Der Internist
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The pandemic triggered by coronavirus disease 2019 (COVID-19) has put intensive care medicine into the focus of public attention. The mortality of patients with the disease escalates, particularly at the moment when the treatment possibilities of intensive medical care end. ⋯ For these severe courses there is still only little evidence available as to which interventions are the most effective. In addition to the knowledge that can be gained from the rapid performance of clinical trials, the treatment is therefore based on analogies to other syndromes, such as sepsis and macrophage activation syndrome.
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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.
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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.