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Barbotti A, Gheorghiu AC, Fusi-Schmidhauser T, Grazioli-Gauthier L. Leukocytoclastic Vasculitis Induced by Cocaine Adulterated with Levamisole. Eur J Case Rep Intern Med 2022; 9:003468. [PMID: 36051168 PMCID: PMC9426969 DOI: 10.12890/2022_003468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 11/05/2022] Open
Abstract
Leukocytoclastic vasculitis is a cutaneous, small-vessel vasculitis. In 50% of cases the aetiology is idiopathic but it can be linked to drugs, infections, autoimmune disorders and various types of cancer. Levamisole is used as an adulterant in cocaine and heroin and has been associated with the development of leukocytoclastic vasculitis. We describe an atypical presentation of a patient with levamisole-induced leukocytoclastic vasculitis who presented with diffuse skin abscesses and a purpuric rash of the upper and lower limbs.
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Affiliation(s)
- Alberto Barbotti
- Department of Internal Medicine, Ospedale Regionale di Lugano EOC, Lugano, Switzerland
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Regoli F, Roberto M, Grazioli-Gauthier L, Cioffi G, Pasotti E, Caputo ML, Conte G, Breitenstein A, Moccetti T. Feasibility and clinical efficacy of double suture-mediated closure device technique for hemostasis during positioning of miniaturized wireless pacemaker. J Interv Card Electrophysiol 2022; 64:129-135. [DOI: 10.1007/s10840-021-01102-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
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Grazioli-Gauthier L, Rigamonti E, Leo LA, Martinetti Lucchini G, Lo Priore E, Bernasconi E. Lactobacillus jensenii mitral valve endocarditis: Case report, literature review and new perspectives. IDCases 2022; 27:e01401. [PMID: 35079575 PMCID: PMC8777067 DOI: 10.1016/j.idcr.2022.e01401] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/10/2022] [Indexed: 11/19/2022] Open
Abstract
Lactobacillus is a facultative anaerobic Gram-positive rod usually found in the normal microbiota of the gastrointestinal and genitourinary tract. Frequently dismissed as a contaminant, it is implicated in several diseases. We describe a rare case of endocarditis caused by Lactobacillus jensenii in an immunocompetent 40 year-old male patient, with a history of mitral valve repair. He presented complaining of asthenia and his laboratory results showed a moderate increase in inflammatory markers. A trans-thoracic echocardiography confirmed a vegetation on the posterior leaflet of the mitral valve, with associated severe mitral insufficiency. Blood cultures revealed the significant growth of L. jensenii. The patient developed an acute abdomen with intestinal ischemia and occlusion of the superior mesenteric artery, requiring urgent surgical laparotomy. A cerebral MRI showed multiple minor emboli in the frontal and left parietal cortex. The patient consequently underwent surgery to have his mitral valve replaced with a mechanical valve. L. jensenii was isolated in culture from the mitral valve and from a mesenteric artery thrombus. After one week of combined amoxicillin and gentamicin therapy, ampicillin alone was continued for a total of six weeks and the patient could be discharged in a good general condition. Only five cases of L. jensenii are described in literature, and they mainly affect immunocompromised hosts. In our case, a long delay between the start of symptoms and the full onset of the disease was observed. tolerance of Lactobacilli to penicillin is a key determinant of therapy choice.
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Affiliation(s)
- Lorenzo Grazioli-Gauthier
- Department of Internal Medicine, EOC Regional Hospital of Lugano, 6903 Lugano, Switzerland
- Corresponding author.
| | - Elia Rigamonti
- Department of Internal Medicine, EOC Regional Hospital of Lugano, 6903 Lugano, Switzerland
| | - Laura Anna Leo
- Cardiovascular Imaging Department, Istituto Cardiocentro Ticino, EOC Regional Hospital of Lugano, Lugano, Switzerland
| | - Gladys Martinetti Lucchini
- Diagnostic Microbiology, Department of Laboratory Medicine, EOC Regional Hospital of Bellinzona and Valleys, Via Mirasole 22a, 6500 Bellinzona, Switzerland
| | - Elia Lo Priore
- Department of Infectious Diseases, EOC Regional Hospital of Lugano, 6903 Lugano, Switzerland
| | - Enos Bernasconi
- Department of Internal Medicine, EOC Regional Hospital of Lugano, 6903 Lugano, Switzerland
- University of Geneva, Geneva, and University of Southern Switzerland, Lugano, Switzerland
- Corresponding author at: Department of Internal Medicine, EOC Regional Hospital of Lugano, 6903 Lugano, Switzerland.
