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1.
Ann Vasc Surg ; 76: 289-292, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1525692

ABSTRACT

To describe the case of a young female patient, affected by Systemic Lupus Erythematous, hospitalized for severe SARS-CoV-2 infection pneumonia and presenting a treatment-resistant acute upper limb ischemia. Two days after hospital admission, the patient suffered sudden right upper limb pain associated with mild functional impairment. At physical examination, radial and ulnar pulses were absent, and no flow signal was detected at duplex ultrasound scan. Therefore, an acute limb ischemia diagnoses was posed. Despite several surgical and endovascular revascularization attempts, the patient underwent an above the elbow amputation in 10th postoperative day from first surgical embolectomy, and she died for respiratory failure 25 days after hospitalization. Our case of acute upper limb ischemia seems to confirm that clinical manifestation and fate of thrombotic disorder in COVID-19 patients could be precipitated by concomitant autoimmune diseases.


Subject(s)
COVID-19/complications , Ischemia/etiology , Lupus Erythematosus, Systemic/complications , Upper Extremity/blood supply , Acute Disease , Amputation , COVID-19/diagnosis , COVID-19/therapy , Disease Progression , Embolectomy , Endovascular Procedures , Fatal Outcome , Female , Humans , Ischemia/diagnostic imaging , Ischemia/physiopathology , Ischemia/therapy , Lupus Erythematosus, Systemic/diagnosis , Middle Aged , Treatment Outcome
5.
Clin J Gastroenterol ; 14(6): 1655-1660, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1474148

ABSTRACT

COVID-19 pandemic is one of the most devastating worldwide crises in recent years. During this pandemic, people have been exposed to products that have not been proven to be safe and effective against COVID-19. We present an adult chronic consumer of chlorine dioxide, in which a fatal outcome is described. This case demonstrates that for people searching products to protect themselves from COVID-19, unregulated access to industrial disinfectants represents a dangerous alternative. To date, there is no scientific evidence to uphold the use of chlorine dioxide or chlorine derivatives as preventive or therapeutic agents against COVID-19. Researchers and general population must take into consideration the fatal possible consequences of not following communications and warnings from health authorities and government institutions.


Subject(s)
Chlorine Compounds/poisoning , Disinfectants/poisoning , Intestinal Perforation , Oxides/poisoning , Adult , COVID-19/prevention & control , Fatal Outcome , Humans , Intestinal Perforation/chemically induced , Pandemics
7.
Anaesthesist ; 70(2): 121-126, 2021 Feb.
Article in German | MEDLINE | ID: covidwho-1453674

ABSTRACT

A 59-year-old male patient was admitted to hospital diagnosed with moderate pneumonia associated with COVID-19. Upfront treatment with hydroxychloroquine and azithromycin was started. Due to a clinical deterioration (ARDS, circulatory shock) and greatly increased inflammation markers 6 days after admission, a cytokine storm was suspected and off-label treatment with the IL­6 receptor antagonist tocilizumab was initiated. Subsequently there was a dramatic rise of D­dimers indicating pulmonary intravascular coagulopathy and respiratory insufficiency worsened. After a second dose of tocilizumab was administered severe perimyocarditis with cardiac arrhythmia, hemodynamic instability and ST elevation occurred. Shortly afterwards the patient died due to multiorgan failure. From our experience, exacerbation of COVID-19 following treatment with tocilizumab cannot be ruled out. Randomized controlled studies are necessary to further investigate the efficacy, safety and patient selection criteria for tocilizumab treatment in COVID-19.


Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Antibodies, Monoclonal, Humanized/therapeutic use , Antiviral Agents/adverse effects , Antiviral Agents/therapeutic use , Blood Coagulation Disorders/etiology , COVID-19/drug therapy , Cytokine Release Syndrome/drug therapy , Myocarditis/etiology , Receptors, Interleukin-6/antagonists & inhibitors , Fatal Outcome , Humans , Male , Middle Aged , Multiple Organ Failure/etiology , Off-Label Use , Respiratory Distress Syndrome/etiology , Respiratory Insufficiency , Treatment Outcome
8.
Pan Afr Med J ; 39: 199, 2021.
Article in English | MEDLINE | ID: covidwho-1449267

