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Al-Ansari RY, Almuhaish LA, Hassan KA, Fadoul T, Woodman A. A Saudi Woman with Ceftriaxone Induced Fixed Drug Eruption. Case Rep Dermatol Med 2024; 2024:9975455. [PMID: 38523830 PMCID: PMC10959582 DOI: 10.1155/2024/9975455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/24/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024] Open
Abstract
Background A fixed drug eruption (FDE) is an immunological cutaneous adverse reaction, classified as a cutaneous adverse drug reaction (CADR) and characterized by well-defined lichenoid lesions that occur at the same site each time. Ceftriaxone is a third-generation antibiotic of cephalosporin antibiotics of the beta-lactam antibiotic family, which has typical in vitro activity against many Gram-negative aerobic bacteria. This is the first clinical case from Saudi Arabia and the fifth in the world to document a woman's experience with recurrent FDE after repeated ceftriaxone use. Case Report. A 25-year-old Saudi woman with a known case of sickle cell anemia (SCA) with a history of avascular necrosis of the right hip after replacement was hospitalized with a pain crisis triggered by an upper respiratory tract infection. The patient denied having a history of allergy previously. Due to fever, leukocytosis, and active follicular tonsillitis, ceftriaxone was started. However, a few hours later she developed lip edema and a fixed drug eruption measuring 7 × 11 cm on the left side of her back. The lesion reformed over a hyperpigmented lesion (4 × 8 cm) that the patient did not report upon initial examination. It turned out that this was due to the intravenous administration of ceftriaxone, a year ago in another hospital. An allergy to ceftriaxone was considered, and steroids and antihistamines were started. The case was labeled as ceftriaxone induced FDE. Conclusion Ceftriaxone induced FDE is an uncommon type of allergic reaction that has been reported infrequently. Understanding this condition and the mechanism by which FDE becomes recurrent with the same previous fixed lesion is of great importance for both academic and future research purposes.
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Affiliation(s)
- Rehab Y. Al-Ansari
- Adult Hematology Unit, Internal Medicine Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | | | - Khaled Abdullah Hassan
- General Medicine Unit, Internal Medicine Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Tawasoul Fadoul
- General Medicine Unit, Internal Medicine Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
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Al-Ansari RY, Al-Rayes H, Abdalla LM, Alshehri AA, Woodman A. Impending splenic rupture as indicator of atypical chronic lymphocytic leukemia: A case report from Saudi Arabia. Int J Surg Case Rep 2023; 110:108748. [PMID: 37678031 PMCID: PMC10509882 DOI: 10.1016/j.ijscr.2023.108748] [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: 07/23/2023] [Revised: 08/26/2023] [Accepted: 08/26/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) is one of the hematological malignancies in which the bone marrow overproduces mature, dysfunctional lymphocytes. Affected lymphocytic cells can affect the lymph nodes, spleen, liver, bone marrow, and rarely other organs. Spontaneous rupture of the spleen is a rare health condition, with a few cases caused by CLL. Since the preliminary presentation of either impending or real splenic rupture is unusual and requires recording and reporting, this case report was developed. CASE REPORT A 55-year-old male patient presented with a significant weight loss of 20 kg, loss of appetite, fatigue, abdominal pain, and early satiety. Clinical examination revealed massive splenomegaly 22 cm below the costal margin, otherwise unremarkable on systemic examination. The size and dimensions of the spleen were confirmed by computed tomography of the body. The patient underwent a bone marrow biopsy, which was suggestive of atypical CLL. Due to the rapid progression of the size of the spleen and the pattern of impending rupture of the spleen, an emergency splenectomy was performed, and the histopathological report confirmed low-grade B-cell non-Hodgkin's lymphoma, mostly typical of CLL. CONCLUSION Given the rarity of cases, continuous data recording and reporting is required to enrich the scientific literature and share experiences from case to case. This will create a complete picture of this health condition across diverse regions and countries.
