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Corticosteroid-induced lipomatosis is not a rare condition, but lipoma in the central veins has scarcely been described. According to the databases consulted, this is the first report of a lipoma within the central veins coexistent with long-term use of corticosteroid. It involved a 47-year-old male under treatment for pulmonary sarcoidosis with prednisone. Computerized tomography of the thorax was performed and incidentally the images showed a mass within the central veins with the characteristics of lipoma. He was asymptomatic and refused surgical procedures. The intraluminal lipoma originated in the right brachiocephalic and subclavian veins. Control tomography showed a slow development of this lipoma, without obstructive effects or malignant features. Oral prednisone was changed for methotrexate. The patient is asymptomatic and under longstanding out-patient surveillance. Corticosteroid treatments for sarcoidosis can play a role in the development of intravascular lipoma, but this association is not well defined. Case reports could contribute to clarifying whether this relationship is causal or merely casual. REsUMEnLa lipomatosis inducida por glucocorticoides no es una entidad rara, pero hay pocos casos descritos de lipoma en las venas centrales. Según la bibliografía, éste es el primer trabajo de un paciente con un lipoma en las venas centrales coexistente con el uso de glucocorticoide a largo plazo. Se trata de un hombre de 47 años, en tratamiento de sarcoidosis pulmonar con prednisona. Se realizó tomografía computarizada de tórax e incidentalmente, las imágenes mostraron una masa en las venas centrales, con características de lipoma. El paciente estaba asintomático y se negó a la realización del procedimiento quirúrgico. Este lipoma intraluminal se originó en la vena braquiocefálica y subclavia derecha. El estudio tomográfico demostró un desarrollo lento del lipoma, sin efectos obstructivos ni características malignas. La prednisona oral se cambió por metotrexate. El paciente permanece asintomático, realizando un seguimiento ambulatorio. Los tratamientos con glucocorticoides para sarcoidosis pueden desempeñar un papel importante en el desarrollo de lipomas intravasculares, pero esta asociación no está bien definida. Se desconoce si la relación de esta asociación es causal o meramente casual.Palabras clave. Glucocorticoides. Lipoma intravascular. Sarcoidosis. Vena braquiocefálica. Vena subclavia.

Objectives We aim to compare differences in mortality risk factors between admission and follow-up incorporated models. Methods A retrospective cohort study with 524 patients with confirmed COVID-19 infection admitted to a tertiary medical center in São Paulo, Brazil, from March 13 th to April 30 th , 2020. We collected data at admission, 3 rd , 8 th and 14 th day of hospitalization. We calculated the hazard ratio (HR) and compared 28-day in-hospital mortality risk factors between admission and follow-up models using a time-dependent Cox regression model. Results Of 524 patients, 50.4% needed mechanical ventilation. The 28-day mortality rate was 32.8%. Compared to follow-up, admission models under-estimated the mortality HR for peripheral oxygen saturation<92% (1.21 versus 2.09), heart rate>100bpm (1.19 versus 2.04), respiratory rate>24ipm (1.01 versus 1.82) and mechanical ventilation (1.92 versus 12.93). Low oxygen saturation, higher oxygen support and more biomarkers including lactate dehydrogenase, c-reactive protein, neutrophil-lymphocyte ratio and urea remained associated with mortality after adjustment for clinical factors at follow-up compared to only urea and oxygen support at admission. Conclusions The inclusion of follow-up measurements changed mortality hazards of clinical signs and biomarkers. Low oxygen saturation, higher oxygen support, lactate dehydrogenase, c-reactive protein, neutrophil-lymphocyte ratio and urea could help prognose patients during follow-up.

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