Introduction: Viral infections can induce autoimmune diseases in susceptible patients. SARS-CoV-2 has been associated with the development of rheumatic disease, especially small vessel vasculitis and arthritis. Typically, onset occurs days to weeks after the antigenic challenge and in patients with mild COVID-19. We report a case of large vessel vasculitis (LVV) temporally related to SARS-CoV-2 infection. Case description: An otherwise healthy 19-year-old woman presented with fatigue, malaise, and chest and low back pain. The symptoms had begun 5 weeks earlier and 1 month after mild SARS-CoV-2 infection. Serological work-up revealed a marked proinflammatory state and anaemia without signs of infectious or autoimmune disease. Computerized tomography revealed thickening and blurring of the perivascular fat of the descending thoracic and abdominal aorta, progressing along the proximal iliac and renal arteries. Fluorodeoxyglucose positron emission tomography confirmed inflammatory activity. Symptoms and laboratory values normalized after prednisolone treatment. Discussion: Recent SARS-CoV-2 infection may be a trigger for LVV, including Takayasu arteritis, as well as other rheumatic diseases. A prompt and thorough differential diagnosis is essential to exclude aortitis and LVV mimickers. Moreover, physicians should be aware of the potential spectrum of systemic and autoimmune diseases that could be precipitated by SARS-CoV-2 infection. This will allow timely diagnosis and treatment, with significant improvement in prognosis.

INTRODUCTION: Regional inequalities in access and health results have become a relevant issue in all developed countries. In this paper it was sought to evaluate possible disparities due to geographical localization, in cases of acute and severe illness.MATERIAL AND METHODS: By accessing the logbook of the emergency room of the polyvalent emergency service (PES) in Viseu, Portugal, detailed information was extracted from 2812 episodes that occurred during 2019. This sample also includes users from two medical and surgical emergency services (MSES), which serve Guarda and Covilhã regions, as well as three basic emergency services (BES). It was used a retrospective design and logistic regression models were estimated to assess differences in mortality.RESULTS: Our data prove the existence of a protective effect of BES (p-value = 0.031) and an adverse impact of distance, particularly in cases of stroke (p-value = 0.027). In addition, we did not find difference in 30-day mortality between patients from Guarda, Covilhã and Viseu regions (p-value = 0.536).CONCLUSION: This study is pioneer in demonstrating the importance of BES. Furthermore, it confirms that the creation of reference centers contributes to the improvement of outcomes, with no difference in mortality of patients who are initially approached by lower differentiation centers.

A 40-year-old woman was admitted to hospital with fever and cough during the pandemic of COVID-19. Past medical was notable for advanced chronic kidney disease. On admission, nucleic acid testing of a nasopharyngeal swab was positive for SARS-CoV-2. After 11 days she was considered cure with two negative tests in a row. Eight weeks later, she was going to receive a kidney transplant from a deceased donor, but she was tested again for SARS-CoV-2 and the result came out positive. After that, surgery was cancelled. In our opinion, this test should not have been performed. Through this case we overview the knowledge about infectivity, reinfection and reactivation of SARS-CoV-2. We believe who has been considered cured in the last three months should undertake immunosuppression treatment in case of transplant or cancer treatment. In these cases, benefits outweigh the eventual risks for most patients.