High-dose Steroid Therapy Research Articles

Atraumatic Elbow Avascular Necrosis in the Adult is Rare, Multifocal, and Associated with Systemic Corticosteroid Use

BackgroundAtraumatic avascular necrosis (AVN) of the elbow is a rare diagnosis with little literature describing features of this pathology. The purpose of this study is to investigate atraumatic elbow AVN in adults, with a focus on the anatomic distribution of AVN within skeletally mature elbows. MethodsA retrospective chart review was conducted on six patients who were identified via term searches of elbow magnetic resonance images (MRI) done at the authors’ institution that also had appropriate diagnoses. Terms included “necrosis”, “AVN”, and “avascular”. Demographic data was collected including age of diagnosis, sex, associated comorbidities, use of steroids, use of chemotherapeutic agents, alcohol consumption, smoking status, and associated joint involvement. Clinical information regarding presentation and treatment course were also gathered. Both plain film and MRI were evaluated for identification of anatomic involvement of disease and staging. ResultsSix patients were included in the study: three men and three women with a mean age of 26.5 years (17-46) at time of diagnosis. All patients presented with elbow pain and one patient presented additionally with loss of full range of motion (ROM). Four of the six patients had a prior cancer diagnosis (T-cell acute lymphoblastic leukemia x2, follicular lymphoma, acute myeloblastic leukemia) that lead to chemotherapy exposure, and two of them had additional steroid therapy. Another two had autoimmune diseases (systemic lupus erythematous and dermatomyositis) that required high dose steroid therapy. At time of initial imaging, the capitellum was involved in 8 of 9 elbows, the trochlea in 8 of 9 elbows, the radial head in 4 of 9 elbows, the proximal ulna in 2 of 9 elbows, and the olecranon in 1 of 9 elbows. Only one elbow had additional sites of the elbow affected at future follow ups. One patient presented with AVN of the capitellum, trochlea, and ulnar neck, and two years later had signs of olecranon osteonecrosis on MRI. Two patients underwent operative treatment with resolution of symptoms. ConclusionsThis study describes the anatomic incidence of AVN of the elbow. Most involved are the capitellum and trochlea, with involvement in the radial head, proximal ulna, and olecranon also being observed. This information can be used to help orthopedic surgeons in their diagnosis and clinical decision making for affected patients.

Steroid-Induced Hyperosmolar Hyperglycemic Syndrome in a Young Patient Without Diabetes After Treating Him for Minimal Change Disease-Case Report.

Hyperosmolar hyperglycemic syndrome (HHS) is a common complication of diabetes mellitus. The episodes of HHS have been reported in patients with no prior history of diabetes. However, these incidents have rarely been reported in the literature. The present study reports the case of hyperosmolar hyperglycemic syndrome in a patient without diabetes history after being prescribed high-dose steroid therapy. This case highlights the importance of regularly monitoring blood glucose levels in patients prescribed supraphysiological doses of steroids. The present study presents a 29-year-old male patient with no previous history of diabetes who presented with HHS, manifested by a decreased level of consciousness, lethargy, and history of polyuria. Laboratory work revealed significantly high serum glucose and high serum osmolality, with no ketones. Two weeks prior to the presentation, the patient was started on 1 mg/kg of oral prednisolone for his new diagnosis of minimal change disease with a nephrotic syndrome picture. The management of HHS included aggressive fluid intake and insulin therapy, and the steroid was tapered quickly. Hyperglycemia resolved completely with normalization of his HbA1c after the complete stoppage of steroids and he did not require to continue lifelong insulin. The present study highlights the importance of assessing the risk of hyperglycemia, screening, and regular glucose monitoring in patients prescribed supraphysiological doses of steroids, even if no prior history of diabetes has been recorded..

