Lithium Toxicity in Two Coronavirus Disease 2019 (COVID-19) Patients

Coronavirus disease 2019 (COVID-19) is a highly contagious disease, which is currently causing a devastating pandemic resulting in more than millions of infected cases worldwide. Emerging evidence reports the impact of several co-morbidities on the clinical features and outcomes of COVID-19. However, the evidence regarding the association of mental health illnesses and psychiatric treatment on the prognoses of COVID-19 is still lacking. Lithium is a commonly prescribed psychiatric medication that is also well known for its highly lethal toxicity. Many factors can fluctuate the level of lithium, such as drug interaction, illness, and infection. Prompt recognition and management of lithium intoxication is required to reduce patients' morbidity and mortality. Currently, there is no report regarding COVID-19 and lithium toxicity. Herein, we are presenting two patients with COVID-19 who initially presented with signs and symptoms of lithium toxicity. Our cases emphasize the need for special attention in taking care of patients who are taking lithium during the COVID-19 pandemic. In general, we recommend obtaining lithium levels in all patients who have been taking lithium and have the diagnosis of COVID-19.

Newly diagnosed diabetes mellitus, DKA, and COVID-19: Causality or coincidence? A report of three cases.

Novel coronavirus disease 2019 (COVID-19), a 2020 pandemic, has resulted in an unexpected loss in lives, quality of life, and the economy. The COVID-19 clinical spectrum varies from asymptomatic to death, and its complications may involve various organs. Notwithstanding, the impact of COVID-19 on endocrine systems is understudied. Previous coronavirus outbreaks such as severe acute respiratory syndrome coronavirus can cause new-onset diabetes mellitus (DM). However, there were only two previous case reports on newly diagnosed DM in COVID-19 patients. Here, we described three patients who had newly diagnosed DM associated with COVID-19. COVID-19 likely unmasked existing DM by aggravating its metabolic complications rather than causing the new-onset DM in these patients. However, more research is needed to evaluate if there is a casual relationship between the development of DM, DKA, and COVID-19.

SARS-CoV-2 seroprevalence among health care workers in a New York City hospital: A cross-sectional analysis during the COVID-19 pandemic.

BACKGROUND: New York City (NYC) has endured the greatest burden of COVID-19 infections in the US. Health inequities in South Bronx predisposed this community to a large number of infectious cases, hospitalizations, and mortality. Health care workers (HCWs) are at a high risk of exposure to the infection. This study aims to assess seroprevalence and the associated characteristics of consenting HCWs from an NYC public hospital. METHODS: This cross-sectional study includes serum samples for qualitative SARS-CoV-2 antibody testing with nasopharyngeal swabs for SARS-CoV-2; PCR and completion of an online survey capturing demographics, COVID-19 symptoms during the preceding months on duty, details of healthcare and community exposure, and travel history were collected from consenting participants in May 2020. Participants' risk of exposure to COVID-19 infection in the hospital and in the community was defined based on CDC guidelines. Travel history to high-risk areas was also considered an additional risk. The Odds Ratio with bivariable and multivariable logistic regression was used to assess characteristics associated with seroprevalence. RESULTS: A total of 500 HCW were tested, 137 (27%) tested positive for the SARS-CoV-2 antibody. Symptomatic participants had a 75% rate of seroconversion compared to those without symptoms. Subjects with anosmia and ageusia had increased odds of seroconversion in comparison to those without these symptoms. Community exposure was 34% among those who had positive antibodies. CONCLUSION: Seroprevalence among HCWs was high compared to the community at the epicenter of the pandemic. Further studies to evaluate sustained adaptive immunity in this high-risk group will guide our response to a future surge.

Bilateral Popliteal Vein Thrombosis, Acute Pulmonary Embolism and Mild COVID-19.

In 2020, the coronavirus disease 2019 (COVID-19) has become a global health disaster. Patients with COVID-19 have variable clinical features and unpredictable prognoses; the infectious complication may occur in many organs, causing a broad spectrum of symptoms and severity. Pulmonary embolism (PE) is a fatal urgent complication, which may occur following a severe infection. While the pathogenesis of PE in COVID-19 remains uncertain, it has mainly occurred in patients with severe disease. PE, as an initial presentation of COVID-19 in a patient with mild diseases, is rare and understudied. Here, we describe a young woman with mild COVID-19 illness and no significant risk factors for PE, except obesity, but had developed bilateral popliteal vein thrombosis and submassive PE. Our case emphasizes that thrombotic complications can occur in any COVID-19 patients regardless of the disease severity, questioning the role of preventive anticoagulants in mild COVID-19 cases with certain risk factors.

Hyperpyrexia in patients with COVID-19.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global health emergency, in which its effective treatment and prevention remain obscured. Hyperpyrexia is an elevation of body temperature above 106.7°F (41.5°C) due to an abnormally increased hypothalamic-thermoregulatory set. The pathophysiology, impact, and outcomes of hyperpyrexia in patients with COVID-19 have not yet been studied. Herein, we present clinical features and outcomes of six patients with COVID-19 who had developed hyperpyrexia during hospitalization. All patients expired shortly after the onset of hyperpyrexia. Hyperpyrexia seems to adversely impact the outcomes and mortality in patients with COVID-19. The underlying mechanisms of developing hyperpyrexia in COVID-19 are mysterious. We propose it may be caused by SARS-CoV-2-related brain injury, exuberant immune response, and thrombus formation. More research is needed to verify our results. Understanding the association between hyperpyrexia and SARS-CoV-2 will help to elucidate the COVID-19 pathogenesis, which is mandatory for developing effective treatment strategies.

