RESUMO
A severe case of COVID-19 was observed in an otherwise healthy 28-year-old man who had taken oxandrolone 40 mg/day as an anabolic steroid. The patient had been taking oxandrolone for enhanced bodybuilding 30 days prior to presenting to an outpatient clinic with COVID-19 symptoms. The patient reported that his symptoms have rapidly worsened over the course of 4 days prior to presenting at the clinic. As part of an experimental antiandrogen treatment for hyperandrogenic men suffering from COVID-19, he was administered a single 600 mg dose of the novel antiandrogen proxalutamide. Twenty-four hours after administration of this dose, marked improvement of symptoms and markers of disease severity were observed. To our knowledge, this is the first case that potentially links anabolic steroid use to COVID-19 disease severity.
Assuntos
Anabolizantes/efeitos adversos , Antagonistas de Androgênios/administração & dosagem , Tratamento Farmacológico da COVID-19 , Oxandrolona/efeitos adversos , Oxazóis/administração & dosagem , Tioidantoínas/administração & dosagem , Adulto , Anabolizantes/administração & dosagem , Progressão da Doença , Humanos , Masculino , Oxandrolona/administração & dosagem , Substâncias para Melhoria do Desempenho/efeitos adversos , SARS-CoV-2 , Índice de Gravidade de DoençaAssuntos
Alopecia em Áreas/classificação , Alopecia em Áreas/tratamento farmacológico , Inibidores de Janus Quinases/uso terapêutico , Pensamento , Alopecia em Áreas/patologia , Ensaios Clínicos como Assunto , Feminino , Humanos , Masculino , Prognóstico , Índice de Gravidade de Doença , Resultado do Tratamento , Organização Mundial da SaúdeRESUMO
BACKGROUND: Nuclear factor kappa B (NFκB) transcription factors play a central role in controlling the expression of genes involved in inflammatory reactions, proliferation, and survival of human cells. However, the in situ evaluation of NFκB activity in leprosy has not been completed previously. The aim of this study was to determine whether NFκB activity correlates with susceptibility or resistance to Mycobacterium leprae infection in biopsies from skin lesions of 38 patients with the clinical and laboratory diagnosis of leprosy. METHODS: The NFκB activation profile was evaluated in biopsies from skin lesions of 38 patients with the clinical and laboratory diagnosis of leprosy. NFκB activation was evaluated and quantified by Southwestern histochemistry, and its activation index (range, 0-4) was calculated according to the percentage of nuclear positivity by the histochemistry. Activation index >1 was considered representative of activation of NFκB. RESULTS: Fifteen patients (39.5%) demonstrated activated NFκB. Multibacillary leprosy was associated with activated NFκB (54.5%, P=0.028). Borderline leprosy was most strongly associated with NFκB activation (80%), with an odds ratio of 32.7 (P=0.016). These clinical forms are characterized by increased susceptibility to M. leprae and by immunological instability. Activation of NFκB was absent in the granulomas in tuberculoid leprosy, which represents an effective inflammatory reaction pattern against M. leprae. CONCLUSION: These results indicate that NFκB activation could favor susceptibility and immunological instability to M. leprae infection, potentially by the stimulation of phagocytosis and the regulation of apoptotic mechanisms of infected cells, leading to the proliferation of this intracellular bacillus. Further studies are needed to evaluate if inhibition of NFκB activation in multibacillary leprosy could favor resistance and an effective granulomatous immune response.