A 34-Year-Old Woman with a Diamniotic Dichorionic Twin Pregnancy Presenting with an Erythematous and Papular Skin Rash Associated with SARS-CoV-2 Infection.

BACKGROUND The damage caused by the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has been extensive. Pregnant women are a group requiring special attention in medicine given the anatomical and physiological changes that occur during pregnancy. Skin rash is commonly associated with pregnancy, with the most common form of an erythematous maculopapular rash being pruritic urticarial papules and plaques of pregnancy. Skin rash is also an increasingly reported initial presentation in patients with coronavirus disease 2019 (COVID-19), due to infection with SARS-CoV-2. CASE REPORT A 34-year-old woman with a diamniotic dichorionic twin pregnancy presented with clinical picture characterized by dermatological manifestations, namely an erythematous and papular skin rash associated with SARS-CoV-2 infection. A real-time reverse transcription-polymerase chain reaction (GeneFinder) test was positive for SARS-CoV-2 detection. CONCLUSIONS Ten months after the onset of this pandemic, there is no conclusive evidence indicating that pregnant women represent a sector more or less vulnerable to severe forms of COVID-19 than the general population. This report has highlighted the importance of performing a reliable diagnostic test for SARS-CoV-2 infection in patients who present with a skin rash, particularly pregnant women.

A 65-Year-Old Woman with a History of Type 2 Diabetes Mellitus and Hypertension and a 15-Day History of Dry Cough and Fever Who Presented with Acute Renal Failure Due to Infection with SARS-Cov-2.

BACKGROUND Acute kidney injury is one of the most common complications in patients infected with SARS-CoV-2, occurring in up to 7% of cases and increasing to 23% in patients treated in the Intensive Care Unit (ICU). The objective of this report was to describe the clinical case of a patient infected by SARS-CoV-2 who developed acute renal injury, probably secondary to this infection. CASE REPORT On 1 April 2020, a 65-year-old woman presented to the emergency service of the National Institute of Respiratory Diseases, Mexico City, with a 15-day history of dry cough and subjective fever. Finally, the following diagnoses were integrated: Acute renal injury of etiology to be determined (acute chronic kidney disease secondary to T2DM vs. acute renal injury by SARS-CoV-2) and COVID-19. The patient had a typical presentation of severe COVID-19, evidencing all the risk and severity factors for this disease. However, after being admitted to the hospital, she showed evidence of acute renal injury. Although the renal injury may have been due to microangiopathic damage caused by chronic hypertension and diabetes, it is imperative to consider the possibility that such exacerbation contributes to SARS-CoV-2 infection or synergy of multiple factors. CONCLUSIONS Every aspect of this pandemic remains unclear. The formulation of hypotheses to explain the physiopathological mechanisms by which this new virus can cause mortality in infected patients may help reduce mortality rates and control the pandemic itself.

COVID-19 and Tuberculosis Coinfection in a 51-Year-Old Taxi Driver in Mexico City.

BACKGROUND Coinfection with severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2) and Mycobacterium tuberculosis (MBT) has been reported, albeit rarely, in various parts of the world and has received attention from health systems because up to one-third of the world's population has been infected with SARS-CoV-2. Mexico was not included in the first-ever report on a global cohort of patients with this coinfection. We report on a case of SARS-CoV-2/MBT coinfection in a 51-year-old taxi driver from Mexico City that underscores the importance of rapid and accurate laboratory testing, diagnosis, and treatment. CASE REPORT We present the case of a man in the sixth decade of life who was admitted to the National Institute of Respiratory Diseases (INER) with a diagnosis of COVID-19 pneumonia, which was confirmed by nasopharyngeal exudate using real-time polymerase chain reaction (RT-PCR) for the identification of SARS-CoV-2. Findings from imaging studies suggested that the patient might be coinfected with MBT. That suspicion was confirmed with light microscopy of a sputum sample after Ziehl-Neelsen staining and when a Cepheid Xpert MTB/RIF assay, an automated semi-quantitative RT-PCR assay, failed to detect rifampicin resistance. The patient was discharged from the hospital 10 days later. CONCLUSIONS The present report underscores the importance of using validated molecular diagnostic tests to identify coinfections in areas where there is a high prevalence of other causes of pneumonia, such as MBT, as a way to improve clinical outcomes in patients during the COVID-19 pandemic. While it is imperative to control the COVID-19 pandemic, the medical community must not forget about the other pandemics to which populations are still prey, and tuberculosis is one of them. We must remain alert to any clinical subtleties so as to ensure timely and accurate diagnosis and stay one step ahead of COVID-19.

Pituitary apoplexy secondary to pituitary macroadenoma, a diagnostic challenge / Apoplejía hipofisaria secundaria a macroadenoma hipofisario, un reto diagnóstico

Background: Pituitary apoplexy is a clinical syndrome reflecting a rapid expansion of sellar content, typically secondary to a stroke in a previous pituitary adenoma. This pathology is a rare complication, and, therefore, underdiagnosed. The consequences of a delay in the diagnosis are translated into serious functional and even deadly complications for the patient. Case report: We present the case of a 42-year-old male patient, who began his condition with a diffuse clinical setting, characterized by headache, amblyopia, and alterations of consciousness. The diagnosis was pituitary apoplexy, and secondary hypopituitarism, and it was treated in a conservative way, with steroid anti-inflammatories and hormonal substitution. The patient presented a psychotic episode induced by steroids, due to the supraphysiological doses used, necessary to reverse the existing neurological damage; however, it ended in a restitutio ad integrum 15 days after medical treatment, without requiring neuro-surgical intervention. Conclusions: The clinical case presented and its resolution are clear evidence of the importance of a timely and adequate diagnosis, given that being detected in early stages, and treated early according to the evolution of the pathology, will not always require surgical intervention, allowing a total neurological restitution.

Introducción: la apoplejía hipofisaria es un síndrome clínico que refleja la existencia de una rápida expansión del contenido selar, comúnmente tributario a un infarto hemorrágico o isquémico en un adenoma hipofisario previo. Esta patología es una complicación poco común y, por lo tanto, infradiagnosticada. Las consecuencias de un retraso en el diagnóstico se traducen en complicaciones funcionales graves e incluso mortales para el paciente. Caso clínico: se presenta el caso de un paciente hombre de 42 años, el cual inició su padecimiento con un cuadro clínico difuso, caracterizado por cefalea, ambliopía y alteraciones de la conciencia. El diagnóstico se resolvió como apoplejía hipofisaria e hipopituitarismo secundario, cuyo tratamiento se hizo de manera conservadora, con antiinflamatorios esteroideos y sustitución hormonal. El paciente presentó un episodio psicótico inducido por esteroides, esto a causa de las dosis suprafisiológicas utilizadas necesarias para revertir el daño neurológico existente; sin embargo, finalizó en una restitución funcional ad integrum a los 15 días postratamiento médico, sin requerir intervención neuroquirúrgica. Conclusiones: el caso clínico presentado y su resolución son evidencia clara de la importancia de un diagnóstico oportuno y adecuado, ya que de ser detectado en etapas tempranas y tratado precozmente, de acuerdo con la evolución de la patología, no siempre requerirá intervención quirúrgica, lo cual permitirá una restitución neurológica total.