A Case of Multiple Sclerosis with Protracted Course of COVID-19.

BACKGROUND: We reported a case of multiple sclerosis (MS) with persistent symptomatic COVID-19, which was complicated by new-appearing severe pneumonia 40 days after disease onset. CASE PRESENTATION: A 38-year-old man with a history of multiple sclerosis referred to our hospital with fever, shaking chills, cough, and dyspnea. In his history, the patient had developed mild COVID-19 from 40 days ago. After 7 days of disease onset, the COVID symptoms had been subsided partially, but fatigue, myalgia, intermittent fever, and loss of taste and smell had been continued. In physical examinations, his oral temperature was 39.4 °C. He had respiratory distress, and his blood oxygen saturation on the room air was 90%. The spiral chest CT scan was performed, which revealed bilateral ground-glass and alveolar opacities in favor of COVID-19 pneumonia. The result of the RT-PCR test for SARS-COV-2 was reported positive subsequently. His current MS medication was rituximab and he had received the last dose of rituximab two months before developing COVID-19. The patient was admitted to the COVID ward and put on Remdesivir, subcutaneous interferon-beta1b, and dexamethasone. He improved gradually and was discharged from the hospital with the favorable condition after 10 days. This patient had a rare protracted disease course. We presumed that prolonged high degree fever (above 38 °C) in our patient is beyond the diagnosis of the post-COVID-19 syndrome and is more compatible with persistent infection. CONCLUSION: Although most immunocompromised patients effectively clear SARS-CoV-2 infection, this case report highlights the risk of persistent infection associated with recurrence of the disease.

The relationship between cumulative dose of immunosuppressive agents and COVID-19-associated mucormycosis: A multicenter cross-sectional study.

Background and Aims: Immunosuppressive therapy has a key role in developing coronavirus disease-2019 (COVID-19)-associated mucormycosis. In this study, we investigated the effect of the type and cumulative dose of immunosuppressive agents on COVID-19-associated mucormycosis. Methods: We designed a descriptive cross-sectional study involving three COVID-19 hospitals in Iran. Clinical and demographic data were gathered from the medical records and checked by two independent researchers to minimize errors in data collection. Results: Seventy-three patients were included in the study. The mean age of cases was 57.41 (SD = 12.64) and 43.8% were female. Among patients, 20.5% were admitted to the intensive care unit (ICU) during COVID-19. Furthermore, 17 patients (23.29%) had a history of diabetes mellitus. Sixty-nine patients (94.52%) had a history of receiving corticosteroids (dexamethasone) during treatment of COVID-19, and of those, five patients (6.85%) received Tocilizumab beside. The mean cumulative dose of corticosteroids prescribed was 185.22 mg (SD = 114.738). The average cumulative dosage of tocilizumab was 720 mg (SD = 178.89). All of the included patients received amphotericin B for mucormycosis treatment, and 42 survived (57.53%). Also, there was a significant relationship between hospitalization in ICU for COVID-19 and the mucormycosis outcome (p = 0.007). However, there weren't any significant associations between cumulative doses of immunosuppressive drugs and mucormycosis outcome (p = 0.52). Conclusion: The prevalence of COVID-19-associated mucormycosis is increasing and should be considered in the treatment protocols of COVID-19. Controlling risk factors such as diabetes, malignancy and the administration of immunosuppressive agents based on recommended dosage in validated guidelines are ways to prevent mucormycosis.

Risk Factors of COVID-19 Associated Mucormycosis (CAM) in Iranian Patients: A Single-Center Retrospective Study.

