Facial Angioedema after the first dose of Covishield (adenovirus-vectored severe acute respiratory syndrome coronavirus 2 vaccine): follow-up after the second and third booster doses

ABSTRACT Mass vaccination campaigns are essential to control the ongoing novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic. The Covishield vaccine consists of the replication-deficient simian adenovirus vector ChAdOx1, which contains the full-length structural spike protein of SARS-CoV-2. Occasionally, it can lead to cutaneous reactions that contribute to fear of vaccination, hesitancy, and incomplete vaccination schedules. We report a case of facial angioedema following the first dose of Covishield in a 63-year-old woman with no previous history of allergies or hypersensitivity to drugs or vaccines. No rebound of angioedema was recorded after the second homologous and third heterologous doses.

A case of Bartonella neuroretinitis with macular star diagnosed by clinical, epidemiological, serological, and molecular data: resolution after initiation of antimicrobial therapy

Abstract The differential diagnosis of optic neuritis is broad and varied. We report the case of a 24-year-old Brazilian man who presented with five-week history of fever, malaise, myalgia, severe fatigue, tender right preauricular lymphadenopathy, and acute vision blurring associated with right optic disc swelling and exudates in a macular star pattern. His illness developed soon after an infestation of fleas broke out among his cats. Diagnosis of ocular bartonellosis was confirmed by serological and molecular analyses targeting amplification of Bartonella spp. htrA gene. Signs and symptoms only improved after initiation of antimicrobial therapy.

Facial botryomycosis-like pyoderma in an HIV-infected patient: remission after initiation of darunavir and raltegravir

Abstract Botryomycosis is an uncommon, chronic, suppurative, bacterial infection that primarily affects the skin and subcutaneous tissues. It has long been associated with defects of cellular immunity. We report a 28-year-old woman who presented with a chronic, ulcerated lesion with draining sinuses in the right malar region. Predisposing factors were HIV infection with poor immunological control, alcoholism, and a previous trauma to the right cheek. Several courses of antimicrobial therapy provided only partial and temporary remission. Complete clinical remission was only achieved 5 years later when a novel antiretroviral regimen composed of darunavir and raltegravir was initiated.

A case of chikungunya virus disease presenting with remarkable acute arthritis of a previously damaged finger joint

Abstract: Chikungunya virus (CHIKV) is a mosquito-borne arthritogenic alphavirus that has recently been introduced to Brazil. We report the case of a 36-year-old male patient from the City of Rio de Janeiro who developed molecularly-confirmed CHIKV disease and whose clinical picture was remarkable because of acute arthritis of an interphalangeal joint that had been damaged by trauma 8 years previously. This case illustrates that acute CHIKV disease may preferentially target previously damaged joints. Careful study of individual cases may provide valuable information on the presentation and management of this emerging zoonosis in Brazil.

Factors associated with a diagnosis of major depression among HIV-infected elderly patients

Introduction Acquired immunodeficiency syndrome (AIDS) is being increasingly reported among the elderly and major depression (MD) may be associated with suboptimal adherence to treatment. Methods Cross-sectional study on factors associated with MD among 72 HIV-infected elderly individuals. Results Twenty (27.7%) patients were found to have MD. The female gender (odds ratio [OR] = 10.65; p = 0.00586), a low CD4 count during the study (OR = 1.005247; p = 0.01539), and current smoking status (OR = 12.89; p = 0.01693) were independently associated with MD. Conclusions Our data underscore the need to attentively search and treat MD among HIV-infected elderly patients. .

Acute gouty arthritis as a manifestation of immune reconstitution inflammatory syndrome after initiation of antiretroviral therapy / Gota aguda como manifestação da síndrome inflamatória de reconstituição imune após início de terapia antirretroviral

Immune reconstitution inflammatory syndrome (IRIS) in HIV-infected subjects initiating antiretroviral therapy most commonly involves new or worsening manifestations of previously subclinical or overt infectious diseases. Reports of non-infectious IRIS are much less common but represent important diagnostic and treatment challenges. We report on a 34-year-old HIV-infected male patient with no history of gout who developed acute gouty arthritis in a single joint one month after initiating highly active antiretroviral therapy.

A síndrome inflamatória da reconstituição imune (IRIS) observada quando do início da terapia antirretroviral em indivíduos com infecção pelo HIV envolve mais comumente manifestações novas ou piora clínica de desordens infecciosas, previamente subclínicas ou não. Muito mais raras são as descrições de casos de IRIS de natureza não-infecciosa, embora representem importantes desafios ao diagnóstico e tratamento. Neste relato descrevemos um paciente HIV-positivo do sexo masculino, de 34 anos, sem antecedentes de gota e que desenvolveu monoartrite de gota um mês após início de terapia antirretroviral de alta atividade.

