A doença COVID-19 surgiu em dezembro de 2019 e desde então disseminou-se por todo o mundo, obrigando à adaptação de estruturas e reorganização de serviços hospitalares, e colocando à classe médica o grande desafio de em tempo recorde, se atualizar e se manter em constante aprendizagem. Para os sobreviventes desta doença, a eliminação do vírus SARS-CoV-2, é apenas o começo de um caminho de recuperação incerto e desconhecido. De facto, segundo o conhecimento atual, o que se segue à fase aguda da infeção por SARS-CoV-2 depende da extensão e gravidade da invasão viral nos diferentes tipos de células e órgãos, mas apesar do número crescente de artigos publicados no último ano, ainda não existe uma descrição inequívoca, de um quadro clínico típico das consequências da COVID-19. Com o objetivo de conhecer o estado da arte sobre este tema, as autoras fazem uma revisão do que tem sido publicado sobre complicações/sequelas da infeção por SARS-CoV-2.
Background. Iatrogenic agranulocytosis (IA), by nonchemotherapeutic drugs, is a rare adverse event, resulting in a neutrophil count under 0.5 × 109 cells/L with fever or other suggestive signs of infection. Methods. This paper discusses the possible mechanisms responsible for agranulocytosis induced by nonchemotherapeutic drugs. It also describes three cases as well as potential ways to handle such iatrogenic situations. Conclusion. Neutropenia under 0.1 × 109 cells/L predispose patients to potentially fatal infections. Empiric broad-spectrum antibiotic and hematopoietic growth factors may be helpful in shortening hospitalization and prevent further infectious complications. Not all drugs associated with IA require frequent hematological monitoring, except medications such as clozapine, ticlopidine, and antithyroids.
Introduction: Kikuchi-Fujimoto disease (KFD) is a rare, benign, necrotizing lymphadenitis of unknown aetiology with good prognosis. It is characterized by cervical lymphadenopathy, nocturnal diaphoresis and fever. Surgical excision of the adenopathy, histopathological study and immunophenotyping are crucial for diagnosis. Patients and methods: This paper describes five patients with three different histological subtypes of KFD, including an atypical presentation masquerading as pyelonephritis and two other cases where physicians mistakenly started chemotherapy. In one other case cytomegalovirus was identified as the responsible aetiological agent, while in the remaining patient, KFD evolved into an autoimmune condition. Discussion: KFD, although rare, may mimic infectious, autoimmune and neoplastic diseases. It also poses a risk for the subsequent development of an autoimmune disorder.
Pulmonary embolism (PE) related to the presence of right heart thromboemboli entails a higher mortality rate than PE alone. Furthermore, right heart thromboemboli are often associated with deep venous thrombosis. The most effective therapy for haemodynamically stable patients remains unknown, although recent data suggest that thrombolytic therapy is associated with a better outcome. We describe the case of an 83-year-old woman, hospitalized with PE consequent to right heart thrombus-in-transit, in whom investigation revealed a concomitant deep venous thrombosis. She required thrombolysis, given the high mortality risk that is traditionally associated with this clinical entity.
LEARNING POINTS• Pulmonary embolism secondary to right-sided cardiac thromboembolus entails a higher mortality rate than PE alone.
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