BACKGROUND: COVID-19 associated mucormycosis (CAM) has been known as one of the most severe post-COVID morbidities. OBJECTIVES: To describe CAM cases, identify possible risk factors, and report outcomes of patients. METHODS: This retrospective study was performed in Amir-Alam Hospital, Tehran, Iran between February 2020 and September 2021. Patients with mucormycosis who had an active or previous diagnosis of COVID-19 have been included. RESULTS: Of 94 patients with mucormycosis, 52 (33 men and 19 women; mean age: 57.0 ± 11.82 years) were identified with an active or history of COVID-19. Rhino-orbital, rhino maxillary, rhino-orbito cerebral subtypes of mucormycosis were detected in 6 (11.5%), 18(34.6%), and 28(53.8%) patients. As a control group, 130 (69 men and 61 women; mean age: 53.10 ± 14.49 years) random RT-PCR-confirmed COVID-19 patients without mucormycosis have been included. The mean interval between COVID-19 diagnosis and initial mucormycosis symptoms was 16.63 ± 8.4 days (range 0-51). Those in the CAM group had a significantly more severe course of COVID-19 (OR = 3.60, P-value < 0.01). Known history of previous diabetes mellitus (OR = 7.37, P-value < 0.01), smoking (OR = 4.55, P-value < 0.01), and history of receiving high-dose corticosteroid pulse therapy because of more severe COVID-19 (P-value = 0.022) were found as risk factors. New-onset post-COVID hyperglycemia was lower in the CAM group (46.2% vs. 63.8%; OR = 0.485, P-value = 0.028). After treatment of the CAM group, 41(78.8%) of patients recovered from mucormycosis. The mean ages of the expired patients in the CAM group were significantly higher than those who recovered from mucormycosis (66.18 ± 9.56 vs. 54.56 ± 11.22 years; P < 0.01); and COVID-19 disease was more severe (P = 0.046). CONCLUSION: Either active or history of COVID-19 can cause an increase in the risk of mucormycosis development. Some of the most important risk factors are the medical history of diabetes mellitus, smoking, and high-dose corticosteroid therapy. CAM is important possible comorbidity related to COVID-19, which could make the post-COVID conditions more complicated. More research and studies with greater sample sizes among different ethnicities are needed to explore the association between COVID-19 and mucormycosis.

The Value of Spiral Chest Computed Tomography Scan in the Diagnosis of Asymptomatic Coronavirus Carriers among Paranasal Sinus and Pharynx Surgery Candidates.

Introduction The nasopharynx and oropharynx are the main colonization sites of coronavirus. Therefore, patients with paranasal sinuses and pharyngeal problems (ear, nose, and throat [ENT] patients) predispose coronavirus infection. Ear, nose, and throat patients with concomitant asymptomatic coronavirus infection may develop severe pneumonia following surgical procedures. As a result, presurgical screening for coronavirus infection is a substantial concern. Objective We evaluated the usefulness of a spiral chest computed tomography (CT) scan in the diagnosis of asymptomatic coronavirus infection in the presurgical assessment of ENT patients Methods In this study, candidates of paranasal sinus or pharyngeal surgery were evaluated for coronavirus infection. Patients with neither history of coronavirus disease 2019 (COVID-19) nor compatible symptoms and signs were screened for asymptomatic coronavirus infection. These patients composed two groups: the first group underwent a reverse transcription polymerase chain reaction (RT-PCR) test of nasopharyngeal sample and spiral chest CT scan, but for the second one, only the latter was performed. Results In the first group, which consisted of 106 patients, 11 (10.4%) cases had positive RT-PCR test results, and 17 (16%) patients showed positive findings in favor of coronavirus infection in the spiral chest CT scan. In the second group, which consisted of 173 patients, 34 (19.7%) cases had positive chest CT scan results. Conclusion The chest CT scan has a valuable role in the early diagnosis of asymptomatic coronavirus carriers in patients highly predisposed to infection, especially in low resource areas, where the RT-PCR test is unavailable.

Distinguishing Characteristics of COVID-19-Associated Mucormycosis; a Case Series.

Introduction: Since the emergence of COVID-19 pandemic, several articles have reported the co-existence of mucormycosis and COVID-19. This study aimed to distinguish the characteristics of COVID-19-associated rhinocerebral mucormycosis. Methods: In this case series, 18 patients with COVID-19-associated rhinocerebral mucormycosis and unique clinical manifestations and outcomes, who were referred to Amiralam Hospital, a tertiary otorhinolaryngology center, Tehran, Iran, during the COVID-19 era, were reported. Results: Eighteen patients with the mean age of 62.0 ± 11.6 (range: 42 - 83) years were studied (50% males). The mean time interval between diagnosis of COVID-19 and first manifestation of mucormycosis was 15.5 ± 9.7 days. The most common presenting symptom was facial paresthesia (72.2%). Fifty percent of patients developed frozen eye. Palatal necrosis was seen in 7 cases (38.8%). Remarkably, facial paralysis was observed in 5 (27.7%) patients. Another notable clinical picture was cavernous sinus thrombosis, seen in 7 patients. We also had two cases of carotid artery occlusion. Three patients, unfortunately, passed away. Conclusion: Rhinocerebral mucormycosis is one of the most important complications of COVID-19 patients, especially those with underlying diseases. It seems that the key to proper management of mucormycosis is early diagnosis and timely intervention, which could give a patient a chance to live more.

Convalescent plasma therapy in patients with severe COVID-19, A single-arm, retrospective study.