Severe shoulder tendinopathy associated with levofloxacin

Fluoroquinolone (FQ)-associated tendinopathy and myopathy are uncommon but well recognized complications of the use of this class of antibacterial agents. The case of a 63-year-old previously asymptomatic female patient who developed severe left shoulder tendinopathy after surreptitiously doubling the prescribed dose of levofloxacin for the treatment of community-acquired pneumonia is reported here. Surgical stabilization with suture anchors and subacromial decompression were needed.

What should we know about metabolic syndrome and lipodystrophy in AIDS? / O que devemos saber sobre síndrome metabólica e lipodistrofia na AIDS?

OBJECTIVE: Prevalence of chronic complications of HIV infection is increasing and early recognition and treatment of the components of metabolic syndrome (MS) are essential to prevent cardiovascular and metabolic complications. Considering this, we performed a cross-sectional study on the prevalence and risk-factors for MS among HIV-infected subjects. METHODS: A total of 819 patients followed at a large outpatient HIV unit were assessed by an interviewer-administered questionnaire that recorded several demographic, epidemiologic, clinical, laboratory, and social variables. Lipodystrophy diagnosis relied on agreement between patient's self-report and physician's observation of altered body-fat deposits. The presence of three or more of the following characteristics identified MS: increased waist circumference, hypertriglyceridemia, low HDL cholesterol level, hypertension, and hyperglycemia. We used logistic regression analyses to study variables independently associated with MS. RESULTS: The prevalence of MS was 20.6 percent and that of lipodystrophy was 38.5 percent. 61 (36.1 percent) out of 169 patients with MS had also lipodystrophy. Patients with metabolic syndrome were significantly more likely to be older (OR = 1.08), had higher CD4 counts (OR = 1.001), had an increased body mass index (OR = 1.27) and had longer exposure to antiretroviral therapy (OR = 1.01) than those without metabolic syndrome. CONCLUSION: Both traditional risk factors for cardiovascular disease and factors associated with HIV infection itself, such as an increased CD4 cell count and a longer exposure to antiretroviral therapy, seem to be associated with metabolic syndrome in the present study population.

OBJETIVO: A prevalência de complicações crônicas da infecção HIV está aumentando, e o reconhecimento precoce e o tratamento dos componentes da síndrome metabólica (SM) são essenciais para a prevenção de complicações cardiovasculares e metabólicas. Considerando isso, realizamos um estudo transversal sobre prevalência e fatores de risco para SM em indivíduos HIV+. MÉTODOS: Um total de 819 pacientes acompanhados em um ambulatório de HIV foi avaliado por um entrevistador que registrou em questionário dados demográficos, epidemiológicos, clínicos, laboratoriais e variáveis sociais. O diagnóstico de lipodistrofia baseou-se na concordância entre autorrelato do paciente e observação do médico das alterações de gordura corporal. A SM foi identificada pela presença de três ou mais das seguintes características: circunferência abdominal aumentada, hipertrigliceridemia, colesterol HDL baixo, hipertensão e hiperglicemia. Análises de regressão logística foram utilizadas para identificar variáveis associadas à SM. RESULTADOS: A prevalência de SM foi 20,6 por cento e de lipodistrofia foi 38,5 por cento. Entre os 169 pacientes com SM, 61 (36,1 por cento) apresentavam lipodistrofia. Os pacientes com síndrome metabólica tinham, significativamente, maior probabilidade de ser mais velhos (OR = 1,08), ter maior contagem de CD4 (OR = 1,001), ter maior índice de massa corporal (OR = 1,27) e ter maior tempo de exposição à terapia antirretroviral (OR = 1,01). CONCLUSÃO: Tanto fatores de risco tradicionais para doença cardiovascular quanto fatores associados à infecção HIV, como aumento da contagem de CD4 e maior exposição à terapia antirretroviral, parecem estar associados à SM na população estudada.

A historical note on an imported case of loiasis in Rio de Janeiro, Brazil, 1964 / Nota histórica sobre caso importado de loíase no Rio de Janeiro, Brasil, 1964

Loiasis is a filarial disease transmitted by the Chrysops spp. tabanid flies in West and Central Africa. It is most commonly diagnosed by the clinical manifestations of Calabar swellings (transient localized inflammatory edema) or, most dramatically, by the appearance of a migrating worm through the conjunctival tissues or the bridge of the nose. We report the case of a 35-year-old resident in the city of Rio de Janeiro who displayed a moving Loa loa in the bulbar conjunctival tissue two years after returning from a six-month trip to Uganda. Surgical removal of the worm was performed.

A loaíase é uma filaríase transmitida por tabanídeos (mutucas) do gênero Chrysops na África central e ocidental, comumente diagnosticada pela apresentação clínica de edema de Calabar (edema inflamatório transitório e localizado) ou, mais dramaticamente, pela migração de um verme adulto pelo tecido conjuntival ou asa do nariz. Descrevemos o caso clínico de um paciente do sexo masculino, 35 anos, residente no Rio de Janeiro, que se apresentou com um verme adulto de Loa loa migrando sobre o tecido conjuntival bulbar dois anos após retornar de uma viagem de seis meses de duração a Uganda. Procedeu-se a remoção cirúrgica do verme.