COVID-19 has proven to be one of the deadliestrespiratory diseases present in the world today. While many infections result in a mild, self-limiting illness, patients with severe disease often require high level critical care. Despite our best life saving measures, patients with COVID-19 who are admitted to intensive care units (ICUs) have a significantly higher mortality ratecompared to patients admitted to ICUs for other respiratory illnesses. This review of the literature aims to describe a pathophysiologic mechanism that we believe contributes to high mortality in severely ill COVID-19 patients. Critical illness myopathy and polyneuropathy (CIMPN) is a poorly understood disease process that contributes to muscle and nerve damage in critically ill patients. In CIMPN, excessive systemic inflammation and changes in blood composition lead to damage of nerves and vasculature, which results in weakening of musculature. Damage to respiratory muscles can further exacerbate poor blood oxygenation causedbylung inflammation. Many of the same inflammatory markers seen in SARS-CoV-2 infections have also been shown to contribute to CIMPN. Additionally, high blood sugar levels caused by the bodys stress response can also contribute to CIMPN. Based on our findings, we recommend that future studies of critically ill COVID-19 patients focus on suppressing the cytokine TGF-beta and controllingblood sugar levels in order to combat the effects of CIMPN.
Breast involvement by lymphoma is rare, constituting ≤0.5% of all breast malignancies, with T-cell lymphomas, comprising 2.5 to 7.5% of all lymphomas involving breast. Several types of T-cell lymphomas have been reported in breast, including anaplastic large-cell lymphoma, breast implant associated anaplastic large cell lymphoma, peripheral T-cell lymphoma not otherwise specified, adult T-cell lymphoma/leukemia, NK/T-cell lymphoma, and T-lymphoblastic lymphoma. Breast involvement by T-lymphoblastic lymphoma is very unusual and when it is observed, it usually occurs as a secondary involvement by known lymphoma. We report the case of a 33-year-old woman with family history of breast cancer who presented with a single right breast mass which was diagnosed as T-lymphoblastic lymphoma. At presentation, the patient was feeling well and did not have any B symptoms or any other signs of lymphoma or leukemia. One month after diagnosis, the patient presented to the emergency room with chest pain and shortness of breath and was found to have a large mediastinal mass with both pleural and pericardial effusions. Subsequent evaluation of peripheral blood smear and bone marrow biopsy showed increased amount of blasts and involvement by T-lymphoblastic lymphoma. The patient was induced with cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride, and dexamethasone chemotherapy. After two-cycles of chemotherapy, a computed tomography of the thorax showed marked interval decrease in size of anterior mediastinal mass, suggestive of positive treatment response. Here, we report the first well documented case of T-lymphoblastic lymphoma presented as a single breast mass without history of B symptoms and perform an extensive English language literature review.
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