Severe acute respiratory syndrome coronavirus–2 (SARS-CoV-2) is the novel coronavirus initially detected in Wuhan, China, and is responsible for the worldwide pandemic coronavirus disease 2019 (Covid-19). Influenza is a common endemic respiratory virus that causes seasonal outbreaks of respiratory illness. There are currently few reports in the literature describing patients with coexisting infections. This case series of 4 patients identified at our single institution in Louisiana highlights the patient characteristics, laboratory findings, and outcomes in patients with both Covid-19 and influenza infection.

Idiopathic multicentric Castleman disease (iMCD) is a lymphoproliferative disorder that manifests as multiorgan dysfunction secondary to widespread inflammation. The underlying pathogenesis is driven by an excessive and inappropriate cytokine storm. TAFRO syndrome is a rare subtype of iMCD, characterized by thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly. Multiorgan dysfunction is a known consequence of this syndrome, although endocrine involvement has yet to be reported. We present a case of TAFRO in a previously healthy Caucasian male who presented with abdominal pain, dysuria, diffuse anasarca, and ascites. On presentation, the patient was found to have acute kidney injury, thrombocytopenia, elevated inflammatory markers, elevated interleukin-6 (IL-6), and endocrinopathy. Following an extensive infectious and autoimmune workup, lymph node biopsy confirmed the diagnosis of TAFRO. The patient was started on prednisone, rituximab, and anti-IL-6 therapy with siltuximab. He achieved clinical remission after 4 months of treatment, with normalization of renal function, thrombocytopenia, inflammatory markers, and endocrinopathy. He has continued on siltuximab for maintenance therapy. It is our hope that this unique case of TAFRO syndrome with significant endocrinopathy will add to the growing literature surrounding iMCD, and help clinicians better understand the pathogenesis and treatment of this rare disease.

Background The community transmission of coronavirus disease 2019 (Covid-19) was detected in Baton Rouge, Louisiana, in March 2020. Several previous studies have reported elevations of inflammatory markers in Covid-19 positive patients and suggested a possible correlation to disease severity. Methods We identified 69 patients from Baton Rouge General (BRG) Hospital who were admitted with acute hypoxic respiratory failure and laboratory confirmed positive severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) between March 13 and April 5, 2020. Demographic and laboratory data were obtained through a review of medical records. Statistical analysis was performed on several inflammatory markers in association with clinical disease severity. Results We identified 69 patients with confirmed Covid-19 infection. The mean (±SD) age of the patients was 65±14 years, 68% were male and 32% were female. A total of 13 patients (19%) were considered to have mild disease, 25 (36%) had moderate disease, and 31 (45%) were considered to have severe disease. A total of nine patients died (13%), 25 (36%) have been discharged from the hospital, 20 (29%) remain in the ICU, and 15 (22%) remain admitted to the hospital at the time of writing. Lymphopenia was common among hospitalized patients (39%) and was found to be statistically more pronounced in patients with severe disease (p<0.05). Inflammatory marker elevations were also seen in several patients, with statistically significant elevations in C-reactive protein (CRP) and lactate dehydrogenase (LDH) (p <0.05). We found no statistically significant associations between ferritin, D-dimer, troponin I, body mass index (BMI), or creatine kinase (CK) with disease severity. Conclusions During the first three weeks of the Covid-19 outbreak in Baton Rouge, Louisiana, the most common reason for admission amongst Covid-19 positive patients was acute hypoxic respiratory failure. Previously, several studies have suggested a correlation between elevated inflammatory markers and disease severity. The presence of lymphopenia and elevations of CRP and LDH may be helpful in the risk stratification of these patients. In an effort to guide clinical decision making and provide insight into disease severity, further characterization of Covid-19 infection in hospitalized patients is urgently needed.

Ibrutinib is approved for the first-line treatment of chronic lymphocytic leukemia (CLL). A well-known side effect of ibrutinib therapy is increased bleeding risk, which ranges from mild mucocutaneous bleeding to rarely life-threatening hemorrhage. e increased bleeding tendency associated with ibrutinib is thought to be related to its effect on several platelet signaling pathways, which can be exacerbated in the setting of concurrent antiplatelet or anticoagulant therapy. We present an 82-year-old male with CLL on ibrutinib and concurrent antiplatelet therapy who developed cardiac tamponade due to a hemorrhagic pericardial effusion requiring emergent placement of a pericardial window. is case further highlights the risk of major bleeding in patients treated with ibrutinib and concurrent antiplatelet therapy.

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