COVID-19

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• Human Granulocytic Anaplasmosis as a COVID-19 Mimicker Deeksha Ramanujam, Adeel Nasrullah, Obaid Ashraf, Marshall Bahr, Khalid Malik Views: 582 HTML: 135 PDF: 276

  Introduction: Human granulocytic anaplasmosis (HGA) is a tick-borne illness caused by the bacterium Anaplasma phagocytophilum. HGA has a widely variable clinical presentation and can be life-threatening.

  Case description: A 77-year-old man was transferred from an outside facility with altered mental status, a fever of up to 40.5°C, and shortness of breath. Laboratory analysis revealed a progressively worsening pro-inflammatory state and abnormalities in the patient’s coagulation studies. With clinical and laboratory evidence concerning for potential COVID-19 infection, the patient was placed in isolation as a precaution. The results of two COVID-19 tests, given approximately 24 hours apart, were negative. The patient’s spouse confirmed a bug bite to his upper extremity while working outdoors. His symptoms resolved completely after a 10-day course of empiric doxycycline.

  Discussion: The diverse clinical presentations of HGA necessitate a broad differential diagnosis, including viral, bacterial and non-infectious aetiologies. In severe cases, a cytokine-mediated immune cascade can occur (namely, cytokine storm) leading to devastating downstream effects. This cytokine storm can be seen in many other diseases, but most recently it has been demonstrated in the novel coronavirus disease 2019 (COVID-19).

  Conclusion: Here we present a case of HGA in which diagnosis was delayed due to mimicry of COVID-19 infection. This case highlights the importance of taking clinical and social histories, seasonality and geography into account during diagnosis, and maintaining a broad differential with non-specific symptoms. Despite the current COVID-19 pandemic, we recommend that HGA remains in the differential diagnosis of a pro-inflammatory state with an atypical respiratory presentation.

• SARS-CoV-2-related Multisystem Inflammatory Syndrome in Adults Antonio Martins, Sílvia Policarpo, André Silva Pinto, Ana Sofia Santos, Paulo Figueiredo, António Sarmento, Lurdes Santos Views: 570 HTML: 69 PDF: 265

  Adults infected with SARS-CoV-2 may develop a multisystem inflammatory syndrome (MIS-A) characterized by elevated inflammatory markers and multisystem organ involvement. We report the case of a patient who presented with fever and vomiting at hospital admission. He tested positive for SARS-CoV-2 infection and blood tests showed elevated inflammatory markers. The patient developed acute cardiac dysfunction and shock in less than 24 hours and the echocardiogram revealed an LVEF of 30%. He was discharged 3 weeks later fully recovered. MIS-A should be considered if a compatible syndrome is observed in patients with evidence of SARS-CoV-2 infection by PCR test or serology.

• Autoimmune Thrombocytopenia in SLE and COVID-19 Yeremia Suryo Pratama, Riska Pradiptakirana, Azkia Rachmah, Nurhasan Agung Prabowo Views: 690 HTML: 68 PDF: 354

  Thrombocytopenia and hypercoagulopathy are haematological abnormalities commonly seen in individuals with coronavirus disease 2019 (COVID-19) and systemic lupus erythematosus (SLE). The difficulty arises when the patient has both diseases concurrently. The clinician should be able to comprehend the pathophysiology of these patient abnormalities in order to provide the best treatment possible. We present a case of a 20-year-old female COVID-19 patient with a history of SLE who had thrombocytopenia but normal D-dimer results. Our analysis revealed that the thrombocytopenia may have been caused by a relapse of lupus, not by COVID-19 infection. In this case, glucocorticoids were the primary therapy and produced excellent results.

• A Case of Severe COVID-19 in a Patient with Good's Syndrome Maria Duarte, Luciana Faria, Catarina Patronillo, Sónia da Costa Fernandes, Vera Seara Views: 751 HTML: 118 PDF: 383

  Good’s syndrome is a rare adult-onset combined immunodeficiency. The association of hypogammaglobulinaemia with a history of recurrent infectious or autoimmune manifestations in a middle-aged patient with evidence of a mediastinal mass should lead to the clinical suspicion of Good’s syndrome. The mortality rate associated with infectious complications is high. Thus, although it is rare, the disease should be diagnosed early so that proper treatment can be started. Thymectomy and immunoglobulin replacement are the main therapeutic strategies. We describe the case of a patient with a history of thymoma and recurrent respiratory infections, with a late diagnosis of Good’s syndrome in the context of severe organizing pneumonia secondary to COVID-19.

• Late-Term Complications of COVID-19: Retropharyngeal Infection and Myocarditis in a 26-Year-Old Patient Mohammad Yousef, Basel Abdelazeem, Atefeh Kalantary, Rebecca Pratiti Views: 543 HTML: 98 PDF: 309

  Deep neck space infection and viral myocarditis related to coronavirus disease 2019 (COVID-19) have both been described in the medical literature. However, there are only three reported cases of retropharyngeal infection as a presenting pathology in the setting of COVID-19.