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Grazioli-Gauthier L, Vanini G, Argentieri G, Bernasconi E, Gianella P. Clinical course and serial chest ultra-low-dose CT findings in a patient with COVID-19 treated with remdesivir. Minerva Med 2021; 112:516-518. [PMID: 34269015 DOI: 10.23736/s0026-4806.20.06644-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lorenzo Grazioli-Gauthier
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Ospedale Civico and Ospedale Italiano, Lugano, Switzerland -
| | - Gianluca Vanini
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Ospedale Civico and Ospedale Italiano, Lugano, Switzerland.,Department of Immunology and Allergology, Ente Ospedaliero Cantonale, Ospedale Civico and Ospedale Italiano, Lugano, Switzerland
| | - Gianluca Argentieri
- Department of Radiology, Ente Ospedaliero Cantonale, Ospedale Civico and Ospedale Italiano, Lugano, Switzerland
| | - Enos Bernasconi
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Ospedale Civico and Ospedale Italiano, Lugano, Switzerland.,Department of Infectious Diseases, Ente Ospedaliero Cantonale, Ospedale Civico and Ospedale Italiano, Lugano, Switzerland
| | - Pietro Gianella
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Ospedale Civico and Ospedale Italiano, Lugano, Switzerland.,Department of Pulmonology, Ente Ospedaliero Cantonale, Ospedale Civico and Ospedale Italiano, Lugano, Switzerland
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Giannantoni NM, Rigamonti E, Rampolli FI, Grazioli-Gauthier L, Allali G, Vanini G. Myoclonus and Cerebellar Ataxia Associated with SARS-CoV-2 Infection: Case Report and Review of the Literature. Eur J Case Rep Intern Med 2021; 8:002531. [PMID: 34123943 DOI: 10.12890/2021_002531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/16/2021] [Indexed: 12/26/2022] Open
Abstract
The current SARS-CoV-2/COVID-19 pandemic has led to a global health crisis. The clinical spectrum of SARS-CoV-2 infection ranges from asymptomatic infection to critical illness affecting almost every organ including the central and peripheral nervous systems. Myoclonus, a less expected and relatively unusual neurological complication, together with ataxia, has lately been associated with SARS-CoV-2 infection. We describe the case of a 67-year-old male patient, admitted to our hospital for interstitial bilateral pneumonia due to SARS-CoV-2 infection, who progressively developed general myoclonus and later cerebellar ataxia and gait disturbance. Given the timeline from COVID-19 systemic symptoms to neurological manifestations and the normal results of extensive and non-conclusive diagnostic work-up (blood test, lumbar puncture, EEG, cerebral MRI), a para-infectious encephalopathy related to SARS-CoV-2 was contemplated and a high dose of methylprednisolone was started with prompt symptom improvement. Further investigation and neuroepidemiological studies are needed to help define the mechanism of neuroinvasion and the entire spectrum of neurological manifestations of SARS-CoV-2 infection, even in mildly affected patients, in terms of prevention, treatment and possible neurological sequelae. LEARNING POINTS SARS-CoV-2 infection can be related to neurological symptoms and sequelae.Myoclonus, specifically when associated with ataxia, might represent the expression of COVID-19-related encephalopathy.Myoclonus associated with SARS-CoV-2 infection mostly responds to treatment with steroids.
