Eye Swelling Research Articles

LBSAT311 Rhabdomyolysis: A Rare Presentation Of Hashimoto Thyroiditis In An Adolescent Boy

Abstract Introduction Hashimoto thyroiditis is the most common cause of hypothyroidism and is associated with a wide range of clinical presentations in children and adolescents. Hypothyroidism-induced rhabdomyolysis without precipitating factors is extremely rare, particularly in pediatric patients. We describe a previously healthy adolescent boy who came to our institution with vague symptoms and was found to have rhabdomyolysis secondary to hypothyroidism due to Hashimoto thyroiditis. Clinical Case A 16 year old boy presented to the emergency department at Riley Hospital for Children due to a two week history of bilateral eye and lip swelling. Additional symptoms included fatigue, sleepiness, slowing of speech, decreased attention span and weight gain. He was not on any medications and had no history of allergies. There was no family history of endocrine or neuromuscular disorders. Physical exam revealed a height of 177 cm (75th tile), weight of 118.4 kg (99th %tile) and BMI at the 99th %tile. Exam was significant for slow generalized movements, facial edema, and delayed deep tendon reflexes in all extremities. The thyroid gland was normal. Laboratory evaluation revealed Creatinine-1.46 mg/dL (0.3-1.2), ALT-88 Units/L (7-52), AST-254 Units/L (13-39), TSH-32.2 mcU/mL (0.4-4.2), fT4 <0.2 ng/dL (0.6-1.5) and CK 20,500 Units/L (30-223). Thyroid peroxidase antibody was elevated at 686.1 IU/mL. A renal and bladder ultrasound showed trace intra-abdominal ascites and decreased echogenicity of the bilateral psoas muscles favoring edema and consistent with rhabdomyolysis. He received IV hydration and was started on levothyroxine 25 mcg daily that was increased over a 10 month period to achieve euthyroidism. Genetic testing for rhabdomyolysis revealed two variants of unknown significance. Acyl carnitine and carnitine profiles were normal ruling out a metabolic myopathy. His symptoms improved significantly after treatment with levothyroxine although his CK levels plateaued around 1,000 Units/L. Liver and kidney function normalized during follow up. Conclusion Rhabdomyolysis is a rare but serious complication of hypothyroidism, the pathogenesis of which is unclear. Proposed hypotheses include impaired mitochondrial oxidative metabolism, decreased muscle carnitine and switching of muscle fibers from fast-twitching type II to slow-twitching type I due to thyroxine deficiency ultimately leading to myolysis and release of intracellular muscle contents into the circulation. It is important for clinicians to have a high index of suspicion for hypothyroidism in children who present with muscle weakness and high creatinine kinase levels. The etiology of the disproportionately mild elevation of TSH in the setting of an unmeasurable free T4 and severe clinical hypothyroidism in our patient remains a mystery. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

RF35 | PSAT299 Thyroid Eye Disease Activation After mRNA SARS-CoV-2 Vaccination in Patients With Autoimmune Thyroid Disease

