Neuropsychiatric Systemic Lupus Erythematosus and Posterior Reversible Encephalopathy Syndrome in a Young Woman: A Case Report.

INTRODUCTION: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease with variable clinical presentation, including neuropsychiatric manifestations. It has a different diagnostic approach and several different therapeutic options. CASE REPORT: We describe a case of a young woman who first presented with arthritis, serositis, and pancreatitis, and was treated with mycophenolate mofetil initially. The patient presented with neurological symptoms suggestive of neuropsychiatric manifestations three weeks later, confirmed by Brain Magnetic Resonance Imaging (MRI). The treatment was changed to cyclophosphamide; however, the day after the infusion, she developed status epilepticus and was admitted to the intensive care unit. Repeated brain MRI revealed Posterior Reversible Encephalopathy Syndrome (PRES). Cyclophosphamide was discontinued and rituximab was initiated. The patient's neurological manifestations improved, and she was discharged after 25 days of use. CONCLUSION: Immunosuppressive agents, such as cyclophosphamide have been described as a potential risk factor for PRES; however, it is not clear from the available literature whether cyclophosphamide therapy is just a marker of more severe SLE or a true risk factor for PRES.

Mepolizumab and dupilumab as a replacement to systemic glucocorticoids for the treatment of Chronic Eosinophilic Pneumonia and Allergic Bronchopulmonary Aspergillosis - Case series, Almoosa specialist hospital.

In this case series, we present four patients who had asthma and blood eosinophilia. Two patients were diagnosed with Chronic Eosinophilic Pneumonia (CEP) and the other two with Allergic Bronchopulmonary Aspergillosis (ABPA). Laboratory findings revealed profound peripheral eosinophilia with abnormal chest radiography (alveolar shadows, segmental atelectasis, and cystic changes). Initial improvement (clinical, laboratory, and radiological) occurred with traditional asthma therapy, including systemic corticosteroids. The patients did not tolerate corticosteroid therapy because of weight gain, uncontrolled diabetes, bone fractures, and psychological adverse effects. Mepolizumab (administered to two CEP cases and one ABPA case) and Dupilumab (administered to one ABPA case) were initiated as steroid-sparing agents, resulting in successful therapy without relapse or adverse effects. Mepolizumab, and Interleukin-5 (IL-5) antagonist, targets diseases mediated by eosinophil activity and proliferation. Dupilumab blocks the Interleukin-4/Interleukin-13 pathway and suppresses Type 2 inflammation, including Immunoglobulin E (IgE). Dupilumab resulted in up to 70% drop in total IgE levels from baseline and reduced eosinophil-mediated lung inflammation, despite the presence of normal or increased blood eosinophil counts.

Favipiravir versus standard of care in patients with severe COVID-19 infections: A retrospective comparative study.

OBJECTIVE: To assess the efficacy of Favipiravir compared to the standard therapy in treating patients with severe COVID-19 infection. METHODS: This is a retrospective cohort of patients with COVID-19 pneumonia who were treated with favipiravir, versus comparison group that received the standard of care. RESULTS: A total of 226 patients were included; 110 patients received favipiravir and 116 patients received standard of care. Patients who received favipiravir had longer time to recovery (14.2 ± 8.8 versus 12.8 ± 5.2, p = 0.17). Favipiravir was associated with an improved early day 14 mortality (4 [3.6%] versus 11 [9.5%]), p = 0.008), but was associated with a higher day 28 mortality (26 [23.6%] versus 11 [9.5%], p = 0.02). The overall mortality was higher in the favipiravir versus the standard of care group but difference was not statistically significant (33 [30.0%] versus 24 [20.7%], p = 0.10). CONCLUSION: The addition of favipiravir to standard of care was not associated with any improvement in clinical outcomes or mortality. Larger randomized controlled clinical trials are needed to further assess the efficacy of favipiravir.