Journal of Clinical Case Reports

Background: Elderly patient with community-acquired pneumonia is the leading infectious cause of death. During the clinical diagnosis and treatment, some elderly patients do not have typical clinical symptoms. Therefore establishment of safe and effective diagnosis, prognostic assessment systems is important for clinicians.

Objective: To evaluate the diagnostic and prognostic value of the neutrophil CD64 (nCD64) index in elderly patients with community-acquired pneumonia.

Methods: One hundred and twenty-eight elderly patients (≥ 65year) diagnosed with community-acquired pneumonia from December 2018 to December 2020. All patients were further subdivided into two groups: Non severe community-acquired pneumonia (N-SCAP) group and severe community-acquired pneumonia (SCAP) group. nCD64 index, procalcitonin (PCT) level, C-reactive protein (CRP) level, White blood cell (WBC) counts and Neutrophil (NEUT) absolute counts were obtained and CURB-65 scores were calculated for each patient.

Results: The nCD64 index, CRP, PCT, WBC, NEUT levels, CURB-65 score were higher in severe community-acquired pneumonia group patients. The nCD64 index, CRP, PCT levels, CURB-65 score was higher in non-survivors. The receiver operating characteristic (ROC) curve of nCD64 index was higher than those of CRP, PCT, WBC, NEUT levels for diagnosing infection. The AUC of nCD64 index for predicting 28-day mortality in community-acquired pneumonia was significantly higher than those of CRP, PCT, WBC and NEUT levels. The AUC of nCD64 index combined with CURB-65 score was significantly higher than that of CRP, PCT, WBC and NEUT parameter combined with CURB-65 score for predicting 28-day mortality.

Conclusion: The neutrophil CD64 index is a valuable biomarker for diagnosis of infection and prognostic evaluation in elderly patients (≥ 65 year) with community-acquired pneumonia.

The present article reports a case of Whipple's disease as a rare cause of intestinal malabsorption syndrome, in a young individual with G6PD deficiency and hypothyroidism, without previous follow-up. The male patient initially complained of diarrhea and long-standing weight loss. The complementary examination findings were consistent with Whipple's Disease. Antibiotic therapy (Ceftriaxone) was initiated with subsequent clinical improvement. Although rare, this disease should be considered as a differential diagnosis in patients with intestinal malabsorption, especially considering the systemic impact of the disease and the possible control with appropriate antibiotic therapy.

We present a 76 years old lady who presented with a total of four episodes of Takotsubo Cardiomyopathy (TC) over the last 15 years. Her first presentation was in 2006 and she had further admissions for the same problem over the next 10 years. Each time she presented with chest pain and ECG changes and had normal coronary angiogram despite having echocardiography and electrocardiogram (ECG) changes. She had raised troponin levels on each presentation. She had coronary angiogram on the previous three occasions and computerized tomography scan of coronary arteries (CTCA) in this admission that was normal. She described her chest pain as 8/10 on severity scale, had elevated troponin of 111 and 152. ECG showed left bundle branch block and biphasic T waves in leads V2-V6. She was treated for Acute Coronary Syndrome (ACS) and had normal CTCA and was diagnosed with fourth episode of takotsubo cardiomyopathy.

We present a case of 72 year old patient who presented with chest pain, shortness of breath (sob) for 2 days and 3 episodes of collapses with loss of consciousness (LOC). His past medical history includes Prostate carcinoma, hypercholesterolaemia and he had AstraZeneca covid vaccines 6 months ago. He was haemodynamically stable and had urgent Computerized Tomography Pulmonary Angiography (CTPA), confirming bilateral pulmonary embolism with evidence of right heart strain. His clinical examination was unremarkable apart from dyspnoea. He was commenced on twice daily treatment dose Clexane and was not thrombolysed in view of haemodynamic stability. He had urgent bedside echocardiogram confirming right ventricular thrombus with associated right heart strain, with no evidence of Patent Foramen Ovale (PFO). Electrocardiogram (ECG) showed right bundle branch block (RBBB) and left axis deviation (LAD). He was discharged home after three weeks on Rivaroxaban 15 mg BD for 21 days followed by 20 mg OD.

Alopecia Areata (AA) is an immune-mediated form of hair loss that occurs in all ethnic groups, ages, and both sexes, with an estimated lifetime risk of 1.7% among the general population. Approximately 15-25% of all AA cases progress to Alopecia Universalis (AU), which is a complete loss of scalp and body hair. Complete recovery from AU is rare (<10%). We report a case of AU in a patient who was referred to us for lung transplantation due to advanced bronchiectasis. The patient recovered from AU within three months of bilateral lung transplant using standard triple immunosuppressive therapy. To our knowledge, this is the first case report of AU recovery with standard immunosuppression use after lung transplantation.