We report a case of a granulomatous skin lesion in an AIDS patient whereby biopsy revealed both HSV-1 and HSV-2. This lesion was resistant to acyclovir and successfully treated with intralesional cidofovir without recurrence to date. This is the only known reported case of a granulomatous skin lesion in an HIV patient, whereby both HSV-1 and HSV-2 were isolated.
Background:Tocilizumab, an IL-6 receptor antagonist has been used in patients with Coronavirus Disease 2019 (COVID-19) as an anti-cytokine agent. IL-6 also plays a complex role in hemostasis and thrombosis. We observed a transient elevation of D-dimer in our patients who received Tocilizumab, which triggered the current study.Methods:A retrospective hospital-based cohort analysis of patients with confirmed COVID-19 who received Tocilizumab during the study period of 03/15/2020 to 05/20/2020. We retrieved demographic, clinical and laboratory data, we excluded patients who were receiving therapeutic anticoagulation therapy prior to Tocilizumab administration. Descriptive analysis was performed, the cause of death and trends of D-dimer and inflammatory markers were studied. Results: Out of the 436 confirmed COVID 19 patients admitted during the study period, 24 met the inclusion criteria. Their median age was 47.5 years old. They were 18 males and 6 females; 15 patients survived, and 9 expired. Of the group that survived, 12 received therapeutic anticoagulation. Of the 7 patients who did not receive therapeutic anticoagulation, 4 expired, 1 from sepsis and 3 probably from thromboembolic complications, compared to 5 deaths in the 17 patients who received therapeutic anticoagulation with 4 dying from sepsis, and one possibly from thromboembolic complications.Conclusions:The interplay between IL-6, IL-6 receptor antagonist and venous thromboembolism are complex. We observed a transient elevation of D-dimer in COVID-19 patients who received Tocilizumab, and a trend toward increased death secondary to thromboembolism. This observation is novel and highlights the potential thrombophilic side effects of Tocilizumab.
Coronavirus disease 2019 (COVID-19) has overwhelmed healthcare globally with millions of cases and over 2 million deaths worldwide. The hypercoagulable state associated with COVID-19 is a well-recognized complication that carries a poor prognosis. Marantic endocarditis, or non-bacterial thrombotic endocarditis (NBTE), is caused by a sterile vegetation on the cardiac valves resulting from the deposition of fibrin and platelet aggregates. It is highly associated with the hypercoagulable and acquired inflammatory states. Herein, we report a unique and rare case of COVID-19 presenting with NBTE.
Patients with HIV are at increased risk of malignancy, particularly lymphoma, which is the most common malignancy leading to death. With the advent of highly active antiretroviral therapy (HAART), patients live longer but have a longer duration of antigenic stimulation, increasing the prevalence of AIDS-related lymphoma (ARL) in the population living with HIV. Highly active antiretroviral therapy plays a direct role in preserving the immune system, helping to decrease the incidence of ARL. We present a case of a female patient with HIV (CD4 count of 576 cells/mm3) diagnosed with a stage Ill-B non-Hodgkin lymphoma in 2009 while off HAART. She was subsequently started on HAART, leading to full resolution of her lymphoma without any chemotherapeutic intervention. She was last seen in the clinic in December 2013 without any evidence of recurrence of her lymphoma. To our knowledge, this is the first case report of a stage III-B non-Hodgkin
BackgroundPre-exposure prophylaxis (PrEP) is a highly effective method for preventing HIV transmission among at-risk patients. There is limited and conflicting data regarding the risk of other STIs following PrEP initiation. The objective of this study was to compare the incidence of STIs before and during PrEP therapy.MethodsA retrospective observational study of patients seeking PrEP therapy at an inner-city clinic in Newark, New Jersey, between May 1, 2016 and March 30, 2018. Patients who were MSM, intravenous drug users, or heterosexual with multiple or HIV-positive partners were considered at risk for HIV and offered PrEP. Patients were initially screened and tested every 3 months for HIV, Chlamydia trachomatis, Neisseria gonorrhoea, syphilis, hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis A virus (HAV), herpes simplex virus (HSV), medication adherence and continued high-risk behavior. Patients were also counseled on risk-reduction behaviors. STI incidence before and during PrEP was compared.ResultsBetween May 1, 2016 to March 30, 2018, 125 patients were considered at risk. Fifty-one (41%) patients were lost to follow-up after the initial visit and were excluded. Seventy-four (59%) patients completed screening and were included in the study. The mean age was 35.0 ± 11.6 years. The majority of the patients were males 74% (54). 29 (40%) were MSM, and 33 (45%) had HIV-positive partners. The mean duration of PrEP was 386 ± 183 days. Upon initial screening 14 (19%) patients were positive for at least one STI; 3 (21%) patients had HCV, 3 (21%) had chlamydia, 2 (14.3%) had HBV, 2 (14.3%) had gonorrhea, 2(14.3%) had syphilis, one had HSV II and one was found to have HIV. Two patients acquired a new STI on PreP. One tested positive for chlamydia and gonorrhea 1 month after initiating prep and another contracted syphilis after 6 months. No patient had recurrent STIs nor acquired HIV while on PrEP therapy.ConclusionThe use of PrEP not only reduces the transmission of HIV but also appears to reduce the incidence of other STIs. Frequent STI screenings and behavioral counseling on risk reduction likely contributed toward lower STI incidence. Larger studies examining similar data over longer durations are needed to confirm these findings.Disclosures All authors: No reported disclosures.
Background COVID-19 is a major global pandemic. Since the first case reported in Wuhan, China, COVID-19 has spread across the globe with more than 7.6 million individuals affected worldwide. Several studies have tried to investigate the risk factors for mortality but there has bot been a definitive study in patients with ESRD. Herein, we aimed to investigate whether ESRD is associated with mortality as compared to age, gender and comorbidities matched cohorts. Methods A retrospective case control study was performed on patients 18-year-old with confirmed SARS-CoV-2 admitted to our hospital during the study period (03/15/2020 to 05/15/2020). Demographic, characteristics and clinical outcome were retrieved and reviewed. We found 39 ESRD patients, we matched them for 5 variables: Age, gender, diabetes mellitus (DM), hypertension (HTN), and body mass index (BMI). Age was stratified into 3 groups (< 30, 30 to 60, >60), history of DM and HTN were defined by reviewing the admission medications, and BMI was divided into 2 categories (< 30 and 30 kg/m2). The primary endpoint was percentage of inpatient mortality. Results We had 39 ESRD patients with COVID-19 out of the 400 patients admitted during the study period with known clinical outcome. Nineteen patients (49%) were between 30 to 60 years old while the rest (51%) were older than 60 years old. As for gender, 25 (64%) were males and 14 (36%) females. Additional comorbidities were present in 38 patients with hypertension (92%) being the most common, followed by DM (64%) and BMI >30 kg/m2 (49%). With the 5 variables, we were able to match with 177 controls. Nineteen individuals expired out of the 39 ESRD patients (49%), as compared to 46 patients from the 177 matched cohort (26%) (z-score 2.80, p=0.0051; odds ratio [OR], 2.71; 95% confidence interval [CI], 1.28–5.41). Conclusion Our results suggest that ESRD patients is an independent risk factor for increased mortality in patients with COVID 19 disease. Larger prospective studies will need to confirm this finding and try to find ways to mitigate this very high mortality in this vulnerable population. Disclosures Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)
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