Yara Hodaifa’s research while affiliated with Damascus University and other places

Introduction and importance Leukopenia is a condition in which a person has few white blood cells. It should not be considered a disease in itself, but rather a sign of a disease that needs to be further investigated. Leukopenia is a rare complication and is not commonly seen in patients with COVID-19 disease. Here, we report a case of leukopenia in a previously immunocompetent female patient with SARS-CoV-2 infection. Case presentation A 31-year-old woman presented to the emergency department with complaints of fever, fatigue, and dyspnea with a dry cough of 10 days’ duration. Initial laboratory investigations revealed leukopenia. She was diagnosed with severe COVID-19 disease with leukopenia and admitted to intensive care. After 3 years of infection, she is doing well with persistent leukopenia. Clinical discussion Various hematological abnormalities have been reported in COVID-19 disease, including lymphopenia, thrombocytopenia, leukopenia, and hypercoagulability. Possible causes of leukopenia include nutritional deficiencies, megaloblastic anemia, hypersplenism, malignancies, radiotherapy, chemotherapy-induced bone marrow toxicity, connective tissue diseases, and immunosuppressive drugs. Conclusion Leukopenia is a rare complication of COVID-19 disease. We report a case of this manifestation associated with a disease likely caused by bone marrow suppression that persisted for 3 years.

Introduction and importance Low back pain (LBP) is one of the most common complaints and sacroiliac joint dysfunction is the third cause of this chronic burden. Sacroiliitis might be a primary sign of axial spondylarthritis, although it might be found in other diseases, and malignancies, either primary tumors or metastases, meanwhile, this is a rare case that is described as sacroiliitis with adenocarcinoma of unknown origin. Case presentation A 24-year-old male presented at the hospital with fever and urinary retention. He had a history of progressively worsening chronic LBP, with increased curvature in the dorsal vertebrae. Physical examination revealed fever (39°C), a dorsal kyphosis with an absence of lumbar lordosis. Strength was low in the proximal and distal muscles of the lower limbs, with hyperreflexia in the left lower limb and paresthesia limbs in the whole lower and lower region of the abdomen. Laboratory studies revealed normocytic anemia, high ESR and CRP levels, and hypercalcemia with low PTH. The radiology study showed sacroiliitis, many lytic bone lesions, and a collapse in the 4th lumbar vertebral, and increased lung density. Biopsy from a lytic lesion showed metastatic poorly differentiated adenocarcinoma of unknown origin with features suggestive of pancreatic primary. Palliative radiotherapy was started; unfortunately, he died after 4 months. Clinical discussion Cancer is an additional risk factor for the development of sacroiliac joint pain and disorder. A lot of tumors and metastases can be associated with sacroiliitis. Many patients present with bone lytic metastases of unknown origin as a first manifest. The association between metastatic adenocarcinoma and sacroiliitis was reported three cases in the literature; meanwhile, this was a rare case that described sacroiliitis with adenocarcinoma of unknown origin. Conclusion Low back pain is one of the most common complaints, but it may be an initial symptom of serious conditions. Awareness of clinical clues can prevent faulty or delayed diagnoses. Although sacroiliitis is usually associated with axial spondylarthritis in adult patients, it can be the first manifestation of adenocarcinoma.

Introduction and importance The interactions between the susceptibility of the host and some of the COVID-19 vaccine components happened. Viral infections, including COVID-19, are related to the pathogenesis of bipolar disorder (BD). These findings could trigger an initial bipolar episode. Case presentation A 48-year-old Syrian married female, presented to the out-clinic of Modern Medical Centre Hospital, in July 2022 for episodes of sub-maniac/mania episodes, which began within 15 days after the booster dose of COVID-19 vaccination, preceded by depressive mood. Both family and personal past psychiatric and/or trauma history were negatives. Initiation of carbamazepine 600 mg/day showed significant improvement within 3 days; 3 months later, carbamazepine dose was decreased to 200 mg/day, as there were no clinical symptoms. Clinical discussion mRNA vaccines of COVID-19 increase the levels of type I interferon (INF), an inflammatory cytokine that creates a signal leading to the expression of interleukins, INF, and tumor necrosis factor-alpha. The pathology of BD is also unclear. Genetic predisposition, immunological effects, and the classification of BD, itself, as an autoimmune disease play a role. Although rapid improvement following treatment, prolonged and maintenance treatment by essentially mood stabilizer should be considered in bipolar episodes initiated by COVID-19 vaccination. Rare data are available about maniac episodes after COVID-19 infection, but to our knowledge, we reported the first case of bipolar onset after the booster vaccination of COVID-19. Conclusion Bipolar disease can present following a booster dose of COVID-19 vaccination in previously healthy people.

