Peripheral infiltration of remdesivir in 3 patients with COVID-19: Case series and discussion.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic resulted in accelerated market access to remdesivir worldwide. Therefore, data about complications experienced during use of the drug are limited. This is the first published case series (1 case report exists) to describe remdesivir infiltration in 3 patients with COVID-19. SUMMARY: In the first case, a 91-year-old woman experienced remdesivir infiltration resulting in edema, hematoma at the area of infiltration; on palpation, the affected area felt cooler than the surrounding areas. Swelling was still present after 6 weeks. In the second case, remdesivir infiltration occurred in a 72-year-old male, resulting in edema, hematoma, and pain at the area of infiltration. The hematoma lasted for 7 days. The third case concerned a 67-year-old woman, in whom remdesivir infiltration led to edema and a small hematoma. The hematoma regressed to a negligible size within 3 days. However, a week after infiltration, redness had reappeared. In 2 cases, the patient was immediately treated with hyaluronidase injections, but no specific treatments were provided in the other case. CONCLUSION: Based on the product information provided by remdesivir's manufacturer, we believe symptoms and signs observed in the 3 cases may have resulted from the low pH (~4) of the nonbuffered remdesivir solution, although the patients were not formally assessed for caustic injury. Previous experience with other noncytotoxic medications suggests that infusion-specific factors (eg, volume of leaked fluid) and patient-specific factors (eg, advanced age) may have a role in the outcome of remdesivir infiltration. The possibility of symptoms caused by cyclodextrins in the formulation or by intrinsic toxicity of remdesivir warrants exploration.

Chest computed tomography and alveolar-arterial oxygen gradient as rapid tools to diagnose and triage mildly symptomatic COVID-19 pneumonia patients.

BACKGROUND: In the coronavirus disease 2019 (COVID-19) pandemic, rapid clinical triage is crucial to determine which patients need hospitalisation. We hypothesised that chest computed tomography (CT) and alveolar-arterial oxygen tension ratio (A-a) gradient may be useful to triage these patients, since they reflect the severity of the pneumonia-associated ventilation/perfusion abnormalities. METHODS: A retrospective analysis was performed in 235 consecutive patients suspected for COVID-19. The diagnostic protocol included low-dose chest CT and arterial blood gas analysis. In patients with CT-based COVID-19 pneumonia, the association between "need for hospitalisation" and A-a gradient was investigated by a multivariable logistic regression model. The A-a gradient was tested as a predictor for need for hospitalisation using receiver operating characteristic curve analysis and a logistic regression model. RESULTS: 72 out of 235 patients (mean±sd age 55.5±14.6 years, 40% female) screened by chest CT showed evidence for COVID-19 pneumonia. In these patients, A-a gradient was shown to be a predictor of need for hospitalisation, with an optimal decision level (cut-off) of 36.4 mmHg (95% CI 0.70-0.91, p<0.001). The A-a gradient was shown to be independently associated with need for hospitalisation (OR 1.97 (95% CI 1.23-3.15), p=0.005; A-a gradient per 10 points) from CT severity score (OR 1.13 (95% CI 0.94-1.36), p=0.191), National Early Warning Score (OR 1.19 (95% CI 0.91-1.57), p=0.321) or peripheral oxygen saturation (OR 0.88 (95% CI 0.68-1.14), p=0.345). CONCLUSION: Low-dose chest CT and the A-a gradient may serve as rapid and accurate tools to diagnose COVID-19 pneumonia and to select mildly symptomatic patients in need for hospitalisation.