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COVID-19 patients, particularly those with severe pulmonary involvement, are at an increased thromboembolic risk related, among various causes, to the cytokine storm and excessive activation of the coagulation cascade and platelets. Different intensity of anticoagulation for them is proposed, mainly with low molecular weight heparins (LMWHs); in a confirmed pulmonary embolism (PE) the therapeutic dose of LMWH is routinely used. Some authors suggest that hemorrhagic complications in COVID-19 patients are rare. At the same time, one can find reports on internal bleeding, including retroperitoneal hematoma (RPH) and other abdominal hematomas., Case Reports: The authors describe 5 cases (3 of those aged more than 80 years) with giant RPHs and with moderate/severe COVID-19 pneumonia, treated before RPH diagnosis with different enoxaparin doses. The therapeutic dose was given to the male with verified PE limited to the segmental/subsegmental pulmonary arteries and initially to the female in whom echocardiography was strongly suggestive of PE, yet this diagnosis was excluded on CT angiography. In one patient, the enoxaparin dose was escalated from 40 mg bd to 60 mg bd after the D-dimer increase. Two patients had bleeding complications despite the enoxaparin dose restricted to 40 mg/daily or bd. Two males had a coexistent psoas hematoma while in only one female there was a coexistent femoral hematoma. RPHs occurred between day 4 and 14 of hospitalization and all were treated conservatively. Three patients who died were particularly charged, so their deaths were not merely directly associated with RPH, which was closely analyzed in one autopsy performed. The authors underline that the choice of anticoagulation intensity in patients with COVID-19 pneumonia without venous thromboembolism seems sometimes difficult but recent publications indicate the low prophylactic enoxaparin dose as an optimal option. Anticoagulation dose escalation based only on the D-dimer level may not be appropriate for certain patients; moreover, the D-dimer increase is commonly observed during internal bleeding., (© 2022 MEDPRESS.)

Influenza is associated with a high prevalence of cardiac complications, including myocarditis and exacerbation of ischemic heart disease or heart failure (HF). However, only four cases of stress-induced takotsubo cardiomyopathy (TC), all of them triggered by virus A influenza, have been reported so far. Another two TC cases after anti-influenza vaccination are also available in the literature. The authors describe a new case of TC, this time provoked by influenza B. An 89-year-old female with a history of hypertension and chronic obstructive pulmonary disease (COPD) was admitted due to a fever (39oC), muscle aches and cough. Pneumonia was excluded in chest X-ray while the test for influenza confirmed virus B infection, so she was given oseltamivir. On the second day of hospitalization, she developed severe HF. ECG showed new negative T waves in inferior and anterolateral leads coexisting with a moderate troponin I and marked brain natriuretic peptide release, while echocardiography revealed left ventricular (LV) apical ballooning with decreased ejection fraction (EF 24%) and global longitudinal strain (GLS -8.1%). Symptomatic treatment of HF was initiated. The symptoms of influenza resolved after 5 days. LV function began to improve after 4 days and became normal after 6 days (EF 58%, GLS -18.1%). Despite an advanced age and the coexisting disorders (COPD, mild cognitive impairment, possible neoplastic disease), the patient was discharged in stable clinical condition on day 10. The authors conclude that in the evaluation of cardiac complications of influenza, TC should be taken into account., (© 2018 MEDPRESS.)

Among diverse triggering factors of stress-induced takotsubo cardiomyopathy (TC), a viral or bacterial infection is rarely observed. Sepsis is an exception, regardless of the etiologic pathogen, in which case an excess of catecholamines may result in acute left ventricular dysfunction. TC precipitated by Clostridium difficile infection (CDI) has been reported only in two patients so far., A Case Report: The authors describe another case of TC triggered this time by recurrent C. difficile colitis which occurred in a 72-yearold female. Severe heart failure developed on the second day of a new episode of diarrhea. Echocardiography revealed apical ballooning, a typical form of TC, while the coronary arteries in coronary angiography were normal. Despite proper treatment of CDI, the course of the disease was fatal due to heart failure progression. In considerations of TC pathogenesis in the case presented, the impact of C. difficile toxins should be taken into account. One should remember about the potential extraintestinal complications of CDI, including sudden myocardial depression.

The varicella zoster virus (VZV) belongs to cardiotropic viruses, although the frequency of cardiac complications during VZV infection is low. Diagnosis of myocarditis or myopericarditis is rare during varicella - primary infection of VZV and sporadic in zoster - reactivation of latent VZV. Only few such cases have been described. The authors present a case of a 23-year-old male in whom clinical symptoms of myopericarditis developed a week after diagnosis of zoster that was localized in the left-upper part of the thorax. Retrosternal chest pain and fever were accompanied by ECG mimicking acute myocardial infarction. A dynamic pattern of troponin I release and slow normalization of ECG were observed. Serial echocardiography showed normal left ventricular function, transient changes in echogenicity of the interventricular septum and small pericardial effusion. In magnetic resonance imaging subepicardial and intramyocardial areas of late gadolinium enhancement were found. He was treated with intravenous acyclovir. No late sequels of the disease were observed., (© 2016 MEDPRESS.)

Chronic hepatitis B and C are among most important problems in contemporary hepatology. Natural history of the disease can be changed as a result of superinfection with other primary hepatotropic viruses. Clinical consequences of such events are uncommon subjects of clinical reports. Acute viral hepatitis occurring in HBV- or HCV-infected patients can result in severe exacerbation of liver disease, including acute liver failure; sometimes progression of liver disease toward liver cirrhosis is observed; HBV and/or HCV clearance is also possible. Because of potentially severe outcomes of superinfections, prevention of such events based on vaccinations and education about the risk related with additional infections should be implemented in the management of patients with chronic viral hepatitis B and C.

The authors describe diagnostic problems encountered while treating two children finally diagnosed to have anaplastic lymphoma in the first case and infection-associated haemophagocytic syndrome (IAHS) in the second. Both diseases represented secondary immunodeficiencies masked by local and systemic severe infections.