[Autoimmune hemolytic anemia following the third dose of the COVID-19 vaccine].

The development and exacerbation of autoimmune diseases following coronavirus disease 2019 (COVID-19) vaccination have been reported; however, there are few reports of autoimmune hemolytic anemia (AIHA). A 75-year-old woman was admitted to the emergency department 46 days after receiving her third dose of the mRNA-1273 COVID-19 vaccine because of fatigue and general weakness. Initial laboratory analyses revealed severe hemolytic anemia with positive direct and indirect Coombs test and elevation of serum indirect bilirubin and lactate dehydrogenase. The patient had no underlying disease after a close examination and was diagnosed with warm AIHA, which was thought to be associated with COVID-19 vaccination. The anemia improved daily after the administration of prednisolone. Clinicians should be aware of the possibility of AIHA being caused by COVID-19 vaccination, and monotherapy with prednisolone should be considered in cases of severe anemia.

A Case of COVID-19 and Methicillin-Resistant Staphylococcus aureus (MRSA) Coinfection Resulting in MRSA Empyema.

Bacterial coinfections in patients with COVID-19 are rare; however, coinfection with Staphylococcus (S.) aureus is relatively common. No detailed report of patients with COVID-19 and methicillin-resistant S. aureus (MRSA) coinfection has been documented. Herein, we present a case of a patient with COVID-19 and MRSA coinfection who developed MRSA empyema after pneumonia and bacteremia. A 59-year-old man was admitted to the intensive care unit for treatment of COVID-19 and bacterial pneumonia with septic shock. He was initially treated with antibiotics, antiviral agents, and steroids. On the third day of admission, MRSA was detected in both sputum and blood cultures. Although he was treated with appropriate vancomycin doses with monitoring of renal function and serum vancomycin concentrations, he developed bilateral pleural effusions one week after starting treatment. Initially, the bilateral pleural effusions were thought to have been caused by hypoalbuminemia. However, bilateral chest drainage was performed due to the onset of left-sided chest pain. The left-sided pleural effusion was exudative, whereas the right-sided pleural effusion was transudative. MRSA was later detected on culture of the left-sided effusion but not the right-sided effusion. Based on the findings of the pleural fluid examination, the patient was diagnosed with left-sided empyema. His symptoms and radiographic findings improved after a repeat drainage of the left pleural effusion. Vancomycin was administered for 28 days, and the patient was discharged on the twenty-eighth day of admission. These findings highlight the importance of pleural fluid examination for the prompt diagnosis of pleural infection. Early diagnosis of empyema and prompt chest drainage may help avoid the need for surgery. This report could contribute to the clinical management of patients with COVID-19 and MRSA coinfection.

Time course of skin rash, computed tomography findings, and viral load in a rheumatoid arthritis patient with severe varicella pneumonia.

Varicella-zoster virus (VZV) infection in adults or immunocompromised patients has a more severe presentation compared to the mild disease in children. To the best of our knowledge, no reports have described the clinical course of VZV pneumonia focusing on time course of skin rash, chest computed tomography (CT) findings, and viral load. Furthermore, no reports have described the reactivation of human herpes virus 6 (HHV-6) in VZV pneumonia. Here, we report a case of severe VZV pneumonia that resulted in reactivation of HHV-6 in a patient with rheumatoid arthritis (RA). A 66-year-old female treated for RA was admitted to our hospital with papules. Her chest CT showed granular infiltrates, micronodules, and ground-glass opacities. The day after admission, because the typical skin rashes and chest CT findings were observed, she was diagnosed with VZV pneumonia and treated with acyclovir. Her skin rash then crusted over five days and entered the healing process, whereas it took approximately two weeks for her respiratory condition and chest CT findings to improve. In addition, VZV deoxyribonucleic acid (DNA) gradually decreased with treatment. On the 34th day of admission, VZV DNA was not found in the serum sample but remained in the sputum sample. Furthermore, although reactivation of HHV-6 was observed, viremia resolved without treatment. Clinicians should be able to recognize the differences in the improvement of skin rashes, respiratory status, and chest CT findings. In addition, treatment for HHV-6 reactivation should be carefully determined for each case.