finding of ILF-RADS. The pulmonary findings were 13 items and extrapulmonary findings were 5 items. The score was 5 types according to ILF-RADS: ILF-RADS 0 (incomplete assessment), ILF-RADS 1 (typical UIP), ILF-RADS 2 (probable UIP), ILF-RADS 3 (indeterminate UIP), ILF-RADS 4 (CT features most consistent with non-UIP diagnosis). RESULTS There was an excellent interobserver agreement of both reviewers for overall ILF-RADS (K = 0.88, P = 0.001) with 95.4% agreement. There was an excellent interobserver agreement for overall pulmonary findings (K = 0.901, 95% CI = 0.877-0.926, P = 0.001), excellent interobserver agreement for seven items including lung volume, traction bronchiectasis, nodules, cysts, consolidation, emphysema, and complications and moderate interobserver agreement for six items including reticulations, honeycomb, ground glass, mosaic attenuation, and axial and zonal distribution. There was excellent interobserver agreement for overall extra-pulmonary findings (K = 0.902, 95% CI = 0.852-0.952, P = 0.001), excellent interobserver agreement for four items including mediastinum, pleura, visible abdomen, and soft tissue and bone and moderate interobserver agreement for trachea and main bronchi. There was excellent interobserver agreement for ILF-RADS score: ILF-RADS 1 (K = 0.84, P = 0.001), ILF-RADS 3 (K = 0.881, P = 0.001), and ILF-RADS 4 (K = 0.878, 95% CI = 0.743-1.0, P = 0.001) and moderate interobserver agreement for ILF-RADS 2 (K = 0.784, P = 0.001). CONCLUSION ILF-RADS is a reliable reporting system which can be routinely performed for standard interpretation of ILD.
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Gai X, Chi H, Cao W, Zeng L, Chen L, Zhang W, Song D, Wang Y, Liu P, Li R, Sun Y. Acute miliary tuberculosis in pregnancy after in vitro fertilization and embryo transfer: a report of seven cases. BMC Infect Dis 2021; 21:913. [PMID: 34488670 PMCID: PMC8419986 DOI: 10.1186/s12879-021-06564-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/12/2021] [Indexed: 12/13/2022] Open
Abstract
Background While miliary tuberculosis (TB) in pregnancy is rare after in vitro fertilization and embryo transfer (IVF-ET), it poses a serious threat to the health of pregnant women and their fetuses. The present study aimed to describe the clinical features of miliary TB and pregnancy outcomes of patients after IVF-ET. Methods Data of infertile patients who received IVF-ET at Peking University Third Hospital between January 2012 and December 2017 were retrospectively analyzed. Patients who developed miliary TB during pregnancy were identified, and clinical characteristics of miliary TB were described. Results Out of 62,755 infertile women enrolled, 7137 (11.4 %) showed signs of prior pulmonary TB on chest X-ray (CXR). Among the 15,136 women (mean age: 33.2 ± 5.0 years) who successfully achieved clinical pregnancy, seven patients aged 28–35 years had miliary TB during pregnancy, with two patients having a complication of TB meningitis. All these patients presented with fever. Notably, old TB lesions were detected on CXR in six patients before IVF-ET; nevertheless, no anti-TB therapy was administered. Furthermore, salpingography revealed oviduct obstruction in all patients (7/7). Patients received anti-TB therapy following a diagnosis of miliary TB and were clinically cured. However, pregnancy was terminated due to spontaneous (4/7) and induced (3/7) abortion. Conclusions TB reactivation, mostly as miliary TB and TB meningitis, is severe in pregnant women after IVF-ET and deleterious to pregnancy outcomes. Signs of prior TB on CXR may be risk factors for TB reactivation during pregnancy.
