Introduction. Dysfunction in the renin-angiotensin-aldosterone system (RAAS) has been observed in patients with coronavirus disease 2019 (COVID-19). It is presumed that the effect of reducing interleukin-6 (IL-6) levels by angiotensin II receptor blockers (ARBs) by RAAS modulation. We investigated changes in angiotensin II and IL-6 levels in four COVID-19 patients treated with ARBs. Case Presentation. Cases 1 and 2 were who had not received ARBs before and were newly administered ARBs. Case 3 restarted ARBs after discontinuation for 7 days, and case 4 received an increased dose of ARBs. The mean in angiotensin II levels (607.5 pg/mL, range: 488–850 pg/mL, reference   range < 100   pg / mL ), C-reactive protein (CRP) (10.58 mg/dL, range 4.45-18.05 mg/dL), and IL-6 (55.78 pg/mL, range: 12.86–144.82 pg/mL, reference   range < 7   pg / mL ) was observed at the admission in all patients. Upon clinical improvement, the mean decrease in CRP (1.02 mg/dL, range 0.06-3.78 mg/dL) and IL-6 (5.63 pg/mL, range 0.17-20.87 pg/mL) was observed in all patients. Conversely, angiotensin II levels gradually increased. Conclusion. This report supports the potential benefit of ARBs to improve the clinical outcomes of COVID-19 patients by controlling RAAS dysfunction.

Embolic event is a common and important complication of infective endocarditis (IE). The objective of this study was to investigate the clinical impacts of embolic event in patients with IE and the predictors of in-hospital mortality. Data was collected in Pusan National University Hospital and Pusan National University Yangsan Hospital between January 2009 and December 2010. One hundred ten patients were included. Embolic events occur in 39 of 110 patients (35.5%). Brain (n = 18, 38.5%) was the main site of embolic infarction. Patients with embolism showed higher in-hospital mortality (46.2% vs. 8.5%, respectively, P = 0.03), more frequent ICU admission (53.8% vs. 35.2%, respectively, P = 0.045) and more accompanying other cardiac complication (43.6% vs. 21.1%, respectively, P = 0.017). The in-hospital mortality rate was 18.2%. On the logistic regression analysis of the predictors for in-hospital mortality, age (RR, 1.079; 95% CI, 1.036-1.123, P = 0.001), embolic event (RR, 3.510; 95% CI, 1.271-9.69, P = 0.015) and staphylococcal infection (RR, 5.098; 95% CI, 1.308-18.508, P = 0.023) were independently associated with in-hospital mortality. Embolic events in IE are associated with poor in-hospital outcome; and these data about embolic events and the predictors of in-hospital mortality may improve the management of this disease in hospitals.Graphical Abstract

Brucellosis is a multisystem disease with various clinical symptoms. Neurobrucellosis is a rare but serious manifestation of brucellosis. A 60-year-old man with a previous diagnosis of brucellar spondylitis presented with sudden onset of aphasia and numbness of the right upper extremity. Cerebral angiography showed diffuse narrowing and dilatation on the distal branches of both the anterior cerebral artery (ACA) and the left middle cerebral artery (MCA) which indicated cerebral vasculitis, and the patient's Brucella agglutinin titer was 1:1280. After combined antimicrobial and steroid therapy was started, the patient's condition improved significantly, and he was discharged after 1 month. Antimicrobial therapy was continued for 16 months on an outpatient basis, and the last Brucella agglutinin titer was 1:40. To our knowledge, this is the first case of relapsed neurobrucellosis with vasculitis in Korea to have been treated successfully.

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