El virus SARS-CoV-2 ha originado una pandemia con gran impacto en la sanidad, en la economía y en la sociedad, no entendiendo de barreras ni fronteras ni nacionalidades. Frente a la patología que origina su infección, la COVID-19, hemos descubierto una enfermedad que afecta de distintas maneras en función de cada persona con un espectro de manifestaciones, evoluciones y secuelas muy variado. Frente a este desastre que ha paralizado al mundo y que tantas muertes ha ocasionado, ha habido un dique de contención representado por la sanidad y un ariete que acaba de iniciar el camino hacia el fin de esta pandemia, la ciencia.

Figure 1. Presence of gram-positive coco bacteria in the macrophage cell cytoplasm.

Male neonate born one-day-old preterm during the week 29 + 1, whose mother presents a history of a Klebsiella pneumoniae urinary tract infection (UTI) treated with phosphomycin. At delivery, she did not report fever or other infectious symptoms.

On admission, the blood test of the newborn presents leukocytosis together with neutrophilia (63500 leucocytes/μL with 31200 neutrophils/μL); the acute phase reactants (RFA) being negative: C reactive protein (PCR) 0.21 mg/L and procalcitonin (PCT) 0.19 ng/mL. The next day, he maintained leukocytosis with neutrophilia (40000 leucocytes/μL with 22400 neutrophils/μL); RFAs being positive: PCR 150 mg/dL and PCT 3.66 mg/dL.

Figure 1. A peripheral blood smear with presence of red cells agglutination and some segmented neutrophils.

A 66-year-old male case with lung disease and atrial fibrillation, who is admitted due to coronavirus disease 2019 (COVID-19), however the discovery of cold agglutinins in blood smears by the clinical laboratory’s specialists, raises up suspicions of a possible superinfection by Mycoplasma pneumoniae, which was treated with antibiotics.

Patient come to the emergency room due to a week-long dyspnoea with minimal exertion and a dry cough without fever. Given the COVID-19 pandemic situation, an analysis with RT-PCR, biochemistry, blood count, and coagulation is requested. Table 1 shows the most relevant analytical data.

Figure 1. Image taken in ordinary light (oc x10, obj x40). In which structures compatible with yeasts are observed in CSF.

A 36-year-old male patient from Brazil who has lived in Spain for 3 months, comes to the emergency unit with a 3-month history of holocranial and throbbing headache, although with progression in intensity. The patient denies risky sexual contacts, drug use, eating spoiled food and contact with animals.

A lumbar puncture is performed, along with basic analysis that show anemia and increase in CRP (1.4 mg / dL).

In the CSF count 53 red blood cells / μL, 5 leukocytes / μL and structures compatible with yeast (Image 1) are observed. CSF biochemistry shows glucose of 22 mg / dL (NV: 50-80) and proteins of 44.0 mg / dL (NV: 15-40).

Figure 1. Large organic structure with undigested plant appendages. Fragments of plant parenchyma (red arrow), isolated plant cells (green arrow) and yeasts with pseudohyphae (blue arrow) are observed on a background with a large number of bacteria. 20x optical microscope.

52-year-old man with no cardiovascular risk factors with a history of active alcoholic liver cirrhosis, Child B8, and portal hypertension who attended the emergency department due to deterioration in general condition, fever, abdominal pain in the right upper quadrant, and vomiting of less than 48 hours of evolution. A diagnostic paracentesis was performed with criteria of spontaneous bacterial peritonitis (410 leukocytes/uL, 70% polymorphonuclear cells) and a 1-liter evacuator, later entering the Digestive Medicine service.

Figure 1. Radiographs of a 2-year-old patient who was admitted to the Pediatric Surgery Service due to the ingestion of a 12 mm diameter lead fishing sinker that was not expelled after inducing vomiting.

In the first radiograph, (figure 1A) the radiopaque image of the sinker is visualized in the gastric chamber, and its course through the digestive system in the subsequent images: (figure 1B) jejunum, (figure 1C) ileum, (figure 1D) ileocecal valve, (figure 1E) transverse colon, (figure 1F) transverse colon-hepatic flexure and (figure 1G) cecum-ascending colon, from where it was extracted three days after the ingestion with a polyp retrieval net(figure 1H). During admission, the patient did not present complications and she remained asymptomatic with good condition. Laxatives, a high-fiber diet and rectal enemas were administered without achieving spontaneous expulsion of the object. No pathological findings were evident in the cecum, right colon, transverse colon, descending colon and rectum-sigmoid mucosa on examination.

Figure 1. A: Blood differential. B. Scattergram (Sysmex XN-1000) C: Alarm of blast cells. D: Maygrünwald-Giemsa stain of peripheral blood.

A 74-year-old patient arrives at the the emergency room with dysphagia, intolerance to solids and liquids, that has been evolving for 3 to 4 days, nausea, constipation and a feeling of abdominal distension. Blood chemistry tests and complete blood count (CBC) arrives at the emergency laboratory. The CBC results showed leukocytosis (52.59 x 103/μL), at the expense of monocytes and lymphocytes, thrombopenia and alarm by blast cells (Figure 1A). The lymphocyte and monocyte populations can’t be properly separated in the scattergram, and the population seems to be only made up of a single cellular type (Figure 1B). Furthermore, in the WPC scattergramm the blast cells are the principal component of this population (Figure 1C). A peripheral blood cytomorphology stained with May-Grünwald-Giemsa is performed. We observed that approximately 80% of the leucocytes are medium-sized cells, with round nuclei and immature appearance. They also present scarce cytoplasm and an intense polar vacuolization. This characteristic finding makes us suspect a potential Burkitt Lymphoma (Figure 1D).

Figure 1. (a) Multiple kidney stones composed of calcium phosphocarbonate (FFC) with a total weight of 21.6 g, extracted from the patient's bladder. (b) A single elongated stone composed of Magnesium Ammonium Phosphate (AMP) with a total weight of 562mg extracted from the patient's left ureter.

A 42-year-old male patient with myelomeningocele and hydrocephalus resolved in the perinatal period by ventriculoperitoneal shunt and cerebrospinal fluid valve implantation.

The patient presents neurogenic bladder and sphincter incontinence, a very common sequel in patients with spina bifida. This was attempted to be resolved by implanting an artificial sphincter, which was finally inactivated due to bladder emptying problems.

Figure 1. A 48-year-old- woman was admitted to the major burned unit for extensive burn injury about 72 % of total body surface área. During the hospital stay we received in the laboratory a green-colored urine. In the follow-up of the patient, extreme values of anion clohride (Dimension Vista 1500, SIEMENS) and anion GAP were obtained, therefore the laboratory clinician studied the clinical history of the patient as the prescribed medication to find the possible cause of these results.

A 48-year-old- woman was admitted to the major burned unit for extensive burn injury about 72 % of total body surface area. In the follow-up of the patient during her stay in the hospital the following results of anion clohride (Dimension Vista 1500, SIEMENS) and anion GAP were obtained (Table 1).