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Affiliation(s)
- Rehab Y Al-Ansari
- Adult Hematology Unit, Internal Medicine Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia.
| | - Hezab Al-Rayes
- Internal Medicine Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Leena Mohamed Abdalla
- Pathology Department, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | | | - Alexander Woodman
- School of Health Sciences, University of Salford, Manchester, England
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Al-Ansari RY, Alruwaili AF, Alqahtani KM, Al-Harbi AF, Woodman A. "Familial Multiple Coagulation Factor Deficiencies of FXI and FXII in an Asymptomatic Saudi Woman". J Investig Med High Impact Case Rep 2023; 11:23247096231199413. [PMID: 37705386 PMCID: PMC10503275 DOI: 10.1177/23247096231199413] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/09/2023] [Accepted: 08/19/2023] [Indexed: 09/15/2023] Open
Abstract
Factor XI deficiency (FXI) is the third most common coagulation factor deficiency after hemophilia A and B, ie, in the hierarchy after factors VIII and IX, taking into account von Willebrand's factor deficiency, as bleeding disorders are higher than in hemophilia C. Factor XII deficiency (FXII) is a congenital condition, inherited in the vast majority of cases in an autosomal recessive manner, more often associated with thromboembolic complications. A combination of both factor deficiencies has been found very rarely, and it can be familial multiple coagulation factor deficiency (FMCFD). This study reports the case of a 39-year-old woman from Saudi Arabia who had the combination of FXI and FXII deficiencies, known to be on treatment for hypothyroidism and was referred to a hematology clinic with an incidental finding of prolonged activated partial thromboplastin time (aPTT). Although there was no history of bleeding tendency, her siblings had a family history of an unknown type of bleeding disorder. On physical examination, the patient did not show any bruising, petechiae, or ecchymosis. The aPTT was 69 seconds (27-38) with normal use of other hemostatic agents and was corrected after a 50:50 mixing study. Intrinsic coagulation factors were evaluated, and they revealed severe FXI and moderate FXII deficiencies. Due to a strong family history, the patient was diagnosed with FMCFD. In conclusion, familial combined multiple clotting factor deficiency (FCMFD) is a rare condition that requires attention and reporting. The management strategy in such cases has not been well studied, especially in the long-term symptomatic patient with severe but asymptomatic combined FXI and FXII deficiencies, which is an area for review and further study.
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Al-Ansari RY, AL Qahtany FH, Qomawi Y, Fadoul T, Woodman A. Severe thrombocytopenia after Vaxzevria vaccination in a single patient: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221091407. [PMID: 35465020 PMCID: PMC9019373 DOI: 10.1177/2050313x221091407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/15/2022] [Indexed: 11/18/2022] Open
Abstract
AstraZeneca vaccine became one of the four vaccines that encode different forms of the SARS-CoV-2 spike glycoprotein. We report the case of an 18-year-old medically free female with progressive bruising of the upper and lower extremities for 1 week, beginning 3 days after the first dose of AstraZeneca. Laboratory results showed severe thrombocytopenia of 4.3 × 103/µL with a normal white blood cell count, renal profile, and hemolytic markers. She was treated conservatively with high-dose steroids and intravenous immunoglobulin, which resulted in a full recovery of her platelet count. In our case, the question was raised about the possibility of receiving a second dose of another vaccine product instead of not being vaccinated again, a subject for further research.
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Affiliation(s)
- Rehab Y Al-Ansari
- Adult Hematology Unit, Department of Internal Medicine, King Fahad Military Medical City (KFMMC), Dhahran, Kingdom of Saudi Arabia
| | - Faisal Hani AL Qahtany
- Department of Internal Medicine, King Fahad Military Medical City (KFMMC), Dhahran, Kingdom of Saudi Arabia
| | - Yasmin Qomawi
- Department of Internal Medicine, King Fahad Military Medical City (KFMMC), Dhahran, Kingdom of Saudi Arabia
| | - Tawasoul Fadoul
- Department of Internal Medicine, King Fahad Military Medical City (KFMMC), Dhahran, Kingdom of Saudi Arabia
| | - Alexander Woodman
- Vice Deanship of Postgraduate Studies and Research, Prince Sultan Military College of Health Sciences (PSMCHS), Dhahran, Kingdom of Saudi Arabia
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Al-Ansari RY, Al-Yami F, Almulhim G, Woodman A. Hereditary factor XII deficiency in an adult patient: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221118728. [PMID: 36003888 PMCID: PMC9393349 DOI: 10.1177/2050313x221118728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/25/2022] [Indexed: 10/27/2022] Open
Abstract
Factor XII deficiency is a rare autosomal recessive health condition usually discovered incidentally during routine coagulation screening before surgery after investigating a prolongation of the activated partial thromboplastin time. This is a case of a 29-year-old man from Saudi Arabia who was selectively admitted to the surgical department to treat a perianal fistula and found incidentally prolonged activated partial thromboplastin time and factor XII deficiency. Examination of the skin revealed no bruising, petechiae, or ecchymosis. Systemic examination was normal. Laboratory examination showed an activated partial thromboplastin time > 160 s (normal between 27 and 38), which was repeated twice with low factor XII < 5.7% (73–121). Other factors and the work of hemostasis were within the normal range. Surgery was delayed at the request of the patient. One year later, the patient was admitted to the clinic after surgery without bleeding and did not require factor correction before or after surgery. However, treating factor XII–deficient patients specifically for preoperative preparation is challenging. Therefore, this rare case should be recorded and reported the same way as a number of previously rarely reported cases.