ABSTRACT

Coronavirus disease 2019 (COVID-19) was first reported in December 2019. The disease is caused by severe acute respiratory syndrome virus corona virus 2 (SARS-CoV-2). Mild respiratory symptoms are the most common manifestations of SARS-CoV-2, but new signs are constantly being discovered as it spreads. Disorders of sodium balance are increasingly described in patients with SARS-CoV-2. We report, here, the cases of two patients presented with COVID-19 and in whom we discovered sodium disorders. The first patient is a 74-year-old man who presented with fatal hypernatremia. The second patient is a 66-years-old man presented with COVID-19 and euvolemic hyponatremia attributed to syndrome of inappropriate anti-diuretic hormone secretion (SIADH). This hyponatremia persisted long after the respiratory signs disappeared. Sodium balance disorders are increasingly described in the literature; special attention should be paid to the electrolyte status of COVID-19 patients. Pathophysiological mechanisms associating SARS-CoV-2 with these disorders are being studied.


Subject(s)
COVID-19/complications , Hypernatremia/virology , Inappropriate ADH Syndrome/virology , Aged , Fatal Outcome , Humans , Hypernatremia/diagnosis , Hyponatremia/diagnosis , Hyponatremia/virology , Inappropriate ADH Syndrome/diagnosis , Male , Sodium/blood
9.
BMC Infect Dis ; 21(1): 736, 2021 Aug 03.
Article in English | MEDLINE | ID: covidwho-1435224

ABSTRACT

BACKGROUND: Capnocytophaga canimorsus (C. canimorsus) infections are rare and usually present with unspecific symptoms, which can eventually end in fatal septic shock and multiorgan failure. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) related coronavirus disease 2019 (COVID-19), on the other hand, is predominantly characterized by acute respiratory failure, although other organ complications can occur. Both infectious diseases have in common that hyperinflammation with a cytokine storm can occur. While microbial detection of C. canimorsus in blood cultures can take over 48 h, diagnosis of SARS-CoV-2 is facilitated by a widely available rapid antigen diagnostic test (Ag-RDT) the results of which are available within half an hour. These Ag-RDT results are commonly verified by a nucleic acid amplification test (NAAT), whose results are only available after a further 24 h. CASE PRESENTATION: A 68-year-old male patient with the diagnosis of COVID-19 pneumonia was referred to our Intensive Care Unit (ICU) from another hospital after testing positive on an Ag-RDT. While the initial therapy was focused on COVID-19, the patient developed a fulminant septic shock within a few hours after admission to the ICU, unresponsive to maximum treatment. SARS-CoV-2 NAATs were negative, but bacteremia of C. canimorsus was diagnosed post-mortem. Further anamnestic information suggest that a small skin injury caused by a dog leash or the subsequent contact of this injury with the patient's dog could be the possible point of entry for these bacteria. CONCLUSION: During the acute phase of hyperinflammation and cytokine storm, laboratory results can resemble both, sepsis of bacterial origin or SARS-CoV-2. This means that even in the light of a global SARS-CoV-2 pandemic, where this diagnosis provides the most salient train of thoughts, differential diagnoses must be considered. Ag-RDT can contribute to early detection of a SARS-CoV-2 infection, but false-positive results may cause fixation errors with severe consequences for patient outcome.


Subject(s)
Bacteremia , COVID-19 , Shock, Septic , Capnocytophaga , Fatal Outcome , Humans , Male , SARS-CoV-2 , Shock, Septic/diagnosis
10.
BMJ Open Respir Res ; 8(1)2021 09.
Article in English | MEDLINE | ID: covidwho-1430194

ABSTRACT

There have been a few reports of successful lung transplantation (LTx) in patients with SARS-CoV-2-induced acute respiratory distress syndrome (ARDS); however, all reports were with rather short follow-up. Here we present a 62-year-old man without prior lung diseases. Following SARS-CoV-2-induced ARDS and 6 months of extracorporeal membrane oxygenation, he underwent LTx. 3 months post-transplantation he developed acute hypoxia requiring emergency intubation. Chest imaging showed acute rejection, and de novo DQ8-DSA was discovered. He was treated with a high dose of corticosteroids and plasmapheresis and was extubated 4 days later, yet the de novo DQ8-DSA remained. After sessions of plasmapheresis and rituximab, the levels of de novo DQ8-DSA remained unchanged. Nine months post-transplantation the patient died of respiratory failure. We herein discuss the decision to transplant, the transplantation itself and the postoperative course with severe antibody-mediated rejection. In addition, we evaluated the histological changes of the explanted lungs and compared these with end-stage idiopathic pulmonary fibrosis tissue, where both similarities and differences are seen. With the current case experience, one might consider close monitoring regarding DSA, and gives further support that LTx should only be considered for very carefully selected patients.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Graft Rejection/virology , Lung Transplantation , Respiratory Distress Syndrome , COVID-19/complications , Fatal Outcome , Humans , Lung Transplantation/adverse effects , Male , Middle Aged , Respiratory Distress Syndrome/therapy , Respiratory Distress Syndrome/virology
19.
BMC Pulm Med ; 21(1): 278, 2021 Aug 31.
Article in English | MEDLINE | ID: covidwho-1381257