Pseudo-Appendicitis in an Adolescent With COVID-19.

Coronavirus disease 2019 (COVID-19) pandemic is a global health emergency in 2020. Patients with COVID-19 may present with variable clinical features, involving pulmonary, gastrointestinal, neurological, and cardiovascular symptoms. Notwithstanding, the acute abdomen as a presentation of COVID-19 is rare. We report an adolescent with confirmed COVID-19, initially presented with acute abdominal pain mimicking appendicitis. Our case highlights the inaccuracy of using clinical diagnosis for surgical abdomen in the COVID-19 era. Clinicians should perform screening COVID-19 tests in patients presenting with acute abdominal pain before admitting the patients to implement proper preventive measures in order to reduce viral transmission to other patients and healthcare professionals. Confirmed COVID-19 patients with acute abdomen may need proper imaging tests before surgery to avoid iatrogenic complications.

Lithium Toxicity in Two Coronavirus Disease 2019 (COVID-19) Patients.

Coronavirus disease 2019 (COVID-19) is a highly contagious disease, which is currently causing a devastating pandemic resulting in more than millions of infected cases worldwide. Emerging evidence reports the impact of several co-morbidities on the clinical features and outcomes of COVID-19. However, the evidence regarding the association of mental health illnesses and psychiatric treatment on the prognoses of COVID-19 is still lacking. Lithium is a commonly prescribed psychiatric medication that is also well known for its highly lethal toxicity. Many factors can fluctuate the level of lithium, such as drug interaction, illness, and infection. Prompt recognition and management of lithium intoxication is required to reduce patients' morbidity and mortality. Currently, there is no report regarding COVID-19 and lithium toxicity. Herein, we are presenting two patients with COVID-19 who initially presented with signs and symptoms of lithium toxicity. Our cases emphasize the need for special attention in taking care of patients who are taking lithium during the COVID-19 pandemic. In general, we recommend obtaining lithium levels in all patients who have been taking lithium and have the diagnosis of COVID-19.

Fatal Outcome in a Kidney-Pancreas Transplant Recipient With COVID-19.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious pathogen causing the novel coronavirus disease 2019 (COVID-19), the ongoing unprecedented pandemic in 2020. SARS-CoV-2 primarily targets the respiratory systems, so acute respiratory distress syndrome is the major cause of death. Clinical courses of COVID-19 are variable and unpredictable, while some epidemiologic and clinical factors have been found to have a negative impact on the disease prognosis. Despite a growing report on clinical characteristics and prognosis of patients with COVID-19, the data in the special population, including transplant recipients, is still limited. Herein we report on the clinical features and fatal outcome of COVID-19 in a dual pancreas-kidney transplant recipient (with failure of the pancreas graft). Our case illustrates the similarities and differences of the COVID-19 disease course between transplant recipients and the general population. We proposed that the pre-existing T-cell dysfunction from the long-term use of immunosuppressive agents in organ transplant recipients adversely affects COVID-19 prognosis and worsens COVID-19 mortality.

Successful Conservative Management of Acute Appendicitis in a Coronavirus Disease 2019 (COVID-19) Patient.

Appendectomy is the gold standard of treatment for acute appendicitis; however, recent evidence suggests conservative management with intravenous antibiotics may provide similar outcomes and can be used as an alternative in selected patients. Performing appendectomy in acute appendicitis patients with 2019 novel Coronavirus Disease (COVID-19) is challenging, as it involves considerable operative risks for the patients and risks for health care professionals (HCPs) exposed to COVID-19. Medical management eliminates the morbidity and mortality associated with surgery but involves significant risks of treatment failures that, in turn, may lead to perforation, peritonitis, and death. We are reporting a case of a middle-aged man with multiple co-morbidities, who was diagnosed with COVID-19 and acute appendicitis. Our patient received intravenous antibiotics for seven days with a significant improvement in symptoms. Our case report illustrates the implementation of successful conservative treatment for acute appendicitis in COVID-19 patients.

Rhabdomyolysis as a Presentation of 2019 Novel Coronavirus Disease.

An emerging viral infection is a global public health challenge. The development of modern, fast, and extensive transportation makes the outbreak hard to contain. Everyone is at risk, and the outbreak can rapidly turn into a pandemic crisis, like what we are currently facing for the 2019 novel coronavirus disease (COVID-19). Prompt diagnosis of the case is required to improve patients' prognosis and control of the outbreak. The common manifestations of COVID-19 include fever, cough, dyspnea, and malaise. However, patients may present with atypical symptoms that pose a diagnostic challenge. We report the first case of an elderly male who presented with rhabdomyolysis and later was diagnosed with COVID-19. Clinicians should be aware that rhabdomyolysis can be an initial presentation of COVID-19 or can occur at any time during the disease course. Patients with rhabdomyolysis should receive aggressive fluid administration to prevent acute kidney injury (AKI). However, COVID-19 patients are at risk of worsening oxygenation and acute hypoxemic respiratory failure from fluid overload. Therefore, cautious fluid administration is needed in COVID-19 patients with rhabdomyolysis.