BACKGROUND: Cold agglutination syndrome is a subtype of autoimmune hemolytic anemia. The condition is referred to as \"cold\" because the antibodies become active and induce hemolysis at cold temperatures, typically 3-4 °C, which is not always the case in other kinds of autoimmune hemolytic anemia. Whereas primary cold agglutination syndrome may occur in the absence of underlying conditions, secondary cold agglutination syndrome is associated with the presence of underlying infections, including coronavirus disease 2019.
METHODS: We report the case of a 69-year-old Japanese woman with periodontitis who was referred to our hospital with complaints of brown-colored urine and chest pain. Her hemoglobin level was 6.1 g/dL. Computed tomography revealed multiple lung abscesses. Her direct antibody test results were positive (2+) for anti-complement direct antiglobulin and negative for immunoglobulin G, and her cold agglutinin titer was elevated at 1:4096. Workup for anemia revealed a positive result for cold agglutination syndrome. The patient had received the fourth dose of coronavirus disease 2019 vaccination. Nasopharyngeal swab test for detecting severe acute respiratory syndrome coronavirus 2 using a real-time reverse-transcription polymerase chain reaction gave a cycle threshold value of 42.3, and the level of virus-specific immunoglobulin G was elevated at 7.71 S/C (normal range -1.4 S/C).
CONCLUSIONS: A decrease in hemoglobin in patients with coronavirus disease 2019 may be associated with secondary cold agglutination syndrome. The patient was hypothesized to have developed multiple lung abscesses with secondary cold agglutination syndrome following coronavirus disease 2019. Thus, following coronavirus disease 2019, patients can develop secondary cold agglutination syndrome, which could worsen owing to associated bloodstream bacterial infections.

Although endothelial damage has been hypothesized to be associated with coronavirus disease 2019 (COVID-19)-related cerebral infarction based on the specificity of the viral cellular invasion pathway, no case has been reported to date. We herein report a 51-year-old Japanese woman who presented with neck pain one week after COVID-19 infection. Computed tomography and magnetic resonance imaging revealed inflammation of the carotid and vertebral arteries. Ultrasonography revealed multiple flap-like structures that were assumed to be thrombi. Although the patient had no cerebral infarction, this could be an important case of vascular damage and thrombus formation in a COVID-19 patient.

暂无摘要。

暂无摘要。

Acute necrotizing encephalopathy (ANE) is a rare immune-mediated complication of a viral infection commonly involving the bilateral thalamus and has been reported mainly in children. Here, we describe the MRI findings of coronavirus disease 2019 (COVID-19)-associated ANE in two pediatric patients, including a 7-year-old girl with fever and mental change, and a 6-year-old girl with fever and generalized seizures. Brain MRI revealed symmetrical T2 fluid attenuated inversion recovery high-signal intensity lesions in the bilateral thalamus with central hemorrhage. In one patient, the thalamic lesions showed a trilaminar pattern on the apparent diffusion coefficient map. This report emphasizes the importance of creating awareness regarding these findings in patients with COVID-19, particularly in children with severe neurological symptoms. Furthermore, it provides a literature review of several documented cases of COVID-19 presenting with bilateral thalamic hemorrhagic necrosis, suggesting a diagnosis of ANE.
급성 괴사성 뇌병증은 바이러스 감염의 드문 면역 매개 합병증이다. 일반적으로 양쪽 시상을 침범하며, 주로 어린이에서 보고된다. 저자들은 소아에서 발생한 코로나바이러스감염증과 관련된 급성 괴사성 뇌병증 2건을 보고하고자 한다. 7세 여아는 발열과 의식변화, 6세 여아는 발열과 전신성 간질로 내원하였다. 뇌 MRI에서 두 환자 모두 양쪽 시상에 중심부 출혈을 동반한 대칭적인 액체감쇠역전회 고신호강도 병변이 보였고, 한 환자에서는 겉보기확산계수에서 시상에 층상 병변이 보였다. 저자들은 이 보고를 통해 급성 괴사성 뇌병증의 특징적인 뇌 MRI 영상 소견을 인지함으로써 심각한 신경학적 증상을 나타내는 코로나바이러스감염증 환자의 경우 특히 소아에서 영상 소견을 바탕으로 한 빠른 진단이 필요함을 강조하고자 한다. 또한, 급성 괴사성 뇌병증을 시사하는 양측 시상의 출혈성 괴사로 나타났던 코로나바이러스 감염 증례에 대한 문헌을 검토하고자 한다.

BACKGROUND: Although guidelines recommend vaccination for individuals who have recovered from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to prevent reinfection, comprehensive evaluation studies are limited. We aimed to evaluate vaccine effectiveness against SARS-CoV-2 reinfection according to the primary vaccination status, booster vaccination status, and vaccination methods used.
METHODS: This population-based case-control study enrolled all SARS-CoV-2-infected patients in Seoul between January 2020 and February 2022. Individuals were categorized into case (reinfection) and control (no reinfection) groups. Data were analyzed using conditional logistic regression after adjusting for underlying comorbidities using multiple regression.
RESULTS: The case group included 7,678 participants (average age: 32.26 years). In all vaccinated individuals, patients who received the first and second booster doses showed reduced reinfection rates compared with individuals who received basic vaccination (odds ratio [OR] = 0.605, P < 0.001 and OR = 0.002, P < 0.001). Patients who received BNT162b2 or mRNA-1273, NVX-CoV2373 and heterologous vaccination showed reduced reinfection rates compared with unvaccinated individuals (OR = 0.546, P < 0.001; OR = 0.356, P < 0.001; and OR = 0.472, P < 0.001). However, the ChAdOx1-S or Ad26.COV2.S vaccination group showed a higher reinfection rate than the BNT162b2 or mRNA-1273 vaccination group (OR = 4.419, P < 0.001).
CONCLUSIONS: In SARS-CoV-2-infected individuals, completion of the basic vaccination series showed significant protection against reinfection compared with no vaccination. If the first or second booster vaccination was received, the protective effect against reinfection was higher than that of basic vaccination; when vaccinated with BNT162b2 or mRNA-1273 only or heterologous vaccination, the protective effect was higher than that of ChAdOx1-S or Ad26.COV2.S vaccination only.

