1
|
Nery B, Filho CB, Nunes L, Quaggio E, Filho FB, Neto JA, Melo LR, Oliveira AC, Rabello R, Durand VR, Silva RR, Costa RE, Segundo JA. Acute Paraplegia Caused by Spinal Epidural Empyema Following Infectious Cellulitis of the Hand: Case Report and Literature Review. J Neurol Surg Rep 2024; 85:e29-e38. [PMID: 38596232 PMCID: PMC11001457 DOI: 10.1055/a-2267-1810] [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: 07/04/2023] [Accepted: 01/14/2024] [Indexed: 04/11/2024] Open
Abstract
Background Spinal epidural abscess is a rare but serious condition that can cause spinal cord compression and neurological deficits. Case Description and Methods The article reports a case of a 31-year-old patient who presented with an infectious cellulitis in the left hand, which progressed to a spinal epidural abscess. The diagnosis was confirmed by clinical examination and magnetic resonance imaging. Treatment involved laminectomy, after which the patient had complete recovery of neurological deficits. This article is a case report with a literature review. Patient data and images were collected by the researchers who participated in the patient's care. The literature was reviewed by one of the researchers based on the search for articles in the PubMed database. For the research, the following keywords were inserted: "Spinal epidural empyema," "Spinal epidural abscess." Conclusion Spinal epidural abscess is often underdiagnosed, which can lead to delays in treatment and serious complications. The relationship between cellulitis and spinal epidural abscess may be related to the spread of infection through the lymphatic or blood system.
Collapse
Affiliation(s)
- Breno Nery
- Department of Neurosurgery, Hospital Beneficiência Portuguesa de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Cláudio Brandão Filho
- Department of Neurosurgery, Hospital Beneficiência Portuguesa de Ribeirão Preto, Ribeirão Preto, SP, Brazil
- Department of Neurosurgery, Universitary Center Unifacisa, Campina Grande, Paraíba, Brazil
| | - Lucas Nunes
- Department of Neurosurgery, Hospital Beneficiência Portuguesa de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Eduardo Quaggio
- Department of Neurosurgery, Hospital Beneficiência Portuguesa de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Fred Bernardes Filho
- Department of Neurosurgery, Hospital Beneficiência Portuguesa de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Joaquim Alencar Neto
- Department of Neurosurgery, Hospital Beneficiência Portuguesa de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Layssa Rhossana Melo
- Department of Neurosurgery, Hospital Beneficiência Portuguesa de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Anna Carolyne Oliveira
- Department of Neurosurgery, Hospital Beneficiência Portuguesa de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Rafael Rabello
- Department of Neurosurgery, Hospital Beneficiência Portuguesa de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Victoria Rodrigues Durand
- Department of Neurosurgery, Hospital Beneficiência Portuguesa de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Rayssa Rocha Silva
- Department of Neurosurgery, Hospital Beneficiência Portuguesa de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Rafael Emmanuel Costa
- Department of Neurosurgery, Hospital Beneficiência Portuguesa de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - José Alencar Segundo
- Department of Neurosurgery, Hospital Beneficiência Portuguesa de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| |
Collapse
|
2
|
Mallhi TH, Safdar A, Butt MH, Salman M, Nosheen S, Mustafa ZU, Khan FU, Khan YH. Atypical Complications during the Course of COVID-19: A Comprehensive Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:164. [PMID: 38256424 PMCID: PMC10819426 DOI: 10.3390/medicina60010164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Abstract
COVID-19 is primarily a respiratory disease, but numerous studies have indicated the involvement of various organ systems during the course of illness. We conducted a comprehensive review of atypical complications of COVID-19 with their incidence range (IR) and their impact on hospitalization and mortality rates. We identified 97 studies, including 55 research articles and 42 case studies. We reviewed four major body organ systems for various types of atypical complications: (i) Gastro-intestinal (GI) and hepatobiliary system, e.g., bowel ischemia/infarction (IR: 1.49-83.87%), GI bleeding/hemorrhage (IR: 0.47-10.6%), hepatic ischemia (IR: 1.0-7.4%); (ii) Neurological system, e.g., acute ischemic stroke/cerebral venous sinus thrombosis/cerebral hemorrhage (IR: 0.5-90.9%), anosmia (IR: 4.9-79.6%), dysgeusia (IR: 2.8-83.38%), encephalopathy/encephalitis with or without fever and hypoxia (IR: 0.19-35.2%); (iii) Renal system, e.g., acute kidney injury (AKI)/acute renal failure (IR: 0.5-68.8%); (iv) Cardiovascular system, e.g., acute cardiac injury/non-coronary myocardial injury (IR: 7.2-55.56%), arrhythmia/ventricular tachycardia/ventricular fibrillation (IR: 5.9-16.7%), and coagulopathy/venous thromboembolism (IR: 19-34.4%). This review encourages and informs healthcare practitioners to keenly monitor COVID-19 survivors for these atypical complications in all major organ systems and not only treat the respiratory symptoms of patients. Post-COVID effects should be monitored, and follow-up of patients should be performed on a regular basis to check for long-term complications.
