While the COVID-19 epidemic occurred since December 2019, as of end April 2020, no treatment has been validated or invalidated by accurate clinical trials. Use of hydroxychloroquine has been popularised on mass media and put forward as a valid treatment option without strong evidence of efficacy. Hydroxychloroquine (HCQ) has its own side effects, some of which are very serious like acute haemolysis in glucose-6-phosphate dehydrogenase (G6PD) deficient patients. Side effects may be worse than the disease itself. Belgian national treatment guidelines recommend the use of HCQ in mild to severe COVID-19 disease. As opinions, politics, media and beliefs are governing COVID-19 therapy, performance of randomised controlled blinded clinical trials became difficult. Results of sound clinical trials are eagerly awaited. We report a case of acute haemolysis leading to admission in intensive care unit and renal failure in a patient with uncovered G6PD deficiency. KEYWORDSCovid-19 hydroxychloroquine adverse event haemolysis glucose-6-phosphate dehydrogenase (G6PD) deficiency evidence-based medicine ARTICLE HISTORY

Background Patients with end-stage-renal-disease (ESRD) undergoing hemodialysis (HD) represent a vulnerable population for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, due to their intrinsic fragility and increased exposure to the virus. Therefore, applying effective screening strategies and infection control measures is essential to control the spread of the epidemic within hemodialysis centers. Objective Description and evaluation of the efficacy of systematic screening by rt-PCR and viral cultures, in addition to triage to limit the spread of the epidemic. Evaluation of the performance of these tests using “post-hoc” SARS-CoV-2 serology as a surrogate marker of infection. Methods One hundred and forty-four patients undergoing hemodialysis in the Nephrology-Hemodialysis center of CHU Brugmann, Brussels, benefited from systematic virological screening using viral cultures in asymptomatic patients, or molecular tests (rt-PCR) for symptomatic ones, in addition to general prevention measures. Post-hoc serology was performed in all patients. Results Thirty-eight (26.3%) individuals were infected with SARS-CoV-2. Seventeen infected patients (44.7%) were asymptomatic and thus detected by viral culture. Our strategy allowed us to detect and isolate 97.4% of the infected patients, as proven by post-hoc serology. Only one patient, missed by clinical screening and sequential viral cultures, had a positive serology. Conclusion The implementation of a control and prevention strategy based on a systematic clinical and virological screening showed its effectiveness in limiting (and shortening) the spread of the SARS-CoV-2 epidemic within our hemodialysis unit. Graphic abstract

Abrikossoff tumor, also called granular cell tumor (GCT), is a neoplasm of the soft tissues which is most commonly a solitary, painless, and benign tumor. However, 2% of Abrikossoff tumors can be malignant. We report here the case of a 75-year-old male who presented a local recurrence of Abrikossoff tumor of the left thigh. The anatomopathological analysis concluded to a malignant GCT, and the F-18 fluorodeoxyglucose positron emission tomography showed multiple lesions in the lymph nodes and bones. The potential conversion to malignancy should alert practitioners because of the extremely poor prognosis. The diagnosis of malignant granular cell tumor should be based on a bundle of clinical and histological features and not solely on histologic features because of the challenging distinction between malignant and benign tumors due to the lack of well-defined criteria for the diagnosis of malignancy. Large size and recurrence are the most important clinical features predicting malignant behavior. Patients with a history of Abrikossoff tumor should be followed closely to monitor recurrence and malignant transformation. The apparent originality of our observation – which could lie in the evolution of a GCT tumor, initially considered as benign, to a malignant form – has to be challenged regarding the issue of classifying some cases according to the classical “benign” and “malignant” dichotomy.

