Adult Still's disease and Tako-Tsubo syndrome

Here we describe the case of a 68-year-old Italian female who was admitted in our hospital for the occurrence of arthralgia, abdominal pain and general discomfort. The clinical picture was complicated by recurrent febrile episodes up to 40°C associated with skin rush and cardio-respiratory failure with ECG ischemic alteration, TnT-hs troponin elevation and an ipo-akinetic alteration of the apex at the echocardiogram examination. After an intensive workup, the diagnosis of an adult Still's disease was formulated according to the classification criteria. Moreover, the patient underwent coronarographic study and cardiac MR that, collectively, supported the diagnosis of Tako-Tsubo syndrome. The patient was treated with steroid obtaining the remission of the disease. Myocardial injury with adult Still's disease was been rarely reported. In our case we observed for the first time, to our knowledge, a case of adult Still's disease complicated by a Tako-Tsubo syndrome

Stroke-like manifestations in a patient with Listeria monocytogenes abscess and Horton’s arteritis

Brain abscesses due to Listeria monocytogenes are rare and are a clinical challenge. We report the case of a 72-year old female patient under immunosuppressive treatment for Horton’s arteritis who was admitted with an initial diagnosis of ischemic stroke. Further workup revealed listerial abscesses as the cause of her neurological symptoms. She was treated with ampicillin plus gentamicin with an excellent outcome. In spite of the rarity of this entity, immunosuppresive drugs are the most important predisposing factors. These drugs are widely used and consequently there is an increased number of subjects at risk of listerial brain abscesses

Adult Still’s disease and Tako-Tsubo syndrome

Here we describe the case of a 68-year-old Italian female who was admitted in our hospital for the occurrence of arthralgia, abdominal pain and general discomfort. The clinical picture was complicated by recurrent febrile episodes up to 40°C associated with skin rush and cardio-respiratory failure with ECG ischemic alteration, TnT-hs troponin elevation and an ipo-akinetic alteration of the apex at the echocardiogram examination. After an intensive workup, the diagnosis of an adult Still’s disease was formulated according to the classification criteria. Moreover, the patient underwent coronarographic study and cardiac MR that, collectively, supported the diagnosis of Tako-Tsubo syndrome. The patient was treated with steroid obtaining the remission of the disease. Myocardial injury with adult Still’s disease was been rarely reported. In our case we observed for the first time, to our knowledge, a case of adult Still’s disease complicated by a Tako-Tsubo syndrome

A model based on intensity of medical care may improve outcomes for internal medicine patients in Italy

In medical wards, to guarantee safe, sustainable and effective treatments to heterogeneous and complex patients, care should be graduated into different levels of clinical intensity based on a standardised assessment of acute-illness severity. To support this assumption, we conducted a prospective observational study on all unselected admissions of 3,381 patients to a medium size internal Italian Medicine Unit by comparing Standard Medical Care model (SMC) to a new paradigm of patient admission based on Intensity of Medical Care (IMC)

Early Guillain-Barr\ue9 syndrome in coronavirus disease 2019 (COVID-19): a case report from an Italian COVID-hospital

Guillain-Barr\ue9 syndrome (GBS) is an acute polyradiculoneuropathy associated with dysimmune processes, often related to a previous infectious exposure. During Italian severe acute respiratory syndrome coronavirus-2 outbreak, a woman presented with a rapidly progressive flaccid paralysis with unilateral facial neuropathy after a few days of mild respiratory symptoms. Coronavirus was detected by nasopharyngeal swab, but there was no evidence of its presence in her cerebrospinal fluid, which confirmed the typical albumin-cytological dissociation of GBS, along with consistent neurophysiological data. Despite immunoglobulin infusions and intensive supportive care, her clinical picture worsened simultaneously both from the respiratory and neurological point of view, as if reflecting different aspects of the same systemic inflammatory response. Similar early complications have already been observed in patients with para-infectious GBS related to Zika virus, but pathological mechanisms have yet to be established