6797 Pituitary Apoplexy as initial Presentation of IgG4-Related hypophysitis

Abstract Disclosure: M. Alameri: None. A. Alnuaimi: None. Introduction: IgG4-related hypophysitis is a rare disease due to IgG4 lymphoplasmacytic infiltration of the pituitary gland. It can either be isolated or part of a multisystemic disease. We report a rare case of pituitary apoplexy as first manifestation of IgG4-RD. Case report: A 27-year-old previously healthy male presented to emergency department with severe headache, nausea, vomiting and visual impairment. CT brain showed a large sellar suprasellar mass of 3cm with thick rim enhancement. Blood test showed evidence of central adrenal insufficiency, central hypothyroidism and secondary hypogonadism. Patient was started on hormone replacement therapy for central adrenal insufficiency and central hypothyroidism. Pituitary magnetic resonance imaging (MRI) demonstrated a 3.1 x 2.4 x 2.4 cm well-defined large sellar suprasellar mass with thick rim enhancement with intrinsic heterogeneous T2 signal with hypointense T1 signal on fat-suppressed post contrast imaging consistent with necrotic haemorrhagic suggestive of pituitary apoplexy and background of hypophysitis. Upward displacement of optic chiasm was noted without involvement of cavernous sinus. The patient was initially treated with high-dose steroids aiming for reduction of the pituitary mass. However, eventually, he underwent transsphenoidal surgery due to alternated level of consciousness. Pituitary histopathology showed that vast majority of the tissue is necrotic. A small fragment of viable anterior pituitary tissue is present, which measures up to 5.5 mm in greatest dimension which exhibited marked chronic inflammation, predominantly comprised of small lymphocytes. Plasma cells were present and staining with IgG/IgG4 revealed two high-power fields with clusters of approximately 25 and 50 IgG4 positive plasma cells, respectively. Blood test showed elevated blood IgG4 levels of >2.60 g/L (normal reference range 0.03-2.01 g/L). Case was discussed at Endocrine MDT meeting which agreed that blood tests result along with histopathology findings were in keeping with IgG4-Related hypophysitis as per the Mayo Clinic, Leporati and Japan-Korea proposed criteria. Because blood IgG4 levels were elevated, a systemic evaluation was performed. No evidence of other systemic disease found. High dose steroid therapy was initiated, which reduced remnant inflammatory sellar changes. Discussion and conclusion: IgG4-related pituitary disease should be considered as differential diagnosis in unusual presentations of pituitary apoplexy in the context of sellar suprasellar hypophysitis. Presentation: 6/2/2024

Prediction of hearing recovery with deep learning algorithm in sudden sensorineural hearing loss

This study aimed to establish a deep learning-based predictive model for the prognosis of idiopathic sudden sensorineural hearing loss (SSNHL). Data from 1108 patients with SSNHL between January 2015 and May 2023 were retrospectively analyzed. Patients underwent standardized treatment protocols including high-dose steroid therapy and hearing outcomes were assessed after three months using Siegel’s criteria and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification. For predicting patient recovery, a two-layered classification process was implemented. Initially, a set of 22 Multilayer Perceptrons (MLP) networks was employed to categorize the patients. The outcomes from this initial categorization were subsequently relayed to a second-layer meta-classifier for final prognosis determination. The validity of this methodology was ascertained through a K-fold cross-validation procedure executed with 10 distinct splits. The prediction model for complete recovery, based on Siegel’s criteria, demonstrated an accuracy of 0.892 and area under the curve (AUC) of 0.922. For the class A prediction, according to AAO-HNS classification, the model showed an accuracy of 0.847 and AUC of 0.918. These results suggest that the model may have the potential to contribute to the establishment of tailored patient management strategies by predicting hearing recovery in patients with SSNHL.

Massive bleeding and perforation due to post-colectomy pan-enteritis with a significant response to biologic in a patient with ulcerative colitis: a case report

BackgroundPost-colectomy pan-enteritis in ulcerative colitis (UC) is very rare, but it is often severe and fatal. We present a case of massive bleeding and perforation due to post-colectomy pan-enteritis, which showed a significant response to biologics in a UC patient.Case presentationA 30-year-old woman with a 5-month history of pancolitis UC underwent subtotal colectomy with ileostomy and mucosal fistula for refractory UC. She was diagnosed with small bowel obstruction on postoperative day (POD) 8 and bowel bleeding was observed on POD18. Reoperation was performed for bowel obstruction and bleeding on POD20. Intraoperatively, adhesive small bowel obstruction in the ileum and multiple erosions and ulcers with perforation were observed throughout the small bowel. We diagnosed post-colectomy pan-enteritis, and jejunostomy, lavage, adhesiolysis, and a simple closure of the perforated ileum were performed. High-dose steroid therapy for pan-enteritis was administered immediately after reoperation, and infliximab was administered because of worsening bleeding on day 3 after reoperation. Bleeding decreased one day after biologic administration and bleeding completely disappeared on day 10 after biologic administration. Specimens obtained from the terminal ileum at colectomy showed a normal ileum without inflammation and villus atrophy, while specimens from the perforated ileum showed congestion, villous atrophy, epithelial erosion, and mononuclear cell infiltration. No cryptitis, crypt distortion, or basal plasmacytosis (common characteristics in UC) were observed in either specimen.ConclusionAn early diagnosis and intervention are important for post-colectomy pan-enteritis, and infliximab may be effective. Post-colectomy pan-enteritis with a multiple ulcer phenotype has different histological characteristics from UC and may have a different pathogenesis.

