COVID-19 and SARS-CoV-2. We learn that there's still so much more to learn

Background: Current COVID-19 pandemic exposes health staff to a new and potentially fatal disease Case history: Male, 37 yo, entered ER referring worsening asthenia, feeling non-specifically unwell for 7 days, recent history of SARSCoV- 2 infection with interstitial pneumonia requiring hospitalization two weeks prior admission. Blood tests showed severe anemia (Hb 4gr/dl), mild hyperbilirubinemia, markedly raised LDH, positive direct/ indirect Coombs' reaction. Autoimmune haemolytic anemia was suspected because of symptomatic anaemia, evidence of ongoing haemolysis on blood tests, history of a viral infection. Chest XRay and CT pulmonary angiogram were negative for features suggestive of Covid-19 but highlighted lower right lobar pneumonia. Nasopharyngeal molecular swab was negative, while antibody test showed high titer G Immunoglobulin, confirming recent infection. He was initially treated with high doses steroids (1 gr/Kg bw) as well as antibiotics for pneumonia;but, due to lack of efficacy, on the fourth day we started ev immunoglobulins, obtaining gradual improvement in Hb towards baseline and tests normalization. Discussion: SARS-CoV2 infection frequently meets complications;although the pathophysiology underlying COVID-19 remains poorly understood, evidence argues for hyperinflammatory syndrome and/or various autoimmune disorders, which may appear after pneumonia recovery, highlighting need of medium and longterm follow up, to identify possible presentations of COVID-19 complications.

A rare complication after anti-SARS-CoV-2 vaccination: septic arthritis of the sternoclavicular joint, mediastinitis and pulmonary embolism

Introduction: The systemic side-effects of anti-SARS CoV-2 vaccination are described for all types of vaccines. We describe a case of a likely adverse reaction to the Spikevax Moderna vaccine, manifested by septic arthritis of the left sternoclavicular joint, mediastinitis and pulmonary embolism. Case Report: 22-year- old female soldier developed symptoms of fever, chest and limb discomfort in her left upper arm around 10 days after receiving her first dose of Spikevax Moderna vaccine, necessitating hospitalization 14 days after. Septic arthritis of the left sternoclavicular joint, mediastinitis, deep vein thrombosis of the left upper limb, and pulmonary embolism were diagnosed. The blood culture result showed the development of Staphylococcus aureus. The patient was treated with antibiotic therapy and with anticoagulant therapy. There was a rapid improvement in clinical conditions, allowing the patient to be discharged 10 days after admission. Conclusions: The vaccination's causative role in the formation of the clinical picture is extremely likely in this case, but with a plausible not-specific pathogenetic mechanisms. There have been reports of septic arthritis following SARS CoV2 vaccination, especially of the shoulder joint, but the novelty of our finding stems from the fact that it would be the first case of septic arthritis after vaccination involving a sternoclavicular localization. This case emphasizes the importance of maintaining a high degree of attention when administering vaccines and keeping a close eye on the patient in the days after the vaccine.