Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

HIV infection presenting as bone marrow cryptococcosis

Disseminated cryptococcal infection is an uncommon initial manifestation in immunocompromised patients. We report a rare case of a 40-year-old female presenting with fever and burning epigastrium. Peripheral blood film revealed a leukoerythroblastic picture with thrombocytopenia. Bone marrow aspiration showed granulomas along with cryptococcal yeast forms. The ELISA test for detection of human immunodeficiency virus (HIV) antigen was positive. Disseminated cryptococcosis can develop as the first manifestation of HIV infection in previously healthy individuals and granulomas in such bone marrow aspiration smears are a valuable clue to an underlying opportunistic infection

Diaphyseal osteosarcoma with varying histomorphologic patterns

Osteosarcoma is the most common primary malignant tumor of the skeleton involving predominantly metaphysis of the long bones. Diaphyseal osteosarcoma is a rare form, which accounts for approximately 10% of all cases of osteosarcomas. Osteosarcoma contains a family of lesions with considerable diversity in histologic features and grade. We present a case of a 29-year-old male with diaphyseal osteosarcoma of the left tibia, who presented with pain and swelling over middle one-third of the left leg. The biopsy of the lesion revealed varied histomorphologic features in a small tissue studied. This prompted us to report the various histologic patterns of osteosarcoma

Cytological diagnosis of microfilariae in subcutaneous nodule

Microfilariaemia presenting with subcutaneous nodule is rare. We report a case of a 22-year-old female patient who presented with a subcutaneous nodule on right forearm. Fine-needle aspiration cytology from the nodule showed many sheathed motile microfilaria on wet mount preparation during day time. Wuchereria loa loa is known to be associated with soft tissue swellings as reported earlier. Nocturnal motility and cytomorphological features differentiate Wuchereria bancrofti from Wuchereria loa loa

Diagnostic dilemma of FNA diagnosis of secretory carcinoma of breast

Secretory carcinoma (SC) is one of the least common types of breast carcinoma. The tumor has distinctive histologic features with prominent secretory activity similar to lactational change and minimal nuclear atypia. As the cytomorphologic features of SC overlaps benign breast lesions with lactational change and apocrine change, the initial diagnosis of SC may be missed on cytology in some cases. A 29-year-old woman presented with a lump in the left breast since 9 months. The fine needle aspiration cytology (FNAC) suggested proliferative breast disease without atypia. Excision biopsy showed secretory carcinoma. The case is presented to highlight the cytologic features of SC, which may overlap with lactational change and apocrine change

Unusual Alveolar Pattern in Node Based Diffuse Large B-cell Lymphoma

Diffuse Large B-cell Lymphoma (DLBCL) is the most common subtype of non-Hodgkin’s lymphoma worldwide. We present a case of 45 year old male patient presenting with swelling in right side of the neck since 6 months. A cytological aspirate of the lymph node suggested possibility of malignancy and excision biopsy was advised. Histopathology revealed a well-developed alveolar pattern with nests of dyscohesive large round tumour cells separated by delicate fibrovascular septae. Tumour cells were positive for CD45, CD20 and BCL-6 and negative for CD3, CD 5, CD 10, BCL-2, Desmin, Chromogranin, Synaptophysin and S-100. Based on histopathology and immunohistochemical findings, final diagnosis of DLBCL, NOS was given. The case is presented to highlight an unusual morphological alveolar growth pattern in DLBCL

Intraocular osseous metaplasia

Heterotropic bone formation or intraocular osseous metaplasia is a rare finding. Trauma, chronic inflammation, and long-standing retinal detachment are some of the common etiological factors associated with the onset of intraocular ossification. We report a case of a 16-year-old girl with a history of blunt trauma 6 years back, who complained of right eye blindness. Right eye enucleation was done which on histopathological examination revealed pre-retinal lamellar bone with fatty marrow. We diagnosed her case as intraocular ossification in phthisis bulbi