From laboratory to bedside: a case report of a concise and pragmatic approach on heart failure

Heart failure is one of the most common and intensely studied diseases in the world. Nevertheless, it is considered a difficult condition to diagnose and manage.This case report, starting from the description of a brief clinical case, aims to directly and concisely explain the most important steps, from laboratory to bedside, in the diagnosis and management of heart failure disease. Physicians can rely on some laboratory tests (e.g., natriuretic peptides) and instrumental exams to diagnose and manage the patients in everyday medical practice. Finally, this article highlights that a multidisciplinary team management can improve the clinical status and the quality of life, thus preventing hospital admission and reducing mortality in patients with heart failure

Fever During Anti-integrin Therapy: New Immunodeficiency

Background: The causes of inflammatory bowel disease (IBD) have not yet been clearly elucidated, but it is known that genetic susceptibility, altered gut microbiota and environmental factors are all involved, and that a combination of these factors causes an inappropriate immune response, resulting in impaired intestinal barrier function. With regard to the treatment of IBD, the use of conventional immunosuppressive drugs has been complemented by more specific therapeutic agents, including biological drugs. Systemic immune suppression is a risk factor for cytomegalovirus (CMV) infection, which is associated with considerable morbidity and mortality in immunocompromised hosts. Case Report: A 33-year-old male patient was admitted to our medical unit complaining of a 10-day history of fever, fatigue and headache. He had been suffering from ulcerative colitis and primary sclerosing cholangitis for five years and was currently being treated with azathioprine and vedolizumab. In the past he had already taken infliximab, adalimumab and golimumab without any clinical response. After the exclusion of systemic infectious diseases, his serology was consistent with a primary CMV infection. This was successfully treated with intravenous ganciclovir therapy. Conclusion: Vedolizumab is an anti-integrin biological agent approved for IBD treatment. Its gut-selective mechanism of action would appear to increase its safety profile, however data on this are still limited. Moreover, it should always be remembered that IBD patients have an increased risk of CMV infection, both primary and reactivation, because of their concurrent immunosuppression