ABSTRACT

BACKGROUND: There are various reasons for delayed positive nasopharyngeal PCR tests for coronavirus disease 2019 (COVID19) in not only asymptomatic but also severely diseased patients. The pathophysiological attributes are not known. We explore this possibility through a case report. CASE PRESENTATION: A 64-year-old male with history of pulmonary fungal infection, asthma and chronic pulmonary obstructive disease (COPD), diabetes, coronary artery disease presented with shortness of breath, fever and chest image of ground opacity, reticular interstitial thickening, highly suspicious for COVID19. However, nasopharyngeal swab tests were discordantly negative for four times in two weeks, and IgG antibody for COVID19 was also negative. However, serum IgE level was elevated. No other pathogens are identified. His symptoms deteriorated despite corticosteroid, antibiotics and bronchodilator treatment. Bronchoalveolar lavage (BAL) and open lung wedge biopsy were performed for etiology diagnosis. They demonstrated COVID19 viral RNA positive fibrosing organizing pneumonia with respiratory tract damage characterized by suspicious viral cytopathic effect, mixed neutrophilic, lymphoplasmacytic, histiocytic and eosinophilic inflammation and fibrosis besides expected asthma and COPD change. One week later, repeated COVID19 nasopharyngeal tests on day 40 and day 49 became positive. CONCLUSION: Our case and literature review indicate that allergic asthma and associated high IgE level together with corticosteroid inhalation might contribute to the delayed positive nasopharyngeal swab in upper airway; COPD related chronic airways obstruction and the addition of fibrosis induced ventilator dependence and poor prognosis in COVID19 pneumonia, and should be therapeutically targeted besides antiviral therapy.


Subject(s)
COVID-19 Nucleic Acid Testing , COVID-19/diagnosis , Delayed Diagnosis , Nasopharynx/virology , SARS-CoV-2/isolation & purification , Administration, Inhalation , Adrenal Cortex Hormones/therapeutic use , Asthma/complications , Asthma/drug therapy , Asthma/pathology , Bronchoalveolar Lavage , COVID-19/complications , COVID-19/therapy , Fatal Outcome , Humans , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Disease, Chronic Obstructive/pathology , Reverse Transcriptase Polymerase Chain Reaction
20.
J Med Microbiol ; 70(8)2021 Aug.
Article in English | MEDLINE | ID: covidwho-1376363

ABSTRACT

Following prolonged hospitalization that included broad-spectrum antibiotic exposure, a strain of Providencia rettgeri was cultured from the blood of a patient undergoing extracorporeal membrane oxygenation treatment for hypoxic respiratory failure due to COVID-19. The strain was resistant to all antimicrobials tested including the novel siderophore cephalosporin, cefiderocol. Whole genome sequencing detected ten antimicrobial resistance genes, including the metallo-ß-lactamase bla NDM-1, the extended-spectrum ß-lactamase bla PER-1, and the rare 16S methyltransferase rmtB2.


Subject(s)
Anti-Bacterial Agents/pharmacology , COVID-19/therapy , Drug Resistance, Bacterial , Enterobacteriaceae Infections/mortality , Pneumonia, Ventilator-Associated/mortality , Providencia/drug effects , Aged , COVID-19/complications , Enterobacteriaceae Infections/blood , Enterobacteriaceae Infections/etiology , Enterobacteriaceae Infections/microbiology , Extracorporeal Membrane Oxygenation , Fatal Outcome , Humans , Male , Microbial Sensitivity Tests , Pneumonia, Ventilator-Associated/etiology , Pneumonia, Ventilator-Associated/microbiology , Providencia/genetics , Providencia/isolation & purification
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