ABSTRACT
INTRODUCTION: The proliferation of literature regarding the COVID-19 pandemic has served to highlight a wide spectrum of disease manifestations and complications, such as thrombotic microangiopathies. Our review with a brief case presentation highlights the increasing recognition of TTP in COVID-19 and describes its salient characteristics. METHODS: We screened the available literature in PubMed, EMBASE, and Cochrane databases from inception until April 2022 of articles mentioning COVID-19-associated TTP in English language. RESULTS: From 404 records, we included 8 articles mentioning data of 11 patients in our review. TTP was predominantly reported in females (72%) with a mean age of 48.2 years (SD 15.1). Dyspnea was the most common symptom in one third of patients (36.6%). Neurological symptoms were reported in 27.3% of cases. The time to diagnosis of TTP was 10 days (SD 5.8) from onset of COVID-19. All 11 cases underwent plasma exchange (PLEX), with a mean of 12 sessions per patient, whereas 6 cases received Rituximab (54.5%), and 3 received Caplacizumab (27.3%). One patient died from the illness. CONCLUSION: This review of available literature highlights the atypical and refractory nature of COVID-19-associated TTP. It required longer sessions of PLEX, with half of the patients receiving at least one immunosuppressant.
ABSTRACT
Research Objectives To report a case of COVID-19 associated necrotizing myopathy. Design Case report. Setting Following the patient through acute hospitalization, acute rehab to outpatient therapy follow up. Participants A 76-year-old man with known hypogammaglobulinemia on monthly IVIG infusions who presented to the hospital with 1 week of dyspnea and myalgias. He was a former athlete who participated in daily cardiovascular workouts before admission. He was found to have COVID-19 pneumonia. Interventions Patient was treated with remdesivir and oral dexamethasone. He was transferred to the ICU for 9 days where he received convalescent plasma, intravenous methylprednisolone, and high flow oxygen. He did not require intubation nor sedatives. Main Outcome Measures Following transfer to the floor, he reported new-onset muscle weakness. Physical examination revealed symmetrical proximal upper and lower extremity weakness with elevated CK at 3665 IU/L. His atorvastatin was held, and steroids were tapered. However, his creatinine kinase continued to rise, peaking at 8335 IU/L. High dose methylprednisolone was resumed with improvement in creatinine kinase. Extensive myositis panel and Anti HMGCR antibody were normal. Thyroid studies revealed transient thyroiditis thought to be induced by COVID-19 infection that did not require treatment. Results Right thigh MRI revealed edema of the lateral thigh muscles. Biopsy of the quadriceps showed necrotizing myopathy. Electromyography and NCS revealed inflammatory/immune myositis. Findings were not typical for a steroid, endocrine, or disuse myopathy. He was discharged to an IRF at a dependent level with bilateral hip flexor strength 2/5, triceps 3+/5, and the remainder of his extremity muscles 5/5. By day 40, he was independent with a rolling walker with significant gains in strength. Conclusions Timely recognition of COVID-19 related myopathy may prevent serious necrotizing muscle injury. Author(s) Disclosures None.
ABSTRACT
A 76-year-old man with hypogammaglobulinemia on monthly intravenous immunoglobulin infusions presented to the hospital with fever, cough, and shortness of breath and was diagnosed with COVID-19 pneumonia requiring intensive care unit admission but not intubation. He was treated with convalescent plasma, remdesivir and corticosteroids. Sixteen days into his hospitalisation he began to report weakness without sensory symptoms and was found on biopsy to have a necrotising myopathy.