Collapse
Affiliation(s)
- Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia;
| | - Aqsa Safdar
- Faculty of Pharmaceutical Sciences, University of Central Punjab, Lahore 54000, Pakistan;
| | - Muhammad Hammad Butt
- Department of Medicinal Chemistry, Faculty of Pharmacy, Uppsala University, 75123 Uppsala, Sweden
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore 54000, Pakistan;
| | - Sumbal Nosheen
- Department of Pharmacy, The Children’s Hospital and the University of Child Health Sciences, Lahore 54600, Pakistan;
| | - Zia Ul Mustafa
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan 57400, Pakistan;
| | - Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China;
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia;
| |
Collapse
|
3
|
Abstract
COVID (Coronavirus disease)-19 is a systemic disease and the kidney is one of the target organs of infection. Kidney injury is common and can occur in up to 40% of patients. Several glomerular diseases have been reported in association with COVID-19. Some are likely related to COVID-19 whereas many are likely coincidental. Glomerular diseases that are frequently reported in COVID-19 and have a plausible mechanistic explanation, are likely to be related to COVID-19. On the other hand, glomerular diseases that are seldom reported and have no known plausible mechanism, are likely to be unrelated. Collapsing glomerulopathy (CG) is by far the most prevalent. Its association with COVID-19, resembling human immunodeficiency virus (HIV) and CG, led to the newly proposed term “COVID-19 associated nephropathy” or “COVAN”. High-risk APOL1 genotypes are the major risk factor in COVAN patients. Podocytopathy, membranous nephropathy, pauci-immune crescentic glomerulonephritis, and thrombotic microangiopathy are also reported. In kidney allografts, CG remains the most common glomerular pathology. Patients typically present with acute kidney injury (AKI) or abnormal urinary findings at the time of or shortly after COVID-19 diagnosis. Treatment of glomerular disease in COVID-19 patients is challenging. Providers should cautiously consider balancing risks and benefit of immunosuppression, particularly in patients with active diseases. Short-term outcomes vary but generally remain poor with high morbidity and mortality. Future study of long-term outcomes is needed to improve our understanding of glomerular disease associated with COVID-19.
Collapse
|
4
|
Ma Y, Huang Y, Xu G. New insights into the mucosal immune pathogenesis of IgA nephropathy from the perspective of COVID-19 vaccination. QJM 2023; 116:181-195. [PMID: 36592052 DOI: 10.1093/qjmed/hcac287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/07/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Large-scale SARS-CoV-2 vaccination is one of the key strategies to curb the COVID-19 pandemic; however, there are increasing reports of IgA nephropathy following COVID-19 vaccination. The clinical manifestation, treatment and prognostic effects are different in IgAN patients who have had an onset after the first and second dose of vaccination, as well as new and recurrent IgAN patients. These conditions bring about a relatively important window for understanding the pathogenesis of IgAN. Gd-IgA1 is the core of the pathogenesis of IgAN. Most IgA is produced at mucosal sites; however, antigen-activated Toll-like receptor activation pathways expressed by antigen-presenting cells and B-cell homing receptors are different in the intestinal and respiratory mucosa, and the link between respiratory and intestinal mucosa is not well understood in the pathogenesis of IgAN. Budesonide treatment of IgAN is thought to inhibit the intestinal immune response by binding to glucocorticoid receptors in the intestinal mucosa or submucosa; however, it is unclear whether there is a therapeutic effect in respiratory mucosa-derived IgA nephropathy. The present review firstly described the relationship between the gut and respiratory mucosa, and the differences in antigen-presenting cell activation pathways and B-cell homing from the perspective of COVID-19 vaccines.
Collapse
Affiliation(s)
- Yaohui Ma
- From the Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang 330006, Jiangxi, China
| | - Yan Huang
- From the Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang 330006, Jiangxi, China
| | - Gaosi Xu
- From the Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang 330006, Jiangxi, China
| |
Collapse
|
5
|
Wang B, Grand A, Schub M, Singh H, Ortiz Melo DI, Howell DN. Renal biopsy in systemic infections: expect the unexpected. Ultrastruct Pathol 2023; 47:22-29. [PMID: 36602913 DOI: 10.1080/01913123.2022.2164099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Infection-related glomerulonephritis is well recognized in patients with ongoing infections. It can be missed, however, if the infection is unusual or undetected. We present three cases where the renal biopsy findings prompted the identification or treatment of systemic infections.Case 1: A 84-year-old male presented with acute kidney injury (AKI) and IgA vasculitis on skin biopsy. A renal biopsy showed active glomerulonephritis with abundant neutrophils and predominantly mesangial immune complex deposits containing IgA. The findings prompted an infectious workup which was positive for COVID-19, suggesting exacerbation of IgA nephropathy by recent COVID-19 infection. Case 2: A 31-year-old female status post kidney transplant for granulomatosis with polyangiitis (GPA) had recent pregnancy with preterm delivery, disseminated herpes simplex virus (HSV) infection with HSV hepatitis, E. coli on urine culture, and AKI. A renal biopsy showed proliferative glomerulonephritis with subendothelial and mesangial immune complex deposits containing IgG and C3. The findings were most consistent with infection-related immune complex glomerulonephritis, most likely HSV-related. Case 3: A 78-year-old female presented with AKI, proteinuria, hematuria, and positive p-ANCA. Clinically, ANCA vasculitis was suspected, and renal biopsy did show focal, segmental, necrotizing glomerulonephritis. However, immunofluorescence and electron microscopy showed IgM-rich deposits in the mesangium. The unusual presentation prompted an infectious workup including a Bartonella antibody panel which showed very high titers, suggesting Bartonella endocarditis.Infection-related glomerulonephritis has a wide variety of presentations histologically and clinically. The three cases we present here emphasize the importance of recognizing these entities to help guide treatment and improve patient care.
Collapse
Affiliation(s)
- Bangchen Wang
- Department of Pathology, Duke University Health Systems, Durham, NC, USA
| | - Alexandra Grand
- Department of Medicine, Duke University Health Systems, Durham, NC, USA
| | - Micah Schub
- Department of Medicine, Duke University Health Systems, Durham, NC, USA
| | - Harpreet Singh
- Department of Medicine, Duke University Health Systems, Durham, NC, USA
| | | | - David N Howell
- Department of Pathology, Duke University Health Systems, Durham, NC, USA
| |
Collapse
|