Use of Monoclonal Antibodies Therapy for Treatment of Mild to Moderate COVID-19 in 4 Patients with Rheumatologic Disorders.

BACKGROUND The use of monoclonal antibodies therapy (MAT) in early mild to moderate Coronavirus disease 2019 (COVID-19) has gained importance in recent times. However, there is limited information on the safety and efficacy of MAT in treating COVID-19 in patients with underlying rheumatologic diseases. Patients with rheumatologic diseases are usually on long-term corticosteroids and immunosuppressive therapy, which increases their risk for progressing to more severe forms of COVID-19. We report a case series of 4 patients with rheumatologic diseases who were treated with MAT for COVID-19. MATERIAL AND METHODS A retrospective observational study was conducted in our institution on patients with underlying rheumatological disorders who received MAT as per the EUA protocol of the FDA. RESULTS Two of the 4 patients were on immunosuppresive therapy at the time of receiving MAT. They recovered from COVID-19 without any adverse outcomes. No flare of underlying rheumatologic disease was noted. CONCLUSIONS MAT was observed to be a safe and effective therapy in 4 patients with rheumatological illnesses and COVID-19 treated at our hospital.

A Case of Malignant Pleural Effusion Secondary to Endometrial Cancer After One Year of Hysterectomy.

Endometrial cancer is the most common malignant tumor of the female genital tract. It can rarely metastasize to the lung, presenting as a pulmonary nodule and pleural effusion. Here we present a case of a 76-year-old female with a history of endometrial cancer who underwent a total abdominal hysterectomy and came one year later for evaluation of shortness of breath. She was found to have pleural effusion. Diagnostic and therapeutic thoracentesis was positive for malignant cells originating from endometrial cancer. The patient could not tolerate chemotherapy due to poor functional status, and a tunnel pleural catheter was placed for symptomatic relief. In conclusion, it is a rare finding of malignant pleural effusion to have an origin as endometrial cancer. Pleura is the rare distant site of involvement from endometrial cancer.

A Case of Severe Ovarian Hyperstimulation Syndrome Causing Pleural Effusion.

Ovarian hyperstimulation syndrome is one of the complications of treating infertility by ovarian stimulation. As a result of the stimulation, there is a shift of serum from the intravascular space to the third space, leading to complications like ascites and pleural effusion. Here we present a case of a 29-year-old female with polycystic ovarian syndrome who was being treated for infertility using ovarian stimulation agents for in-vitro fertilization. After egg retrieval, the patient complained of shortness of breath and was found to have right-sided pleural effusion. Her symptoms were eventually relieved following an ultrasound-guided diagnostic and therapeutic thoracentesis. Upon discharge, a repeat chest radiograph in the pulmonary clinic showed no pleural effusion. In conclusion, although severe complications like pleural effusion from ovarian stimulation are rare, the physician should be able to recognize this phenomenon to prevent any further deterioration of the patient.

Nail Polish Remover Induced Methemoglobinemia: An Uncommon Occurrence.

Methemoglobinemia, defined as hemoglobin's impaired oxygen-carrying capacity due to oxidation from the ferrous (Fe2+) state to the ferric (Fe3+) state, has many well-documented etiologies. One example of an uncommon cause of acquired methemoglobinemia is the ingestion of nail polish remover, which can contain methemoglobin generators such as nitroethane, N,N-dimethyl-p-toluidine, and isobutyl nitrite. We present a case of methemoglobinemia in an 81-year-old male following accidental ingestion of isobutyl nitrite-containing nail polish remover, commonly used as a recreational inhalant. Furthermore, we review potentially toxic substances found in commercially available nail products. This case was designed to identify and efficiently treat a rather uncommon cause of methemoglobinemia induced in this case by a common household item, nail polish remover.

Malignant Epithelioid Neoplasm of the Brain.

Malignant epithelioid tumors have been described in various organ systems, but are rarely seen in the brain. They are aggressive tumors and have high mortality. In certain cases, the immunohistochemistry (IHC) findings may not be sufficient to clarify the diagnosis. In these cases, next-generation genetic sequencing may play a role in clarifying the diagnosis. In addition to lab testing, a thorough history and physical exam are necessary to rule out other sources of the tumor such as melanoma. Patients presenting with neurological symptoms are cared for by a wide variety of physicians, hence it is important to raise awareness of rare tumors in order to provide timely and appropriate management and referral for these patients. We present the case of a middle-aged woman who was diagnosed with a 'malignant epithelioid neoplasm' of the brain, a rare variety of tumors. We also give the clinical course of this illness.

Cameron Ulcers: Rare Case of Overt Upper Gastrointestinal Bleed in a Patient with Alcohol Use Disorder.

Cameron lesion is an uncommon cause of overt upper gastrointestinal bleed (GI bleed). Though hiatal hernia is a well-known entity, Cameron lesions that may occur in them are usually missed during upper endoscopy. Patient with Cameron lesions usually presents as chronic iron deficiency anemia, rarely as acute GI bleed. Multiple other risk factors such as non-steroidal anti-inflammatory drug use, alcohol consumption, gastro-esophageal reflux disease (GERD) may be present concomitantly which makes initial differential diagnosis of Cameron lesions more difficult as seen in our case.

