ABSTRACT
Cerebral vein thrombosis (CVT) is a rare condition equivalent to deep vein thrombosis of the intracranial veins. Delayed diagnosis will result in severe and disabling complications. We report a case of a 59-year-old man with CVT with no significant past medical or surgical history. On admission, he reported right-sided numbness and weakness concerns, preceded by the sudden onset of bilateral vision loss and dysarthria. Magnetic resonance imaging and computed tomography scans confirmed the diagnosis of CVT. The most interesting relative risk factor was flying overseas twice a month for the last 10 years; each flight was longer than eight hours. Another possible contributing factor to our patient's condition was polycythemia, with a hemoglobin level of 19, but the most questionable and puzzling is the recent coronavirus disease 2019 (COVID-19) vaccination two months, eight months, and one year prior to admission. Our case highlights a rare COVID-19 vaccine-related CVT diagnosis and that close monitoring for new symptoms and signs is vital to prevent life-threatening complications, herniation, and hemorrhagic transformation.
ABSTRACT
Spontaneous pneumomediastinum is an infrequent complication of COVID-19. The mechanism is still unknown and thought to be related to patient self-inflicted lung injury. Our patient is a 49-year-old male who presented with shortness of breath and cough. A COVID-19 Polymerase Chain Reaction was positive. He required a high-flow nasal cannula, but he did not demand mechanical ventilation. Computed tomography angiography scan of the chest revealed pneumomediastinum. He was managed conservatively, and a complete recovery was achieved. This case highlights the emerging association of COVID-19, patient self-inflicted lung injury, and pneumomediastinum. Furthermore, spontaneous pneumomediastinum should be suspected even in patients who were not mechanically ventilated.
ABSTRACT
Coronavirus disease 2019 (COVID-19) induces a dysregulated immune response, leading to a drastic elevation of proinflammatory cytokines. This cytokine storm has the potential to aggravate any prior ongoing inflammation. Moreover, acute pancreatitis can cause local necrosis, thereby causing extensive abdominal inflammation. This condition increases the risk of abdominal compartment syndrome (ACS) and its deleterious consequences. We report the case of a 37-year-old male with a past medical history of chronic pancreatitis and alcohol use disorder who presented to the emergency department complaining of abdominal pain. Physical examination revealed a tender abdomen. Initial workup showed elevated amylase and lipase, a positive COVID-19 polymerase chain reaction (PCR) test, and elevated inflammatory markers. The patient denied any respiratory symptoms. Initial abdominal CT scan revealed mild pancreatic inflammation. The patient was admitted to the respiratory ICU and managed with fluid resuscitation and pain control. However, the patient had increasing oxygen requirements, leukocytosis, and worsening kidney function. A trans-bladder measurement of intra-abdominal pressure revealed severe ACS. Broad-spectrum antibiotics were started; however, after 72 hours of treatment, the patient had a cardiopulmonary arrest. He returned to spontaneous circulation after advanced cardiovascular life support (ACLS) protocol and intubation. A repeat CT scan of the abdomen showed necrotizing pancreatitis with a large-volume hemoperitoneum. Urgent pancreatic necrosectomy was performed with drainage of the hemoperitoneum. The patient was transferred to a long-term acute care facility for extended antibiotic therapy where he eventually recovered. This case illustrates the catastrophic consequences of necrotizing pancreatitis complicated by sepsis and ACS in a COVID-19-positive patient.