Unusual Manifestation Research Articles

A manifest nodoventricular accessory pathway with unusual electrophysiological manifestations.

A nodoventricular accessory pathway showing the degree of anterograde decremental conduction was more than the atrioventricular node.

Dirofilariasis of the scrotum in a 9-year-old child

Introduction. Dirofilariasis of the scrotum is one of unusual manifestations of this zoonosis in children, especially in regions which are outside the distribution area of this helminth what causes certain difficulties in preoperative diagnostics. Purpose. To describe a clinical case so as to warn physicians about a possibility of meeting dirofilariasis infection in the scrotum outside the area of this helminth location. Clinical case. The authors present a clinical case of a child with a parasitic cyst simulating tumor in the scrotum for what an oncologist was invited for the consultation. At the examination, a rounded formation adjoining the left testicle, densely elastic in consistency, with smooth borders, motionless to the testicle, painless on palpation was revealed. The child did not leave the region. A parasitic cyst of the scrotum was removed in the clinic of pediatric surgery. Results. Histopathology confirmed cyst parasitic origin; the revealed parasite was identified as Dirofilaria repens because of characteristic morphological features. The child was found healthy at one-year follow up examination. Conclusion. Though the disease is rarely met, dirofilariasis should be included in the differential diagnostics in case of mass formations in the scrotum in children.

New Insights into Macular Type of Primary Cutaneous B-Cell Lymphoma: Extension of the Clinical and Histopathological Patterns

Background: Primary cutaneous B-cell lymphoma (PCBCL) classically presents with papules, plaques, and nodules/tumors. Previous reports of PCBCL manifesting with macular lesions are scarce and focused on primary cutaneous follicle-center cell lymphoma (PCFCL). Objectives: The objective of this study was to report our experience with PCBCL presenting with erythematous macules. Methods: Patients with low-grade PCBCL manifesting with erythematous patches, diagnosed and managed between January 2000 through December 2019 at 2 tertiary cutaneous-lymphoma outpatient clinics, were included. Clinical data were retrospectively collected, and biopsy specimens of the macules, and if present of the typical nodular/tumoral lesions, were reviewed. Results: There were 14 patients, aged 16–67 years, 8 had PCFCL and 6 marginal zone lymphoma (PCMZL). All had 1–15 cm erythematous macules, mimicking: interstitial granuloma annulare/vascular tumors/early-stage folliculotropic mycosis fungoides, or presenting with figurate erythema or livedo reticularis-like/net-like pattern. In 3 patients, macules were the presenting lesions, in 2 as the sole manifestation, whereas in 12 patients, typical PCBCL lesions were observed during disease course. The macules showed in all, superficial and deep perivascular infiltrates, and in most, periadnexal infiltrates. Micronodules were observed in 11 specimens, with nodular infiltrates also observed in 4. B cells comprised the majority of the lymphocytes in only 4. Seven of 11 cases tested showed immunoglobulin heavy chain monoclonality. Conclusions: PCMZL and PCFCL may manifest with erythematous macules. Physicians should be aware of this unusual manifestation of low-grade PCBCL, which may represent a clinicopathological diagnostic pitfall.

An Unusual Paraneoplastic Manifestation of Adenocarcinoma Lung

Tripe palms (TP) are the rare paraneoplastic manifestation with the thickened palms and pronounced dermatoglyphics. In cancer patients with mere TP, the most occurring malignancy is pulmonary carcinoma. Although it precedes a malignancy, it may arise at any point in the course of the disease. Here, we present a patient who came with complaints of thickened blackish discoloration of palms and soles for 3 weeks and a clinical diagnosis of TP was made. He had concomitant adenocarcinoma lung TNM stage IB diagnosed 5 months back. Thus, he was diagnosed with TP secondary to adenocarcinoma lung. Although TP precede internal malignancy we report this case as TP occurred after the diagnosis of adenocarcinoma of the lung was made.

Spontaneous and Indentation Subretinal Hemorrhage from Choroidal Melanoma

Choroidal melanoma is the most common primary intraocular malignancy in adults. Herein, the authors report two cases of subretinal hemorrhage associated with it. The first case presented with a large choroidal mass associated with subretinal hemorrhage, no history of trauma and choroidal melanoma diagnosis on ultrasound. The second case was initially diagnosed with retinal detachment but during the surgery a pigmented subretinal mass was observed, starting to bleed after scleral depression. Subretinal hemorrhage can occur due to ruptures in Bruch's membrane spontaneously or precipitated by inadvertent trauma. Despite an unusual manifestation, it should always be considered avoiding misdiagnosis.

