ABSTRACT
Symptoms of COVID-19 infection are usually mild in the healthy pediatric population. In some pediatric patients, COVID-19 infection can lead to multisystem inflammatory syndrome in children (MIS-C). We report two cases. Case 1 is a rare case of MIS-C symptoms, presenting with myalgia, chest pain, and fever three days after the second dose of the Pfizer-BioNTech COVID-19 vaccine, which is compared with Case 2, which is a case of MIS-C in an unvaccinated patient with COVID-19 infection who was noted to have acute kidney injury and fluid refractory hypotension. Although MIS-C was reported as a vaccine side effect, we conclude that COVID-19 infection led to the development of MIS-C in our case, not the COVID-19 vaccine. MIS-C symptoms were also noted to be less severe after the COVID-19 vaccine than in the unvaccinated patients.
ABSTRACT
POTS (Postural Orthostatic Tachycardia Syndrome) is a multisystem disorder characterized by the abnormal autonomic response to an upright posture, causing orthostatic intolerance and excessive tachycardia without hypotension. Recent reports suggest that a significant percentage of COVID-19 survivors develop POTS within 6 to 8 months of infection. Prominent symptoms of POTS include fatigue, orthostatic intolerance, tachycardia, and cognitive impairment. The exact mechanisms of post-COVID-19 POTS are unclear. Still, different hypotheses have been given, including autoantibody production against autonomic nerve fibers, direct toxic effects of SARS-CoV-2, or sympathetic nervous system stimulation secondary to infection. Physicians should have a high suspicion of POTS in COVID-19 survival when presented with symptoms of autonomic dysfunction and should conduct diagnostic tests like the Tilt table and others to confirm it. The management of COVID-19-related POTS requires a comprehensive approach. Most patients respond to initial non-pharmacological options, but when the symptoms become more severe and they do not respond to the non-pharmacological approach, pharmacological options are considered. We have limited understanding and knowledge of post-COVID-19 POTS, and further research is warranted to improve our understanding and formulate a better management plan.
ABSTRACT
Tizanidine is an alpha-2 adrenergic agonist used commonly by medical professionals to treat patients' chronic spasticity, muscle spasms, and neuralgia usually associated with myofascial components. This medication is also used very frequently in detoxification centers on patients treated for analgesic withdrawal, especially those who are suffering from rebound headaches due to the discontinuation of analgesics. Tizanidine is metabolized in the human body by the cytochrome P450 CYP1A2. On the other hand, ciprofloxacin is a common antibiotic belonging to the class of fluoroquinolones and is used to treat various infections. Ciprofloxacin inhibits the bacterial DNA-gyrase enzyme resulting in the destruction of the organism. Ciprofloxacin is also an inhibitor of the cytochrome P450 CYP1A2. Even though these two medications show obvious interaction still, however, both these medications are often prescribed together, and their interactions/contraindications are often overlooked by many physicians and other providers. We hereby describe the case report of the interaction between tizanidine and ciprofloxacin, along with the adverse outcome related to the concomitant use of these two drugs.