Minimization of immunosuppression and administration of antiretrovirals have been recommended for kidney transplant recipients (KTRs) with coronavirus disease 2019 (COVID‐19). However, outcomes remain poor. Given the likely benefit of cyclosporine because of its antiviral and immunomodulatory effect, we have been using it as a strategy in KTRs diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). We studied 29 kidney transplant recipients (KTRs) who were admitted to our institution with COVID‐19 between March 15and April, 24, 2020. Mycophenolate and/or mammalian target of rapamycin inhibitors (mTORi) were discontinued in all patients. Two therapeutic strategies were compared: Group 1, minimization of calcineurin inhibitors (N = 6); and Group 2, cyclosporine‐based therapy (N = 23), with 15 patients switched from tacrolimus. Hydroxychloroquine was considered in both strategies but antivirals in none. Six patients died after respiratory distress (20.6%). Five required mechanical ventilation (17.2%), and 3 could be weaned. Nineteen patients had an uneventful recovery (65.5%). In group 1, 3 of 6 patients died (50%) and 1 of 6 required invasive mechanical ventilation (16.7%). In group 2, 3 of 23 patients died (12.5%). Renal function did not deteriorate and signs of rejection were not observed in any patient on the second treatment regime. In conclusion, immunosuppressant treatment based on cyclosporine could be safe and effective for KTRs diagnosed with COVID‐19.

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Emphysematous pyelonephritis (EPN) is a rare and serious necrotizing infection that is potentially life-threatening. It has been seldom reported in kidney grafts and is usually caused by Gram-negative bacteria, with some case reports caused by anaerobic bacteria, and has been closely associated with poorly controlled diabetes mellitus (DM) and urinary tract structural abnormalities. There are no reports of EPN of fungal etiology in kidney grafts. We present a case of a 53-year-old kidney transplant recipient with a history of DM, active vesicoureteral reflux, and recurrent urinary tract infections who developed EPN in the kidney allograft caused by Candida glabrata, 3 weeks after starting treatment with empagliflozin, with an aggressive course that required urgent transplant nephrectomy.

Involvement of the ear and temporal bone in acute leukemias are uncommon. We report a case of atypical mastoiditis with bilateral facial paralysis in a child diagnosed with Acute Lymphoblastic Leukemia (ALL). A 20-month-old male child was diagnosed with ALL and developed otorrhea unresponsive to antimicrobial treatment during the first week of chemotherapy followed by hearing loss, loss of balance, and bilateral facial paralysis. A CT scan of the mastoids showed cortical erosion of the temporal bone and presence of soft tissue contents filling the mastoid cells and external auditory canal bilaterally. Mastoidectomy was performed to collect material for analysis. Histopathologic examination of the material revealed an active chronic inflammatory process, with a moderate amount of plasma cells. Chemotherapy was reintroduced 3 weeks after the surgical procedure, and progressive improvement of otorrhea and imbalance was noted. Grade III House–Brackmann peripheral facial paralysis persisted on 6-month follow-up, and the patient is in rehabilitation program.

Objetivos: Os objetivos deste estudo foram avaliar a prevalência de perda auditiva em pacientes diagnosticados com doença falciforme (DF) acompanhados no Ambulatório de Hematologia do Conjunto Hospitalar de Sorocaba e correlacionar os achados com o tipo de hemoglobinopatia. Métodos: Neste estudo, foram incluídos 19 pacientes com diagnóstico de DF, sendo 68% da forma homozigota da hemoglobina S (SS); 16% do tipo hemoglobinopatia SC; e 16%, S-β-talassemia. Em cada paciente, foram realizados anamnese direcionada, exame físico otorrinolaringológico e avaliação audiológica com audiometria tonal, vocal e imitanciometria. Do total da amostra, 37% apresentou alguma alteração na audiometria tonal e a média dos limiares mostrou tendência a ser maior nas altas frequências. Resultados: Na amostra, foram encontrados um paciente (5%) com perda auditiva de grau leve a moderado bilateralmente e seis pacientes (32%) com limiares >25 dB em frequências de 250, 6.000 ou 8.000 Hz em um ou ambos os ouvidos. Não foi observada alteração do Índice de Reconhecimento de Fala (IRF) em nenhum paciente e a imitanciometria mostrou-se com curva Tipo A em 100% dos ouvidos avaliados. A relação do tipo de hemoglobinopatia e a presença ou não de perda auditiva não foram significantes. Conclusão: Assim como descrito na literatura, observou-se, neste estudo, a presença de perda auditiva neurossensorial, principalmente em altas frequências, nos pacientes com DF avaliados. Portanto, conclui-se que é de extrema importância o monitoramento audiológico desses pacientes.