Abstract Background Occurrence of Graves’ disease (GD) has been reported following SARS-CoV-2 vaccine administration, but little is known about thyroid eye disease (TED) after SARS-CoV-2 vaccination. Case 1 A 50-year-old non-smoker male was diagnosed with GD in March 2019 and treated with methimazole. In April 2020, he developed TED with bilateral proptosis, pain, erythema and diplopia and clinical activity score (CAS) 6/7. Following poor response to 3-month oral steroids, he underwent total thyroidectomy in November 2020. In six weeks, his TED improved (CAS 4/7) and thyroid stimulated immunoglobulin (TSI) levels normalized from 4.13 IU/l (preoperatively) to 0.70 IU/l (reference< 1.75 IU/l). In January 2021, he received 2 doses of the mRNA BNT162b2-SARS-CoV-2 vaccine (Pfizer-BioNTech). Three weeks after the second dose, TED deteriorated significantly with severe eye pain, lid swelling, conjunctival erythema, and worsening proptosis and diplopia (CAS 6/7). TSI levels rose to 4.45 IU/l, while patient was euthyroid on levothyroxine (TSH 2.3 mIU/l). He received 12 weekly methylprednisolone infusions (cumulative dose of 4.5 g) with limited response. He was then treated with three monthly cycles of intravenous tocilizumab with partial response (CAS 5/7). Case 2 A 71-year-old non-smoker female had a 40-year history of hypothyroidism, controlled on levothyroxine. In March 2021, three days after her second dose of the mRNA-1273 SARS-CoV-2 vaccine (Moderna), she developed bilateral eye swelling and burning. She initially received anti-histamines and steroid eye drops without improvement. By August 2021, her eyes further deteriorated with eye pain, redness, lid edema and erythema, diplopia, and worsening proptosis (CAS 4/7). She also experienced 20 Ib weight loss, palpitations, tremors, and heat intolerance. TSI index was 5.5 (reference ≤1.3), TSH was undetectable, and FT4 1.4 ng/dl (reference 0.93-1.70 ng/dl). Levothyroxine was discontinued. Two weeks later she was admitted to the hospital with loss of color vision and decreased visual acuity in the right eye. She received 2 daily doses of 1 g intravenous methylprednisolone and intravenous teprotumumab on hospital day 3. She responded well to teprotumumab infusions every 3 weeks, with return of color vision and improvement of proptosis and periorbital edema (CAS 1/7). Discussion Activation of TED has so far only been described in four patients following SARS-CoV-2 vaccination. Here we report two more cases: one of TED deterioration in a GD patient with prior TED, and one of de novo TED progressing to dysthyroid optic neuropathy in a patient with a long history of Hashimoto's hypothyroidism. Possible etiologies include a maladaptive autoimmune/inflammatory syndrome from polyclonal B cell stimulation by adjuvants or activation of preexisting autoimmune disease. The possibility of new onset or deterioration of TED after SARS-CoV-2 vaccination in patients with underlying autoimmune thyroid disease and its mechanism should be further studied. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Monday, June 13, 2022 1:18 p.m. - 1:23 p.m.

PMON315 Hyperglycemia Dilemma: Concomitant Type 1 Diabetes Mellitus and Cushing's disease

Abstract Introduction Type 1 diabetes (T1DM) is an autoimmune condition causing destruction of insulin-producing pancreatic beta cells. About a third of patients present with DKA at diagnosis. Insulin is mainstay therapy to achieve glucose control. Glucose hemostasis is affected by several factors. Conditions including acute illness or endocrinopathy such as Cushing's disease can cause hyperglycemia. We present a case of a pediatric patient with T1DM and difficult to control hyperglycemia due to concomitant hypercortisolism. Case The patient is an eleven-year-old male, who first presented in DKA at the age of 10. HgA1c at diagnosis was 17.9%. GAD65 and IA2 antibodies were positive. Compliance to medications as well as post-hospital follow-up has been an issue. At his initial follow-up visit, 8 months after diagnosis, they reported adherence to prescribed insulin regimen although his A1c was 11.3%. Insulin dose was adjusted based on current A1c level and documented glucose monitor readings. 3 months after, improvement of A1c was documented at 10.7%. He however complained of eye swelling and noted to have elevated blood pressure. Due to concerns of nephrotic syndrome he was referred to nephrology. His renal function test and urine micro-albumin came back normal. He was started on Lisinopril 5mg daily but eventually switched to amlodipine 5mg daily to control his blood pressure. In the following 14 months, nephrology noted that his hypertension was difficult to control in spite of optimizing medications. He was eventually admitted for severe headache. Significant exam on admission revealed moon facies, buffalo hump, striae on his extremities. A CT scan revealed pituitary macroadenoma 1.1×2cm. TSH was slightly low, FT4 normal. Growth hormone was also elevated. ACTH was 38 pg/ml (n 7.2-63 pg/ml)and serum cortisol was 7.1mcg/dl (n 3-22 mcg/dl). 24hr urine cortisol sent but was still pending. The rest of the pituitary work up was normal. Patient was scheduled for transsphenoidal surgery. A repeat 24-hour urine cortisol was again sent prior to surgery assuming initial test was lost. Interestingly, the initial 24-hour Urine free cortisol came back significantly elevated at 1,304 mcg (normal 2.3-37mcg) and urine free cortisol is . Pathology came back as pituitary apoplexy. 24-hour urine cortisol right before surgery came back undetectable confirming this. Conclusion Non-adherence to medication is a common reason for persistent hyperglycemia in T1DM but providers should be vigilant of other possible etiologies. Continued follow-up and detailed physical exam to check for clues such as hypertension, striae, buffalo hump, and bruising can lead to unmasking a secondary etiology. We present the first reported case of type 1 diabetes and Cushing's disease from a functional pituitary macro-adenoma that subsequently develop pituitary apoplexy. It is important to note that 24 urine cortisol remains the gold standard for diagnosis regardless of normal serum cortisol levels. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

