Der Internist
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The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has far reaching effects on society, the economy and medical treatment. It is all the more important to understand the characteristics of the virus and to utilize them diagnostically, therapeutically and epidemiologically. This article firstly elucidates the medical importance of coronaviruses in general. ⋯ Thanks to modern techniques thousands of SARS-CoV‑2 sequences are already available, which show a genomic variability. The D614G mutation in the S spikes seems to cause a higher infectiosity. Mutations can impair the diagnostics and treatment, which makes monitoring necessary.
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Skin diseases represent the second most common paraneoplastic manifestations after endocrine disorders. Paraneoplastic dermatoses may arise as the first clinical sign of occult malignancies, or manifest during the course of a previously diagnosed neoplasm. Dermatoses belonging to the group of obligate paraneoplastic syndromes manifest only in the presence of underlying malignancies. Other skin diseases may be associated with malignancy in a subset of patients.
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Case Reports
[Proximal myopathy and fulminant heart failure in a 57 year-old female patient with lupus erythematosus].
A case report is presented of fulminant hydroxychloroquine-induced cardiomyopathy in a 57 year-old female patient with a long history of systemic lupus erythematosus. Diagnosis was established based on clinical findings, imaging (echocardiography and cardiac magnetic resonance imaging) as well as endomyocardial biopsy. Despite immediate discontinuation of the medication, the patient died from heart failure within a few days. Since the rare adverse effect described here might be reversible, early diagnosis and discontinuation of hydroxychloroquine are crucial for the prognosis of these patients.
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Syncope is a frequent disorder, sometimes due to life-threatening causes. The uncertainty in its diagnosis requires a standardized approach. ⋯ However, some aspects require critical appraisal. The inadequate availability and reimbursement of pivotal diagnostic tests, such as tilt table testing and the implantable loop recorder is emphasized.