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SESSION TITLE: Unique Inflammatory and Autoimmune Complications of COVID-19 Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Both COVID-19 infection and sarcoidosis have been associated with long-term systemic complications with current research attempting to link these two diseases based on inflammatory properties. This case presents a patient with previously biopsy proven asymptomatic sarcoidosis who progressed to symptomatic sarcoidosis following severe COVID-19 infection. CASE PRESENTATION: A 58-year-old previously active female with known asymptomatic, biopsy proven pulmonary sarcoidosis presented to hospital in February 2021 with severe COVID-19 pneumonia requiring treatment with Decadron and Remdesivir. She was discharged home on room air but continued to have fatigue, shortness of breath, wheezing and coughing. Due to persistent respiratory symptoms and new onset vomiting with anorexia, she sought evaluation in the emergency department in July 2021. She was febrile with blood work significant for leukopenia and thrombocytopenia. She was found to have Anaplasmosis and despite adequate treatment continued to have persistent hypoxia with oxygen saturation of 82%. CT chest showed new areas of bilateral upper lobe predominant ground glass opacities and ill-defined soft tissue density in the subcarinal region. She was started on inhalers and underwent bronchoscopy with negative infectious disease work-up. She was discharged home on both inhalers and oral prednisone. Upon subsequent follow-up with pulmonology, she reported significant improvement in respiratory symptoms. Repeat CT chest after two of months of oral prednisone showed near resolution of all previous findings. After three of months of steroids, she began a prolonged steroid taper of one month. She reported absence of respiratory symptoms off of steroids. DISCUSSION: Current research is focusing on patients at greater risk of developing symptomatic sarcoidosis due to Th17 cells and the specific cytokines these cells produce. Several case reports suggest correlation between the inflammatory cascade induced by sarcoidosis and COVID-19 infection. One such case report suggests that COVID-19 infection can be a trigger for developing symptomatic pulmonary sarcoidosis. Our patient would be the first reported case of biopsy proven previously asymptomatic sarcoidosis developing into symptomatic sarcoidosis following severe COVID-19 infection. CONCLUSIONS: Therefore, COVID-19 infection may not only predispose individuals to developing pulmonary sarcoid but may also contribute to the progression of once asymptomatic sarcoid to symptomatic sarcoid. Reference #1: Capaccione, K. M., McGroder, C., Garcia, C. K., Fedyna S., Sagi, A., & Salvatore, M. M. (2022). Covid-19-induced pulmonary sarcoid: A case report and review of the literature. Clinical Imaging, 83, 152-158. https://doi.org/10.1016/j.clinimag.2021.12.021 Reference #2: Chen, Edward S. "Reassessing Th1 versus Th17.1 in Sarcoidosis: New Tricks for Old Dogma.” The European Respiratory Journal, vol. 51, no. 3, 2018, p. 1800010. Reference #3: Xu, Zhe, et al. "Pathological Findings of COVID-19 Associated with Acute Respiratory Distress Syndrome.” The Lancet Respiratory Medicine, vol. 8, no. 4, 2020, pp. 420–422. DISCLOSURES: No relevant relationships by Skylar Hartmann No relevant relationships by Jessica Wiseman
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Introduction: The COVID-19 pandemic has become the most prominent event of 2020, posing major challenges to both society and politics. Many surgical departments had to be restructured with more or less vague recommendations to be prepared for the feared onslaught of COVID-patients. This work served to capture the daily routine of spine surgery during the Corona pandemic. Patients & Methods: An online questionnaire with 32 questions about professional and personal daily life was sent to members of neurosurgical and spine surgical societies in the DACH region during the initial lockdown. Results: Daily professional life was very similar for a large proportion of respondents. Outpatient clinics were reduced to a minimum and replaced by telemedical care. Intra-departmental meetings were greatly reduced and employees were divided into „split teams“. The operative program was organized very differently in the DACH region. 92% of respondents reported that semi-acute or acute procedures had been postponed, while 6% of respondents were only able to perform emergency surgeries. Conclusion: Despite the lack of guidelines and almost daily changing policy guidance, many departments in the DACH region demonstrated very similar courses of action to contain nosocomial infections and prepare for the onslaught of COVID-patients. The lack of resources (masks, gloves, etc.) led to a further restriction of the surgical program in order to be able to continue to provide the basic equipment for effective work of medical staff. In light of future medical crises, this problem should be addressed in the future and consequently better organized.