COVID-19 Vaccine-Induced Tolosa-Hunt Syndrome: A Case Report (preprint)

We present the case of a previously healthy 36-year-old male with right eye discomfort, associated diplopia and dizziness as the primary clinical picture, seven days after a booster vaccination with the ChAdOx1-S (Oxford/AstraZeneca) COVID-19 vaccine.

U-shaped-aggressiveness of SARS-CoV-2: Period between onset of nonspecific-specific symptoms for COVID-19. A population-based cohort study (preprint)

Background: Early identification of different COVID-19 clinical presentations may depict distinct pathophysiological mechanisms and guide management strategies. Objective: To determine the aggressiveness of SARS-CoV-2 using symptom progression in COVID-19 patients. Design: Historic cohort study of Mexican patients. Data from January-April 2020 were provided by the Health Ministry. Setting: Population-based. Patients registered in the Epidemiologic Surveillance System in Mexico. Participants: Subjects who sought medical attention for suspicion of COVID-19. All patients were subjected to RT-PCR testing for SARS-CoV-2. Measurements: We measured the period between onset of nonspecific to specific symptoms for COVID-19 (PONSS) and compared it to the primary outcomes (mortality and pneumonia). Results: 65,500 patients were included. Reported fatalities and pneumonia were 2176 (3.32%), and 11568 (17.66%), respectively. According to the PONSS, patients were distributed as follows: 14.89% in <24 hours, 43.25% between 1-3 days, 31.87% between 4-7 days and 9.97% >7 days. The distribution for mortality and pneumonia was 5.2% and 22.5% in <24 hours, 2.5% and 14% between 1-3 days, 3.6% and 19.5% between 4-7 days, 4.1% and 20.6% >7 days, respectively (p<0.001). Adjusted-risk of mortality was (OR [95% CI], p-value): <24 hours= 1.75 [1.55-1.98], p<0.001; 1-3 days= 1 (reference value); 4-7 days= 1.53 [1.37-1.70], p<0.001; >7 days= 1.67 [1.44-1.94], p<0.001. For pneumonia: <24 hours= 1.49 [1.39-1.58], p<0.001; 1-3 days= 1; 4-7 days= 1.48 [1.41-1.56], p<0.001; >7 days= 1.57 [1.46-1.69], p<0.001. Limitations: Using a database fed by large numbers of people carries the risk of data inaccuracy. However, this imprecision is expected to be random and data are consistent with previous studies. Conclusion: The PONSS shows a U-shaped SARS-CoV-2 aggressiveness pattern. Further studies are needed to corroborate the time-related pathophysiology behind these findings.