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Embaby A, Maged LA, Abdel-Hamid HM, El Hadidi KT. Factors associated with severe infection in rheumatoid arthritis patients: lessons learned from the COVID-19 pandemic. Infection 2024:10.1007/s15010-024-02187-z. [PMID: 38381306 DOI: 10.1007/s15010-024-02187-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/15/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE This aimed to identify the factors associated with severe/critical coronavirus disease 2019 (COVID-19) infection in rheumatoid arthritis (RA) patients. METHODS Two-hundred RA patients diagnosed according to the American College of Rheumatology/ European League Against Rheumatism (ACR/EULAR) classification criteria with proven COVID-19 infection were recruited and categorized according to the world health organization (WHO) COVID-19 severity grading into 2 groups: patients with mild/moderate COVID-19 (n = 164) and patients with severe/critical COVID-19 (n = 36). Comparison between both groups was done to identify the risk factors associated with severe/critical infection. Incidence of RA disease activity flare defined as increase in clinical disease activity index (CDAI) more than 10 points following infection was calculated. RESULTS Multivariate analysis identified history of previous serious infection, age > 60 years, and diabetes as factors positively associated, whereas COVID-19 vaccination was negatively associated with severe/critical infection. Following COVID-19 infection, the number of patients with severe/critical COVID-19 who had high RA disease activity and the incidence of flares was significantly higher in comparison to patients with mild/moderate COVID-19 (P < 0.001 and 0.003; respectively). CONCLUSION Age > 60 years, diabetes, and history of previous serious infections are risk factors for severe/critical COVID-19, while vaccination has a protective role in RA patients. Infection particularly when severe is associated with risk of disease flare.
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Affiliation(s)
- Aya Embaby
- Rheumatology Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Lobna A Maged
- Rheumatology Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Hoda M Abdel-Hamid
- Chest Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khaled T El Hadidi
- Rheumatology Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Medhat BM, Behiry ME, Fateen M, El-Ghobashy N, Fouda R, Embaby A, Seif EM, Taha MM, Hasswa MK, Sobhy D, Ragheb CS, Morad MA. Sarcoidosis beyond pulmonary involvement: A case series of unusual presentations. Respir Med Case Rep 2021; 34:101495. [PMID: 34471595 PMCID: PMC8390548 DOI: 10.1016/j.rmcr.2021.101495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/28/2021] [Accepted: 08/10/2021] [Indexed: 12/04/2022] Open
Abstract
Unusual presentations of sarcoidosis pose a diagnostic challenge and warrant attention. Hematologic associations: Case 1 (37-years-old male): Pancytopenia: myelofibrosis (leading to sepsis and mortality) following a two-year quiescent course of biopsy-proven-sarcoidosis. Case 2: (38-years-old male): Presentation with thrombocytopenia (5 × 103/cmm): immune thrombocytopenic purpura (histologically associated with megakaryocytic emperipolesis). Biopsied enlarged lymph nodes demonstrated sarcoidosis. Hematologic sarcoid involvement is usually due to granulomatous bone marrow (3.9%) or splenic infiltration (6–30%); however, the presented manifestations are scarcely reported with a potential significance that is yet to be elucidated. Case 3: Neurologic presentation: 48-years-old female: presentation with bilateral sensorineural hearing loss and facial palsy. Brain magnetic resonance imaging showed leptomeningeal thickening. Biopsied enlarged lymph nodes showed sarcoidosis. Case 4: Neurologic and renal manifestations: 13-years-old male (family history of sarcoidosis): Presenting with acute headache, investigations showed elevated serum creatinine (2.1 mg/dL) and angiotensin converting enzyme, and computed tomography chest and abdominal findings characteristic of sarcoidosis. Associated benign increased intracranial and acute tubulointerstitial nephritis (with eosinophils) were diagnosed upon concordant workup. Of sarcoidosis neurologic affection (5–10%), cranial nerve(s) involvement is among the most common (25–50% of neurosarcoid affection), particularly that of the facial nerve (Case 3). Leptomeningeal enhancement is among the most common neurosarcoid radiologic findings (30–40%). Whereas benign increased intracranial tension (Case 4) is much less reported. Among sarcoidosis renal involvement (35–50%), interstitial nephritis usually presents with granulomatous renal lesions, yet its sole association with sarcoidosis is unusual (Case 4). The portrayed atypical hematologic, neurologic, and renal manifestations further emphasize the masquerading nature of sarcoidosis. Although hematologic involvement in sarcoidosis is usually due to granulomatous infiltration of the bone marrow or spleen and/or hypersplenism, associations with hematologic neoplasms or myelodysplastic syndromes have been reported. However, coexisting myelofibrosis (presented in our first patient) is much less reported and raises interest. We present a patient with coexistent with ITP (case 2) that was further histologically associated with megakaryocytic emperipolesis. The significance of this association is yet to be elucidated. Cranial nerve(s) involvement is among the most widely neurosarcoid manifestations reported which was demonstrated in our third patient. Brain MRI showing evidence of leptomeningeal enhancement which is among the most common radiologic findings of neurosarcoidosis. A juvenile-onset patient with a family history of sarcoidosis manifested with benign increased intracranial tension (ICT) and renal affection in the form of tubulointerstitial nephritis. Unlike cranial nerve affection, benign ICT is a rarely reported neurosarcoid manifestation, and renal involvement is usually due to hypercalcemia or granulomatous involvement with or without tubulointerstitial nephritis. Although unusual presentations warrant attention as the pose a diagnostic and therapeutic challenge, they should be prudently interpreted.
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Affiliation(s)
- Basma M Medhat
- Rheumatology and Rehabilitation Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mervat E Behiry
- Rheumatology Unit. Internal Medicine Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.,Armed Forces College of Medicine (AFCM), Cairo, Egypt
| | - Mohamed Fateen
- Clinical and Chemical Pathology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nehal El-Ghobashy
- Rheumatology and Rehabilitation Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Raghda Fouda
- Clinical and Chemical Pathology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Aya Embaby
- Rheumatology and Rehabilitation Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Esraa M Seif
- Rheumatology and Rehabilitation Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa Magdy Taha
- Rheumatology and Rehabilitation Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Dina Sobhy
- Chest Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mohamed Abdelkader Morad
- Clinical Haematology Unit. Internal Medicine Department Kasr Alainy, Faculty of Medicine, Cairo University, Cairo, Egypt
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