50-year-old man presented with a worsening cough, shortness | Figure 1

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50-year-old man presented with a worsening cough, shortness of breath, and fevers...

A 50-year-old man presented with a worsening cough, shortness of breath, and fevers. He was known to have acute myeloid leukemia and had undergone a bone marrow transplant 3 months prior. He had occasionally required courses of corticosteroids to treat graft versus host disease.

Investigations:

CXR: bilateral interstitial infiltrates, worse in the lower lobes
Bronchoscopy: bacterial and mycobacterial cultures negative
An open lung biopsy was performed
Lung tissue histology: numerous cells seen which are several times larger than surrounding cells with a central inclusion

What would be the most appropriate treatment?

A. Cidofovir
B. CMV immune globulin
C. Foscarnet
D. Ganciclovir
E. Letermovir

Orca-Q, an investigational precision engineered allogeneic T-cell therapy, demonstrated promising safety and efficacy in a phase 1 study of patients with high-risk hematologic malignancies undergoing allogeneic stem cell transplantation. The phase 1 study, presented at the 67th American Society of Hematology Annual Meeting and Exposition, showed that all patients achieved neutrophil engraftment by day 20 with low rates of acute and chronic graft-versus-host disease. One- and two-year overall survival rates were 90% and 86% with low nonrelapse mortality. Patients treated without immunosuppression experienced faster immune recovery and fewer infections, suggesting Orca-Q may help control GVHD while supporting immune reconstitution.

Image description: Computed tomography of the chest with contrast revealed few scattered rounded ground glass and consolidative opacities in the lingula of the left lung and middle lobe of the right lung along with segmental lung consolidation seen within the dependent portion of both lower lobes. Case description: The novel coronavirus disease has brought the world to a standstill with high infectivity and rapid transmission. The disease caused by the novel coronavirus is termed coronavirus disease 2019 (COVID-19). We present the case of a renal transplant patient who was infected with COVID-19 through community spread and presented with fever and gastrointestinal symptoms. Transplant recipients are particularly vulnerable because of the immunosuppressed state. These patients can shed a virus for a prolonged period and can have a higher load of the virus. There have been no COVID-19 cases transmitted through organ donation. Preinfection immunological impairment can aggravate the severity of the infection. The transplant team plays a crucial role in donor and recipient evaluation and guiding the timing of the transplant. Although specific published data are lacking with regard to transplant recipients, they should follow the same precautions as the general population, like avoiding nonessential travel and practicing social distancing.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.