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Affiliation(s)
- Xiaoyan Gai
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing, 100191, China
| | - Hongbin Chi
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, 49 N Garden Rd, Haidian District, 100191, Beijing, China.,National Clinical Research Center for Obstetrics and Gynecology, 100191, Beijing, China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, 100191, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, 100191, Beijing, China
| | - Wenli Cao
- Tuberculosis Department, Beijing Geriatric Hospital, 102699, Beijing, China
| | - Lin Zeng
- Clinical Epidemiology Research Center, Peking University Third Hospital, 100191, Beijing, China
| | - Lixue Chen
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, 49 N Garden Rd, Haidian District, 100191, Beijing, China.,National Clinical Research Center for Obstetrics and Gynecology, 100191, Beijing, China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, 100191, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, 100191, Beijing, China
| | - Weixia Zhang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing, 100191, China
| | - Donghong Song
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, 49 N Garden Rd, Haidian District, 100191, Beijing, China.,National Clinical Research Center for Obstetrics and Gynecology, 100191, Beijing, China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, 100191, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, 100191, Beijing, China
| | - Ying Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, 49 N Garden Rd, Haidian District, 100191, Beijing, China.,National Clinical Research Center for Obstetrics and Gynecology, 100191, Beijing, China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, 100191, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, 100191, Beijing, China
| | - Ping Liu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, 49 N Garden Rd, Haidian District, 100191, Beijing, China.,National Clinical Research Center for Obstetrics and Gynecology, 100191, Beijing, China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, 100191, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, 100191, Beijing, China
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, 49 N Garden Rd, Haidian District, 100191, Beijing, China. .,National Clinical Research Center for Obstetrics and Gynecology, 100191, Beijing, China. .,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, 100191, Beijing, China. .,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, 100191, Beijing, China.
| | - Yongchang Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, 49 N Garden Rd, Haidian District, Beijing, 100191, China.
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Marand AJB, Bach C, Janssen D, Heesakkers J, Ghojazadeh M, Vögeli TA, Salehi-Pourmehr H, Mostafae H, Hajebrahimi S, Rahnama'i MS. Lower urinary tract signs and symptoms in patients with COVID-19. BMC Infect Dis 2021; 21:706. [PMID: 34311703 PMCID: PMC8312200 DOI: 10.1186/s12879-021-06394-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background The type of pneumonia that is caused by the new coronavirus (SARS-CoV-2) has spread across the world in a pandemic. It is not clear if COVID-19 patients have any lower urinary tract signs or symptoms. Methods The effect of COVID-19 on lower urinary tract function was studied in a prospective multi-centre, observational study including 238 patients who were admitted with symptoms caused by COVID-19 to the university hospital of Aachen in Germany and Tabriz in Iran. Results None of the patients reported to have any lower urinary tract symptoms. SARS-CoV-2 was found in the urine of 19% of the tested patients. The mortality rate in COVID-19 infected patients with microscopic haematuria together with white blood cells in their urine, was significantly increased from 48 to 61% in the Tabriz cohort (p-value = 0.03) and from 30 to 35% in the Aachen cohort (p-value =0.045). Furthermore, in the group of patients with SARS-CoV-2 urine PCR, the mortality rate rose from 30 to 58%. (p-value =0.039). Conclusion Patients admitted with COVID-19 did not report to have any lower urinary tract symptoms, even those patient who had a positive Urine SARS-CoV-2 PCR. In addition, hematuria, WBC in urine as well as SARS- CoV-2 presence in urine, were found to be strong negative prognostic factors in admitted COVID-19 patients.
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Affiliation(s)
- Aida Javan Balegh Marand
- Uniklinik RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.,Radboud University, Nijmegen, The Netherlands.,Society of Urological Research and Education (SURE), Heerlen, The Netherlands
| | - Christian Bach
- Uniklinik RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | | | | | - Morteza Ghojazadeh
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Sajjad Rahnama'i
- Uniklinik RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany. .,Radboud University, Nijmegen, The Netherlands.
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8
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Kee TP, Venkatanarasimha N, Mohideen SMH, Chan LL, Gogna A, Schaefer PW, Chia GS, Choi YS, Chen RC. A Tale of Two Organ Systems: Imaging review of diseases affecting the thoracic and neurological systems. Part 1. Curr Probl Diagn Radiol 2021; 51:589-598. [PMID: 34304949 DOI: 10.1067/j.cpradiol.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/01/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
Abstract
In an era of rapidly expanding knowledge and sub-specialization, it is becoming increasingly common to focus on one organ system. However, the human body is intimately linked, and disease processes affecting one region of the body not uncommonly affect the other organ systems as well. Understanding diseases from a macroscopic perspective, rather than a narrow vantage point, enables efficient and accurate diagnosis. This tenet holds true for diseases affecting both the thoracic and neurological systems; in isolation, the radiologic appearance of disease in one organ system may be nonspecific, but viewing the pathophysiologic process in both organ systems may markedly narrow the differential considerations, and potentially lead to a definitive diagnosis. In this article, we discuss a variety of disease entities known to affect both the thoracic and neurological systems, either manifesting simultaneously or at different periods of time. Some of these conditions may show neither thoracic nor neurological manifestations. These diseases have been systematically classified into infectious, immune-mediated / inflammatory, vascular, syndromic / hereditary and neoplastic disorders. The underlying pathophysiological mechanisms linking both regions and radiologic appearances in both organ systems are discussed. When appropriate, brief clinical and diagnostic information is provided. Ultimately, accurate diagnosis will lead to expedited triage and prompt institution of potentially life-saving treatment for these groups of complex disorders.
