A 67-year-old female presents with a small mass in the anterior mediastinum on chest computed tomography. A biopsy proves the mass to be a spindle-cell-type or type A thymoma. Subsequently the patient develops fever and severe Coombs-positive haemolytic anaemia. She is initially treated with oral corticosteroids. Because of persistence of the haemolysis subsequent thymectomy is performed. Haemolysis disappears almost instantly and does not return after discontinuation of the oral corticosteroids. Review of the literature reveals only 17 other cases of thymoma-associated autoimmune haemolytic anaemia.

A woman was admitted to the hospital with lymphadenopathy, fever and a generalised exanthema. Laboratory examination revealed leucopenia, anaemia, high sedimentation, elevated CRP and a markedly elevated serum ferritin. Further exploration showed a positive anti-nuclear factor-titre with anti-double-stranded DNA antibodies, positive p-ANCA and a falsely positive syphilis-test. Bone marrow examination revealed an elevated number of phagocytizing macrophages. Diagnosis of secondary haemophagocytic lymphohistiocytosis in a patient with systemic lupus erythematosus was made, a serious and sometimes fatal condition with often repeated exacerbations of the systemic lupus erythematosus that stays active for long periods in spite of the use of immunosuppressive therapy. Haemophagocytic lymphohistiocytosis and systemic lupus erythematosus are sometimes difficult to differentiate because the clinical presentation and laboratory findings are frequently very similar. The diagnosis depends on the clinical picture, blood and bone marrow examination. Bone marrow reveals an elevated haemophagocytosis. In patients with secondary haemophagocytic lymphohistiocytosis, the treatment of the underlying disorder is sometimes sufficient. In some cases there is need for a specific treatment with corticosteroids, intravenous immunoglobulin, immunosuppressive therapy or etoposide.

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Patients had a median age of 64.33 (58.6;69.7) years at baseline, with a mean (SD) baseline BMI of 30.5 (27.4;32.8) kg/m 2 . The median ICU and ventilator day at time of first IC measurement were respectively 7 (5;14) and 6 (3;14). 70/100 IC's did not fall in the interval of 20-25 kcal/kg/day, coinciding with 32 (56%) different patients. The bias of the ESPEN-formula was -164 kcal/day with lower LOA -1628 (-2142;-1281) kcal/day and upper LOA 1301 (954;1815) kcal/day. Correct REE estimation was associated with RASS score (95% IC OR 0.87;0.99) and ICU day (1.09;2.16). REE was significantly predicted by height (b¼32.5; p<0.01), albumin (b¼26.6; p¼0.058), WBC (b¼23.1; p¼0.009), temperature (b¼131.4; p¼0.039), minute volume (b¼41.8; p¼0.037) and ICU day (b¼-7.1; p¼0.048). Conclusion: REE in ventilated adults with COVID-19 is characterized by a high intra-and inter-individual variation and poorly predicted by the ESPEN equation. REE varies over time and depends on inflammatory and anthropometric parameters. Disclosure of Interest: None declared.