Demographic aspects, clinical characteristics, and therapeutic approaches in geriatric psoriasis: A study from a tertiary center.

Geriatric psoriasis, due to its unusual clinical manifestations and higher rates of systemic complications in this age group, is a challenging issue for dermatologists. Therefore, we aimed to provide an overview of the epidemiological, clinical, and therapeutic consequences among patients aged over 60 years with psoriasis in a referral center in Iran. This cross-sectional study was conducted on 156 patients over 60 years with the definitive diagnosis of psoriasis that were referred to our center between 2015 and 2019. By reviewing the recorded files of the patients, baseline characteristics including demographics, underlying comorbidities, age of disease onset, clinical type of the disease, clinical manifestations, and therapeutic approaches were extracted. The most common clinical feature was plaque type (73.1%) followed by pustular type (10.9%). The most frequent involved zone was the lower extremities (84.6%). Most of the patients were treated topically (87.1%), while as the most frequent systemic approaches, methotrexate and acitretin were considered for 74.4% and 60.3%, respectively. A significantly higher mean age at disease onset was found in female patients compared to male patients. The plaque type was more prevalent in men than in women. Also, the chance of nail involvement was 2.43 times higher in men than in women (p=0.011, 95%CI: 1.22-4.84). The disease duration was significantly longer in patients suffering from plaque compared to those without this feature. Conversely, those with palmoplantar type experienced shorter disease duration. Psoriatic arthritis was also revealed in patients of lower ages. As in other societies, in our society, clinical characteristics, disease involvement patterns, as well as considered treatment approaches, can be influenced by demographic characteristics.

An unusual cardiovascular manifestation of hyperthyroidism

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Simultaneous occurrence of knee septic arthritis and coronavirus disease 2019 (COVID-19): A case report

BackgroundCoronavirus disease 2019 (COVID-19) pandemic is increasingly recognized as a serious, worldwide public health concern. Most of the patients with COVID-19 are asymptomatic or show mild symptoms. It is important to identify the unusual manifestations and their long-term complication. Case presentationA case of COVID-19 in 45 years old man with septic arthritis due to Staphylococcus aureus is presented. COVID-19 was diagnosed using real-time polymerase chain reaction without obvious clinical manifestation. The patient had no history of trauma or inflammatory arthritis and had progressive left knee pain and limitation of movement. Knee X-ray was normal. Aspiration of the knee joint fluid showed a cloudy and purulent appearance. The patient was admitted to hospital and immediately treated with vancomycin 1gr/12 hr. A polymerized chain reaction (PCR) test for COVID-19 was performed, which was positive 24 h after hospitalization. Staphylococcus aureus was reported in synovial fluid culture which was sensitive to vancomycin and ciprofloxacin, thus vancomycin was continued. On the 4th day of hospitalization the patient had cough, therefore underwent CT scan lungs and ground-glass opacities (GGO) characteristic of COVID-19 were noticed. Favipiravir and interferon were started. Patient’s knee aspiration was performed for 5 consecutive days. On the 6th day of hospitalization, joint fluid markedly decreased and the patient's oxygen saturation was 96%. One week after hospitalization, the patient was discharged and a month later knee examination was completely normal. ConclusionsSeptic arthritis should be considered in the manifestations or co-morbidity of COVID-19 patients with joint pain, swelling or redness.

Ophthalmoparesis and Bilateral Ptosis as a Rare Manifestation of Todd's Phenomenon: Case Report and Review

Todd's paresis or phenomenon (TP) is a focal weakness in a part of the body after a seizure. Seizure is an abrupt change in behavior caused by the cerebral cortex's electrical hyper-synchronization of neuronal networks. After the seizure, there is usually a transition period from the ictal state to the pre-seizure baseline level of awareness and function, referred to as the postictal period. Postictal symptoms include many systems, including sensory, motor, and psychosis. This phenomenon is named after Robert Bentley Todd, who first described it. Todd's paresis can be confused with other conditions, most commonly a stroke. Postictal ocular manifestation may be accompanied by aphasia or hemiplegia, but isolated gaze palsy is rarely reported. We are reporting a rare and first known isolated ophthalmoparesis and ptosis as postictal findings with no structural abnormalities present in imaging studies and complete resolution over three weeks on its own as an atypical postictal phenomenon. Patients with an underlying structural abnormality of the brain are more susceptible to Todd's phenomenon. Unusual manifestations of Todd's phenomenon are rare but clinically relevant and are decisive in therapeutic decision-making. Our patient presents a rare manifestation of Todd's phenomenon as ptosis and ophthalmoparesis in an elderly male with no underlying structural brain abnormalities that resolved within three weeks. Further research into the causes is needed to distinguish it from a stroke

