Thrombotic Microangiopathy in Patients Recovering from COVID-19.

INTRODUCTION: During the pandemic caused by the SARS-CoV-2 virus, some patients who develop severe forms of COVID-19 present thrombotic microangiopathy in the course of the disease's clinical progression. METHODS: Data came from direct patient observation and clinical records. We performed a kidney biopsy and used optical microscopy and immunofluorescence techniques. RESULTS: We present the case of a 78-year-old male patient, mestizo, overweight with a history of high blood pressure, ischemic cardiopathy and chronic obstructive pulmonary disease who was first admitted to the hospital due to respiratory symptoms and diarrhea related to COVID-19, from which he recovered. He was subsequently readmitted with symptoms of acute renal dysfunction accompanied by mild anemia and thrombocytopenia; at the same time, he resulted negative for COVID-19 via a real-time polymerase chain reaction test. A kidney biopsy revealed thrombi in glomerular capillaries, acute tubular necrosis, thickening of extraglomerular blood vessel walls, and C3 deposits in the glomerular tufts. CONCLUSIONS: We describe a case of thrombotic microangiopathy with kidney biopsy in a patient recovering from COVID-19. Acute renal dysfunction is a form of thrombotic microangiopathy that has been observed in patients recovering from COVID-19.

Malacoplaquia pulmonar y abdominal en un paciente VIH positivo. Reporte preliminar / Pulmonary and abdominal malakoplakia in HIV-infected patient. Preliminary report

La malacoplaquia pulmonar asociada a infección por Rhodococcus equi es poco frecuente. En el presente estudio describimos el caso de un varón de 19 años con infección por virus de inmunodeficiencia humana que acude por fiebre y tos. La tomografía axial computarizada torácica-abdominal mostró una masa tumoral mediastínica y pulmonar derecha con múltiples ganglios intraabdominales. Se realiza biopsia bronquial y el estudio histológico evidenció la presencia de sábanas de histiocitos con microorganismos tipo cocobacilos intracitoplasmáticos asociada a inclusiones en forma de diana correspondientes con cuerpos de Michaelis-Gutmann. El cultivo de las muestras de biopsia pulmonar detectó la presencia de cocobacilos grampositivos que se catalogaron como Rhodococcus equi. La biopsia de las adenopatías intraabdominales mostró características histológicas similares a las de la biopsia pulmonar. En pacientes inmunocomprometidos se debe considerar la malacoplaquia como diagnóstico diferencial en lesiones pulmonares o sistémicas constituidas predominantemente por histiocitos (AU)

Pulmonary malakoplakia associated with Rhodococcus equi is unusual. Herein we describe a 19-year-old man infected with the human immunodeficiency virus complaining of fever and cough. The computerized tomography scan revealed a mediastinal and right pulmonary tumor mass with multiples abdominal lymph nodes enlargements. Histologic examination of a bronchial biopsy specimen revealed sheets of histiocytic cells that contained coccobacillary organisms and «target-like» cytoplasmic inclusions corresponding with Michaelis-Gutmann bodies. Cultures of the lung tissue yielded growth of gram-positive coccobacilli subsequently identified as Rhodococcus equi. The intraabdominal biopsy reveals areas with similar histopathology of lung lesion. In immunocompromised patients, the possibility of malakoplakia should be considered in the differential diagnosis of pulmonary and/or systemic lesions composed of histiocytic cells (AU)