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Affiliation(s)
- Rehab Y Al-Ansari
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Fatimah Al-Yami
- Hematology Section, Laboratory Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Ghayah Almulhim
- Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Alexander Woodman
- Prince Sultan Military College of Health Sciences, Dhahran, Kingdom of Saudi Arabia
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Al-Ansari RY, Abdalla LM, Qomawi YA, Alromaih LJ, Bakkar MO, Shilash AS, Zakary NY. Coronavirus disease 2019 (COVID-19) in special groups: A single-center experience in sickle cell disease patients in Saudi Arabia. J Family Community Med 2022; 29:71-78. [PMID: 35197731 PMCID: PMC8802730 DOI: 10.4103/jfcm.jfcm_376_21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is a group of hereditary diseases, inherited as autosomal recessive disorder, which causes mutation in the β-globin gene. As a result, there is a change in the sixth amino acid from glutamic acid to valine. The affected red blood cell is then prone to polymerization and sickling crisis under conditions of low oxygen tension. One of the major causes of mortality in SCD is acute chest syndrome (ACS). On the other hand, coronavirus disease 2019 (COVID-19) is a pandemic disease that carries significant mortality and morbidity worldwide with unknown outcomes in the affected SCD population. This study was created for that reason. MATERIALS AND METHODS We report a case series of ten SCD patients who were affected by COVID-19 and required admission between May 1, 2020, and October 30, 2020, at a tertiary care hospital in Dhahran, eastern region of Saudi Arabia. Historical data were obtained retrospectively from electronic records. MS Excel was used for data entry, and SPSS version 23 was used for data analysis. RESULTS The mean age of the patients involved in the study was 32 years, and the mean duration of symptoms was 5.7 days. None required critical care admission, and there was no mortality. All patients were discharged from hospital in good condition with no requirement of home oxygen. CONCLUSION Although we expected a fatal outcome of SCD patients affected by COVID-19 infection, our limited case series showed favorable disease behavior and outcome, with a suspicion of underlying unclear protective mechanism from serious complications. However, further studies are required to better understand COVID-19 behavior in SCD patients.
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Affiliation(s)
- Rehab Y. Al-Ansari
- Department of Internal Medicine, Adult Hematology Unit, KFMMC, Dhahran, Saudi Arabia
| | | | | | | | | | - Amal S. Shilash
- Department of Infectious Control, KFMMC, Dhahran, Saudi Arabia
| | - Nawaf Y. Zakary
- Department of Internal Medicie, Gastroentorology Unit, KFMMC, Dhahran, Saudi Arabia
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Al-Ansari RY, Al-Sharari M, Al-Saadi T. Palms and soles itchiness as a side effect of COVID-19 vaccination. J Infect Public Health 2021; 14:1389-1391. [PMID: 34391695 PMCID: PMC8349407 DOI: 10.1016/j.jiph.2021.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/04/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/26/2022] Open
Abstract
Background COVID-19 is a pandemic disease that has no definite treatment or preventive medication until late 2020 when vaccines were developed. Vaccines are a very useful new tool against COVID-19 that stimulate the immune system after recognition of viruses or their parts. Complications post vaccination could happen and they depend on the types, vaccine mechanism of action as well as some other patients' factors. Case report We are reporting a 39 years old lady who is known as allergic to a strawberry and kiwi, otherwise medically free. She presented to the outpatient unit with a ten-days history of palms of the hands and soles of the feet itchiness that is associated with occasional redness after receiving the first dose of COVID-19 vaccination. There were no skin rashes or pruritis at any other sites. The patient was treated conservatively by antihistamine and the symptoms gradually resolved within five days. Conclusion Allergic reaction is one of the expected complications post any COVID-19 or non-COVID-19 vaccination. Although the type, distributions and severity of allergic reactions are variable from person to another, yet isolated itching to palms and soles could be a rare side effect post first dose of COVID-19 vaccination (Pfizer-BioNTech) which is worth reporting. This presentation could be a type of allergic reaction which may require holding further doses, debate is there for further case reporting, research or evaluation. Learning points: Isolated itching to palms and soles could be one of the side effects of COVID-19 vaccination (Pfizer-BioNTech) which is worth reporting.