Diagnosis of peritoneal tuberculosis by real-time immuno-PCR assay based on detection of a cocktail of Mycobacterium tuberculosis CFP-10 and HspX proteins

ABSTRACT Background : Diagnosis of peritoneal TB is difficult owing to unusual clinical manifestations and low sensitivities obtained with most of the available diagnostic modalities. Hence, there is an urgent need to design a reliable and rapid diagnostic test followed by early therapy so as to avoid the complications associated with disease. Research design and methods : We designed a quantitative real-time immuno-PCR (RT-I-PCR) assay to detect a cocktail of Mycobacterium tuberculosis CFP-10 (Rv3874) and HspX (Rv2031c) proteins in clinical samples (ascitic fluids and peritoneal biopsies) of peritoneal TB patients and results were compared with I-PCR/ELISA. Results : A wide range of CFP-10+HspX (0.6 pg/mL to 9.9 ng/mL) was detected in clinical samples of peritoneal TB patients by RT-I-PCR, whereas ELISA exhibited a narrow range (3ng/mL to 11.5 ng/mL). Sensitivities of 81.5% and 65.7%, and specificities of 92.5% and 90%, were obtained in total 78 cases (comprising 38 peritoneal TB and 40 non-TB controls) by RT-I-PCR and I-PCR, respectively. Markedly, sensitivity obtained by RT-I-PCR was significantly higher than I-PCR (p=0.0143) and ELISA (p=0.0005). Conclusions : Our RT-I-PCR revealed good accuracy for the rapid diagnosis of peritoneal TB cases. After further improving the specificity and reducing the cost, this assay may develop into a diagnostic kit.

AN UNUSUAL CASE OF BRONCHIECTASIS IN A PATIENT WITH DERMATOMYOSITIS

TYPE: Case Report TOPIC: Diffuse Lung Disease INTRODUCTION: Bronchiectasis is a progressive lung disease defined by dilatation of the bronchi in the setting of chronic airway infection and/or inflammation. It is common pulmonary manifestation in certain rhumatologic disorders, however, it has never been reported in association with inflammatory myopathies. Here we present a case of bronchiectasis in a patient with dermatomyositis. CASE PRESENTATION: A 71 year old African American woman with history of dermatomyositis presented with productive cough for two years. She was diagnosed with dermatomyositis 20 years prior, treated with immunosuppressives and no current active disease. She had no history of smoking, recurrent respiratory infection or occupational exposure. Her Chest CT demonstrated bibasilar and upper lobes cylindrical bronchiectasis (figure). Labratory tests indicated normal CBC, CMP, Muscle enzyms, Serum IgE levels to Aspergillus, Alpha-1antitrypsin and negative ANA, RF, Anti-CCP and TB tests. Patient was started on acapella therapy and albuterol as needed with improvement in her symptoms. DISCUSSION: Bronchiectasis often develops in the setting of infections, ciliary clearance impairment, immunodeficiencies, allergic bronchopulmonary aspergillosis and Alpha1-antitrypsin deficiency. It is an unusual manifestation in inflammatory myopathies where Interstitial Lung Diseases (ILDs) are the most common pattern of lung involvement. ILDs often present with dyspnea, dry cough and CT findings of basal reticular abnormalities or honeycombing, as oppose to our patient's presentation and CT findings of diffuse cylindrical bronchiectasis without reticular abnormalities. With all other etiologies ruled out, it was suspected her dermatomyositis to be the underlying etiology of bronchiectasis. CONCLUSIONS: It is important to recognize and suspect atypical lung presentations in patients with inflammatory myopathies. DISCLOSURE: Nothing to declare. KEYWORD: Bronchiectasis

Attention Deficit Hyperactivity Disorder following Hypothalamic Hamartoma Surgery : An unusual manifestation