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Affiliation(s)
- Tze Phei Kee
- Singapore General Hospital, Singapore 169608; National Neuroscience Institute, Singapore 308433.
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Razek AAKA, El-Diasty T, Elhendy A, Fahmy D, El-Adalany MA. Prostate Imaging Reporting and Data System (PI-RADS): What the radiologists need to know? Clin Imaging 2021; 79:183-200. [PMID: 34098371 DOI: 10.1016/j.clinimag.2021.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 01/14/2023]
Abstract
We aim to review the new modifications in MR imaging technique, image interpretation, lexicon, and scoring system of the last version of Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) in a simple and practical way. This last version of PI-RADS v2.1 describes the new technical modifications in the protocol of Multiparametric MRI (MpMRI) including T2, diffusion-weighted imaging (DWI), and dynamic contrast enhancement (DCE) parameters. It includes also; new guidelines in the image interpretation specifications in new locations (lesions located in the central zone and anterior fibromuscular stroma), clarification of T2 scoring of lesions of the transition zone, the distinction between DWI score 2 and 3 lesions in the transition zone and peripheral zone, as well as between positive and negative enhancement in DCE. Biparametric MRI (BpMRI) along with simplified PI-RADS is gaining more acceptances in the assessment of clinically significant prostatic cancer.
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Affiliation(s)
| | - Tarek El-Diasty
- Department of Diagnostic Radiology, Mansoura Urology and Nephrology Center, Mansoura, Egypt
| | - Ahmed Elhendy
- Department of Diagnostic Radiology, Mansoura Urology and Nephrology Center, Mansoura, Egypt
| | - Dalia Fahmy
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
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Pang C, Hou Q, Yang Z, Ren L. Chest computed tomography as a primary tool in COVID-19 detection: an update meta-analysis. Clin Transl Imaging 2021; 9:341-351. [PMID: 34055674 PMCID: PMC8149579 DOI: 10.1007/s40336-021-00434-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/19/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE A growing number of publications have paid close attention to the chest computed tomography (CT) detection of COVID-19 with inconsistent diagnostic accuracy, the present meta-analysis assessed the available evidence regarding the overall performance of chest CT for COVID-19. METHODS 2 × 2 diagnostic table was extracted from each of the included studies. Data on specificity (SPE), sensitivity (SEN), negative likelihood ratio (LR-), positive likelihood ratio (LR+), and diagnostic odds ratio (DOR) were calculated purposefully. RESULTS Fifteen COVID-19 related publications met our inclusion criteria and were judged qualified for the meta-analysis. The following were summary estimates for diagnostic parameters of chest CT for COVID-19: SPE, 0.49 (95% CI 46-52%); SEN, 0.94 (95% CI 93-95%); LR-, 0.15 (95% CI 11-20%); LR+, 1.93 (95% CI 145-256%); DOR, 17.14 (95% CI 918-3199%); and the area under the receiver operating characteristic curve (AUC), 0.93. CONCLUSION Chest CT has high SEN, but the SPE is not ideal. It is highly recommended to use a combination of different diagnostic tools to achieve sufficient SEN and SPE. It should be taken into account as a diagnostic tool for current COVID-19 detection, especially for patients with symptoms. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40336-021-00434-z.
