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- Systemic Effects of Anabolic-Androgenic Steroid Abuse: A Case in Primary Care.Publication . de Carvalho Vilarinho, Margarida; Cernadas, Joana; Marques Ferreira, MiguelAnabolic-androgenic steroid (AAS) abuse is a growing public health concern due to its wide-ranging physical and psychological effects. This case report highlights the multisystemic consequences of prolonged AAS use in a 30-year-old male presenting initially with a minor respiratory infection during a consultation in his healthcare center. Despite his primary complaint, upon physical examination, muscle hypertrophy, bilateral gynecomastia, and suspected testicular atrophy were observed, prompting further investigation. Laboratory findings showed high levels of testosterone, suppressed gonadotropins, elevated estradiol, dyslipidemia, and liver enzyme elevation, consistent with chronic AAS abuse. Imaging confirmed gynecomastia, and the patient was diagnosed with hypertension, likely secondary to AAS use. Despite counseling on the potential short- and long-term health risks, the patient chose to continue AAS use. Ongoing follow-up in primary care, however, made it possible for the patient to return to care after one year, when he presented with depressive symptoms and body image dissatisfaction following steroid cessation, demonstrating the critical role of family physicians in early detection, patient education, and motivational support. This case shows the importance of a thorough approach in identifying AAS abuse and managing its systemic effects to mitigate potentially perilous health outcomes.
- Marantic Endocarditis in Malignancy: A Case Report of a Challenging Diagnosis.Publication . Ferreira, Inês; Fiúza M Rua, Inês; Ramos, Diogo; Cabaço, Sérgio; Valente, AndréMarantic endocarditis is a condition characterized by sterile vegetations in the heart valves, and is much rarer than infectious endocarditis. It's typically associated with conditions such as cancer or autoimmune diseases. We report the case of a patient with stage four lung cancer, presenting with fever after chemotherapy, and diagnosed with marantic endocarditis, after extensive testing to exclude an infectious agent. The patient's imaging techniques suggested infectious embolization to the liver and spleen, which supported the diagnostic hypothesis of infectious endocarditis, but the liver biopsy was positive for metastasis. Oncology was consulted for follow-up, and the patient was discharged on anticoagulation therapy, the standard treatment for marantic endocarditis. This case underscores the difficulty of diagnosing marantic endocarditis and the extensive testing required, considering its poor prognosis and the importance of treatment.
- Tintelnotia Destructans, the Rare Opportunist of a Behçet's Disease Patient.Publication . Gano, Rita; Buendia Palacios, Diana Cristina; Pinheiro, SofiaBehçet's disease is a systemic vasculitis characterized by recurrent oral and genital ulcers that can have ophthalmologic, cutaneous, neurologic, vascular, and thromboembolic manifestations. Treatment usually involves immunosuppressant medication, which leads to an increased risk of opportunistic infections. Only recently identified, is a rare fungus that can cause eye and nail infections in humans, usually refractory to standard antifungal therapy. Ocular infections are most commonly associated with ocular trauma or the use of contact lenses and may cause permanent damage without adequate treatment. We present a case of a 40-year-old man with Behçet's disease, treated with adalimumab, who developed an ocular abscess due to . This clinical case serves the purpose of alerting for an opportunistic infection caused by a newly described and rare microorganism, which is hard to identify.
- Bone Metastasis: Atypical Presentation of Hepatocellular CarcinomaPublication . Urmal, Inês; Pina Pereira, Ana Catarina; Salvo, Sofia
- Simultaneous Aortic Dissection and Saddle Pulmonary Embolism: Were They Intertwined?Publication . Amaral de Vasconcelos Pinheiro, Miguel João; Constantino, Tiago Serrano; Fonseca Oliveira, João; Cordeiro, Ana Maria; Pinheiro, SofiaWe report the case of a 92-year-old woman who developed sudden paraplegia. A magnetic resonance imaging (MRI) of the dorsal spine revealed extensive spinal cord infarction. Subsequent imaging demonstrated a Stanford type B aortic dissection complicated by false-lumen thrombosis, along with a coexistent saddle pulmonary embolism. Although the coexistence of pulmonary embolism and aortic dissection has been reported, it remains poorly understood and represents a major therapeutic challenge. In this case, the close anatomical relationship between the descending aortic dissection and the site of pulmonary artery thrombosis strongly suggests that the aortic dissection may have contributed to pulmonary thrombus formation through direct mechanical compression and disturbed local hemodynamics arising from their anatomical contiguity. This case illustrates a rare yet clinically significant overlap between two life-threatening vascular entities, suggesting a poorly characterized pathophysiological interplay and underscoring the need for early diagnosis and patient-specific therapeutic approaches.