IN THE EYE OF THE STORM: HYPERVIRULENT KLEBSIELLA PNEUMONIAE

IN THE EYE OF THE STORM: HYPERVIRULENT KLEBSIELLA PNEUMONIAE

S2757 Eye-BD—A Rare Case of Orbital Myositis as an Extra-intestinal Manifestation of Crohn’s Disease

Introduction: Crohn’s Disease (CD) is often associated with a diverse array of extra-intestinal manifestations (EIMs). The estimated prevalence of EIMs in patients with CD is 25-70%. The estimated prevalence of ocular manifestations in patients with CD is 3.5-6.8%. Orbital myositis (OM), characterized by inflammation of the extraocular muscles, is a rare ocular EIM associated with CD. Case Description/Methods: A 22-year-old female with CD on ustekinumab for maintenance therapy in remission presented with three days of right eye swelling and pain with extraocular movements. CT of the orbits reported minimal pre-septal tissue swelling, without evidence of orbital cellulitis. She was started on NSAIDs. A week later, the patient presented to the Ophthalmology clinic with resolution of her right eye symptoms but with new, similar symptoms in her left eye, including diplopia, restriction of lateral and medial gaze, and chemosis of the lateral conjunctiva. She denied symptoms concerning for a Crohn’s flare or other EIMs. The initial CT of the orbits was reviewed, and an addendum was made, reporting subtle enlargements of multiple extra-ocular muscles in the right orbit. She was diagnosed with bilateral OM. Infectious, endocrine, and autoimmune work-up was performed which were unrevealing and her OM was likely an EIM of her CD. She was started on prednisone 40 mg daily, which resulted in complete resolution of her symptoms at one-week follow-up. She was kept on ustekinumab maintenance therapy as she remained in clinical remission without evidence of other EIMs and completed her steroid taper without further complication. The patient was informed of the high recurrence rate of CD-associated OM and close follow-up was arranged. (Figure) Discussion: Overall, our patient’s OM was a likely EIM of her CD, as further laboratory work-up for commonly implicated etiologies to include thyroid disease, vasculitides, sarcoidosis, and IgG4-related disease was all negative. This case illustrates a rare EIM of CD in a patient believed to be in clinical remission, emphasizing the point that certain EIMs may occur independently of gastrointestinal luminal disease activity. Given that a high index of suspicion was necessary to reach the diagnosis given the subtle exam and imaging findings, this case also reiterates the importance of timely diagnosis and early management to minimize morbidity risk, which can be best accomplished through multidisciplinary coordination among subspecialty providers.Figure 1.: Orbital CT, Coronal- Asymmetric enlargement of the medial rectus in the RT orbit.

Rhino-orbital mucormycosis in a patient with no susceptibility following P.vivax malaria infection—a case report