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Affiliation(s)
- Caishuang Pang
- Chongqing Medical University, NO.1, Yi Xue Yuan Road, Yuzhong District, Chongqing, 400016 China
| | - Qingtao Hou
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 China
| | - Zhaowei Yang
- Chongqing Medical University, NO.1, Yi Xue Yuan Road, Yuzhong District, Chongqing, 400016 China
| | - Liwei Ren
- Chongqing Medical University, NO.1, Yi Xue Yuan Road, Yuzhong District, Chongqing, 400016 China
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Golfi N, Mastriforti R, Guidelli L, Scala R. A case of endobronchial actinomycosis as a challenging cause of lung atelectasis. BMC Infect Dis 2021; 21:433. [PMID: 33964874 PMCID: PMC8105992 DOI: 10.1186/s12879-021-06126-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/29/2021] [Indexed: 12/11/2022] Open
Abstract
Background Primary endobronchial actinomycosis is exceptionally uncommon and can be misdiagnosed as unresolving pneumonia, endobronchial lipoma, bronchogenic carcinoma or foreign body. Predisposing factors are immunosuppressive conditions, chronic lung diseases, poor oral hygiene or foreign body aspiration. Case presentation We reported a case of 88-year old woman with a 4 days history of mild exertional dyspnea, productive cough with purulent sputum and fever up to 37.8 °C, who developed left sided endobronchial actinomycosis in absence of any pre-existent risk conditions; endobronchial de-obstruction and specific antibiotic treatment were performed with success, achieving a full resolution of the disease, with bronchoscopy playing a key role in the diagnosticand therapeutic pathways. Conclusions This case raises the necessity for increased awareness in the management of endobronchial lesions and in cases of suspected endobronchial actinomycosis; bronchoscopy plays a key role in the diagnostic and therapeutic process; prompt recognition of this entity can expedite proper treatment and recovery.
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Affiliation(s)
| | | | - Luca Guidelli
- Pulmonology and RICU, S Donato Hospital, Arezzo, Italy
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12
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Trnacevic A, Mujkanovic A, Al-Salloum N, Sakusic A, Trnacevic E, Jusufovic E, Hukic F, Jahic R, Stratton R. COVID-19 in Northeast Bosnia and Herzegovina and patient's length of hospitalization. BMC Infect Dis 2021; 21:367. [PMID: 33874896 PMCID: PMC8054235 DOI: 10.1186/s12879-021-06034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Since the outbreak of COVID-19 pandemic, clinical data from various parts of the world have been reported. Up till now, there has been no clinical data with regards to COVID-19 from Bosnia and Herzegovina (B&H). The aim was to report on the first cohort of patients from B&H and to analyze factors that influence COVID-19 patient’s length of hospitalization (LOH). Methods This retrospective cohort study was conducted at Tuzla University Clinical Center (UKC), B&H. It involved 25 COVID-19 positive patients that needed hospitalisation between March 28th and April 27th 2020. The LOH was measured from the time of admission to discharge. Factors analyzed induced age, BMI, presence of known comorbidities, serum creatinine and O2 saturation upon admission. Results The mean age was 52.92 ± 19.15 years and BMI 28.80 ± 4.22. LOH for patients with BMI < 25 was 9 ± SE2.646 days (CI 95% 3.814–14.816) vs 14.182 ± SE .937 (CI 95% 12.346–16.018 p < 0.05; HR 5.148 CI95% 1.217 to 21.772 p = 0.026) for ≥25 BMI. The mean LOH of patients with normal levels of O2 ≥ 95% was 11.667 ± SE1.202 (CI95% 8.261 to 13.739; p = 0.046), while LOH for patients with < 95% was 14.625 ± SE 1.231 CI95% 12.184 to 16.757 p = 0.042; HR 3.732 CI95%1.137–12.251 p = 0.03). Patients without known comorbidities had a mean LOH of 11.700 ± SE1.075 (CI 95% 9.592–13.808), while those with comorbidities had a mean of 14.8 ± 1.303 (CI 95% 12.247–17.353; p = 0.029) with HR2.552. Conclusion LOH varied among COVID-19 patients and was prolonged when analyzed for BMI ≥25, comorbidities, elevated creatinine, and O2 saturation < 95%. Furthermore, risk factors for COVID-19 patients in B&H do not deviate from those reported in other countries.
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Affiliation(s)
- Alma Trnacevic
- Department of Infectious Diseases, Tuzla University Clinical Center, Ibre Pasica bb, 7500, Tuzla, Bosnia and Herzegovina
| | - Amer Mujkanovic
- Department of Infectious Diseases, Tuzla University Clinical Center, Ibre Pasica bb, 7500, Tuzla, Bosnia and Herzegovina.