IntroductionPsychiatric symptoms are a common comorbid feature of hypothalamic hamartoma(HH) with epilepsy. They are a significant challenge for patient and their families. Most common psychiatric symptoms are externalizing behaviors such as aggression and defiance.ObjectivesTo outline an atypical presentation of HH in form of development of ADHD post-surgery.MethodsA 6-year old child born out of non-consanguinous marriage, with history of hyperemesis gravidarum and depression in mother in ante-natal period, delivered by NVD at term(did not cry at birth and was hospitalized for 3 days) with birth weight of 2.25 kg, currently presented to Neurology with global developemental delay and history of gelastic seizures since 3 years of age. Patient was diagnosed with pituitary hamartoma(through MRI) and precocious puberty that time and was operated for it after which he started having behavioural issues like irritability, aggression, hyperactivity and lack of appropriate social behaviour with peers along with defiance towards parents. Child was then refered to Psychiatry. On MSE patient did not interact with interviewer and was noticed to shout loudly when confronted for using mobile phone. MRI brain(2 months back) showed post-op changes with cystic lesion in suprasellar region. IQ assessment showed borderline intelligence.ResultsPatient was started on Risperidone(upto 1.5 mg) which lead to some improvement. However antiepileptics are being rationalized to prevent behavioural issues secondary to epilepsyConclusionsPatients of HH with epilepsy, present with varied psychiatric symptoms which usually improve after surgery. However we came across a child with worsening of psychiatric symptoms after he was operated for above lesion.DisclosureNo significant relationships.

Unusual ophthalmic manifestation in chronic myeloid leukemia: A case report

Background: Chronic myeloid leukemia (CML) is a myeloproliferative hematopoietic malignancy with a heterogeneous proliferation of hematopoietic cells in the bone marrow. The ocular manifestations are rare symptoms of CML. In this case report, a CML patient with retinal hemorrhage is reported as an uncommon symptom. Case presentation: A 35-year-old man was referred due to decreased right eye vision. The reduction of the visual acuity of the right eye (2/10), rounded and diffuse intra-retinal hemorrhage with white-center Roth’s spots, and macular edema were seen. No systemic diseases and other ophthalmic manifestations were seen in this case. The white blood cell (WBC) count was 135,000 cells/ μl, the platelets were 430,000 cells/μl, and hemoglobin was 12.5 gr/dl. The myeloid progenitor and precursor were present in peripheral blood smear and bone marrow. Also, the quantitative real-time polymerase chain reaction indicated that the BCR-ABL1-to-ABL1 ratio was 0.795. a daily administration of 400 mg of Imatinib was prescribed. Two months later, WBC count reached 6,500 cells/μl, Hb was 11.6 gr/dl, and platelets were 306,000 cells/μl. Conclusion: The ophthalmic manifestations may be a symptom of CML. We found the rounded and diffuse intra-retinal hemorrhage, Roth’s spots, and macular edema as the ocular manifestation of a CML case.

Hyperosmolar hyperglycemic state in children: case report and review of the literature

Hyperosmolar hyperglycemic state (HHS) is a rare complication in children and a life-threatening emergency that presents with a significant increase in blood sugar and hyperosmolarity with or without low ketosis. This study reports the case of a 9-year-old boy with severe HHS due to type 1 diabetes. The patient’s initial serum glucose level was 1600; however, he was discharged in a stable condition. The patient presented many of the known complications of HHS, including decreased level of consciousness, hypovolemic shock, acute kidney injury, and very high serum glucose levels. The patient responded well to invasive fluid resuscitation and insulin administration, was discharged in good general condition without HHS-related complications, and was followed up with insulin therapy. As the prevalence of HHS in children is increasing, it is necessary for physicians to be aware of the unusual manifestations in children, especially children with type 1 diabetes, and to have the ability to diagnose and manage HHS and differentiate it from diabetic ketoacidosis.

Retroperitoneal duodenal perforation due to COVID-19: An extremely rare case report

Introduction and importanceGastrointestinal (GI) symptoms are the most common extrapulmonary presentation of coronavirus disease 2019 (COVID-19) infection. GI perforation may be an unusual manifestation of COVID-19 infection.Case presentationWe report a 45-year-old man who presented with acute abdominal pain without any respiratory symptoms to our emergency department. Investigations revealed retroperitoneal duodenal perforation and fibrotic changes in lung bases. Laboratory findings demonstrated a positive polymerase chain reaction (PCR) test for COVID-19 and mild leukocytosis.Clinical discussionCOVID-19 related perforation of the retroperitoneal part of the duodenum is extremely rare, and to the best of our knowledge, this is the first reported case. With increasing COVID-19 infection, we might see more cases of GI perforation. In the era of COVID-19 pandemic, any abdominal signs and symptoms should alert the clinicians to consider COVID-19 diagnosis in the differential.ConclusionConservative management with close monitoring, antibiotic therapy and serial examinations were completely successful. The patient's general condition improved, and he was discharged on day 7 of hospitalization.