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Affiliation(s)
| | - Elia Rigamonti
- Department of Internal Medicine, Ospedale Regionale di Lugano, Switzerland
| | | | | | - Gilles Allali
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Switzerland.,Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Gianluca Vanini
- Department of Internal Medicine, Ospedale Regionale di Lugano, Switzerland
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Treskes RW, Beles M, Caputo ML, Cordon A, Biundo E, Maes E, Egorova AD, Schalij MJ, Van Bockstal K, Grazioli-Gauthier L, Vanderheyden M, Bartunek J, Auricchio A, Beeres SLMA, Heggermont WA. Clinical and economic impact of HeartLogic™ compared with standard care in heart failure patients. ESC Heart Fail 2021; 8:1541-1551. [PMID: 33619901 PMCID: PMC8006675 DOI: 10.1002/ehf2.13252] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 02/01/2023] Open
Abstract
Aims The implantable cardiac defibrillator/cardiac resynchronization therapy with defibrillator‐based HeartLogic™ algorithm has recently been developed for early detection of impending decompensation in heart failure (HF) patients; but whether this novel algorithm can reduce HF hospitalizations has not been evaluated. We investigated if activation of the HeartLogic algorithm reduces the number of hospital admissions for decompensated HF in a 1 year post‐activation period as compared with a 1 year pre‐activation period. Methods and results Heart failure patients with an implantable cardiac defibrillator/cardiac resynchronization therapy with defibrillator with the ability to activate HeartLogic and willingness to have remote device monitoring were included in this multicentre non‐blinded single‐arm trial with historical comparison. After a HeartLogic alert, the presence of HF symptoms and signs was evaluated. If there were two or more symptoms and signs apart from the HeartLogic alert, lifestyle advices were given and/or medication was adjusted. After activation of the algorithm, patients were followed for 1 year. HF events occurring in the 1 year prior to activation and in the 1 year after activation were compared. Of the 74 eligible patients (67.2 ± 10.3 years, 84% male), 68 patients completed the 1 year follow‐up period. The total number of HF hospitalizations reduced from 27 in the pre‐activation period to 7 in the post‐activation period (P = 0.003). The number of patients hospitalized for HF declined from 21 to 7 (P = 0.005), and the hospitalization length of stay diminished from average 16 to 7 days (P = 0.079). Subgroup analysis showed similar results (P = 0.888) for patients receiving cardiac resynchronization therapy during the pre‐activation period or not receiving cardiac resynchronization therapy, meaning that the effect of hospitalizations cannot solely be attributed to reverse remodelling. Subanalysis of a single‐centre Belgian subpopulation showed important reductions in overall health economic costs (P = 0.025). Conclusion Activation of the HeartLogic algorithm enables remote monitoring of HF patients, coincides with a significant reduction in hospitalizations for decompensated HF, and results in health economic benefits.
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Affiliation(s)
- Roderick W Treskes
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Monika Beles
- Cardiovascular Center Aalst, Department of Cardiology, Onze Lieve Vrouw Hospital, Moorselbaan 164, Aalst, 9300, Belgium
| | - Maria-Luce Caputo
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Audrey Cordon
- Deloitte HEOR (Health Economics and Outcomes Research), Zaventem, Belgium
| | - Eliana Biundo
- Deloitte HEOR (Health Economics and Outcomes Research), Zaventem, Belgium
| | - Edith Maes
- Deloitte HEOR (Health Economics and Outcomes Research), Zaventem, Belgium
| | - Anastasia D Egorova
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Koen Van Bockstal
- Cardiovascular Center Aalst, Department of Cardiology, Onze Lieve Vrouw Hospital, Moorselbaan 164, Aalst, 9300, Belgium
| | | | - Marc Vanderheyden
- Cardiovascular Center Aalst, Department of Cardiology, Onze Lieve Vrouw Hospital, Moorselbaan 164, Aalst, 9300, Belgium
| | - Jozef Bartunek
- Cardiovascular Center Aalst, Department of Cardiology, Onze Lieve Vrouw Hospital, Moorselbaan 164, Aalst, 9300, Belgium
| | - Angelo Auricchio
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Saskia L M A Beeres
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ward A Heggermont
- Cardiovascular Center Aalst, Department of Cardiology, Onze Lieve Vrouw Hospital, Moorselbaan 164, Aalst, 9300, Belgium
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Grazioli-Gauthier L, Marcoli N, Vanini G, Bernasconi E, Degabriel D. Giant Cell Arteritis among Fevers of Unknown Origin (FUO): An Atypical Presentation. Eur J Case Rep Intern Med 2021; 8:002254. [PMID: 33768070 DOI: 10.12890/2021_002254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/26/2021] [Indexed: 11/05/2022] Open
Abstract
Giant cell arteritis (GCA), or Horton's arteritis, presenting solely as fever is very rare. Usually, it manifests with typical features such as visual problems, headache and jaw claudication, or it can be associated with polymyalgia rheumatica. We describe the case of a patient with GCA who presented only with prolonged fever, the cause of which was not determined by diagnostic tests. LEARNING POINTS Fever may be the only symptom of giant cell arteritis (GCA).It is important to consider GCA in the differential diagnosis of fever of unknown origin as early diagnosis is crucial for prompt treatment and to prevent catastrophic complications such as vision loss or stroke.Temporal artery biopsy remains the gold standard for diagnosing GCA.
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Affiliation(s)
- Lorenzo Grazioli-Gauthier
- Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Natalie Marcoli
- Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Department of Rheumatology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Gianluca Vanini
- Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Department of Immunology and Allergology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Enos Bernasconi
- Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Department of Infectious Diseases, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Dea Degabriel
- Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
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