| | - Noura Al-Salloum
- Department for Family Medicine, King Fahad Medical City, As Sulimaniyah, Riyadh, 12231, Saudi Arabia
| | - Amra Sakusic
- Mayo Clinic Florida; Mid Cheshire Hospitals NHS Foundation Trust, Middlewich Rd, Crewe, CW1 4QJ, UK
| | - Emir Trnacevic
- Department of Infectious Diseases, Tuzla University Clinical Center, Ibre Pasica bb, 7500, Tuzla, Bosnia and Herzegovina
| | - Emir Jusufovic
- Department of Infectious Diseases, Tuzla University Clinical Center, Ibre Pasica bb, 7500, Tuzla, Bosnia and Herzegovina
| | - Fatima Hukic
- Department of Infectious Diseases, Tuzla University Clinical Center, Ibre Pasica bb, 7500, Tuzla, Bosnia and Herzegovina
| | - Rahima Jahic
- Department of Infectious Diseases, Tuzla University Clinical Center, Ibre Pasica bb, 7500, Tuzla, Bosnia and Herzegovina
| | - Richard Stratton
- Department of Medicine, Royal Free Trust, Pond St, Hampstead, London, NW3 2QG, UK
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13
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Computed tomography of the chest in patients with COVID-19: what do radiologists want to know? Pol J Radiol 2021; 86:e122-e135. [PMID: 33758638 PMCID: PMC7976235 DOI: 10.5114/pjr.2021.104049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 08/15/2020] [Indexed: 12/14/2022] Open
Abstract
We aim in the current study to review pulmonary and extra-pulmonary imaging features in patients infected with COVID-19. COVID-19 appears to be a highly contagious viral disease that attacks the respiratory system causing pneumonia. Since the beginning of the outbreak, several reports have been published describing various radiological patterns related to COVID-19. Radiological features of COVID-19 are classified into; pulmonary signs of which ground glass opacities are considered the characteristic followed by consolidation, and extra-pulmonary signs such as pulmonary embolism and pneumothorax, which are far less common and appear later in progressive disease. We review the different structured reporting systems that are published by different groups of radiologists using simple unified terms to enable good communication between the radiologist and the referring physician. Computed tomography of the chest is beneficial for early diagnosis of COVID-19 pneumonia, assessment of disease progression and guide to therapy, surveillance of patients with response to therapy, prediction of overlying bacterial infection, differentiation from simulating lesions, and screening with prevention and controls of the disease.
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14
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Canovi S, Besutti G, Bonelli E, Iotti V, Ottone M, Albertazzi L, Zerbini A, Pattacini P, Giorgi Rossi P, Colla R, Fasano T. The association between clinical laboratory data and chest CT findings explains disease severity in a large Italian cohort of COVID-19 patients. BMC Infect Dis 2021; 21:157. [PMID: 33557778 PMCID: PMC7868898 DOI: 10.1186/s12879-021-05855-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Laboratory data and computed tomography (CT) have been used during the COVID-19 pandemic, mainly to determine patient prognosis and guide clinical management. The aim of this study was to evaluate the association between CT findings and laboratory data in a cohort of COVID-19 patients. METHODS This was an observational cross-sectional study including consecutive patients presenting to the Reggio Emilia (Italy) province emergency rooms for suspected COVID-19 for one month during the outbreak peak, who underwent chest CT scan and laboratory testing at presentation and resulted positive for SARS-CoV-2. RESULTS Included were 866 patients. Total leukocytes, neutrophils, C-reactive protein (CRP), creatinine, AST, ALT and LDH increase with worsening parenchymal involvement; an increase in platelets was appreciable with the highest burden of lung involvement. A decrease in lymphocyte counts paralleled worsening parenchymal extension, along with reduced arterial oxygen partial pressure and saturation. After correcting for parenchymal extension, ground-glass opacities were associated with reduced platelets and increased procalcitonin, consolidation with increased CRP and reduced oxygen saturation. CONCLUSIONS Pulmonary lesions induced by SARS-CoV-2 infection were associated with raised inflammatory response, impaired gas exchange and end-organ damage. These data suggest that lung lesions probably exert a central role in COVID-19 pathogenesis and clinical presentation.
