ABSTRACT
Acute respiratory distress syndrome (ARDS) and pulmonary fibrosis (PF) are increasingly identified as complications of coronavirus disease 2019 (COVID-19) infection, the latter being managed with tapering dose glucocorticoids. Studies have shown improved outcomes with steroid use in this subset of patients; however, the use of high doses of steroids predisposes these patients to develop various complications such as opportunistic infections. The incidence of pulmonary cryptococcosis (PC) in patients with post-COVID-19 PF is not known. Here, we discuss a middle-aged male, with no pulmonary comorbidities, who developed PC secondary to the immunocompromised state from high-dose steroid use for the management of post-COVID-19 PF.
ABSTRACT
With the increasing number of COVID-19-associated nephropathy (COVAN), biopsy-proven cases of collapsing variety of focal segmental glomerulosclerosis (FSGS) are emerging. Though the recommendations on treatment for COVID-19-associated respiratory symptoms are evolving, there is still no definitive treatment for the collapsing FSGS secondary to COVAN. We report a case of a 47-year-old male admitted with acute kidney injury from COVID-19 infection and found to have collapsing FSGS on renal biopsy. Almost all the patients who were found to have similar conditions were treated with a relatively smaller dose of steroids and ultimately required dialysis. Our patient showed improvement with the trial of higher doses of steroids and never required dialysis. Hence, our case report emphasizes the need for a randomized controlled trial (RCT) with regard to the use of high-dose steroids in COVAN.
ABSTRACT
COVID-19 infection has cardiovascular manifestations such as acute myocarditis, arrhythmia, ischemic cardiomyopathy, heart failure, pericardial effusion, cardiac tamponade, and thromboembolism. The COVID-19 mRNA vaccines BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna), and viral vector vaccine Ad26.COV2.S (Johnson & Johnson - Janssen) were initially approved for emergency authorized use by the US-FDA. Cases of myocarditis were reported primarily in adolescents and young adults after administration of COVID-19 mRNA vaccines, with the subsequent emergence of cases of myocarditis after administration of viral vector vaccine Ad26.COV2.S. A majority of these cases were observed after the second dose of the mRNA vaccine. This case report demonstrates the occurrence of symptomatic myocarditis in a patient during acute COVID-19 infection, followed by recurrence of symptoms after the first dose of mRNA COVID-19 vaccine and subsequent recurrence of cardiac MRI-proven myocarditis after the second dose of mRNA COVID-19 vaccine. This case stands out due to the occurrence of symptoms with COVID-19 infection and after vaccination, suggesting possible incomplete interval resolution of infection-related myocarditis.