Kikuchi-Fujimoto disease presenting in a patient with SARS-CoV-2: a case report.

BACKGROUND: We present a yet to be described association of SARS-CoV-2 infection with Kikuchi-Fujimoto disease. CASE PRESENTATION: A 32-year-old physician with history of SARS-CoV-2 infection presented to the emergency department with 2 weeks of fever, chills, and right sided cervical lymphadenopathy. He was treated empirically for presumed folliculitis with worsening of symptoms leading to repeat presentation to the emergency department. Extensive workup was unrevealing of an infectious cause and needle biopsy of the lesion was unrevealing. An excisional lymph node biopsy revealed follicular hyperplasia with necrotic foci showing abundance of histiocytes at the edge of necrosis with CD8 predominance of T-cells. Final diagnosis was deemed to be Kikuchi-Fujimoto disease. Antibiotic therapy was discontinued, and the patient's symptoms resolved with steroid therapy and expectant management. CONCLUSIONS: This is the first report of a patient developing Kikuchi-Fujimoto disease following SARS-CoV-2 infection. Clinicians should be aware of Kikuchi-Fujimoto disease as a possibility when approaching patients with hyper-inflammatory states who present with cervical lymphadenopathy.

Exertional hypoxia in patients without resting hypoxia is an early predictor of moderate to severe COVID-19.

The importance of exertional hypoxia without resting hypoxia in COVID-19 is unknown and may help objectively identify high-risk patients. Interventions may be initiated earlier with sufficient lead-time between development of exertional hypoxia and other outcome measures. We performed a retrospective study of adult patients hospitalized with COVID-19 from March 1, 2020 to October 30, 2020 in an integrated academic medical system in the Chicagoland area. We analyzed patients who had daily exertional oximetry measurements taken. We defined exertional hypoxia as SpO2 < 90% with ambulation. We excluded patients who had first exertional oximetry measurements or first exertional hypoxia after the use of oxygen therapies. We determined the association of exertional hypoxia without resting hypoxia with the eventual need for nasal cannula or advanced oxygen therapies (defined as high flow nasal cannula, Bi-PAP, ventilator, or extracorporeal membrane oxygenation). We also calculated the time between development of exertional hypoxia and the need for oxygen therapies. Of 531 patients included, 132 (24.9%) had exertional hypoxia. Presence of exertional hypoxia was strongly associated with eventual use of nasal cannula (OR 4.8, 95% CI 2.8-8.4) and advanced oxygen therapy (IRR 7.7, 95% CI 3.4-17.5). Exertional hypoxia preceded nasal cannula use by a median 12.5 h [IQR 3.25, 29.25] and advanced oxygenation by 54 h [IQR 25, 82]. Exertional hypoxia without resting hypoxia may serve as an early, non-invasive physiologic marker for the likelihood of developing moderate to severe COVID-19. It may help clinicians triage patients and initiate earlier interventions.

Mortality, Critical Illness, and Mechanical Ventilation among Hospitalized Patients with COVID-19 on Therapeutic Anticoagulants

ABSTRACT Background COVID-19 is associated with hypercoagulability and increased incidence of thrombosis. We compared the clinical outcomes of adults hospitalized with COVID-19 who were on therapeutic anticoagulants to those on prophylactic anticoagulation. Materials and Methods We performed an observational study of adult inpatients’ with COVID-19 from March 9 to June 26, 2020. We compared patients who were continued on their outpatient prescribed therapeutic anticoagulation and those who were newly started on therapeutic anticoagulation for COVID-19 (without other indication) to those who were on prophylactic doses. The primary outcome was overall death while secondary outcomes were critical illness (World Health Organization Ordinal Scale for Clinical Improvement score >5), mechanical ventilation, and death among patients who first had critical illness. We adjusted for age, sex, race, body mass index (BMI), Charlson score, glucose on admission, and use of antiplatelet agents. Results Of 1,716 inpatients with COVID-19, 171 patients were continued on their therapeutic anticoagulation and 78 were started on new therapeutic anticoagulation for COVID-19. In patients continued on home therapeutic anticoagulation, there were no differences in overall death, critical illness, mechanical ventilation, or death among patients with critical illness compared to patients on prophylactic anticoagulation. In patients receiving new therapeutic anticoagulation for COVID-19, there was increased death (OR 5.93;95% CI 3.71-9.47), critical illness (OR 14.51;95% CI 7.43-28.31), need mechanical ventilation (OR 11.22;95% CI 6.67-18.86), and death after first having critical illness (OR 5.51;95% CI 2.80 -10.87). Conclusions Therapeutic anticoagulation for inpatients with COVID-19 was not associated with improved outcomes.

Is BMI Higher in Younger Patients with COVID-19? Association Between BMI and COVID-19 Hospitalization by Age.

OBJECTIVE: Obesity has been found to be a risk factor for hospitalization with coronavirus disease (COVID-19). This study investigated whether patients hospitalized with COVID-19 differed in BMI at older versus younger ages and whether trends were independent of diabetes and hypertension. METHODS: A cross-sectional analysis of patients hospitalized with moderate to severe COVID-19 at Northwestern Memorial Hospital from March 19, 2020, until April 4, 2020, was performed. Patients hospitalized with COVID-19 above and below the age of 50 were compared as well as those hospitalized without COVID-19. RESULTS: Patients younger than 50 years of age hospitalized with COVID-19 without diabetes or hypertension had mean BMI greater than those older than 50 years of age, with BMI 43.1 (95% CI: 34.5-51.7) versus 30.1 (95% CI: 27.7-32.5) (P = 0.02). Furthermore, BMI appeared to inversely correlate with increasing age among patients hospitalized with COVID-19. We did not detect the same difference or trend for patients hospitalized without COVID-19. CONCLUSIONS: Younger patients (age < 50 years) with COVID-19 had higher mean BMI than older patients with COVID-19, with and without diabetes and hypertension. This trend did not exist in patients without COVID-19 hospitalized during the same time period.