Conceptos y percepciones acerca del diagnóstico y tratamiento de la fibromialgia en un grupo de reumatólogos colombianos / Concepts and perceptions about fibromyalgia diagnosis and treatment among colombian rheumatologists

RESUMEN Introducción: La fibromialgia es una enfermedad crónica caracterizada por la presencia de dolor músculo esquelético, usualmente asociada a otros síntomas como depresión, fatiga, trastornos del sueño, entre otros. Los conceptos y las percepciones sobre el diagnóstico y el tratamiento de la fibromialgia, entre médicos reumatólogos, no se conocen objetivamente. El propósito de este estudio es describir los conceptos y percepciones sobre el diagnóstico y tratamiento de la fibromialgia, entre un grupo de médicos reumatólogos en Colombia. Métodos: Estudio descriptivo de corte transversal. A través de un grupo focal en el que participaron dos reumatólogos y un experto en métodos de investigación cualitativa, se diseñó una encuesta para evaluar las percepciones y conceptos que los médicos reumatólogos tienen sobre el diagnóstico y el tratamiento de la fibromialgia. La encuesta se aplicó de forma autoadministrada y anónima a médicos reumatólogos pertenecientes a la Asociación Colombiana de Reumatología. Resultados: Encuesta aplicada a 139 reumatólogos. El 25,2% (n = 35) considera que no hay suficiente evidencia para considerar la fibromialgia como una enfermedad; 32,4% (n = 45) usa los criterios ACR (American College of Rheumatology) de 1990 para diagnosticar pacientes con fibromialgia, a pesar de que el 92,1% (n = 128) considera que estos criterios no son suficientes para el diagnóstico de fibromialgia. Los medicamentos más empleados para el manejo de fibromialgia son los antidepresivos, prescritos por el 90,6% (n = 126) de los encuestados, seguido por anticonvulsivantes 64,7% (n = 90) y analgésicos 26,6% (n = 37). Un 76,3% (n = 106) de los reumatólogos considera que el manejo del paciente con fibromialgia debe tener un enfoque multidisciplinario. Por su parte, 81,3% (n = 113) de los reumatólogos considera que el paciente con fibromialgia debe tener como médico tratante principal a un especialista distinto al reumatólogo. Conclusión: El presente estudio muestra información acerca de las distintas percepciones acerca del diagnóstico y tratamiento de fibromialgia entre un grupo de reumatólogos colombianos, documentándose un frecuente uso de los criterios de clasificación ACR 1990. En cuanto a tratamiento, se observa un alto porcentaje de uso de medicamentos, en especial antidepresivos y analgésicos. La mayoría de los reumatólogos considera que los médicos fisiatras, deben ser los líderes del manejo interdisciplinario en el tratamiento del paciente con fibromialgia.

ABSTRACT Bacfeground: Fibromyalgia is a chronic disease characterised by the presence of widespread and persistent musculoskeletal pain associated with a variety of symptoms. The concepts and perceptions around the diagnosis and treatment of fibromyalgia among rheumatologists are not objectively known. The purpose of this study is to obtain objective data using a survey and then describe the concepts and perceptions on the diagnosis and treatment of fibromyalgia among Colombian rheumatologists. Methods: A cross-sectional study was performed using a focus group, consisting of two rheumatologists and one expert in qualitative research methods. A questionnaire was designed to evaluate the perceptions and concepts that rheumatologists have on the diagnosis and treatment of fibromyalgia. The questionnaire was self-completed and anonymous by rheumatologists from the Colombian Association of Rheumatology. Results: A total of 139 rheumatologists completed the questionnaire, with 25.2% (n = 35) of rheumatologists considering that there is not enough evidence to recognise fibromyalgia as a disease. Around one-third (32.4%, n = 45) consider that the 1990 ACR (American College of Rheumatology) criteria are not sufficient to diagnose fibromyalgia, despite the fact that 92.1% (n = 128) of them use the criteria as a tool to approach the diagnosis when suspecting fibromyalgia. The most formulated medications for managing fibromyalgia are antidepressants and analgesics, with both groups being used by 90.6% (n = 126) of the respondents, followed by antiepileptics in 64.7% (n = 90) and analgesics in 26.6% (n = 37). More than three-quarters (76.3%, n = 106) of rheumatologists consider that there should be a multidisciplinary approach to the patient with fibromyalgia. Conclusion: Objective information is presented on the perceptions of fibromyalgia among a group of Colombian rheumatologists, reporting a frequent use of the ACR 1990 classification criteria. As regards treatment, a high percentage use antidepressants and antiepileptics. Most rheumatologists believe that a rehabilitation physician should be among the leaders of multidisciplinary management in the treatment of fibromyalgia patients.