Introduction and importance Behçet’s disease is a rare systemic condition, with the mean age of patients being ~30 years. It affects men more than women. Behçet’s disease should be considered in any patient with a systemic inflammatory disease characterized by recurrent orogenital ulcers and uveitis. Fournier’s gangrene is a rare life-threatening bacterial genital infection that acquires at any age with male predominance. Case presentation A healthy 32-year-old male presented with fatigue, fever, oral ulcers, and discrete scrotal ulcers. He had Fournier’s gangrene and a new diagnosis of Behçet’s disease. He was treated with intravenous antibiotics with surgical debridement. Before discharge, the patient was commenced on 1 mg/day of colchicine. During the follow-up visits, we noted small ulcerations without necrosis on the scrotum, which we started with oral prednisolone and oral methotrexate. He remains under their care 6 months later. Clinical discussion The patient had recurrent oral ulcerations followed by genital aphthous ulceration and acneiform eruptions that met Behçet’s diagnosing criteria. Fournier’s gangrene on the scrotum was diagnosed due to the physical examination, radiological findings, and histological findings. A PubMed search reveals one similar case report. This patient’s only risk factor for Bechet’s was his ethnicity and male gender for Fournier’s gangrene. Conclusion The young adult patient presented unusually, with a diagnosis of Fournier’s gangrene superimposed on undiagnosed Behçet’s disease. An understanding of the epidemiology and risk factors can help in the diagnosis of these rare pathologies.

Background: This study aimed to examine the prevalence of menstrual cycle changes (MCs) and their patterns among healthy Syrian women following the administration of the first and second doses of a vaccine. Methods: A cross-sectional online survey following campaigns for COVID-19 vaccines was conducted in 2022 from June 26 to August 3. Data collected included the participants' demographic characteristics, vaccination status, and multiple-choice questions for MCs changes after the first and second doses. Results: Of 236, 89.8 % completed all shots of the vaccine. After the first dose, 36.9 % reported MCs, and 35 % after the second dose. Most women did not experience changes in menstrual cycle frequency-81.8 % after the first dose and 83.4 % after the second dose. Similarly, most women did not observe changes in cycle length, or menstrual flow quantity-5.5 % after the first dose and 8 % after the second dose reported spotting. Dysmen-orrhea was reported by 15.7 % and 14.1 % of women after the first and second doses, respectively. Conclusion: MCs are a potential symptom that a healthy woman at childbearing age could have after a different type of COVID-19 vaccine. MCs patterns do not significantly differ following vaccine doses.

Introduction Multiple myeloma (MM) is a malignant plasma cell proliferation producing large numbers of monoclonal immunoglobulins. Typical MM symptoms include anemia, bone pain, hypercalcemia, and renal failure. Atypical presentations like joint involvement were rarely reported in the literature and may cause significant delays in treatment and adverse outcomes. Case presentation The authors report a case of a 54-year-old female who presented with symmetrical polyarthritis and was misdiagnosed with rheumatoid arthritis. The diagnosis of MM was made after failing many treatments of rheumatoid arthritis and with further laboratory tests and procedures. Conclusion This rare manifestation of MM carries a diagnostic challenge and causes a significant delay in treating such patients. Here, the authors report this unusual initial presentation with a review of several cases in the literature describing similar presentations.

Introduction and Importance Systemic sclerosis (SSc) is a systemic immune disorder that may overlap with other rheumatologic disease; however, overlapping with antineutrophil cytoplasmic antibody-associated vasculitis is rare. Case Presentation A 28-year-old Syrian male patient with SSc diagnosed according to the American College of Rheumatology/European League against Rheumatism 2013 criteria with a disease duration of 4 years, was admitted to the hospital complaining of palpable purpura in the lower limbs and hemoptysis and later, a rise in creatinine level. Laboratory tests showed high levels of perinuclear antineutrophil cytoplasmic antibodies (p-ANCA). The renal biopsy results were consistent with the diagnosis of glomerulonephritis. He was treated with methylprednisolone, cyclophosphamide, and rituximab, as he was diagnosed with SSc overlapping antineutrophil cytoplasmic antibody-associated vasculitis. Clinical Discussion SSc most commonly renal manifestations are proliferative vasculopathy leading to scleroderma renal crisis. However, other types of renal involvement were also reported in SSc patients with comorbid autoimmune diseases such as glomerulonephritis and signs of concurrent vasculitis. SSc may overlap with rheumatoid arthritis, systemic lupus erythromatosus, polymyositis/dermatomyositis (PM/DM), and Sjogren Syndrome. Overlapping with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is mentioned in rare cases. The authors reported a rare case of overlapping SSc with antineutrophil cytoplasmic antibody-associated vasculitis with renal involvement. Conclusion The authors revealed a rare case of overlapping SSc with antineutrophil cytoplasmic antibody-associated vasculitis with renal involvement. In SSc, renal involvement as glomerulonephritis is infrequent and should be detect in other rheumatologic disease such as systemic lupus erythematosus or antineutrophil cytoplasmic antibody-associated vasculitis.