Myasthenia gravis (MG) is an autoimmune disease that induces skeletal muscle weakness, affecting different muscle groups. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), became both a diagnostic and a therapeutic challenge during the pandemic. The effects of COVID-19 are not only limited to the acute symptoms but also to the post-infectious sequelae. We present the case of a 30-year-old Caucasian woman, with no significant medical history, who presented to the emergency room with acute respiratory failure. The patient tested positive for SARS-CoV-2 with a rapid antigen test and during hospitalization developed a myasthenic crisis, ultimately being diagnosed with seropositive MG.

Bacterial coinfections in patients with COVID-19 are rare; however, coinfection with Staphylococcus (S.) aureus is relatively common. No detailed report of patients with COVID-19 and methicillin-resistant S. aureus (MRSA) coinfection has been documented. Herein, we present a case of a patient with COVID-19 and MRSA coinfection who developed MRSA empyema after pneumonia and bacteremia. A 59-year-old man was admitted to the intensive care unit for treatment of COVID-19 and bacterial pneumonia with septic shock. He was initially treated with antibiotics, antiviral agents, and steroids. On the third day of admission, MRSA was detected in both sputum and blood cultures. Although he was treated with appropriate vancomycin doses with monitoring of renal function and serum vancomycin concentrations, he developed bilateral pleural effusions one week after starting treatment. Initially, the bilateral pleural effusions were thought to have been caused by hypoalbuminemia. However, bilateral chest drainage was performed due to the onset of left-sided chest pain. The left-sided pleural effusion was exudative, whereas the right-sided pleural effusion was transudative. MRSA was later detected on culture of the left-sided effusion but not the right-sided effusion. Based on the findings of the pleural fluid examination, the patient was diagnosed with left-sided empyema. His symptoms and radiographic findings improved after a repeat drainage of the left pleural effusion. Vancomycin was administered for 28 days, and the patient was discharged on the twenty-eighth day of admission. These findings highlight the importance of pleural fluid examination for the prompt diagnosis of pleural infection. Early diagnosis of empyema and prompt chest drainage may help avoid the need for surgery. This report could contribute to the clinical management of patients with COVID-19 and MRSA coinfection.

JC polyomavirus (JCPyV) is a human polyomavirus that can establish lifelong persistent infection in the majority of adults. It is typically asymptomatic in immunocompetent individuals. However, there is a risk of developing progressive multifocal leukoencephalopathy (PML) in immunocompromised or immunosuppressed patients. Though JCPyV commonly resides in the kidney-urinary tract, its involvement in urinary system diseases is extremely rare. Here, we reported a case of a 60-year-old male patient with coronavirus disease 2019 (COVID-19) infection who developed hemorrhagic cystitis after receiving treatment with nirmatrelvir 300 mg/ritonavir 100 mg quaque die (QD). Subsequent metagenomic next-generation sequencing (mNGS) confirmed the infection to be caused by JCPyV type 2. Then, human immunoglobulin (PH4) for intravenous injection at a dose of 25 g QD was administered to the patient. Three days later, the hematuria resolved. This case illustrates that in the setting of compromised host immune function, JCPyV is not limited to causing central nervous system diseases but can also exhibit pathogenicity in the urinary system. Moreover, mNGS technology facilitates rapid diagnosis of infectious etiology by clinical practitioners, contributing to precise treatment for patients.

Various ocular manifestations associated with COVID-19 and vaccines, affecting both the anterior and posterior segments of the eye have been documented in the literature. In this report, we present the case of a 25-year-old male who complained of sudden-onset blurred vision and metamorphopsia in both eyes one day after receiving the second dose of the Sinopharm COVID-19 vaccine. The visual loss was painless, with no reported flashes or floaters. The patient had no significant medical or surgical history, no history of trauma, and no drug intake. Upon ocular examination, the best-corrected visual acuity was 6/60 (Snellen chart) in both eyes. The anterior segments appeared unremarkable, while fundoscopy revealed multiple yellowish-white subretinal lesions at the posterior pole of both eyes. Spectral domain optical coherence tomography (SD-OCT) confirmed the presence of subretinal fluid (SRF) with neurosensory detachment in each eye, along with bacillary layer detachment (BALAD). There were no signs of inflammation in the vitreous cavity. A diagnosis of acute posterior multifocal plaque pigment epitheliopathy (APMPPE) was established. The patient was prescribed nepafenac 0.1% drops to be instilled three times a day in both eyes and was advised to return for a follow-up examination in two weeks. At the follow-up visit, the patient\'s vision had improved to 6/9 in the right eye and 6/6 in the left eye, with most of the SRF absorbed. Unilateral APMPPE with BALAD has been mentioned in the literature following various COVID-19 vaccinations, but, to the best of our knowledge, this is the first case report where bilateral APMPPE with BALAD is reported. This case emphasizes the importance of a thorough eye examination for individuals experiencing ocular symptoms after receiving the COVID-19 vaccine.