analogs could restore antiviral T-cell responses in COVID-19 models, through blocking the A2AR. Therefore, we propose that adenosine analogs that interact with A2AR may be endowed with dual – dual- immunomodulatory and intrinsic-antiviral functions. Study: In this study, we used a drug discovery technique, Molecular Docking, to investigate possible adenosine analogs that could be used as antiviral and immunomodulatory dual agents. We screened adenosine analogs, known or predicted to inhibit SARS-CoV-2 replication, to test if they may bind to A2AR. We found that forodesine, an adenosine analog, treatment restored T-cell
proliferation from the A2AR agonist CGS in CD8+ T-cells, suggesting that forodesine blocks A2AR.
Discussion: Our results indicate that adenosine analogs, like forodesine, may be endowed with immunomodulatory properties through A2AR, in addition to their intrinsic antiviral properties. Adenosine analogs, like forodesine, could be used as novel dual–immunomodulatory and intrinsic–antiviral drugs. These compounds could represent game-changing therapies, not only to control COVID-19 but also other emerging viral diseases and future pandemics.
AN EYE-POPPING TWIST: UNUSUAL OCULAR AND CEREBRAL MANIFESTATIONS OF LEMIERRE SYNDROME. Megan Vasterling 1 , Danielle Gilber DO, MPH 2 , Victoria Burke MD, FACP 2 ; School of Medicine 1 , Department of Medicine, Section of Infectious Diseases 2 , LSU Health New Orleans, New Orleans, LA
Introduction: Lemierre Syndrome, a condition marked by septic thrombophlebitis of the internal jugular vein, typically stems from oropharyngeal infections. Secondary clinical manifestations often include pulmonary septic emboli, splenic infarct, and sepsis. We present a unique variant of Lemierre Syndrome complicated by multiple cerebral venous sinus thromboses. Case: A 31-year-old female with no significant medical history presented with sudden onset diplopia, left eye pain, and swelling following two weeks of progressively worsening headaches, nausea, fever, malaise, and intermittent right lower quadrant pain. She also noted right-sided neck swelling and tenderness several days prior. Upon examination, the patient was febrile to 100.7°F. She displayed poor dentition with a clear oropharynx and poorly demarcated swelling of her right neck. Her right ocular examination was normal. In contrast, the left eye exhibited periorbital edema, chemosis, left lateral gaze palsy, absent pupillary light reflex, and a nonreactive 6 mm round pupil. Laboratory findings included leukocytosis (26,400/uL). Subsequent imaging revealed a
thrombus in the right internal jugular vein with surrounding inflammatory changes and reactive lymphadenopathy, in addition to multiple septic emboli in the chest, and a wedge-shaped splenic infarct consistent with Lemierre Syndrome. MRI/ MRV of the brain confirmed thrombosis in the right internal jugular vein and also revealed thrombosis in the left superior ophthalmic vein, cavernous sinus, and right sigmoid dural venous sinus. She was started on empiric broad coverage, a heparin drip, and underwent emergent cerebral angiogram and thrombectomy with gram-positive cocci in chains seen on the initial gram stain of the extracted thrombus. Blood as well as thrombus cultures ultimately grew Parvimonas micra and Slackia exigua. The patient was ultimately discharged on a 6-week course of piperacillin-tazobactam and apixaban with clinical improvement noted at follow-up. Discussion: This case illustrates an atypical presentation of Lemierre Syndrome involving cerebral and ocular complications, highlighting the importance of prompt recognition and collaboration among specialists for successful management and improved patient outcomes.
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