- Familial Hypercholesterolaemia and the Risk of Cardiovascular Events.Publication . Conchinha, André; Rodrigues, Afonso; Pack, Tiago; Cunha, Sofia; Santos, AntónioFamilial hypercholesterolaemia (FH) is an autosomal dominant genetic disorder, characterised by markedly elevated levels of low-density lipoprotein cholesterol (LDL-C) from birth, which confers a substantially increased risk of premature atherosclerotic cardiovascular disease (ASCVD). Pathogenic variants primarily occur in the genes encoding the low-density lipoprotein receptor (LDLR), apolipoprotein B (ApoB), low-density lipoprotein receptor adaptor protein 1 (LDLRAP1), or proprotein convertase subtilisin/kexin type 9 (PCSK9). Early diagnosis, based on clinical criteria, family history, and genetic testing, is imperative to promptly initiate aggressive therapeutic strategies. Standard treatment involves lifestyle modifications and high-intensity pharmacotherapy, primarily with statins, often in combination with ezetimibe. For patients who do not achieve their therapeutic goals or are intolerant, PCSK9 inhibitors represent a significant evolution in the treatment paradigm. In this article, we present a case of homozygous familial hypercholesterolaemia.
- Sarcopenia in Acute Care Patients: Protocol for the European Collaboration of Geriatric Surveys: Sarcopenia 9+ EAMA Project.Publication . Sanchez-Rodriguez, Dolores; Hope, Suzy; Piotrowicz, Karolina; Benoit, Florence; Czesak, Joanna; Dallmeier, Dhayana; Decker, Genia; De Spiegeleer, Anton; Højmann, Anette Hansen; Hrnciarikova, Dana; Marco, Ester; Mendes, Diana; Meza, Delky; Nascimento, Paula; Rodrigues, Afonso; Surquin, Murielle; Toscano-Rico, Miguel; Vankova, Hana; Vetrano, Davide L; Gąsowski, Jerzy; Van Den Noortgate, Nele; Landi, Francesco
- Successful Management of Rhino-Orbital Mucormycosis in a Diabetic Patient: a Case Report.Publication . Tsisar, Stanislav; Salvado de Morais, Mariana; Gameiro, Rita; Rodrigues, MarioMucormycosis is a rare but aggressive fungal infection, primarily affecting immunocompromised patients, with diabetes being a significant risk factor. This report describes the case of a 20-year-old male with poorly controlled type 1 diabetes who presented with facial swelling, proptosis, and necrotic nasal lesions. Imaging and biopsy confirmed rhino-orbital mucormycosis with . The patient underwent multiple surgical debridements and received dual antifungal therapy with liposomal amphotericin B and isavuconazole, alongside adjunctive hyperbaric oxygen therapy. Despite multiple complications, such as septic and cardiogenic shock, "in and out" diabetic ketoacidosis, and long-term oral compromise, clinical stabilization was achieved after prolonged hospitalization and a multidisciplinary approach. Currently, the patient is clinically and radiologically stable over two years of suppressive therapy with isavuconazole. This case highlights the importance of early diagnosis, aggressive multidisciplinary management, and tailored antifungal therapy in the treatment of rhino-orbital mucormycosis.