BackgroundMucormycosis is a potentially lethal, angioinvasive fungal infection caused by the Mucoracea family comprising Mucor, Rhizopus, and Absidia species. It is commonly associated with uncontrolled diabetes mellitus, the use of corticosteroids, immunosuppressive drugs, and Covid-19 infection. The occurrence of mucormycosis in an immunocompetent patient is rare. Also, only a few case reports have been published where patients developed mucormycosis with associated malarial infection.Case presentationA young female presented with a 3-weeks history of painful swelling and outward protrusion of the right eye with complete loss of vision. She had a history of P.vivax malaria two weeks before her ocular symptoms. On ocular examination, there was proptosis and total ophthalmoplegia with loss of corneal sensations in the right eye. Hematological examination revealed normocytic normochromic anemia and thrombocytopenia. MRI was suggestive of right-sided pansinusitis and orbital cellulitis with right superior ophthalmic vein thrombosis and bulky cavernous sinus.Nasal biopsy was negative for fungal culture. An emergency surgical debridement of all the sinuses was done with right orbital exenteration. Histopathology confirmed the diagnosis of mucormycosis and the patient improved post-operatively on systemic antifungals.ConclusionSuch an association of mucormycosis with malaria infection is rarely reported in the literature and is hypothesized to be a result of immunosuppression caused by malaria. Also, emphasis is laid upon having a high index of suspicion for fungal infection in the setting of pansinusitis even if the risk factors are absent.We hereby report a case of rhino-orbital mucormycosis following P.vivax malaria in a 20-year-old female with anemia and thrombocytopenia.

Rhino-orbital mucormycosis after COVID-19 in the emergency department

Introduction 
 Rhino-orbital mucormycosis (ROM) is an acute and fulminant infection. The number of ROM cases developing after coronavirus disease 2019 (COVID-19) is increasing.
 Case Report
 A 62-year-old male patient was admitted to the emergency department in northern Syria complaining of new-onset vision loss, swelling, and severe swelling of the left eye. It was noted that a 3-day course of prednisolone 250 mg was given to treat COVID-19. We found that he had a history of diabetes mellitus (DM) for 10 years. Physical examination revealed ptosis, proptosis, and ocular movement restriction in all directions in the left eye. All other systemic examinations were normal. A cranial and orbital magnetic resonance imaging scan performed after hospitalization for further evaluation and treatment showed an increase in the density of the sphenoid, ethmoid, and frontal sinus walls in the left orbit. Despite antifungal and surgical treatment, the patient died on day 14.
 Conclusion
 The use of steroids in treatment and the presence of concomitant DM are the main predisposing factors. The prognosis of this disease, which has a high mortality and morbidity, is adversely affected in geographic regions where health care is inadequate.

A case of severe endogenous endophthalmitis with orbital cellulitis post COVID-19

Coronavirus disease 2019 (COVID-19) is a novel pandemic viral illness which may lead to severe respiratory diseases. However, its ophthalmic manifestations are still not well understood. There could be serious complications involving various organs in patients with the disease and in those who are recovering, or have recovered, from COVID-19. Endogenous endophthalmitis, was a rare occurrence in the past but has increased in the post-COVID-19 pandemic. Endogenous endophthalmitis results from hematogenous spread from a remote primary source. A 55-year-old man with confirmed COVID-19 presented to a local hospital with unilateral gradual loss of vision and swelling of the left eye that occurred 10 days after discharge from the hospital. Based on detailed ophthalmic examination, this patient with a co-morbidity, namely diabetes mellitus was placed in the intensive care unit where he was given corticosteroids and ventilation for two weeks. Most patients requiring mechanical ventilation may experience disorders of the eye, and it may be difficult to treat these occurrences while the patient remains in ICU. COVID-19 can lead to ocular complications especially in the late stages of infection. Follow-up of post COVID-19 patients is crucial to monitor possible ocular complaints including endophthalmitis as early diagnosis and treatment is essential to salvage vision.ContributionThere is a possible link between COVID-19 and endophthalmitis, which is a rare but devastating eye infection. The medical community should consider the eye when evaluating the role of anti-infectious treatment and immunomodulation.

Life-threatening cause of a painful red eye

A 54-year-old male was referred following an acute episode of severe ocular pain, swelling, and redness of the left eye treated as scleritis with topical corticosteroids. Fundus examination revealed a choroidal melanoma (Fig. 1A, arrow) with central excavation on ultrasonography (Fig. 1B, arrow) suggestive of focal tumour necrosis and responsible for the pain. Optical coherence tomography demonstrated chronic retinal detachment with loss of photoreceptors and an excavated choroid mass (Fig. 1C, asterisk).