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Affiliation(s)
- Rehab Y Al-Ansari
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran 31932, Saudi Arabia.
| | | | - Talal Al-Saadi
- Internal Medicine Department, KFMMC, Dhahran 31932, Saudi Arabia
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Al-Ansari RY, Al Otaibi D, Al Hudaithi N, Abdalla L. Isolated ten-eleven translocation 2 positive in triple negative essential thrombocythemia: Case report and literature review. SAGE Open Med Case Rep 2021; 9:2050313X211032066. [PMID: 34350001 PMCID: PMC8287412 DOI: 10.1177/2050313x211032066] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/23/2021] [Indexed: 12/03/2022] Open
Abstract
Essential thrombocythemia is one of the famous diseases under the category of
myeloproliferative disorder. It is an end result of a genetic mutation of one or more of
the most frequent oncogenes such as Janos kinase 2 (JAK2), MPL proto-oncogene,
thrombopoietin receptor (MPL), and calreticulin (CALR). However, negative genetic markers,
so-called (triple negative disease), can happen in the presence of other uncommon types of
mutation. TET2 (ten-eleven translocation 2) positive as isolated genetic marker in triple
negative essential thrombocythemia is uncommon genetic presentation. For that, we are
reporting a 22-year-old lady who presented with a feature of dyspepsia and accidentally
found to have persistently high platelet count, even after treating her mild iron
deficiency anemia with no other secondary causes. Further investigations and bone marrow
biopsy supported the diagnosis of isolated TET2 positive in triple negative essential
thrombocythemia. We treated her conservatively with good hydration and low dose of
aspirin. In conclusion, isolated TET2 positive in triple negative essential
thrombocythemia at presentation is uncommon with no clear management or risk
stratification guideline. However, it is hypothesized that TET2 mutation
precedes JAK2; therefore, the detection of isolated TET2 in a triple
negative essential thrombocythemia case should be closely followed for clonal evolution in
long term. Further study and guidelines required in this area.
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Affiliation(s)
- Rehab Y Al-Ansari
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Dena Al Otaibi
- Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Nourah Al Hudaithi
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Leena Abdalla
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
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Al-Ansari RY, Alshaer A, Al-Anazi A, Al-Otaibi N, Abdalla L, Al-Tarrah S, Shilash A, Al-Zahrani N. ABO in Correlation to the Requirement of Mechanical Ventilation and Mortality in Critically Ill Patients With COVID-19. J Hematol 2021; 10:64-70. [PMID: 34007367 PMCID: PMC8110225 DOI: 10.14740/jh821] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/06/2021] [Indexed: 12/18/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that was first discovered in December 2019 and turned to be pandemic in early March 2020. We aimed to describe the dominant ABO group and outcomes of critically ill patients (respiratory failure requiring mechanical ventilation and mortality) in a Saudi Arabian setting. Methods We conducted an observational, analytic cross-sectional, retrospective study in a tertiary care hospital. Around 90 candidates tested positive for COVID-19 were enrolled in this study during admission to critical care unit between May 2020 and September 2020. Blood group was detected in all patients included in the study during admission to critical care unit. Results In this study, data of 90 patients with COVID-19 admitted to critical care unit were collected. Some prevalent medical conditions were collected, in which hypertension (64.2%) and diabetes mellitus (58.9%) were the most reported comorbidities among patients and there was no significant difference between groups. Most of the sample had blood group of O (45.6%), while the least group was AB (5.6%). Patients with blood group of A/AB showed the highest mortality vs. group O/B (32% vs. 18.5%) with significant P value of 0.001. Patients of groups A/AB had higher risk for intubation than O/B groups (52.0% and 49.2%, respectively; confidence interval of 0.44 - 2.8 with insignificant P value of 0.055). Length of stay in critical care unit was significantly higher in group A/AB with a mean course of 18.20 days in comparison to group O/B with a mean course of 12.63 days (P = 0.033). Conclusion Our data indicate that critically ill patients with COVID-19 with blood group A/AB are at increased risk of mortality and length of stay in critical care unit, with insignificant requirement of mechanical ventilation when compared with patients with blood group O/B. Future larger studies are needed to validate and understand the underlying mechanisms.
