ABSTRACT
Thrombotic complications have been reported widely in patients with severe coronavirus disease 2019 (COVID-19) infection. There has been an increasing trend of arterial thrombosis leading to significant morbidity and mortality. We report a case of a patient with COVID-19 related pneumonia who presented with acute limb ischemia.
ABSTRACT
Introduction: COVID-19 virus has been known to be a major cause of mortality secondary to cytokine storm and respiratory failure. Other manifestations include GI symptoms, loss of taste and smell and thromboembolism. Here we introduce a case of suspected COVID-19 induced viral myocarditis in an 86 year old woman. Case presentation: An 86-year-old female with no reported past medical history, not on daily medications, was brought in by ambulance after fall and unable to get up for many hours. On presentation, she was in mild distress due to left sided musculoskeletal pain, afebrile, tachycardic, tachypneic, and saturating at 93% on room air. Patient denied chest pain throughout her hospitalization. Tenderness in the left chest wall, left upper and lower extremities was elicited on physical examination. Labs obtained were significant for a creatine kinase of 37,000 IU/L and troponin I of 9.93ng/mL. EKG showed nonspecific T wave abnormalities, and prolonged QTC of 548ms. Chest x-ray showed multifocal pneumonia with no features suggestive of trauma. She was admitted to telemetry for further management of COVID-91 pneumonia and cardiac work up. Her troponin I peaked to 12.52ng/mL and she was treated with empiric intravenous heparin and aspirin. Echocardiogram shows global hypokinesis with left ventricular ejection fraction of 35-40%. Heart failure regimen with beta blocker and aldosterone receptor blocker were started. Rhabdomyolysis normalized with intravenous fluids. For COVID-19 pneumonia, she received dexamethasone and remdesivir and was weaned to 4L oxygen on discharge. Discussion:Viral myocarditis often results from a combination of direct viral injury and subsequent cellular immune activation. There is limited knowledge for COVID-19 associated viral myocarditis;most documented cases are from existing case reports, where most patients are male, and under the age of 70 years. Diagnosis is often challenging, as endomyocardial biopsy is often forgone in the setting of the ongoing pandemic and increased infection risk. Treatment for viral myocarditis involves heart failure management followed by directed therapy based on suspected etiology. Lymphocytic myocarditis, as seen in the setting of COVID-19, would typically involve immunosuppression in the form of glucocorticoids and intravenous immunoglobulin;although these regimens have yet to be extensively studied in COVID-19 associated myocarditis. As literature on this infection is rapidly evolving, it is vital to recognize and document suspected cases. This case helps to establish presentation of COVID-19 induced viral myocarditis and facilitate future understanding and raises awareness of this extrapulmonary presentation.
ABSTRACT
Background: COVID-19 also known as SARS C0V-2, is now a pandemic which started in December 2019 in China. RT-PCR based nucleic acid detection is currently the standard diagnostic method for COVID-19, but certain shortcomings make it unfeasible for use as a screening test. Aims and objectives: To study the dynamics of IgM and IgG antibody, establish its role in diagnosis and prognosis of COVID-19 patients. Methods: It was a cross-sectional study conducted over 100 RT PCR confirmed COVID-19 patients admitted in various wards of a dedicated Corona hospital, RNTMedical College, Udaipur, Rajasthan, India over a period of 2months – fromApril 2020 toMay 2020. Results: We performed an anti-SARS-CoV-2 IgG/IgM test on 100 confirmed COVID-19 patients and found that 61%patients hadantibody positivity. Dynamics of antibody show that seroconversion, peaking, anddisappearance of IgMantibody occur at end of 1st week, 2nd week, and 3rdweek respectively, while for IgG seroconversion was seen at the end of 2nd week, and was persistently positive up to 32nd day of illness in our study. Patients with development of anti-SARS-CoV-2 antibodies had a mild degree of illness with positive outcome and vice versa. Conclusion: Our study concludes that serological responses have been observed in COVID-19 patients, and the dynamic pattern of these responses is consistent with acute viral infection which is useful to see the immune status of these patients and diagnosis of COVID-19.