Convalescent plasma (CP) therapy has been suggested as a treatment for emerging viral diseases. Moreover, many studies have been conducted to evaluate the efficacy of COVID-19 CP therapy, with some of them indicating that CP may be a promising treatment for the disease. However, the evidence for CP therapy's effectiveness in severe COVID-19 cases is limited. So, this study aimed to assess the probable effects of CP therapy in patients diagnosed with severe COVID-19. The study was designed as a single-arm, retrospective cohort of patients with severe COVID. Demographic data, laboratory test reports, and convalescent plasma transfusion doses were collected from medical records for patients before and after convalescent plasma transfusion. The clinical outcomes were hospital discharge and death. Also, laboratory parameters considered secondary outcomes. After CP therapy, some symptoms improved, especially in patients under 55 years old, as follows. Respiratory function was significantly enhanced after convalescent plasma transfusion, and the inflammatory biomarkers' values decreased significantly (p < 0.05). Moreover, the estimated median of partial thromboplastin time (PTT) and Prothrombin time (PT) in patients did not change after CP therapy (p > 0.05). Regarding COVID-19 mortality, a strong association was found between older ages and death (p < 0.001). Also, CP transfusion in the early days of admission was effective in treatment outcomes (p = 0.023). Other characteristics, including sex, blood group, number of CP transfusions, and preexisting conditions, did not significantly correlate with mortality. In conclusion, this study demonstrates the effectiveness of CP therapy in patients under the age of 55. Despite some improvement, we could not say that they were entirely due to the CP treatment. More extensive randomized clinical trials that cover different stages of the disease are needed.

Protracted COVID-19 during Treatment of Facial Palsy.

Neurologic manifestations are increasingly reported as the coronavirus disease 2019 (COVID-19) pandemic continues. This is a report of a COVID-19 patient with Bell's palsy. Case Summary. A 52-year-old man with fever and malaise was tested positive for COVID-19. After a week, he developed right-sided peripheral facial palsy and was treated with corticosteroids in conjunction with antiviral treatment which resulted in complete recovery. Discussion. Concomitant treatment of corticosteroids and antiviral treatment can decrease morbidity in patients with COVID-19-related Bell's palsy.

COVID-19 and Alcohol Misuse: A Case Report.

At the beginning of 2020, a newly emerged virus, now named SARS-CoV-2, began to spread in China. After four months, it has reached all over the globe, infecting more than 2.5 million people. Currently, there are no proved treatments available. However, in social media, false information about alcohol consumption and its role against the virus is spreading. We described a victim of these false facts, who was present with reduced eyesight due to alcohol drinking. A few days later, he showed symptoms of COVID-19 and, even though received treatment, lost his eyesight partially. Alcohol taking has no preventive or curative effect on COVID-19 and negatively impacts the body and immune system, which, therefore, should not be considered a treatment for COVID-19 disease.

Possible role of hypothyroidism in the prognosis of COVID-19.

In patients with COVID-19, certain medical conditions could result in poorer clinical outcomes. However, the prognostic role of hypothyroidism in COVID-19 is still unknown. In the present retrospective study, we estimated the prevalence of hypothyroidism in COVID-19 admitted patients in Tehran, Iran. Among 390 COVID-19 admitted patients, 21 hypothyroid cases (5.4%) were found, in which nearly 90% were aged 50 years and older. Regarding the effect of hypothyroidism on COVID-19 mortality, 60 (15.3%) of total patients and 4 (19%) of hypothyroid patients died, and no significant difference was found between the two groups.

Postoperative COVID-19 Pneumonia in an Asymptomatic Patient: A Case Report.

BACKGROUND: The recent outbreak of the coronavirus disease (COVID-19) in China has rapidly spread throughout the world and there are many reports of symptoms ranging from malaise to acute respiratory distress syndrome (ARDS) caused by this infection. However, few reports have been discussed surgical outcomes in COVID-19 patients. CASE PRESENTATION: In this report, we described a case of an elderly female developed with postoperative pulmonary complications after uneventful elective minor surgery. The patient was asymptomatic before the operation with no history of cough or fever. After surgery, the patient developed respiratory distress and chest radiological imaging revealed bilateral ground-glass opacities. It seems any type of surgeries requiring local anesthesia or general anesthesia may contribute to worsening outcomes in patients with covid19.

Lung Involvement Found on Chest CT Scan in a Pre-Symptomatic Person with SARS-CoV-2 Infection: A Case Report.

The novel coronavirus SARS-CoV-2 infection is spreading worldwide, and there are many reports of acute respiratory distress syndrome caused by this infection. However, asymptomatic lung involvement has not been reported. We hereby present the case of a 44-year-old health-care worker, who was found to be infected with the SARS-CoV-2 virus after a CT-scan performed for an unrelated condition revealed a lesion in the lung field compatible with COVID-19 infection. His condition deteriorated initially, but eventually improved with supportive treatment and the compassionate use of antivirals and antimalarials and is now in a stable condition.