1.Severe COVID-19 infection in a lupus nephritis patient on treatment for multidrug-resistant disseminated tuberculosis
Vincent M. Luceñ ; o ; Leonid D. Zamora ; Sandra V. Navarra
Philippine Journal of Internal Medicine 2024;62(2):106-109
Background:
Systemic lupus erythematosus is a multisystem autoimmune disease with variable manifestations, dysregulated type I interferon responses, and defective immune tolerance mechanisms. SLE, multidrug-resistant tuberculosis (MDR-TB), and coronavirus disease 2019 infection may be a rare, complex combination presenting a significant challenge in screening, management, and infection control.
Case:
A 24-year-old female diagnosed with SLE nephritis maintained on mycophenolate, mofetil, and hydroxychloroquine developed disseminated multidrug-resistant tuberculosis (MDR-TB) involving the lungs, liver, and lymph nodes. She was started on an anti-TB regimen. However, QT prolongation and heart failure was noted, thus discontinuation of HCQ. On the 10th month of treatment with clofazimine, cycloserine, p-aminosalicylic acid, and delamanid, she developed fever, dyspnea, chest pain, and disorientation accompanied by progressive oxygen desaturation. A nasopharyngeal swab for SARS-CoV-2 RT-PCR was positive, and a high-resolution chest CT showed new peripheral ground-glass opacities consistent with COVID-19 pneumonia. Oxygen support with a high-flow nasal cannula at 60% FiO2, low molecular weight heparin, meropenem, remdesivir, and dexamethasone were given; MDR-TB treatment was temporarily withheld. The patient recovered after 3 weeks of hospitalization, and MDR-TB treatment was resumed following hospital discharge.
Conclusion
This case illustrates the challenges in healthcare access brought about by the pandemic and the management of drug-to-drug interactions in the different treatment regimens for lupus nephritis, disseminated MDRTB, and severe COVID-19 infection.
Lupus Nephritis
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Tuberculosis, Multidrug-Resistant
2.Target-Oriented Clinical Skill Enhancement (TOCSE) builds up confidence of fourth-year medical students during first-time patient encounter: An effective bridging tool after online didactic undergraduate classes during the COVID-19 pandemic
Maria Faye Anne S GOMEZ ; Leonid D ZAMORA ; Paul John ABLAZA ; Melvin Remulla MARCIAL ; Leilani B MERCADO-ASIS
Journal of Medicine University of Santo Tomas 2022;6(S1):114-125
Clinical Competence
3.A cross sectional validation study of sonographic findings of the first metatarsophalangeal Joint in gout and asymptomatic hyperuricemia
Dominic Dela Cruz ; Julie Li-Yu ; Richelle Joy Bayson ; Leonid D. Zamora ; Juan Javier T. Lichauco
Philippine Journal of Internal Medicine 2023;61(3):117-121
Objective:
Musculoskeletal ultrasound has gained recognition in early identification of crystal deposits in the joints and soft tissues. This study aims to validate the sonographic features of 1st metatarsophalangeal joints (MTPJs) in gout and asymptomatic hyperuricemia (AH).
Methods
Patients with gout (n=20) and AH (n=16) underwent a gray-scale ultrasound assessment of both 1st MTPJs on 3 positions (dorsal, medial, plantar) in longitudinal view. The static images were read by 2 blinded trained sonologists for the presence of double contour sign (DCS), erosions, and tophi.
Gout
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Validation Study