Dynamics of a Zika virus transmission model with seasonality and periodic delays

Zika virus is an arbovirus transmitted by mosquitoes, which can cause low fever, mild skin rash and eye swelling. In severe cases, it may cause neurological and autoimmune complications, such as microcephaly. Climate factors and weather, especially temperature, have a strong effect on the transmission dynamics of vector-borne diseases, such as Dengue, West Nile virus, Schistosomiasis, and Zika. To study the comprehensive effects of spatial structure, seasonality and the temperature sensitivity of incubation period on the transmission of Zika virus, we propose a PDE model with periodic delay. We present the basic reproduction number R0 and explore the global dynamics of the model. Our simulations show that (i) it is possible to overestimate R0 in the periodic system if the spatial averaged system is used; (ii) R0 can be underestimated in the absence of seasonality; and (iii) shortening the incubation period may reduce the risk of disease transmission, which is critical for modeling the transmission of Zika virus dynamics to understand geographic and seasonal limits of Zika risk.

Embryonal Tumour in the Eye of a Lady Gouldian Finch (Erythrura gouldiae) and Limited Review of Intraocular Tumours in Birds

Primary intraocular tumours are infrequent in birds. A 2-year-old male Lady Gouldian finch (Erythrura gouldiae) originally presented to the referring veterinarian after the owner noticed mild swelling of the right eye. After the eye had enlarged rapidly and bulged from the orbit, the bird was seen at the referral hospital. Enucleation was attempted but the bird died after sedation. The eye was removed and, on sectioning, a mass was seen primarily in the vitreous chamber with extension through the sclera to the retrobulbar area. After routine histology, immunohistochemistry and electron microscopy, the mass was diagnosed as an embryonal tumour of probable retinal origin. This type of tumour has rarely been documented in birds and we could find no references to any report in Estrildidae.

Screen Time and Health Disturbances during the Covid-19 Pandemic: A Case of University Students in Zimbabwe

This study sought to establish health disturbances experienced by university students due to prolonged screen use during the covid-19 Pandemic in Zimbabwe. It employed the descriptive design under the quantitative approach. The study involved students from two universities in Zimbabwe, and it used a random sampling technique. A total of 128 students participated completing a survey. Data collection was conducted through a survey with a one closed-ended question seeking to identify health challenges experienced by students due to prolonged use of screens. Results were presented in percentages through graphs. The study concludes that headaches, tiredness and difficulties to sleep were experienced by students as a consequence of prolonged screen time. Furthermore, students experienced different psychological disturbances including stress and depression, inattention (difficulties to concentrate), anxiety and low self-esteem as a consequence of prolonged screen time. Finally, sight loss, tearing eyes, eye irritation, eye redness, eye swelling and dry eye disease were experienced by respondents. Based on the conclusions, the study recommends that students and all users of digital technologies for different purposes should control the time they spend on the screen and visit doctors whenever they have abnormal experience in their eyes for further guidance. The study further recommends that learning institution should come up with measures to reduce the time individuals spend on the screen by providing alternative study options that may reduce the time spent on screens for learning.

Evaluation of experimental animal behaviors through establishment of an ovalbumin-induced experimental mouse model of allergic rhinitis

Allergic rhinitis (AR) was also called hay fever which was a type of nasal inflammation when the immune system overreacts to environmental allergen exposures. AR’s clinical symptoms included a runny or stuffy nose, sneezing, red, itchy, watery eyes, and eye swelling. The fluid in the nasal cavity was usually clear. Patients with AR can affect sleep and work qualities. Seriously, the AR symptoms can also cause asthma, allergic conjunctivitis, or atopic dermatitis. Therefore, it is an important issue to attenuate AR symptoms and research the novel therapeutic drugs for AR patients. The purpose of this study was to introduce an easy-to-establish experimental mouse model of AR. In this study, the male BALB/c mice were divided respectively into as the Group A (n = 12) and the Group B (n = 12). Group A and Group B were designed as the normal control and RA, respectively. BALB/c mice in Group B were sensitized by intraperitoneal injection of ovalbumin (OVA) on day 0, day 4, day 13, and day 20, followed by continuous nasal administration of OVA solution once per day between day 21-43. BALB/c mice in Group A received sensitization of intraperitoneal injection of phosphate-buffered saline (PBS) on day 0, day 4, day 13, and day 20 and continuous nasal administration of PBS instead of OVA once per day between day 21-43. Before and after sensitization, the frequencies of nasal symptoms (sneezing, nasal rubbing) were recorded and counted. Results were showed that sneezing times in Group B were higher than Group A on D29, D30, D36, and D43 of the experiment. The sneezing times in Group A were significant higher on D29 and D30 of the experiment. However, the sneezing times in Group B were significant higher on D29, D30, D36, and D43 of the experiment. The rubbing times in Group B were higher than Group A on D29, D30, D36, and D43 of the experiment. The rubbing times in Group A were significant higher on D30 and D43 of the experiment. However, the rubbing times in Group B were significant higher on D29, D30, D36, and D43 of the experiment. Based on these results, a successful mouse model of AR has been established. We hope that this RA mouse model will provide a tool for the research of the novel AR therapeutic drugs and apply these novel AR therapeutic drugs to attenuate the AR symptoms in AR patients in the future.

