RESUMO
CASE PRESENTATION: A 67-year-old obese man (BMI 38.0) with type 2 diabetes mellitus (DM), chronic atrial fibrillation, and chronic lymphocytic leukemia stage II, stable for 8 years after chemotherapy, and a history of smoking presented to the ED with progressive dyspnea and fever due to SARS-CoV-2 infection. He was admitted to a general ward and treated with dexamethasone (6 mg IV once daily) and oxygen. On day 3 of hospital admission, he became progressively hypoxemic and was admitted to the ICU for invasive mechanical ventilation. Dexamethasone treatment was continued, and a single dose of tocilizumab (800 mg) was administered. On day 9 of ICU admission, voriconazole treatment was initiated after tracheal white plaques at bronchoscopy, suggestive of invasive Aspergillus tracheobronchitis, were noticed. However, his medical situation dramatically deteriorated.
Assuntos
Injúria Renal Aguda/virologia , Antifúngicos/uso terapêutico , COVID-19/complicações , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/tratamento farmacológico , Idoso , Anfotericina B/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Fibrilação Atrial/complicações , Broncoscopia , Dexametasona/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Evolução Fatal , Humanos , Leucemia Linfocítica Crônica de Células B/complicações , Masculino , Nitrilas/uso terapêutico , Obesidade/complicações , Oxigenoterapia , Piridinas/uso terapêutico , Respiração Artificial , SARS-CoV-2 , Fumar/efeitos adversos , Tomografia Computadorizada por Raios X , Triazóis/uso terapêutico , Voriconazol/uso terapêuticoRESUMO
STUDY OBJECTIVE: Müllerian (paramesonephric) duct anomalies (MDAs) are associated with several coexisting congenital abnormalities, including renal abnormalities. Although congenital renal abnormalities may remain asymptomatic, the consequences should not be underestimated. In both the literature and clinical practice, it remains necessary to improve awareness of the co-occurrence of different congenital renal abnormalities in women with MDAs. To gain further insight into this co-occurrence and to estimate whether guidelines for women with MDAs should be optimized, this study was performed. DESIGN: A descriptive retrospective analysis. SETTING: University Medical Centre Utrecht in the Netherlands. PARTICIPANTS: Women with MDAs diagnosed or treated between 1980 and 2015. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The prevalence of the co-occurrence of congenital renal abnormalities in women with MDAs. RESULTS: Renal status was recorded in 186 of 255 women (72.9%), and the other women (27.1%) did not have a retrievable renal status. Congenital renal abnormalities were present in 90 of 186 women (48.4%) and were observed most frequently in women having a duplex uterus with obstructed hemivagina. The most common renal abnormality was unilateral renal agenesis, which was observed in 58 of 90 women (64.4%). CONCLUSIONS: MDAs are highly associated with different congenital renal abnormalities, and these results emphasize that women with MDAs should be routinely screened for their co-occurrence. However, these results also highlight that there remains a lack of awareness of this association. Whether all women with congenital renal abnormalities should be routinely screened for MDAs requires further investigation.