Delayed Post-hypoxic Leukoencephalopathy after Carbon Monoxide Intoxication Improved by High-dose Steroid Treatment

Delayed post-hypoxic leukoencephalopathy (DHPL) is a demyelinating syndrome characterized by acute onset of neuropsychiatric symptoms within days to weeks following apparent recovery from coma after a period of prolonged cerebral hypo-oxygenation. The majority of DPHL cases are associated with carbon monoxide intoxication. There is no specific treatment, and the prognosis is usually poor. However, we present a case of DHPL patient with akinetic mutism, parkinsonism, stool and urine incontinence, and severe cognitive impairment improved after treatment with high-dose steroid therapy.

Novel germline STAT3 gain-of-function mutation causes autoimmune diseases and severe growth failure

In recent years, germline gain-of-function (GOF) mutations in signal transducer and activator of transcription 3 (STAT3) have been identified as a cause of early-onset multiorgan autoimmune diseases with the widespread use of next-generation sequencing, and targeted therapies such as tocilizumab have been reported to be effective. We sought to assess whether a novel STAT3 mutation detected by whole-exome sequencing is pathogenic and examine the efficacy of targeted therapy. A pediatric patient with idiopathic pulmonary hemosiderosis, autoimmune thyroiditis, inflammatory bowel disease unclassified, leukocytosis, thrombocytosis, and severe growth failure was examined. This 7-year-old boy had idiopathic pulmonary hemosiderosis at the age of 6 months. Despite high-dose steroid therapy, pulmonary fibrosis progressed. Furthermore, he presented with severe growth failure, autoimmune thyroiditis, leukocytosis, thrombocytosis, and inflammation bowel disease unclassified. Given the presence of multiple autoimmune diseases, whole-exome sequencing was performed, which detected germline de novo heterozygous STAT3 mutation (NM_139276.2; c.2144C>A, p.(P715Q)). Dual-luciferase reporter assay revealed this novel STAT3 mutation as GOF. After starting tocilizumab therapy at the age of 6, hospital stays decreased, and the progression of pulmonary fibrosis was decelerated without increasing the steroid dose. New autoimmune diseases did not develop, and no apparent adverse effects on growth have been observed. Tocilizumab may be effective for patients with STAT3 GOF mutation, including those requiring long-term management of idiopathic pulmonary hemosiderosis. Diagnosis of patients with early-onset multiorgan autoimmune diseases in which STAT3 GOF is suspected should be confirmed by genetic testing and functional analysis to consider the introduction of targeted therapies.

Mixed Autoimmune Hemolytic Anemia - A Rare Case Report

Abstract Mixed autoimmune hemolytic anemia (MAIHA) is a rare clinical condition where both warm and cold antibodies cause red cell destruction, leading to anemia. MAIHA can present as a blood group discrepancy or crossmatch incompatibility, which can be very challenging for transfusion medicine services to diagnose and issuing of best-matched blood. Therefore, a comprehensive immunohematology workup, including a monospecific direct antiglobulin test, and indirect antiglobulin test is performed to determine the thermal amplitude and titer of autoantibodies. It is important to be aware of this phenomenon because, like warm AIHA and MAIHA should be treated immediately, with steroids. We hereby report a case of a 14-year-old girl presenting with a history of generalized weakness and dizziness; preliminary investigations revealed anemia, increased reticulocyte count, and antinuclear antibodies positive. Hence, further diagnosis of MAIHA associated with systemic lupus erythematosus was made. A high-dose steroid therapy was given to the patient, and significant improvement was seen clinically.

