Despite the fact that the general clinical manifestations of COVID-19 are well known, there remain problems associated with the impact of COVID-19 on human health, in addition to its effects on the respiratory system. Patients with COVID-19 and concomitant cardiovascular diseases are more likely to be hospitalized and to pass treatment in the intensive care units and to have worse prognoses. The article discusses the problems arising from the effect of type 2 coronavirus acute respiratory syndrome (SARS-CoV-2) on the cardiovascular system, starting with the mechanisms associated with angiotensin converting enzyme 2 (ACE2) receptors, as well as discusses cases of major pathological changes in the heart and blood vessels that are detected in these patients. In addition to the known risk factors for severe COVID-19: cardiovascular diseases, diabetes mellitus, chronic lung diseases and old age, even young patients without a history of risk factors may develop myocardial damage. We present a description of a clinical case of acute myocardial infarction against the background of a new coronavirus infection COVID-19 in a patient aged 28 years with a diagnosis of coronary heart disease.
A clinical case of systemic lupus erythematosus (SLE) is presented. Since childhood the patient had preclinical lupus: leukopenia, anemia, photoallergy, vasculitis, and serological changes a-SS-A (+++), but at that time the findings did not meet the criteria for SLE. At the initial examination of the woman at the age of 24 years, a clinical blood test revealed hemoglobin 101 g/l, leukopenia 3.2×109/l, ESR 41 mm/h, hyper-γ-globulinemia 29%. The immunological blood analysis revealed a-DNA (+++), a-SS-A (+++), aSm (+++), aRNP (+++). The diagnosis was "Systemic lupus erythematosus of chronic (at the beginning) course, activity of the 1st degree (2 points by the SLEDA scale): with hematological disorders (leukopenia), immunological disorders (ANA+)". Metypred was administered at a dose of 16 mg/day, followed by the dose reduction to 6 mg/day and Plaquenil 400 mg/day. The woman received inpatient and outpatient treatment, repeatedly consulted in the Federal State Budgetary Institution "V.A. Nasonova Research Institute" under the Russian Academy of Medical Sciences. At the age of 26, the diagnosis was made: "Systemic lupus erythematosus, grade 2 activity with skin lesions of the type of subacute cutaneous lupus, cheilitis, lymphadenopathy", blood tests revealed leukopenia, lymphopenia, anemia, as well as immunological disorders: a-n DNA 93.4 u/ml, aSm > 200 u/ml, aRo > 200 u/ml, C3 0.63 g/l, rheumatoid factor 69.5 mIU/ml, ANA (Нер-2) 1/640 Sp. A complex therapy was performed with the use of Metypred, Cyclophosphane and Azathioprine. Against the background of the therapy, the patient's condition is stable, but immunological disorders are preserved: persistent high positivity for aRo-SS-A and the presence of the rheumatoid factor. The case demonstrates the need for an in-depth examination of women with anemia of unknown origin in combination with leukopenia to exclude systemic diseases of the connective tissue.
The purpose of this study is to evaluate the effectiveness of the treatment of juvenile idiopathic arthritis with systemic manifestations with interleukin-1 (IL-1) inhibitors. Material and methods. A prospective analysis of the course of systemic juvenile idiopathic arthritis was performed in a 15-year-old patient; she was examined using laboratory and instrumental methods before and after therapy with the interleukin-1 (IL-1) inhibitor canakinumab. Laboratory examination included general and biochemical blood tests, determination of rheumatoid factor, C-reactive protein, lactate dehydrogenase, procalcitonin, antinuclear antibodies, anti-citrullinated peptide (ACCP) antibody titer, antistreptolysin-O titer. The patient underwent ECG, echocardiography (EchoCG), ultrasound examination of the pleural cavities, abdominal organs, kidneys, knee joints, radiography of the chest cavity organs and radiography of the hand, computed tomography of the chest and abdominal cavities. Results. Examination of the patient revealed: synovitis of the knee joints, bilateral pleurisy and pericarditis, positive markers of the inflammatory process, characteristic of juvenile idiopathic arthritis with systemic manifestations. The patient was diagnosed with leukocytosis up to 20.3×109/l with a stab shift of leukocytes up to 18%, an increase in the erythrocyte sedimentation rate of 55 mm/h, an increase in C-reactive protein up to 288 mg/l, lactate dehydrogenase up to 500 units/l, in the analyzes urine revealed moderate hematuria and proteinuria. X-ray examination revealed structural changes in the knee and interphalangeal joints. We observed the effectiveness of canakinumab therapy. During therapy with canakinumab, after the second injection, positive dynamics was noted: leukocytes 5.1 × 109/l, ESR 6 mm/h, CRP 12 mg/l, relief of symptoms of the disease. Conclusions. During therapy with canakinumab, the patient showed positive clinical and laboratory dynamics of the disease. The study demonstrated the effectiveness of interleukin-1 (IL-1) inhibitors, canakinumab, in achieving remission of the disease.
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