Rhino-orbito-cerebral with cutaneous mucormycosis

<p>"Mucormycosis" term is used for a group of fungal diseases caused by the order mucorales. It typically presents as sino-nasal-orbital involvement and rarely involves skin. Management of such cases is quite challenging. Reported here is a case of a young girl, who presented with right eye swelling and reduced vision and got detected with type 1 diabetes mellitus on admission with rare occurrence of cutaneous lesions while on treatment. Direct nasal endoscopy with biopsy was undertaken. KOH and histopathology report was suggestive of mucormycosis, for which the patient was administered intravenous amphotericin B and surgical debridement was carried out. With the accurate application of a multidisciplinary approach with timely investigations, imaging studies, antifungals and debridement, successful outcome in mucormycosis is well within our reach.</p>

A Case of Choroidal Folds in a Patient with Immunoglobulin G4-related Ophthalmic Disease

Purpose: To report a case of choroidal folds caused by enlargement of the extraocular muscles (EOM) and orbital fat in a patient with immunoglobulin (Ig) G4-related ophthalmic disease. A full recovery was achieved after steroid administration.Case summary: A 56-year-old male received intravenous high-dose steroids to treat IgG4-related ophthalmic disease presenting with bilateral eyelid edema, hypertrophy of all EOM, and mild exophthalmos. After 3 months, only slight improvement was observed and azathioprine was initiated. The patient exhibited only a minimal response over the next 2 months; all medications were therefore stopped. One month later, the patient presented with aggravation of the swelling (both eyelids), exophthalmos, and visual impairment of the left eye. The corrected vision was 1.0 in the right eye and 0.2 in the left eye; choroid folds were observed in the posterior pole of the left eye. Intravenous steroid (500 mg) was given once and oral steroids prescribed as maintenance therapy. After 2 weeks, the corrected visual acuity recovered to 1.0 in both eyes, the eyelid edema and exophthalmos improved and the choroidal folds resolved completely.Conclusions: Choroidal folds associated with enlargement of EOM and orbital fat tissue can cause visual impairment in patients with IgG4-related ophthalmic disease. Steroids are effective in the acute phases and prevent irreversible visual impairment.

Ulceronecrotic rash in an immunocompetent individual

A 28-year-old woman presented with a 6-week history of a pustular rash that began on her ankles and spread upward. Two weeks prior to presentation, she began experiencing eye redness, swelling, and vision loss with enlarged lymph nodes and fatigue. Examination revealed ulcerated papules and plaques involving the face, shins, knees, and thighs (Fig 1). The palms and soles were spared. Postauricular and cervical lymphadenopathy was present, and there was bilateral periorbital edema with conjunctival injection (Fig 2).

Photo Quiz: Orbital Apex Mass: First, Do No Harm.