Clinical Changes and Autoantibody Level Changes in Thyroid Eye Disease Patients after Intravenous High-dose Steroid therapy

Purpose: To evaluate the effects of intravenous steroid therapy on the clinical activity score (CAS), exophthalmos, margin-reflex distance 1 (MRD1), and autoantibody levels in patients with thyroid eye disease.Methods: In this retrospective observational study, we enrolled 83 patients diagnosed with thyroid eye disease treated with intravenous steroid therapy. We assessed exophthalmos, MRD1, CAS, thyroid-stimulating antibody (TSAb), and thyroid-stimulating hormone receptor antibody (TSHR Ab) levels at baseline, 6 and 12 weeks after initiating therapy, and 2 months after therapy termination. Additionally, baseline serum selenium levels were examined to determine their impact on treatment efficacy.Results: TSAb, TSHRAb, and CAS levels showed a continuous decline from 443.22 to 341.03 specimen-to-reference control ratio (SRR%), 22.18 to 7.91 IU/L, and 3.37 to 1.88, respectively (<i>p</i> < 0.0001), up to 2 months following therapy termination. Exophthalmos did not show significant changes at any assessed time point up to 2 months after therapy termination. MRD1 decreased until 12 weeks after therapy initiation but showed no significant change 2 months later. No correlation was found between baseline serum selenium levels and changes in exophthalmos, MRD1, TSAb, TSHR Ab, or CAS.Conclusions: Intravenous steroid therapy was effective in reducing TSAb, TSHR Ab, and CAS levels up to 2 months after therapy termination. However, it had limited positive impact on exophthalmos or eyelid retraction. Baseline selenium levels did not correlate with the changes in any of the examined parameters.

Clinical Case Report on Electroacupuncture Combined with Warm Acupuncture for the Treatment of Painful Ophthalmoplegia (Tolosa-hunt Syndrome)

Tolosa-Hunt Syndrome (THS) is a rare and complex clinical syndrome characterized by severe headache, orbital pain, and multiple cranial nerve palsies. The precise etiology of THS remains unclear, though it is hypothesized to be related to immune system deficiencies, viral infections, or nonspecific inflammation. Due to its low incidence, THS is infrequently encountered in clinical practice. This case report presents a 39-year-old female patient with THS who was successfully treated with a combination of electroacupuncture and warm acupuncture. The patient's symptoms included left eyelid ptosis, left-sided headache, and reduced eye movement, which initially responded to high-dose steroid therapy but recurred upon cessation. After discontinuing steroid treatment, the patient received comprehensive acupuncture therapy aimed at soothing the liver and gallbladder, tonifying Qi, activating blood, and unblocking channels to relieve pain. Over the course of more than 30 acupuncture sessions, the patient's symptoms significantly improved, with complete resolution of pain and restoration of eye function. This case highlights the potential of acupuncture as an effective alternative treatment for THS, providing valuable insights for the management of this rare condition. Future research should further explore the mechanisms and efficacy of acupuncture in treating THS and other cranial nerve disorders.

Multifocal Osteonecrosis in Spinal Cord Injury

Dear Editors, Necrosis of the bone marrow and trabecular portion as a result of limited blood flow is known as osteonecrosis (ON) [1]. Several causes have been proposed for the development of ON, including vascular occlusions, ischemia, intravascular coagulation in interosseous tissue, increased intracortical pressure, mechanical stress, precursor cell death, and suppression of angiogenesis. There are multiple risk factors and medical condition associated with ON, including infections, hematological and coagulation problems, connective tissue illnesses, kidney diseases, excessive alcohol and tobacco use, and the use of corticosteroids and cytotoxic drugs [2]. Multifocal osteonecrosis, defined as the presence of osteonecrosis in three or more bone sites, is a rare entity representing less than 3% of osteonecrosis patients [3]. Due to its potent anti-inflammatory properties, methyl prednisolone (MP), one of the most extensively used corticosteroids, has been used for a long time in the acute phase of spinal cord injury and brain edema due to its strong anti-inflammatory properties [4]. Although studies have reported cases of multifocal osteonecrosis (MFON) brought on by corticosteroid medication, this link has never been examined in a patient with a spinal cord injury. This letter aims to highlight MFON that occurred in a patient who underwent acute spinal cord injury and high-dose steroid therapy.

