RESUMO
Clopidogrel is an antithrombotic agent widely used for the secondary prevention of cerebrovascular and cardiovascular complications. Clopidogrel can cause serious adverse events, including gastrointestinal bleeding. Pulmonary complications caused by clopidogrel are not widely described, and clopidogrel-induced interstitial lung disease (ILD) is rare. Here, we report a case of drug-induced ILD in a patient who presented with dyspnea, chest pain, and mild fever. The patient underwent percutaneous coronary intervention two months ago and was commenced on clopidogrel. He was diagnosed with clopidogrel-induced ILD based on clinical and imaging findings, history of drug exposure without any change, exclusion of other respiratory disorders, and clinical improvement after discontinuation of clopidogrel and steroid use.
RESUMO
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is an immune-mediated disorder of small and medium-sized vessels, characterized by the production of autoantibodies that target the neutrophilic antigens leading to mononuclear cell infiltration and destruction of blood vessels in lungs, skin, and kidneys. Although rare, the coronavirus disease 2019 (COVID-19) vaccine may trigger autoimmune vasculitis. We report a rare case of ANCA-associated renal vasculitis following COVID-19 vaccination in a 59-year-old male who presented with flu-like symptoms and deranged renal function tests. He received his second dose of the Pfizer COVID-19 vaccine 17 days ago. His clinical picture, serological testing, and radiological imaging were concerned with glomerular disease. His serum was positive for ANCAs, and the renal biopsy specimen revealed pauci-immune glomerulonephritis. He was diagnosed with AAV-associated renal vasculitis following COVID-19 vaccination because no other etiology was identified. His clinical improvement after starting rituximab and steroids reinforced the diagnosis.
RESUMO
Hemophagocytic lymphohistiocytosis (HLH) is categorized into primary HLH and secondary HLH. Primary or familial HLH is an autosomal recessive disorder due to mutation in immune regulatory genes. Secondary HLH is an uncommon hyperinflammatory disease triggered by a critical illness (malignancies or viral infection) that induces an uncontrollable excessive immune response, which results in multiorgan failure. Due to the rarity of the syndrome, HLH is associated with worse outcomes. Severe coronavirus disease-19 (COVID-19) is identified as a trigger of HLH, and published literature suggests that patients with severe COVID-19 are at high risk of developing HLH. COVID-19-associated HLH is rarely reported in the literature. Herein we present a case of secondary HLH due to COVID-19 presented in the emergency department with prolonged non-resolving fever.