ABSTRACT
The aim of the work - to provide variants of extrapulmonary manifestations of coronavirus disease (COVID-19) based on the analysis of the relevant course of the disease in adults.Results. The paper presents two clinical cases of coronavirus disease (COVID-19) with the manifestation of extrapulmonary symptoms, which required some individualization of therapy.The first clinical observation showed that in a 56-year-old patient with moderate COVID-19, the development of oxygen dependence on the 8th day of the disease was combined with the manifestation of extrapulmonary symptoms in the form of cutaneous manifestations. Individualization of glucocorticosteroid therapy and endothelioprotective therapy has been shown to be effective in regressing both oxygen dependence and cutaneous vasculitis.The second clinical observation showed that in a 35-year-old patient, moderate COVID-19 without oxygen dependence was accompanied by the development of extrapulmonary manifestations, namely short-lasting diarrheal syndrome, which manifested in the onset of the disease and of the development of orchiepididymitis on the 9th day of illness, which required the appointment of anti-inflammatory therapy.Conclusions. The abovementioned clinical observations of COVID-19 cases show relatively rare cases of SARS-CoV-2-associated extrapulmonary manifestations in patients with moderate disease, but their development necessitated individualization of treatment.
ABSTRACT
The aim of the study is to analyze the literature data on modern views concerning extrapulmonary manifestations of coronavirus disease (COVID-19).Based on the analysis of current publications, the article analyzes the clinical manifestations of coronavirus disease (COVID-19) as a multisystem disorder with two main types of clinical manifestations, namely pulmonary and extrapulmonary. Determining pathogenetic mechanisms of extrapulmonary symptoms are, on the one hand, the tropism of SARS-CoV-2 to ACE2 receptors, expressed not only by alveolar epithelial type II cells, but also by cells of the heart, nervous system, vascular endothelium, small and large intestine, basal layer cells of the epidermis, cells of endocrine organs, etc., and on the other hand, immune-dependent mechanisms, in particular the development of "cytokine storm".It is shown that the spectrum of extrapulmonary manifestations of COVID-19 is very wide, and clinical manifestations are characterized by significant polymorphism. Extrapulmonary symptoms of COVID-19 were analyzed considering the organs of the gastrointestinal tract, nervous, cardiovascular and endocrine systems, skin and others. Attention is drawn to a certain association between definite extrapulmonary manifestations and the severity of COVID-19 course.Thus, particular extrapulmonary manifestations are associated with a milder course of COVID-19 (anosmia, dysgeusia, etc.), others, vice versa, occur in severe disease (damage to liver, kidney, heart, pancreas). In addition, some extrapulmonary manifestations, especially of the nervous system, may remain in patients even after an acute period of the disease. Some extrapulmonary manifestations, which are currently described in a small number of patients, are also reviewed.Conclusions. COVID-19 is characterized by a wide range and high frequency of extrapulmonary manifestations, which is ex-plained by both the direct action of SARS-CoV-2 and immune-dependent mechanisms. Some extrapulmonary manifestations are associated with a milder course of COVID-19, others, on the contrary, occur in severe disease.
ABSTRACT
The aim of the work - to present a case of positive use of tocilizumab in the treatment of pregnant woman with severe COVID-19. Materials and methods. A self-observation clinical case of severe coronavirus disease (COVID-19) in pregnant K., 40 years old, who was treated at Municipal Non-Profit Enterprise "Regional Infectious Diseases Clinical Hospital" of Zaporizhzhia Regional Council. The patient was treated in accordance with the "Protocol for the provision of medical care for the treatment of coronavirus disease (COVID-19)". Results. Our own clinical observation demonstrates the formation of severe COVID-19 in a 40-year-old pregnant woman in the second trimester of pregnancy. Combination treatment with glucocorticoids in the presence of oxygen dependence on the 11th day of the disease was ineffective for two days of clinical and laboratory parameters monitoring, which required a decision on the additional appointment of tocilizumab. The development of "cytokine storm" clinical and laboratory signs on the 12th day of the disease was evidenced by the preservation of fever in the range of 37.5-37.8 degrees C, no regression of oxygen dependence. According to laboratory data, an increase in the severity of lymphopenia as a relative quantity - up to 5 % and absolute quantity - up to 0.5 x 10(9)/l, an increase in fibrinogen - up to 5.8 g/l and D-dimer - up to 1.9 ng/ml, high level of C-reactive protein - up to 190 mg/l. These data justify the additional use of tocilizumab, which was administered at a dose of 8 mg/kg in the absence of contraindications. Tocilizumab administration was effective, contributing to oxygen dependence regression and recovery of laboratory parameters within a week. Conclusions. Our own clinical observation demonstrates the formation of severe COVID-19 in pregnant woman in the second trimester of pregnancy. Due to the ineffectiveness of glucocorticosteroid therapy and the presence of clear clinical and laboratory signs of "cytokine storm" on the 12th day of the disease, the use of tocilizumab was effective, which contributed to the oxygen dependence regression and recovery of laboratory parameters within a week. Treatment of pregnant woman with severe COVID-19 requires adherence to existing protocols.