Avacopan's potential to decrease MPO-ANCA titres concurrent with ameliorated activity in ANCA-associated vasculitis.

Avacopan, an orally administered C5a receptor antagonist, is effective in microscopic polyangiitis via the inhibition of neutrophil priming induced by C5a. However, the exact effect of avacopan on the production of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) is yet to be clearly established. This report presents a microscopic polyangiitis patient without major organ damage where high levels of MPO-ANCA persisted with high-dose steroid therapy and azathioprine, but the addition of avacopan led to a reduction in MPO-ANCA titres. The present case implies that avacopan-mediated inhibition of C5a may lead to a reduction in MPO-ANCA levels, thereby potentially ameliorating the pathophysiology of ANCA-associated vasculitis. Nevertheless, the impact of avacopan on MPO-ANCA production cannot be asserted solely based on this report; therefore, further examination is necessary through subgroup analysis using data from larger-scale studies.

A Case of Asymmetrical Vogt-Koyanagi-Harada Disease in a Patient with Ota Nevus Following Laser Treatment

Purpose: To report a case of Vogt-Koyanagi-Harada (VKH) disease exhibiting asymmetric symptoms, predominantly in the affected eye, aside from the bilateral findings noted in indocyanine green angiography (ICG) in a patient who had undergone treatment for nevus of Ota.Case summary: A 33-year-old male presented with decreased visual acuity, ocular pain in the right eye, and a 3-week history of headache. The patient had undergone two laser treatments at 1-month intervals to address a nevus of Ota on the upper and lower eyelids and the maxillary area of the right side. He had no notable medical history. Fundus examination and optical coherence tomography indicated multiple serous retinal detachments. ICG displayed multiple hyperfluorescent spots in both eyes. Given these findings, the patient was diagnosed with VKH disease, predominantly affecting the right eye. Human leukocyte antigen (HLA) testing revealed the presence of the HLA-DRB1*09 and HLA-DQB1*03 (DQ8) alleles. The patient initially received high-dose intravenous steroid therapy, later transitioning to oral steroids. After a month of treatment, the serous retinal detachments had resolved and his vision improved. No signs of recurrence were evident during a 6-month follow-up.Conclusions: VKH disease can manifest asymmetrically, especially in the eye affected after laser treatment for nevus of Ota. Despite potential monocular presentation, it is crucial to assess for binocular involvement through comprehensive examinations.

Risk Factors for Pneumocystis jirovecii Pneumonia in Children With Systemic Lupus Erythematosus Exposed to Prolonged High-Dose Glucocorticoids.

Pneumocystis jirovecii pneumonia (PJP) is a life-threatening opportunistic infection in immunocompromised children with systemic lupus erythematosus (SLE). Prophylaxis against PJP in high-risk children is crucial, but the risk factors for PJP in children with SLE are not adequately characterized. This study sought to identify the risk factors for PJP in long-term glucocorticoid-treated pediatric SLE patients. This study encompassed 71 treatment episodes involving 64 children with prolonged (≥4 weeks) high-dose (≥20 mg/d prednisone) steroid regimens. Fourteen treatment episodes involved the PJP, whereas others did not. Risk factors for PJP were assessed through Cox regression. The predictive value of these factors was evaluated using receiver operating characteristic curves. The incidence of PJP in different risk groups was compared using the Kaplan-Meier method. The creatinine (hazard ratio, 1.009; 95% confidence interval [CI], 1.001-1.017; p = 0.021) and the lowest lymphocyte count (hazard ratio, 0.007; 95% CI, 0.000-0.373; p = 0.014) were independent risk factors for PJP in children with SLE. The receiver operating characteristic curve showed that using creatinine greater than 72.5 μmol/L and the lowest lymphocyte count less than 0.6 × 109/L as risk predictors for PJP resulted in an area under the curve value of 0.934 (95% CI, 0.870-0.997; p < 0.001). The study revealed a significant increase in PJP prevalence (p < 0.001) in children with elevated creatinine levels and low lymphocyte count. Elevated levels of creatinine and decreased lymphocyte count are identified as distinct risk factors for PJP in children with SLE who receive prolonged high-dose steroid therapy.