Abstract 351: Orbital Ischemia Syndrome In A Patient With Carotid Artery Dissection

Introduction: Orbital ischemia syndrome is a very rare presentation of ocular ischemic syndrome. The cause is usually vascular pathology in the carotid artery, most often on the basis of atherosclerosis or, more rarely, dissection of the carotid artery. Our aim is to draw attention in the form of a case report to an unusual clinical manifestation of carotid artery dissection. Methods: The case report deals with a patient (male, 49 years old) who suffered from intense pain behind the right eye. After a few days of pain, he arrives at the emergency room, where he was sent by a neurologist to the CTA. Preocclusive dissection of the right carotid artery was diagnosed. Neurosonological examination shows a massive reverse flow in the right ophthalmic artery. The pain behind the eye was so intense in the following days that opiate therapy was necessary. Results: Carotid dissection was treated with anticoagulant therapy and a statin. According to the control CTA, the dissection heals at three-month intervals. Neurosonological control also shows normalization of flow in the right ophthalmic artery. The decrease in residual pain intensity even on analgesic therapy correlated with a decrease in the amplitude of retrograde flow in the ophthalmic artery. Conclusion: Painful presentation of ocular ischemic syndrome, moreover caused by carotid artery dissection, is very rare.. However, if intense periorbital pain is present, carotid artery CTA should always be performed as part of the diagnostic proces.

A novel TCN2 mutation with unusual clinical manifestations of hemolytic crisis and unexplained metabolic acidosis: expanding the genotype and phenotype of transcobalamin II deficiency

BackgroundTranscobalamin deficiency is a rare inborn metabolic disorder, characterized by pancytopenia, megaloblastic anemia, failure to thrive, diarrhea, and psychomotor retardation.Case presentationWe describe a patient who first presented at 3 months of age, with pancytopenia, hepatosplenomegaly, recurrent infection, metabolic acidosis, and acute hemolytic crisis. Extensive hematologic and immunologic investigations did not identify inherited bone marrow failure syndrome, acute leukemia or its related disorders. Whole exome sequencing identified a novel homozygous TCN2 mutation, c.428-2A > G and mRNA study confirmed an aberrant transcription of exon 4 skipping. The mutant protein is predicted to have an in-fame 51 amino acids deletion (NP_000346:p.Gly143_Val193del). The patient exhibited marked clinical improvement following hydroxocobalamin treatment.ConclusionsTranscobalamin deficiency should be investigated in infants with unexplained pancytopenia and acute hemolytic crisis with or without typical evidence of vitamin B12 deficiency.

An unusual clinical manifestation of coronavirus disease 2019 in a woman with twin pregnancy: a case report

BackgroundAlthough coronavirus disease 2019 affects mainly the respiratory system, as time passes and our understanding of the disease improves, many nonrespiratory clinical manifestations such as thromboembolic events have been shown to occur with or without respiratory tract involvement.Case presentationWe present the case of a 21-year-old gravid 3, live 1, abortion 1 Iranian woman pregnant with twins in her early first trimester. Her initial chief complaint was headache that gradually increased in intensity. Eventually, cerebral vein thrombosis was confirmed. Although the patient first manifested with neurological involvement, she developed upper respiratory symptoms soon after, and then nasopharyngeal polymerase chain reaction test returned positive.ConclusionAny neurological complaints in pregnant women during the current coronavirus disease 2019 pandemic should raise suspicion for the presence of significant cerebral thrombotic or ischemic events, even if the patient has no complaint of respiratory tract involvement and/or when an initial nasopharyngeal polymerase chain reaction test is negative.

