Abstract Body

BACKGROUND AND PURPOSE

In the current pandemic situation, in the presence of respiratory symptoms we suspect COVID-19 coronavirus, with the risk of postponing the diagnosis of other pathologies.

Dyspnea has multiple causes:pulmonary, cardiovascular, anxiety, anemia...

METHODS

23-year-old woman. Sanitary.

History:migraine with aura, asthma and venous insufficiency. She takes oral contraceptives(OCs). No toxic habits.

She consults for headache and odynophagia. Diagnostic Guidance:Possible COVID-19. Negative rapid antigenic test(RT).

She reconsults after 48h due to dyspnea. Normals blood test, temperature, oxygen saturation, electrocardiogram and chest x-ray. Negative RT-PCR and coronavirus serology.

24h later she was admitted to hospital with dyspnea at rest, tachypnea, tachycardia and paraesthesia in the right arm.

Differential diagnosis:COVID-19/reacute asthma/pulmonary thromboembolism(PTE).

RESULTS

Chest X-ray, electrocardiogram, saturation, and blood test with D-dimer were normal.

Normal CT-angiography, lower extremities Doppler and cranial resonance. Pulmonary perfusion SPECT with CT perfusion defects in the left lung, diagnostic of PTE.

More detailed anamnesis:primary antiphospholipid syndrome in mother and maternal grandfather. Pending results of the patient’s trombophilia study

Treatment:

-OCs suspension

-Oral anticoagulants.

CONCLUSIONS

1-Focusing visits for possible coronaviruses only on this pathology can lead to not asking for antecedents that could lead to other causes of equal or greater severity.

2-A family history of thrombotic pathology indicates that antithrombin III(AT-III) should be determined,especially before starting OCs, which was not done at the time.

3-Although there is variability in protocols on screening for AT-III, protein C and S before starting OCs, the current evidence does not recommend it, except for women with a family history of coagulopathy or a history of thromboembolism before the age of 41.

Abstract Body

Agranulocytosis. Should we be more careful controlling the medications we prescribe?

Background:Metamizole is an antipyretic and analgesic drug available since 1921. It seems to be a more safe choice compared to other analgesics, that's why it is being more used. Nevertheless, the agranulocytosis risk is an infrequent serious side effect, that is why many countries are concerned about its prescription. Medical experts believe that North European were more susceptible to this side effect, but is there any evidence?

Clinical case

45 years Russian old male patient consulted for asthenia and oral ulcer symptomatology.

Pathologycal history:severe degenerative lumbar disc disease

Treatment: metamizol 575 mg /8h and sometimes extra-dose of 2 mg during 2 months.

Haemogram emphasize Hemoglobin 12,8 platelets 208 x10E9/L, Leukocytes 2,41x10E9/L Neutrophil count 0,25x10E9/L (severe neutropenia)

Results:After 6 weeks without methimazole the haemogram was normal.

Discussion:The available information about metamizole on both, intermediate and long-term safety, is very limited. The agranulocytosis effect produced by metamizole could be linked to specific HLA allele(s), consequently, those individuals with a higher frequency of variant HLA may be at a greater risk.The possibility that north european show higher susceptibility to metamizole‐induced agranulocytosis cannot be ruled out.

Spanish Drug Agency recommends that metamizole should only be used for short treatments(<7d). In case the treatment lasts a longer period the patient should be controlled with haemograms.Metamizole should’nt be used in patients with risk of agranulocytosis and carefully in old people.

Abstract Body

1.BACKGROUND AND PURPOSE

Onychodystrophies are very common. More than 50% are mycotic. In feet most of them are dermatophytes, especially T. Rubrum. Other causes : psoriatic,traumatic,vascular,lichen...

Nannizzia nana is a zoophilic and geophilic dermatophyte fungus with a worldwide distribution. It causes ringworm in pigs and is in the soil of farms. In humans it produces rare cases of tinea corporis and capitis. Tinea unguium is very rare.

We describe the first case of onychomycosis caused by Nanizzia nana (Microsporum nanum) in our setting.

2.METHODS

35-year-old woman from a rural area of Honduras and resident in our country for more than 1year. Major nail dystrophy in the first toe of both feet for 5 years and without improvement after several treatments.

3.RESULTS

Nail samples are sent to the laboratory, plated in DTM and SGC medium (BioMérieux) and incubated at 30*C. At 9 days a colony grows whose microscopic examination with lactophenol blue allowed to identify as Nannizzia nana.

Lesions disappeared after treatment with oral terbinafine.

Reviewing the literature there are hardly any published cases of Nannizzia nana as an agent of Tinea unguium

4.CONCLUSIONS

1-Relapses and resistance to treatment, along with the need for a correct differential diagnosis, make recommendable mycological examination of onychodystrophies.

2-Epidemiological antecedents: contact with pigs and life in a rural environment are very important for the diagnosis of this dermatophytosis.

3-This is the first isolation of Nannizzia nana in our environment. It coincides with two published cases of patients from South America