Prevalence of Steroid-Induced Hyperglycemia in King Abdulaziz Specialist Hospital, Taif City, Saudi Arabia.

Background Hyperglycemia is a common side effect of high-dose steroid therapy in hospitalized patients. Objectives To assess the prevalence of hyperglycemia among hospitalized patients receiving steroid therapy. Methods A retrospective study was conducted among 245 patients. The inclusion criteria were patients undergoing steroid therapy and admitted to a single tertiary care hospital due to medical complications or exacerbation of the diseases they were suffering from. Data encompassing patient demographics, admission, discharge dates, comorbidities, medication histories, laboratory results (including blood glucose levels), and documented corticosteroid administrations were meticulously gathered from electronic health records (EHRs). A logistic regression model analysis was done to predict the risk factors of poor glycemic control among hospitalized patients. Results The prevalence of hyperglycemia among the patients who were on steroid therapy was 34.2%. About 70.7% of the patients who required insulin at the time of admission required >17 units, and the insulin requirement was significantly higher among patients who received dexamethasone compared to other steroids (p<0.05). Older age (>65 years) was found to be independently associated with poor glycemic control (p<0.05). Conclusion The study revealed that almost one-third of patients on steroid therapy had hyperglycemia. Monitoring of patients for hyperglycemia after beginning high-dose steroid therapy should be done.

An Adolescent Case of Unilateral Papillophlebitis Treated with Intravitreal Bevacizumab

Purpose: To report a case of papillophlebitis treated with an intravitreal bevacizumab injection in an adolescent patient.Case summary: A 15-year-old female with no medical history presented with a 3-day history of blurred vision and a floating sensation. The initial visual acuity (VA) was 0.0 logarithm of minimal angle of resolution (logMAR) in the left eye. A fundus examination revealed a blurry disc margin, peripapillary hemorrhage, and venous engorgement. Optical coherence tomography indicated subretinal fluid (SRF) accumulation. Both color vision and pupillary reactions were normal in bilateral eyes. Blood tests revealed no significant abnormalities. Brain magnetic resonance imaging (MRI) showed mild focal papillitis, but the patient did not report eye movement pain or discomfort. The diagnosis was papillophlebitis; however, high-dose steroid treatment was not initiated due to the absence of a significant decrease in VA. A single injection of intravitreal bevacizumab was administered to address the SRF. At the 9-month follow-up, VA remained at 0.0 logMAR, and the retina demonstrated anatomical stabilization after complete absorption of the SRF without recurrence.Conclusions: Papillophlebitis can manifest during adolescence. Treatment of a 15-year-old patient with intravitreal bevacizumab obviated the need for high-dose steroid therapy and produced favorable outcomes, including preservation of VA and anatomical stabilization of the retina.

Orbital Apex Syndrome in a diabetic patient, Is It Tolosa Hunt?

Abstract&#x0D; Introduction : The presence of that specific sign in neuro ophthalmology cases can easily determine the differential diagnosis. But the challenge is how do we found the cause. We describe a case of visual loss with ophthalmoplegia in a diabetic patient suspected of having Tolosa Hunt syndrome.&#x0D; Case Illustration : Woman, 63 years old with acute visual loss and feel a "heavy eyelid" in the left eye for 2 weeks. The Visual Acuity is no light perception on the left and ophthalmoplegia with mild proptosis. We do the laboratory test and MRI. No specific result of infection was found but the patient was diagnosed with diabetes mellitus (DM) type 2. MRI shows a lesion in the left cavernous sinus. Diagnosis of Orbital Apex syndrome was made. We give the patient a high dose of steroid and then continue with prednisone orally. In 24 hours after treatment the "heavy eyelid" decreased. One month after therapy there are improvements in eye movement but still no light perception.&#x0D; Discussion : In cases of orbital apex syndrome with DM, we need to consider mucormycosis as the cause. In this case, the symptoms and signs as well as the MRI led to a Tolosa Hunt. Steroid administration was able to reduce heavy eyelids and cranial nerve palsy even though visual acuity had not improved after 1 month of therapy.&#x0D; Conclusion : Laboratory test and Neuroimaging plays an important role to find out the cause. High-dose steroid therapy in a diabetic patient with Tolosa Hunt Syndrome can be given with tight hyperglycemic control.