Urticarial drug eruption following tocilizumab administration

Tocilizumab is a humanized anti-IL-6 receptor antibody that exerts its immunosuppressive effect by blocking IL-6 receptor-mediated signal transduction and shows therapeutic anti-inflammatory action in autoimmune diseases. On the contrary, several cutaneous adverse reactions have been reported in patients treated with tocilizumab administration. Herein, we report a case of urticarial drug eruption following tocilizumab administration. Interleukin 6 (IL-6) plays a vital role in the pathogenesis of various inflammatory diseases, especially rheumatoid arthritis.1 Tocilizumab is a humanized anti-IL-6 receptor antibody that exerts its immunosuppressive effect by blocking IL-6 receptor-mediated signal transduction2, 3 and shows therapeutic anti-inflammatory action in autoimmune diseases. On the contrary, several cutaneous adverse reactions have been reported in patients treated with tocilizumab administration.4 Herein, we report a case of urticarial drug eruption following tocilizumab administration. A 50-year-old woman had developed rheumatoid arthritis 5 years ago and was treated with methotrexate and certolizumab. She had no history of urticaria. Because her arthritis was intractable by these treatments, tocilizumab was administrated. One month after the repeated tocilizumab administration, she recognized urticarial eruption in trunk and extremities after the second-time administration of tocilizumab (Figure 1). Her eruption occurred in several hours and disappeared within 24 h after the tocilizumab administration. Her eruption continued to repeat the occurrence of urticaria following repeated tocilizumab administration. Blood examination showed that eosinophil frequency in peripheral blood (11.9%) and IgE-RAST (443 U/ml) were elevated, while the white blood cell count (6,000/μl) and CRP (0.04 mg/dl) were within normal ranges. Although an anti-histamine agent showed less response to her eruption, her urticaria completely diminished after switching into certolizumab without the recurrence of her eruption. Tocilizumab was administrated in total 12 times before switching into certolizumab. Because her urticaria was reproducible following every tocilizumab administration recognized as a positive reaction to challenge test, we diagnosed her skin eruption as urticaria following tocilizumab administration. Tocilizumab shows various cutaneous adverse reactions, and the majority of these cases are type IV delayed hypersensitivity reactions. However, this case showed an unusual clinical manifestation of type I allergic reaction. As a reason to cause urticarial eruption, we thought there were several possibilities. The first one is an immune response to additives in this drug. Tocilizumab contains polysorbate 80, which is a synthetic nonionic surfactant and is used in various medications. Polysorbate 80 is also known as one of the representative agents to cause type I allergic reactions.5 Indeed, polysorbate 80 containing medication induces urticaria.6 Although allergic skin test could be conducted in our case, it should be kept in mind a possibility to cause the same skin eruption following polysorbate 80 containing biologic agents. The second one is a pharmacological effect of tocilizumab mediated by the IL-6 blocking pathway. However, IL-6 increases in various types of urticaria,7 suggesting that a pharmacological effect of tocilizumab mediated by the IL-6 blocking pathway might not contribute to the development of urticaria. As another possibility, tocilizumab might become a trigger to produce tocilizumab-specific anti-IgE production and contribute to the development of urticaria. Since there is no case report of urticaria responding to biologics itself, a further case study is expected to conclude the possibility. The authors declare no conflicts of interest. Approval of the research protocol: No. Informed Consent: N/A. Registry and the Registration: N/A. Animal Studies: N/A.

Sympathovagal equilibrium analysis in patients with COVID-19

Introduction: With the increase of COVID-19 cases, an unusual manifestation for this type of virus began to appear anosmia and dysgeusia, which could indicate a neurologic alteration. In this context, it seems likely that subclinical manifestations of baroreflex involvement occur. The vegetative nervous system carries out the regulation of the baroreflex through the balance between sympathetic and parasympathetic activity. The objective of this study is to verify whether patients with COVID-19 present alteration of this equilibrium. Material and methods: Patients included had a confirmed diagnosis of COVID-19 admitted to the Internal Medicine Department of JB Iturraspe Hospital. A Holter recording was performed at rest for 5 minutes, determining the variables in the frequency domain using Fourier transform analysis. We excluded patients with diabetes, medicated with drugs that modify heart rate or with a history of irradiation to the neck. Results: 68 patients were studied. The mean age was 49±13 years. The median systolic blood pressure was 120 mmHg and the diastolic blood pressure 80 mmHg. The heart rate was 76±13 beats per minute and the median respiratory rate was 24 (16 to 40). Anosmia was observed in 22% and dysgeusia in 19% The variables in the frequency domain were: Low-frequency power (LF) 135.8ms2 (13.7-2861.7); High-frequency power (HF), 89.04ms2 (4.1-5234.4), LFnu 57.5±22.3, HFnu 43.1±22.6. LF:HF 2.1±2. 41.2% of the patients had a high LF:HF. Conclusions: LF and HF components can be obtained through frequency analysis. The relationship between these two elements would thus represent the sympathovagal balance and is expressed as the LF/HF ratio. We observed that 41.2% of the studied patients showed elevated LF/HF ratio. The 41.2% of the patients presented an increased LF:HF ratio, which could be interpreted as an alteration in autonomic function.