The coronavirus disease 2019 (COVID-19) pandemic has become a worldwide public health crisis since December 2019. Reports of COVID-19 recurrences are uncommon but raise the question of whether patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will develop lasting immunity against or whether there are multiple viral strains that need to be considered. Although severe disease typically occurs in older individuals with comorbidities, this case report describes a patient in this demographic group who presented with COVID-19 recurrence and remained relatively asymptomatic throughout both disease courses. This case highlights how SARS-CoV-2 appears to affect some patients unpredictably, indicating that more research is needed to further understand its viral pathophysiology and disease outcomes.
Merkel cell carcinoma (MCC) is a rare but deadly skin cancer, observed classically in the sun-damaged skin of older, white males. The cancer is characterized by rapid growth as well as high morbidity and mortality. In this article, we detail an atypical presentation of MCC in an African-American patient being treated with prednisone, methotrexate, and adalimumab for rheumatoid arthritis. Initially presenting as a subcutaneous nodule, the tumor in our patient was misdiagnosed first as an abscess and treated accordingly. Only after the subcutaneous mass failed to resolve with antibiotics as well as repeated incision and drainage was a biopsy performed, which yielded the final diagnosis. In the text, we detail the patient’s symptomatology as well as steps that eventually lead to diagnostic confirmation. Our case demonstrates the importance of heightened clinical suspicion for MCC in immunosuppressed patients with unexplained subcutaneous nodules. Prompt diagnosis is crucial for positive outcomes; therefore, we aim to provide information that may aid in identification of MCC tumors in future patients. With the increasing use of biologic agents such as adalimumab to treat rheumatic disease, the literature is demonstrating an increasing incidence of previously “rare” malignancies such as MCC. It is crucial for physicians to convey these risks when initiating a patient on chronic immunosuppressive therapy and to provide routine surveillance for MCC and other complications.
Figure 3. Transesophageal echocardiogram showing mobile echodensity at the junction of the superior vena cava and right atrium, likely to be an infected fibrin cast of a central venous catheter removed one month prior.
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