Multisystem Inflammatory Syndrome in Adults Associated with Recent Infection with COVID-19.

Multisystem inflammatory syndrome in adults (MIS-A) is an uncommon but severe and still understudied post-infectious complication of COVID-19. Clinically, the disease manifests itself most often 2-6 weeks after overcoming the infection. Young and middle-aged patients are especially affected. The clinical picture of the disease is very diverse. The dominant symptoms are mainly fever and myalgia, usually accompanied by various, especially extrapulmonary, manifestations. Cardiac damage (often in the form of cardiogenic shock) and significantly increased inflammatory parameters are often associated with MIS-A, while respiratory symptoms, including hypoxia, are less frequent. Due to the seriousness of the disease and the possibility of rapid progression, the basis of a successful treatment of the patient is early diagnosis, based mainly on anamnesis (overcoming the disease of COVID-19 in the recent past) and clinical symptoms, which often imitate other severe conditions such as, e.g., sepsis, septic shock, or toxic shock syndrome. Because of the danger of missing the treatment, it is necessary to initiate it immediately after the suspicion of MIS-A is expressed, without waiting for the results of microbiological and serological examinations. The cornerstone of pharmacological therapy is the administration of corticosteroids and intravenous immunoglobulins, to which the majority of patients clinically react. In this article, the authors describe the case report of a 21-year-old patient admitted to the Clinic of Infectology and Travel Medicine for febrility up to 40.5 °C, myalgia, arthralgia, headache, vomiting, and diarrhea three weeks after overcoming COVID-19. However, as part of the routine differential diagnosis of fevers (imaging and laboratory examinations), their cause was not clarified. Due to the overall worsening of the condition, the patient was transferred to the ICU with suspicion of developing MIS-A (he met all clinical and laboratory criteria). Given the above, reserve antibiotics, intravenous corticosteroids, and immunoglobulins were added to the treatment due to the risk of missing them, with a good clinical and laboratory effect. After stabilizing the condition and adjusting the laboratory parameters, the patient was transferred to a standard bed and sent home.

Delayed Spontaneous Pneumothorax in a Previously Healthy Nonventilated COVID-19 Patient.

Spontaneous pneumothorax is a serious and life-threatening complication of SARS-CoV-2 pneumonia. It most commonly occurs during the acute phase of the disease in patients with pre-existing lung disease (e.g. emphysema, bronchiectasis, cystic fibrosis, etc.) and in patients who require oxygen supplementation in any form (low-flow oxygen therapy, high-flow non-invasive or mechanical invasive or mechanical invasion). A rare case of a 52-year-old patient with a spontaneous pneumothorax who developed four weeks after PCR SARS-CoV-2 positivity was described. Interestingly, the patient did not have any factors that the literature considered risky for the development of this complication. During the acute phase of the disease, his condition did not require hospitalization. Imaging examinations could not clarify the cause of pneumothorax. With this case report, we want to point out the fact that spontaneous pneumothorax, as a rare and life-threatening complication of COVID-19 infection, may develop during recovery, and it is necessary to think about this complication in the differential diagnosis of dyspnoea.

Intravenous veterinary ivermectin in a COVID-19 patient causing neurotoxicity.

Ivermectin administration for Coronavirus disease 2019 (COVID-19) infection has gained a lot of attention recently. Although ivermectin has a relatively good safety profile, serious adverse events may occur in patients given doses that are presumed experimental. Ivermectin for human use is available only as an oral formulation. Parenteral administration, as a subcutaneous injection, is possible in veterinary medicine only. In this brief report we describe an unprecedented case of a patient with severe neurotoxicity after intravenous administration of veterinary ivermectin for confirmed COVID-19 infection. The patient required hospitalization in the intensive care unit (ICU). The toxic serum concentration of ivermectin was determined by liquid chromatography/mass spectrometry - time of flight (LC/MS-TOF) with the value of 187.74 ng/mL.