ABSTRACT
Background: Peripheral nervous (PNS) system involvement in SARS-CoV-2 infection has been described as a consequence of direct neurotropic invasion or parainfectious autoimmune spinal nerve demyelination in the clinical form of acute inflammatory demyelinating polyraduculoneuropathy (AIDP). Few cases have been described with cranial nerves involvement too. Description of the case: A 62 year-old male patient was admitted in March 2020 to our CoViD Unit in Miulli Hospital in Acquaviva delle Fonti (Bari) for recent onset of cough, fever, with interstitial pneumonia with peripheral and central ground glass opacities and consolidation at lungs CT. Oropharyngeal swab tested positive for SARS-CoV-2. Despite an early clinical and radiological remission, the swab became negative after two months. In May, he came back to our attention for chest pain and fever with echocardiography documenting pericardial effusion;SARS-CoV-2 swab was positive again. Some weeks later, he presented weakness in both legs ascending to arms, with severe fatigue and iporeflexia followed in a few days by bilateral facial palsy. Cerebrospinal fluid (CSF) analysis and electromyography (EMG) were suggestive for AIDP, so we started infusion of human immunoglobulins, with immediate partial recovery followed by complete recovery in a few weeks after rehabilitation. Conclusions: The persistence of SARS-CoV-2 induces an abnormal immunological activation that may result in neurologic issues such as involvement of peripheral nervous system (PNS) with spinal - and in some cases - cranial nerves inflammatory demyelination.
ABSTRACT
Background: SARS-CoV2 infection is frequently associated withcardiovascular and neurological manifestations, but pericardiumand Peripheral Nervous System (PNS) are rarely involved. Case Report: A 61 year-old man was admitted in March 2020 tothe Covid Unit of Miulli Hospital in Acquaviva delle Fonti (Bari) forfever, cough and oropharyngeal swab positive for SARS-CoV2. Hiscomorbidities were hypertension and obesity. Laboratory testsshowed high levels of inflammatory proteins and the presence ofIgM for Chlamydia. Computed Tomography (CT) documented pneumonia with bilateral peripheral and central ground glass opacitiesand little areas of consolidation. He was treated with hydroxychloroquine, ritonavir and quinolone. Despite an early clinical andradiological remission, the swab became negative after twomonths. In May the patient returned for chest pain and fever.SARS-CoV2 swab resulted positive again. Transthoracic Echocardiography (TTE) documented mild pericardial effusion that reducedafter ibuprofen. In June the patient presented to the EmergencyDepartment for weekness in both legs and arms, severe fatigueand evidence of simmetric iporeflexia. He tested negative forSARS-CoV2. Cerebrospinal Fluid (CSF) and Electromyography(EMG) were diagnostic for Guillain-Barrè Syndrome (GBS), AcuteInflammatory Demyelinating Polyradiculoneuropathy (AIDP) type,so we started infusion of human immunoglobulins. Conclusions: The persistence of SARS-CoV2 viral RNA induces anabnormal immunological activation that may damage pericardiumand Peripheral Nervous System (PNS).
ABSTRACT
Background and Aim of the study: The SARS-CoV 2 pandemicinvolved about 230.00 people in Italy with about 35.000 deaths.In China the lethality rate of confirmed cases is 4.7% in men compared to 2.8% in women. In Italy women represent 34.0% of thetotal and are older than men (respectively 83 years vs 79). A single-center observational cohort study was conducted to evaluategender differences in clinical features, laboratory, length of stayand mortality in patients admitted in sub-intensive COVID Unit ofF. Miulli Hospital (Acquaviva delle Fonti, Bari, Italy) from 17 marchto 17 may 2020.Materials and Methods: The data contained in the medicalrecords were studied.Results: A total of 174 patients were analyzed. Females accountfor 39.6%. The average age was 66 yrs and 70 yrs respectively inmales and females. No difference was observed with respect to themain inflammation markers (IL6, d-Dimer, CRP);the length of hospital stay was similar, 20 days in females and 21 days in males.Chronic heart failure, COPD, diabetes, chronic renal failure, wereequally represented in the two groups. Disease severity and mortalitywere similar. The only significant difference (p <0.02) was in the useof hydroxychloroquine, prevalent in the group of male subjects.Discussion and Conclusions: The data of our study, although witha limited sample of subjects, do not show significant differencesbetween males and females. Length of stay and mortality are notinfluenced by gender. We could conclude that when women getsick they feel the disease in the same way as men.