Copper Deficiency Myeloneuropathy Following Roux-en-Y Gastric Bypass in a 72-Year-Old Female.

Following the implementation of gastric bypass for weight management, copper deficiency has become an increasingly recognized cause of myeloneuropathy. This condition typically presents with primarily sensory deficits leading to ataxia, similar to subacute combined degeneration from Vitamin B12 deficiency. We describe the case of a 72-year-old female patient who initially presented for insidious loss of sensation in her hands and feet, along with intermittent urinary retention. MRI findings included T2 hyperintensities of the dorsal cervicothoracic spinal cord. After identification of low serum copper, intravenous supplementation was started, with immediate improvement in symptoms by the time of discharge. Clinicians should recognize copper deficiency as a potential cause of progressive sensory neuropathy, particularly in patients with a history of gastric bypass.

Effectiveness of COVID-19 Convalescent Plasma Infusion Within 48 Hours of Hospitalization With SARS-CoV-2 Infection.

On January 30, 2020, the World Health Organization (WHO) declared the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic a worldwide emergency. Worldwide there have been 170 million cases of the resulting disease coronavirus 2019 (COVID-19), of those, 3.53 million have resulted in death. The Food and Drug Administration (FDA) with Mayo Clinic as the lead institution authorized COVID-19 convalescent plasma (CCP) for treatment of SARS-CoV-2 infection. Effective therapeutic window for CCP administration had yet to be defined. We addressed this gap by characterizing longitudinal biologic response and clinical outcomes of COVID-19 patients treated with CCP. Primary outcome was discharged to home/home health.

Recurrent Aseptic Meningitis From Herpes Simplex Virus-2: Mollaret's Meningitis in a 30-Year-Old Female.

Aseptic meningitis is most commonly caused by herpes simplex virus (HSV), most often viral subtype 2. While typical meningeal symptoms include headache, photophobia/phonophobia, and nuchal rigidity, these are often much less severe than in bacterial meningitis. Rarely, patients may develop recurrent episodes of aseptic meningitis, sometimes with years between each presentation. A minimum of three episodes with at least one documented viral identification is classified as Mollaret meningitis. First described by Mollaret in 1945, the condition is self-limiting and often requires no intervention or suppressive antivirals. In fact, antiviral therapy may increase frequency of presentation. Our patient presented for her third bout of meningitis, with viral polymerase chain reaction positive for HSV-2 on lumbar puncture. The patient was successfully managed with supportive care without further suppressive antiviral therapy. As the disease is self-limiting, clinician education can mediate patient expectations, reduce unnecessary antiviral usage, and decrease superfluous healthcare resource utilization.

To Anticoagulate or Not: Acute Stroke in a COVID-19 Patient With Gastrointestinal Bleed.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a member of the coronavirus family, which comprises enveloped positive sense ribonucleic acid (RNA) viruses responsible for pandemic outbreaks including Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV), and most recently coronavirus disease 2019 (COVID-19). A 30-year-old previously healthy male diagnosed 11 days earlier with COVID-19 presented with right-sided weakness and dysarthria. The patient was found to have an acute left carotid thrombus with embolic multifocal infarcts throughout the left cerebral hemisphere. He was treated acutely with intravenous heparin however developed gastrointestinal bleeding, prompting discontinuation of anticoagulation. Follow up CT angiography 12 days following his stroke demonstrated complete resolution of the thrombus. Since discharge, the patient has been managed with antiplatelet therapy alone with complete neurologic recovery. Large vessel strokes amongst young patients have been a growing concern during the SARS-CoV-2 outbreak. The use of acute therapeutic and prophylactic anticoagulation is based on risk assessment. Albeit, the utility of anticoagulation in COVID-19 patients remains undetermined.  Prevention of stroke recurrence is a clinical priority for providers treating large vessel stroke patients. More research is required to establish the effectiveness of anticoagulation and antiplatelet therapy for stroke prevention in patients diagnosed with COVID-19.