Síndrome DRESS causado por alopurinol y desencadenado por COVID-19 / Allopurinol-induced DRESS syndrome triggered by COVID-19

Drug reaction with eosinophilia and systemic symptoms syndrome (DRESS Syndrome) is caused by many different aetiological factors. We present the case of a 56-year-old woman who started allopurinol treatment about 3 weeks before. She presented with fever, hypotension, tachycardia, generalized maculopapular cutaneous rash, facial edema and axillar, inguinal and cervical enlarged lymph nodes. Complementary diagnostic exams: slight lymphocytosis, eosinophilia, acute renal failure, elevated hepatic enzymes. Swab for SARS-CoV-2 was positive. Serologic tests for another virus were negative. Histopathological analysis was compatible with DRESS syndrome. SARS-CoV-2 could also be taken into account when suspected DRESS syndrome. (AU)

Schwannoma: un caso atípico de dolor pleurítico / Schwannoma: a rare cause of pleuritic pain

Spinal schwannomas account for 30% of primitive spinal tumors. Symptoms are related to tumor location and its proximity to spinal cord and nerve roots. Radiographic and histopathologic examinations are vital diagnostic tools. Complete surgical resection is the mainstay of treatment and offers an excellent prognosis. (AU)

Cetoacidosis diabética euglucémica, un diagnóstico difícil de identificar / Euglicemic diabetic ketoacidosis, an easily missed diagnosis

Diabetic ketoacidosis is a serious and potentially life-threatening acute complication of diabetes mellitus. SGLT-2 inhibitors are recommended as first-line therapy in patients unable to tolerate metformin or as second-line agents after metformin. Their use is increasing as new data show, besides improving glycemic control, weight loss, blood pressure reduction, and beneficial cardiovascular and reno-protective effects. Euglycemic diabetic ketoacidosis is a rare but potential complication of SGLT-2 inhibitors. Physicians including internists, intensivists and emergency physicians should all be aware as this diagnosis can easily be missed in the absence of evident hyperglycemia. We report a case of 61-year-old male admitted in the emergency room because of altered mental status, associated with holocranial headache. He had medical history of type 2 diabetes and had recently started a SLGT-2 inhibitor. Arterial blood gases showed a severe high anion gap uncompensated metabolic acidosis. Blood and urine ketones were high with normal serum glucose levels. The diagnosis of euglycemic ketoacidosis due to SLGT-2 inhibitor was made. (AU)