Introduction Les patients en hémodialyse représentent une population à haut risque pour le « Severe acute respiratory syndrome Coronavirus2 » (SARS-COV-2) ou COVID-19, d’une part, du fait de leur fragilité intrinsèque (immunodépression de l’urémie, âge, comorbidités) et d’une exposition accrue par leurs déplacements réguliers entre leur domicile et l’hôpital et la difficulté d’assurer distanciation et isolement. L’application d’une stratégie de dépistage efficace s’impose comme moyen de contrôler la diffusion de l’épidémie dans les centres d’hémodialyse. Description Stratégie de dépistage systématique du COVID-19 chez les patients hémodialysés par culture virale sur frottis nasopharyngé et scanner thoracique des patients positifs. Méthodes Le test par rt-PCR a été utilisé comme test diagnostique chez les patients symptomatiques et faute de disposer de tests en suffisance, nous avons réalisé un dépistage hebdomadaire du COVID-19 chez tous nos patients hémodialysés ( n = 157) par culture virale sur frottis nasopharyngé. Et nous avons réalisé un scanner thoracique chez nos patients positifs à la rt-PCR ou à la culture virale. Résultats Entre la mi-mars 2020 et fin avril, nous avons enregistré 37 patients atteints du COVID-19 soit 23,5 % de notre population. Dix-sept patients asymptomatiques ont été testés positifs, grâce au dépistage systématique par culture virale, soit 46 % de la totalité de nos patients infectés. Parmi les patients infectés mais asymptomatiques, 11 (69 %) présentaient une atteinte pulmonaire au scanner thoracique, pouvant atteindre 20 à 40 % du parenchyme pulmonaire dans 43,7 % des cas. Conclusion Le dépistage systématique chez les patients hémodialysés par culture virale hebdomadaire, est une stratégie proactive de lutte contre l’épidémie COVID-19 permettant de repérer et d’isoler, après scanner thoracique, les patients asymptomatiques mais potentiellement contagieux. La validité du dépistage utilisant la culture virale est en cours d’évaluation en la confrontant aux résultats des sérologies.

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Hemodialyzed patients with COVID‐19 are at risk for severe complications from acute respiratory distress syndrome, requiring admission to the intensive‐care unit for invasive mechanical ventilation. Post tracheotomy stenosis can be a life‐threatening condition that commonly occurs after iatrogenic injury secondary to tracheotomy or tracheal intubation. We report a case of a 44‐year‐old female patient on maintenance haemodialysis who presented a COVID‐19‐related ARDS that required mechanical ventilation for 4 weeks, followed by a persistent stridor and finally succumbed, 1 month after being discharged from intensive care unit, from a severe respiratory distress due to a tracheal stenosis. Our aim is to highlight the importance of the early recognition and management of post tracheotomy stenosis in patients with persistent respiratory difficulty as stridor after prolonged intubation requiring tracheotomy, in order to improve the prognosis of these patients.

Infectious spondylodiscitis (IS) is defined as the pathogenic invasion of the vertebrae and intervertebral disks. It is a serious condition that can lead to many complications such as chronic pain, permanent neurological deficits, and even death. Vertebral surgical procedures, invasive urinary tract manipulations, and central line‐associated bloodstream infection are the primary methods by which microorganisms reach the vertebrae and intervertebral disks. Hemodialysis (HD) patients are regularly exposed to bloodstream infections due to long‐term catheter utilization or repeated vascular puncturing in patients with arteriovenous fistula. Due to the high risk of blood stream infections, HD patients have a higher risk of developing IS. Despite advanced diagnostic methods, diagnosis of spondylodiscitis is often delayed due to insidious and nonspecific symptoms, allowing dissemination of the infection, which explains the high level of mortality due to spondylodiscitis in HD patients. The infectious process typically occurs in the thoracic or lumbar region, although cervical IS does occur. We herein report the case of a 67‐year‐old man on HD who developed infectious cervical spondylodiscitis. The diagnosis was established a few days after symptom onset, but the issue was unfortunately fatal despite a well‐conducted antibiotic treatment.

Presentation of the Case. Penile gangrene is a rare entity with significant morbidity and mortality. There are only few case reports of isolated penile Fournier’s gangrene in literature. Its rare occurrence, associated with complex and serious comorbidity, poses a major challenge to the attending medical personnel. A 53-year-old Caucasian patient with poorly controlled diabetes, progressive renal insufficiency, and multiple vascular complications presented with progressive necrosis of the penis (localized Fournier’s gangrene). Discussion. Fournier’s gangrene or necrotizing fasciitis refers to any synergistic necrotizing infection of the external genitalia or perineum and is a hallmark of severe systemic vascular disease. Fournier’s gangrene is an absolute emergency because the time interval between diagnosis and treatment significantly influences morbidity and mortality. Despite aggressive management, the estimated mortality rates range from 57 to 71%. Conclusions. Improved integration of palliative care services into the care of such patients is important to improve end-of-life care even though they do not have a malignant disease. The “Palliative Care Indicator Tool” can help identifying people at risk of deteriorating health and is important to improve end-of-life care.