A Rare Case of Postpartum Paraplegia: A Case Report

ABSTRACT In this case report, a 27-year-old woman who had pre-eclampsia in the past and had a cesarean section as a result of the condition presents with an uncommon and difficult form of postpartum paraplegia. She experienced bilateral lower limb paralysis and urine incontinence soon after the surgery, which quickly led to unconsciousness and required mechanical ventilator support and intensive care treatment. Comprehensive diagnostic testing, which included magnetic resonance imaging scans of the brain and spinal cord, identified signs typical of “Posterior Reversible Encephalopathy Syndrome (PRES)” and spinal cord infarction affecting segments C3 to D2. “Antiphospholipid Antibody Syndrome (APLA)” was identified by laboratory testing, highlighting the significance of taking a thorough approach to comprehending this uncommon clinical condition. Treatment included anticoagulant therapy, high-dose steroid therapy, and antihypertensive drugs, emphasizing the crucial importance of inter-disciplinary care in handling such complex situations. Even if the patient’s symptoms have partially improved, their condition is still being closely monitored in the intensive care unit. In the context of postpartum neurological problems and the complex interplay between pre-eclampsia, spinal cord infarction, and related clinical symptoms, this case emphasizes the need for increased awareness and prompt management.

Rhino-orbital mucormycosis during COVID-19 pandemic: our clinical experience

Background: The ongoing COVID-19 pandemic declared by the WHO was compounded by the sudden and unexpected increase of Rhino-orbital mucormycosis infections during the year 2021. Mucormycosis a life-threatening infection, with added COVID-19 infection further increases the morbidity and mortality of the disease. Our aim is to shed some light on possible risk factors, treatment options and outcomes when these diseases occur together. Methods: 22 cases diagnosed with rhino-orbital mucormycosis with history of COVID-19 infection were selected. Cases underwent surgical and medical management. Patients were followed up for 3 months and were continued on medical treatment and regular post-operative DNE, CECT PNS and brain and relapses were treated accordingly. Results: Of these 22 patients, 15 were males and 7 were females ranging between 31-60 years. 15 (68.18%) had history of DM, 16 (72.72%) gave history of oxygen therapy and 18 (81.82%) had history of high dose steroid therapy. 15 (68.18%), 4 (18.18%) and 3 (13.64%) respectively underwent Endoscopic debridement, Total maxillectomy and Medial maxillectomy. There were 3 cases of relapse which were managed with additional full course treatment with Intravenous Liposomal Amphotericin B. Conclusion: COIVD-19 and uncontrolled DM to both be probable pre-disposing factors for developing Mucormycosis. Oxygen therapy &amp; high dose of steroids used in the treatment of COIVD-19 may increase incidences of mucormycosis. Early treatment with surgery is necessary to reduce the need for more radical procedures and improving the recovery.

Treatment outcomes for idiopathic sudden sensorineural hearing loss in dialysis patients

Idiopathic sudden sensorineural hearing loss (ISSNHL) is challenging for both nephrologists and otolaryngologists treating patients undergoing dialysis. This single-center, retrospective, observational study investigated the treatment outcomes of patients with ISSNHL undergoing dialysis, enrolling 700 patients (47 undergoing and 653 not undergoing dialysis) diagnosed with ISSNHL between January 2005 and December 2021 at Asan Medical Center, Republic of Korea. To balance pre-existing clinical characteristics, 1:5 propensity score matching (PSM) was performed with the patients who were not undergoing dialysis. Treatment included high-dose systemic steroid therapy or intra-tympanic steroid injections. The pure tone average of the groups was compared before and 2 weeks and 2 months after treatment. The hearing-improvement degree was evaluated using Siegel's criteria. Before PSM, age, prevalence of diabetes or hypertension, initial hearing threshold at each frequency level (0.5, 1, 2, and 4 kHz), and treatment strategies exhibited significant between-group differences. However, in the PS-matched cohort, none of the confounders showed significant between-group differences. Two months after steroid treatment, the non-dialysis patient group demonstrated significantly higher average improvement in pure tone audiometry (P = 0.029) and greater percentage of complete response according to Siegel's criteria. This study suggests that treatment outcomes for ISSNHL are significantly poorer for patients undergoing than for those not undergoing dialysis.