  A 26-year-old woman presented to the emergency room with fever and neck swelling and pain 1 month after COVID-19 infection. A computed tomography scan of the neck demonstrated tonsillitis with retropharyngeal infection. She was also found to have heart failure with an ejection fraction (EF) of <20% due to acute myocarditis. Her infection resolved and the EF improved to 40% prior to discharge.

  Our case is the first to describe retropharyngeal infection as a late complication in an adult with a history of COVID-19 several weeks previously. It also presented a clinical challenge in terms of tailoring goal-directed medical therapy to manage severe left ventricular dysfunction caused by myocarditis.

• Platypnoea-Orthodeoxia Syndrome in COVID-19 Francesca Salvotti, Francesco Poiatti, Stefano Bressa, Giovanni Montani, Matteo Nardin, Damiano Rizzoni Views: 859 HTML: 134 PDF: 218

  Platypnoea-orthodeoxia syndrome (POS) is a rare disorder and its pathophysiology has puzzled clinicians for years. Few cases of POS are described in COVID-19 patients in the literature, with a high variability of conditions related to the syndrome. 
  In this article, we report the case of a patient admitted to our hospital for SARS-CoV-2 interstitial pneumonia, who developed POS during the hospitalization.

• Recurrence of Graves’ Disease (a Th1-type Cytokine Disease) Following SARS-CoV-2 mRNA Vaccine Administration: A Simple Coincidence? Guillaume Pierman, Etienne Delgrange, Corinne Jonas Views: 2836 HTML: 411 PDF: 890

  Graves’ disease is the most frequent cause of hyperthyroidism in young women. This auto-immune disease is due to the production of class 1 IgG stimulating the TSH receptor. These antibodies are produced secondary to a Th1 immune response in which interferon gamma plays a key role. Vaccination is ongoing worldwide against SARS-CoV-2 and some of the vaccines include mRNA which seems to stimulate the Th1 immune response. Here, we report a case of recurrence of hyperthyroidism due to Graves’ disease following mRNA vaccination and discuss the possible implicated mechanism. This observation argues for a systematic study of a population of patients with previous Graves’ disease in order to assess the risk of recurrence following vaccination.

• Delayed Use of the Recombinant Human IL-1 Receptor Antagonist Anakinra in Five COVID-19 Patients with Pulmonary Fibrosis and Persistent Hypoxaemia: A Preliminary Report Daniel Nan, Cristina Abraira-Meriel, Sandra de la Roz-Fernandez, Tamara Maestre-Orozco, Jose Luis Hernandez, Marta Fernandez-Ayala Views: 891 HTML: 71 PDF: 281

  Coronavirus disease 2019 (COVID-19) is currently a major public health problem. The development of pulmonary fibrosis secondary to acute respiratory distress syndrome (ARDS) is one of the expected sequelae. In this case series, we describe five instances of the use of anakinra in late-phase COVID-19 pneumonia in hospitalized patients with pulmonary fibrosis and refractory respiratory failure fulfilling ARDS criteria. The study demonstrates that anakinra has promising efficacy and safety in late-phase COVID-19 infection in patients with ARDS and refractory hypoxaemia, and suggests its potential application as antifibrotic therapy in these patients.

• A Rare Case of Guillain-Barré Syndrome following COVID-19 Vaccination Yash Kripalani, Vidyadhara Lakkappan, Lipeeka Parulekar, Anjum Shaikh, Rakesh Singh, Pradeep Vyas Views: 1235 HTML: 132 PDF: 451

  Various vaccines against COVID-19 have been developed since SARS-CoV-2 emerged at the end of 2019. Their emergency administration in healthcare settings has been accompanied by numerous adverse effects. A case of Guillain-Barré syndrome following vaccination with Covishield is presented here to highlight this possible adverse condition.

• The Development of Ecchymosis after Administration of Convalescent Serum in a Patient with COVID-19 Associated with Thrombocytosis Rajashree Khot, Sunita Kumbhalkar, Richa Juneja, Prashant P Joshi Views: 568 HTML: 66 PDF: 275

  COVID-19 can have an unpredictable and severe course, leading to many hypotheses regarding its pathophysiology and clinical manifestations. Haematological manifestations are a significant predictor of disease severity. The most common observation is lymphopenia with an increased neutrophil:lymphocyte ratio. Platelets have been implicated in thrombogenic events, but the most frequently reported abnormality is mild thrombocytopenia.<br />
  Here we present an interesting case of a patient with moderate COVID-19 who presented with cutaneous ecchymoses and thrombocytosis, and discuss this paradox.