- Respiratory Syncytial Virus among People Living with HIV: Is There a Case for Rolling Out Prophylaxis? A Viewpoint Based on a Systematic Review.Publication . Almeida, André; Aliberti, Raffaele; Aceti, Arianna; Boattini, MatteoRespiratory Syncytial Virus (RSV) is responsible for a considerable burden of respiratory disease among children and older adults. Several prophylactic strategies have recently been introduced. We review the available evidence on the interplay between RSV infection and HIV, looking at the specific role of RSV prophylactic strategies in individuals affected by or exposed to HIV. We conducted a systematic review on the association between HIV infection and RSV incidence and severity. We searched in PubMed/MEDLINE for clinical epidemiological studies covering outcomes such as RSV-associated illness, severity, and mortality in individuals affected by or exposed to HIV. A total of 36 studies met the inclusion criteria and were included, the majority conducted in sub-Saharan Africa. There was no compelling evidence suggesting a higher incidence of RSV illness among HIV-infected people. A higher risk of severe disease was consistent among both HIV-positive and HIV-exposed but uninfected (HEU) children. Case fatality rates were also higher for these groups. Evidence on a differing risk among adults was scarce. HIV-positive pregnant women should be given priority for recently approved RSV vaccination, for protection of their newborns. HIV-infected and HEU infants should be considered risk groups for nirsevimab prophylaxis in their first year of life and possibly beyond.
- Short and Long-Term Trajectories of the Post COVID-19 Condition: Results From the EuCARE POSTCOVID Study.Publication . Santoro, Andrea; Bai, Francesca; Greco, Maria Francesca; Rovito, Roberta; Sala, Matteo; Borghi, Lidia; Piscopo, Kyrie; Vegni, Elena; de Morais Caporali, Julia Fonseca; Marinho, Carolina Coimbra; Leite, Arnaldo Santos; Santoro, Maria Mercedes; Silberstein, Francesca Ceccherini; Iannetta, Marco; Juozapaite, Dovile; Strumiliene, Edita; Almeida, André; Toscano, Cristina; Quinones, Jesus Arturo Ruiz; Carioti, Luca; Mommo, Chiara; Fanti, Iuri; Incardona, Francesca; Marchetti, GiuliaBackground: Post COVID-19 condition (PCC) affects 10-40% of patients and is characterized by persisting symptoms at ≥ 4 weeks after SARS-CoV-2 infection. Symptoms can last 7 or even more months. How long PCC persists and any changes in its clinical phenotypes over time require further investigation. We investigated PCC trajectories and factors associated with PCC persistence. Material and methods: We included both hospitalized COVID-19 patients and outpatients from February 2020 to June 2023, who underwent at least one follow-up visit after acute infection at San Paolo Hospital, University of Milan. Follow-up visits were conducted at the post COVID-19 clinic or via telemedicine. During each follow-up examination, patients completed a short version of the World Health Organization (WHO) Case Report Form (CRF) for ongoing symptoms, the Hospital Anxiety and Depression Scale (HADS), and a screening tool for Post-Traumatic Stress Disorder (PTSD). Statistical analyses involved Chi-square, Mann-Whitney, Kruskal-Wallis tests, and logistic regression analysis. Results: We enrolled 853 patients (median age 62, IQR 52-73; 41% females). 551/853 (64.6%), 152/418 (36.4%) and 21/69 (30.4%) presented PCC at median follow up of 3 (IQR 2-3), 7 (IQR 6-10) and 26 (IQR 20-33) months, respectively (p < 0.001). The main clinical phenotypes were fatigue, respiratory sequelae, brain fog and chronic pain; anosmia/dysgeusia was observed mostly in the first post-acute period. Female sex, acute disease in 2020, a longer hospital stay and no COVID-19 vaccination were associated with persistence or resolution of PCC compared to never having had PCC. Anxiety, depression and PTSD were more common in PCC patients. By fitting a logistic regression analysis, acute infection in 2020 remained independently associated with persistent PCC, adjusting for age, sex, preexisting comorbidities and disease severity (AOR 0.479 for 2021 vs 2020, 95%CI 0.253-0.908, p = 0.024; AOR 0.771 for 2022 vs 2020, 95%CI 0.259-2.297, p = 0.641; AOR 0.086 for 2023 vs 2020, 95%CI 0.086-3.830, p = 0.565). Conclusions: There was a reduction in the PCC burden 7 months following the acute phase; still, one third of patients experienced long-lasting symptoms. The main clinical presentations of PCC remain fatigue, respiratory symptoms, brain fog, and chronic pain. Having had SARS-CoV-2 infection during the first pandemic phases appears to be associated with persistent PCC.