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Affiliation(s)
- Simone Canovi
- Clinical chemistry and Endocrinology Laboratory, Departement of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123, Reggio Emilia, Italy.
| | - Giulia Besutti
- Radiology Unit, Departement of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, viale Risorgimento, 80, 42123, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD program, University of Modena and Reggio Emilia, Modena, Italy
| | - Efrem Bonelli
- Clinical chemistry and Endocrinology Laboratory, Departement of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123, Reggio Emilia, Italy.,Radiology Unit, Departement of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, viale Risorgimento, 80, 42123, Reggio Emilia, Italy
| | - Valentina Iotti
- Radiology Unit, Departement of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, viale Risorgimento, 80, 42123, Reggio Emilia, Italy
| | - Marta Ottone
- Epidemiology Unit, AUSL-IRCCS di Reggio Emilia, viale Risorgimento, 80, 42123, Reggio Emilia, Italy
| | - Laura Albertazzi
- Clinical chemistry and Endocrinology Laboratory, Departement of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Alessandro Zerbini
- Laboratory of autoimmunity, allergology and innovative biotechnologies, Departement of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, viale Risorgimento, 80, 42123, Reggio Emilia, Italy
| | - Pierpaolo Pattacini
- Radiology Unit, Departement of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, viale Risorgimento, 80, 42123, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, AUSL-IRCCS di Reggio Emilia, viale Risorgimento, 80, 42123, Reggio Emilia, Italy
| | - Rossana Colla
- Clinical chemistry and Endocrinology Laboratory, Departement of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Tommaso Fasano
- Clinical chemistry and Endocrinology Laboratory, Departement of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123, Reggio Emilia, Italy
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15
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Ip A, Ahn J, Zhou Y, Goy AH, Hansen E, Pecora AL, Sinclaire BA, Bednarz U, Marafelias M, Sawczuk IS, Underwood JP, Walker DM, Prasad R, Sweeney RL, Ponce MG, La Capra S, Cunningham FJ, Calise AG, Pulver BL, Ruocco D, Mojares GE, Eagan MP, Ziontz KL, Mastrokyriakos P, Goldberg SL. Hydroxychloroquine in the treatment of outpatients with mildly symptomatic COVID-19: a multi-center observational study. BMC Infect Dis 2021; 21:72. [PMID: 33446136 PMCID: PMC7807228 DOI: 10.1186/s12879-021-05773-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/06/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hydroxychloroquine has not been associated with improved survival among hospitalized COVID-19 patients in the majority of observational studies and similarly was not identified as an effective prophylaxis following exposure in a prospective randomized trial. We aimed to explore the role of hydroxychloroquine therapy in mildly symptomatic patients diagnosed in the outpatient setting. METHODS We examined the association between outpatient hydroxychloroquine exposure and the subsequent progression of disease among mildly symptomatic non-hospitalized patients with documented SARS-CoV-2 infection. The primary outcome assessed was requirement of hospitalization. Data was obtained from a retrospective review of electronic health records within a New Jersey USA multi-hospital network. We compared outcomes in patients who received hydroxychloroquine with those who did not applying a multivariable logistic model with propensity matching. RESULTS Among 1274 outpatients with documented SARS-CoV-2 infection 7.6% were prescribed hydroxychloroquine. In a 1067 patient propensity matched cohort, 21.6% with outpatient exposure to hydroxychloroquine were hospitalized, and 31.4% without exposure were hospitalized. In the primary multivariable logistic regression analysis with propensity matching there was an association between exposure to hydroxychloroquine and a decreased rate of hospitalization from COVID-19 (OR 0.53; 95% CI, 0.29, 0.95). Sensitivity analyses revealed similar associations. QTc prolongation events occurred in 2% of patients prescribed hydroxychloroquine with no reported arrhythmia events among those with data available. CONCLUSIONS In this retrospective observational study of SARS-CoV-2 infected non-hospitalized patients hydroxychloroquine exposure was associated with a decreased rate of subsequent hospitalization. Additional exploration of hydroxychloroquine in this mildly symptomatic outpatient population is warranted.
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Affiliation(s)
- Andrew Ip
- Division of Outcomes and Value Research, John Theurer Cancer Center at Hackensack University Medical Center, 92 Second Street, Hackensack, NJ, 07601, USA.
- Hackensack Meridian Health, Hackensack, NJ, USA.
- Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA.
