Recurrent Pericarditis and Covid-19

Background: Anakinra, an interleukin 1beta recombinant receptor antagonist, could be used to reduce corticosteroid-dosage in colchicine-resistant pericarditis. Recently anakinra has been approved to treat patients presenting covid-19 related pneumonia requiring supplementary oxygen at risk of developing ARDS (identified by the finding of sieric suPAR at least 6 ng/mL.) Clinical case: A 86-years-old woman with history of hypertensive heart disease, diabetes mellitus and hyperthyroidism. Echocardiography showed pericardial effusion with signs of early-stage cardiac tamponade requiring pericardiocentesis. Post-procedural AF occurred. Considering the potential high bleeding risk caused by an high dose of NSAIDs, has been set up medical treatment with colchicine and corticosteroid. During hospitalization patient tested positive for SARS-CoV-2. At the same time pericardial fluid cultures were negative to infectious and non-infectious etiologies. Despite the persisting chest pain (sharp and pleuritic, improved by sitting up and leaning forward), elevated serum CRP and a pericardiocentesis residual right ventricle pericardial effusion, there has been a fast improvement of the clinical picture and of the laboratory findings after the treatment with Anakinra. Conclusion(s): treatment with IL-1 inhibitors (Anakinra) has been exploited to reduce COVID-19-associated mortality and to treat patients with symptoms refractory to first lines of conventional pericarditis therapy.

Anakinra in COVID-19 and pericarditis

Background: Anakinra, an interleukin 1β recombinant receptor antagonist, could be used to reduce corticosteroid-dosage in colchicine-resistant pericarditis. Recently anakinra has been approved to treat patients presenting covid-19 related pneumonia requiring supplementary oxygen at risk of developing ARDS (identified by the finding of sieric suPAR at least 6 ng/mL). Case Report: A 88-years-old woman with history of hypertensive heart disease, diabetes mellitus and hyperthyroidism. Echocardiography showed pericardial effusion with signs of early-stage cardiac tamponade requiring pericardiocentesis. Post-procedural AF occurred. Considering the potential high bleeding risk caused by an high dose of NSAIDs, has been set up medical treatment with colchicine and corticosteroid. During hospitalization patient developed COVID-19. At the same time pericardial fluid cultures were negative to infectious and non-infectious etiologies. Despite the persisting chest pain (sharp and pleuritic, improved by sitting up and leaning forward), elevated serum CRP and a pericardiocentesis residual right ventricle pericardial effusion, there has been a fast improvement of the clinical picture and of the laboratory findings after the treatment with Anakinra. Conclusions: given that Interleukin-1 (IL-1) is a pro-inflammatory cytokine that has been associated with severe COVID-19, in this case treatment with IL-1 inhibitors (Anakinra) has been exploited to reduce COVID-19-associated mortality and to treat patients with symptoms refractory to first lines of therapy.

Acute intracranial bleed symptoms mimic by lactic acidodis linezolid induced

Introduction: Rarely, lactic acidosis can be a life-threatening medication side effect. Hence, determining the etiology of lactic acidosis early in patients is necessary to choose the correct therapeutic intervention. Although lactic acidosis as an adverse drug reaction of linezolid is a well-recognized and documented clinical entity. Case Report: A 90-years-old woman was hospitalized for Sars- CoV-2 related pneumonia, due to an increase of CRP, WBC count and appearance of new opacities on chest CT, it has been decided to start an atimicrobial therapy with Linezolid, suspecting an MRSA superinfection. After six doses she presented an episode of consciusness alteration, lethargy and allucinations.The head CT any bleeding or mass effect has been demonstrate, but blood gas analysis showed a significant lactic acid increase and an important HOC3- reduction. After the suspencion of Linezolid lactate rapidly decrease. Conclusions: Several publications demonstrate that linezolid induces lactic acidosis by disrupting crucial mitochondrial functions, rarely with a rapid onset.It is important that internist are aware that linezolid can cause lactic acidosis not only after a long threatment period but also after few somministration, and that often it may mimic a common disease like cerebrovascular accident. In conclusion, linezolid should be suspected in the differential diagnosis if lactic acidosis exists with an uncommon clinical picture.