A 69-year-old male with a history of polymyalgia rheumatica presented with 4 months of intermittent sharp left retro-orbital pain and worsening vision. Two weeks prior to symptom onset, he underwent an ozone sinus treatment which caused significant “burning” in the area, per the patient, at an outside facility. The patient then developed progressive headache followed by increasing vision changes, nausea, and vomiting. The patient was afebrile throughout. Over the next 4 months, treatments included a frontal balloon sinuplasty and multiple doses of intravenous (i.v.) corticosteroids. In the 4 to 6 weeks prior to transfer to our facility, based on symptoms and imaging findings, he was diagnosed with Tolosa-Hunt syndrome, a rare, corticosteroid-responsive, idiopathic granulomatous inflammatory disorder of the cavernous sinus. He was continuously treated with corticosteroids at escalating doses, culminating in two admissions during which 1 g of i.v. methylprednisolone was given, followed by 60 mg of oral prednisone daily, to be tapered slowly. Immediately prior to transfer he again presented to his local emergency department due to worsening of his left eye swelling and now complete vision loss. He was given 1 g of i.v. methylprednisolone and transferred to our facility.

Clinical Characteristics of 100 Patients With COVID-19-Associated Mucormycosis From a Tertiary Care Center in North India.

BackgroundFungal infection in patients with coronavirus disease 2019 (COVID-19) has emerged as a new challenge in healthcare facilities. This study aimed to describe the demographic and clinical characteristics of COVID-19-associated mucormycosis (CAM).MethodologyThis retrospective, single-center case series included patients who were hospitalized and diagnosed with COVID-19 and mucormycosis at the All India Institute of Medical Sciences, Rishikesh (North India) from April 15, 2021, onwards and last followed up on June 30, 2021. Demographic, clinical, laboratory, radiological, microbiological, pathological, and outcome data were then collected and analyzed.ResultsOf the 100 consecutive inpatients with CAM, 95 (95%) had diabetes mellitus. At the onset of illness, the most common manifestations were facial swelling (85%), eye swelling (83%), headache (68%), pain around the eyeball (67%), malaise (57%), and fever (50%). The most common organ involved on examination was the nose and paranasal sinus (96%), followed by the orbit (83%), palate (19%), and cranial nerves (7%). Pulmonary involvement was seldom observed (1%). Predominant pathological findings were the presence of aseptate hyphae (75%), necrosis (75%), angioinvasion (36%), and perineural invasion (2.6%). During the last follow-up, 13 patients died, with 11 (84.6%) having severe COVID-19 and two (15.3%) having moderate COVID-19.ConclusionsSteroid use and diabetes mellitus are the significant risk factors of CAM. Patients with CAM usually present with face/eye swelling with radiological involvement of the nose and sinus and may die because of severe COVID-19.

Multisystem inflammatory syndrome in children following SARS-CoV-2 infection: A case report

Introduction: COVID-19 in children has a diverse clinical presentation, most of which is asymptomatic or mildly symptomatic. In addition, after 2-6 weeks of being infected with COVID-19, children may have the multisystem inflammatory syndrome in children (MIS-C), which is rare but serious condition, death has also been reported despite active treatment. We describe a severe clinical case of MIS-C treated at our hospital in the early stage of the 4th wave of COVID-19 in Vietnam. Case report: A six-year-old boy admitted to Thu Duc City Hospital on August 27th, 2021. He had a history of COVID-19, which was diagnosed by a positive RT-PCR SARS CoV-2 test on July 24th, 2021. He had no symptoms and was concentrated quarantine with his family. He was discharged on August 12th, 2021. Four weeks after SARS-CoV-2 infection, he had symptoms such as sustained fever (5 days), stomachache (6 days), erythema multiform (8 days), eye and lip swelling (7 days), edema of hands and feet (10 days), dyspnea (5 days), hepatomegaly and shock. After then, he was diagnosed with MIS-C and treated with intravenous methylprednisolone 2 mg/kg/day (3 days), then tapered 1 mg/kg/day (5 days), maintained with prednisone 1 mg/kg/day for 14 days. The patient had no clinical symptoms, was discharged after 14 days of treatment, and continued treatment with aspirin 3 mg/kg/day and prednisolone 1 mg/kg/day. Conclusion: The MIS-C manifestation following SARS-CoV2 infection needs prompt attention and treatment. Intravenous immunoglobulin plays an important role in treatment. However, when intravenous immunoglobulin is not available where limited resources, early appropriate use of methylprednisolone may be beneficial.

Eye Swelling and Weight Loss in an 18-year-old Adolescent.

Eye Swelling and Weight Loss in an 18-year-old Adolescent.