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Affiliation(s)
- Rehab Y Al-Ansari
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran 31932, Saudi Arabia
| | | | - Aamer Al-Anazi
- Laboratory Department-Blood Bank, KFMMC, Dhahran 31932, Saudi Arabia
| | - Nasser Al-Otaibi
- Laboratory Department-Blood Bank, KFMMC, Dhahran 31932, Saudi Arabia
| | - Leena Abdalla
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran 31932, Saudi Arabia
| | - Sufana Al-Tarrah
- Internal Medicine Department, KFMMC, Dhahran 31932, Saudi Arabia
| | - Amal Shilash
- Infection Control Department, KFMMC, Dhahran 31932, Saudi Arabia
| | - Nada Al-Zahrani
- Internal Medicine Department, KFMMC, Dhahran 31932, Saudi Arabia
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Al-Ansari RY, Bakkar M, Abdalla L, Sewify K. Critical Care COVID-19 Patient with a Picture of Thrombotic Thrombocytopenic Purpura. Eur J Case Rep Intern Med 2020; 7:002143. [PMID: 33457377 DOI: 10.12890/2020_002143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/12/2020] [Accepted: 11/19/2020] [Indexed: 11/05/2022] Open
Abstract
Background Thrombotic thrombocytopenic purpura (TTP) is an uncommon haematological disease which can occur at any age and may present with COVID-19. This case describes a COVID-19 complication associated with a presentation resembling TTP. Case description A 51-year-old man who had received a kidney transplant and was on immunosuppressant medication, was admitted to a critical care unit with severe COVID-19 pneumonia/acute respiratory distress syndrome (ARDS) which required intubation, mechanical ventilation and inotropic support. The course was complicated by the classic pentad of thrombocytopenia, intravascular haemolysis, acute kidney injury, neurological symptoms and fever, which prompted the diagnosis of probable TTP. After five sessions of therapeutic plasma exchange, the patient's general status improved, he was weaned off mechanical ventilation and his renal panel and haemolytic markers normalized. Conclusion TTP is a life-threatening condition which requires urgent management with therapeutic plasma exchange. This case highlights some possible complications of COVID-19 generally and in immunocompromised patients specifically. The potential role of plasma exchange in COVID-19 patients without a positive diagnosis of TTP (the so-called 'TTP resembling presentation') is an area of further research. LEARNING POINTS COVID-19 can manifest as a picture of thrombotic thrombocytopenic purpura (TTP) which requires therapeutic plasma exchange as in other cases of TTP.Further research is required on the use of therapeutic plasma exchange in severe COVID-19 with cytokine storm.
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Affiliation(s)
- Rehab Y Al-Ansari
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Mohanad Bakkar
- Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Leena Abdalla
- Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Khaled Sewify
- Critical Care Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
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Al-Ansari RY, Al Harbi M, Al-Jubair N, Abdalla L. Acute Soft Head Syndrome (Subgaleal Haematoma) with Periorbital Oedema as a Rare Presentation in Sickle Cell Disease. Eur J Case Rep Intern Med 2020; 7:001766. [PMID: 33083354 DOI: 10.12890/2020_001766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/31/2020] [Accepted: 06/05/2020] [Indexed: 11/05/2022] Open
Abstract
Background Sickle cell disease is a genetic condition frequently found in Africa and the Arabian Peninsula. Uncommon complications include subgaleal haematoma (soft head syndrome) and periorbital oedema. Case presentation A 17-year-old male patient presented with body aches and progressive right parieto-temporal and frontal head swelling. Physical examination revealed puffiness of the right eye that progressed rapidly to reddish periorbital oedema sparing the extraocular muscle and pupil response to light. CT and MRI of the brain suggested multiple subgaleal haematomas (soft head syndrome) and right periorbital oedema. Conclusion Subgaleal haematoma (soft head syndrome) and periorbital oedema are uncommon complications of sickle cell disease. Management is conservative rather than surgical. LEARNING POINTS Subgaleal haematoma concurrently with periorbital oedema is a rare presentation of sickle cell disease.There are no guidelines on treatment, but the conditions in our patient resolved with conservative management.
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Affiliation(s)
- Rehab Y Al-Ansari
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Maan Al Harbi
- Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
| | - Nawaf Al-Jubair
- Neuroradiology unit, Radiology Department, KFMMC, Dhahra, Kingdom of Saudi Arabia
| | - Leena Abdalla
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
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