Patient: Female, 57-year-oldFinal Diagnosis: Emphysematous osteomyelitis and emphysematous pyelonephritisSymptoms: Diarhea • nausea • vomiting • weaknessMedication: —Clinical Procedure: Conservative therapySpecialty: Infectious DiseasesObjective:Rare diseaseBackground:Emphysematous osteomyelitis of the spine is characterized by intravertebral or intraosseous air. Emphysematous pyelonephritis (EP) is the infection of the renal parenchyma and perirenal tissues caused by gas forming microorganisms and thus is characterized by gas formation. Prompt diagnosis and initiation of necessary treatment is crucial, as both entities are associated with high mortality rates.Case Report:A 57-year-old female with uncontrolled hyperglycemia presented to the emergency department with history of sudden onset of weakness, nausea, vomiting and diarrhea for 3 days and with a fall on the same level the previous day. Laboratory examinations revealed leukocytosis, lymphopenia, thrombocytopenia, deteriorated renal function, and hyperglycemic hyperosmolar non-ketotic state. She was placed on aggressive intravenous hydration and insulin infusion pump. Due to the deterioration of her medical condition, she underwent abdominal and pelvic CT scanning that revealed emphysematous osteomyelitis of the spine and emphysematous pyelonephritis. Despite vigorous fluid resuscitation and systemic broad-spectrum antibiotic therapy, the patient’s condition deteriorated further and eventually led to death within 48 h.Conclusions:This case of fatal emphysematous osteomyelitis of the spine and EP serves as a significant reminder of those rare life-threatening entities, which affect patients with comorbidities, such as diabetes mellitus and other etiologies causing immunosuppression. The aim of the present case report is to highlight the importance and contribution of computed tomography in diagnosing these conditions and to emphasize the rare coexistence of these 2 emphysematous entities.

Low-grade fibromyxoid sarcoma (LGFMS) represents a rare, indolent, benign neoplasm that proliferates at various anatomical locations. Histologically, the tumor consists of bland, deceptively benign-appearing spindle cells in a whirling pattern, as well as myxoid and collagenized stroma. The current treatment includes surgical excision. The aim of this investigation was to analyze a rare clinical case of recurrent LGFMS of the neck. Relevant literature is briefly reviewed. An 81-year-old male was admitted with an enlarging painless nontender mass in the neck. The patient referred a past medical history of LGFMS. Magnetic Resonance Imaging (MRI) depicted a large, well-defined mass in the lower neck and supraclavicular area, extending till the left upper area of the anterior thoracic wall. Based on the imaging characteristics and the medical history, a wide surgical excision of a 5.6×6.6×3.3 cm area, in close proximity to the cervical vertebrae was performed. On microsopic examination, the tumor contained alternating fibrous and mixoid components, with mixed hypo-and hyper-cellular areas, minimal necrosis and negligible cellular pleomorphism or nuclear atypia. As LGFMS is a soft tissue malignancy, any recurrences are usually local; therefore treatment of choice is radical, wide margin surgical excision. Nevertheless, the ideal goal of large safety margin of healthy tissue might be unattainable if it requires resection of vital anatomic structures. Because LGFMS has a very low mitotic rate, neither chemotherapy nor radiotherapy is expected to have significant effect on long-term prognosis.

IntroductionCorona virus disease (COVID)-19 pandemic provoked unprecedented disturbance in hypertension care, while alarming concerns arose about its long-term consequences. We assessed the impact of COVID-19 spread on population behavior regarding hypertension urgencies during its first wave.Material and methodsData from daily unscheduled visits and admission counts in the Cardiology sector were collected from the Emergency Department database of a tertiary General Hospital in Athens, Greece from January 15th-July 15th 2020. This data was compared with the ones from the previous year. Cases presented with hypertensive urgency or admitted due to uncontrolled hypertension were separately analyzed.ResultsA total of 7,373 patients records were analyzed. Hypertension urgency cases demonstrated a “U” shaped distribution in 2020, showing declining trend during the rapid virus spread, an image that was reversed after the transmission rate’s fade. COVID-19 incidence in Greece was inversely associated with uncontrolled hypertension admissions during its declining phase (r=-0.64 p=0.009), whereas total attendance exhibited a similar correlation during the first and the following months of the pandemic (r=0.677, p=0.031, r=-0.789, p=0.001). Uncontrolled hypertension rate on admission was positively related to the national incidence of COVID-19 cases during the first months of 2020 (r= 0.82, p=0.045).ConclusionsHypertensive urgency-related visits followed a “U” shape distribution during the pandemic’s first wave with attendance nadir coincidence to the virus spread peak. The initial relative increase in uncontrolled hypertension-related admissions rate, combined with the later increment of hypertensive urgencies may indicate blood pressure deregulation among the studied population which is multifactorial and potentially detrimental.

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