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, D.C., USA
| | - Yizhao Zhou
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, D.C., USA
| | - Andre H Goy
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - Andrew L Pecora
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | - Brittany A Sinclaire
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | - Urszula Bednarz
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | - Michael Marafelias
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | - Ihor S Sawczuk
- Hackensack Meridian Health, Hackensack, NJ, USA
- Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA
| | | | - David M Walker
- Hackensack University Medical Center, Hackensack, NJ, USA
| | | | | | - Marie G Ponce
- Jersey Shore University Medical Center, Neptune City, NJ, USA
| | | | | | - Arthur G Calise
- Hackensack Meridian Mountainside Medical Center, Montclair, NJ, USA
| | | | | | | | | | | | | | - Stuart L Goldberg
- Division of Outcomes and Value Research, John Theurer Cancer Center at Hackensack University Medical Center, 92 Second Street, Hackensack, NJ, 07601, USA
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16
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Chong WH, Saha BK, Austin A, Chopra A. The Significance of Subpleural Sparing in CT Chest: A State-of-the-Art Review. Am J Med Sci 2021; 361:427-435. [PMID: 33487401 DOI: 10.1016/j.amjms.2021.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/03/2020] [Accepted: 01/08/2021] [Indexed: 12/14/2022]
Abstract
The subpleural sparing pattern is a common finding on computed tomography (CT) of the lungs. It comprises of pulmonary opacities sparing the lung peripheries, typically 1cm and less from the pleural surface. This finding has a variety of causes, including idiopathic, inflammatory, infectious, inhalational, cardiac, traumatic, and bleeding disorders. Specific disorders that can cause subpleural sparing patterns include nonspecific interstitial pneumonia (NSIP), organizing pneumonia (OP), pulmonary alveolar proteinosis (PAP), diffuse alveolar hemorrhage (DAH), vaping-associated lung injury (VALI), cracked lung, pulmonary edema, pneumocystis jirovecii pneumonia (PJP), pulmonary contusion, and more recently, Coronavirus disease 2019 (COVID-19) pneumonia. Knowledge of the many etiologies of this pattern can be useful in preventing diagnostic errors. In addition, although the etiology of subpleural sparing pattern is frequently indistinguishable during an initial radiologic evaluation, the differences in location of opacities in the lungs, as well as the presence of additional radiologic findings, patient history, and clinical presentation, can often be useful to suggest the appropriate diagnosis. We did a comprehensive search on Pubmed and Google Scholar database using keywords of "subpleural sparing," "peripheral sparing," "sparing of peripheries," "CT chest," "chest imaging," and "pulmonary disease." This review aims to describe the primary differential diagnosis of subpleural sparing pattern seen on chest imaging with a strong emphasis on clinical and radiographic findings. We also discuss the pathogenesis and essential clues that are crucial to narrow the differential diagnosis.
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Affiliation(s)
- Woon H Chong
- Department of Pulmonary and Critical Care, Albany Medical Center, Albany, New York.
| | - Biplab K Saha
- Department of Pulmonary and Critical Care, Ozarks Medical Center, West Plains, Missouri
| | - Adam Austin
- Department of Pulmonary and Critical Care, University of Florida, Gainesville, Florida
| | - Amit Chopra
- Department of Pulmonary and Critical Care, Albany Medical Center, Albany, New York
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17
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Alfraji N, Mazahir U, Chaudhri M, Miskoff J. Anti-synthetase syndrome: a rare and challenging diagnosis for bilateral ground-glass opacities-a case report with literature review. BMC Pulm Med 2021; 21:11. [PMID: 33407281 PMCID: PMC7787399 DOI: 10.1186/s12890-020-01388-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background Anti-synthetase syndrome (ASS) is an uncommon immune-mediated entity characterized by myositis, interstitial lung disease (ILD), non-erosive arthritis, and less common features such as fever, Raynaud’s phenomenon, and skin changes in association with anti-aminoacyl-transfer-RNA antibodies, most commonly anti-Jo-1 antibodies.
Case presentation We present a challenging and rare case of ASS-associated ILD presenting with unexplained respiratory symptoms and bilateral infiltrates on chest imaging during the COVID-19 pandemic. High clinical suspicion for ASS with early appropriate therapy with corticosteroids and immunosuppressive agents led to marked clinical improvement. Conclusion High index of suspicion for ASS is mandated in patients with unexplained ILD. A comprehensive autoimmune work-up is important as an early treatment with corticosteroids with or without immunomodulators improves patient outcomes and survival in an otherwise poor prognostic disease.
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Affiliation(s)
- Nasam Alfraji
- Department of Internal Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, 07753, USA.
| | - Usman Mazahir
- Department of Pulmonology and Critical Care, Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
| | - Moiuz Chaudhri
- Department of Pulmonology and Critical Care, Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
| | - Jeffrey Miskoff
- Department of Pulmonology and Critical Care, Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
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