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1.
Pediatr Infect Dis J ; 40(8): e312-e313, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1214709

ABSTRACT

A spectrum of dermatologic manifestations has been reported in multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection. We report 2 patients with multisystem inflammatory syndrome in children and severe cardiovascular dysfunction who developed acral gangrene. Both responded well to therapy and recovered in the follow-up.


Subject(s)
COVID-19/pathology , Gangrene/virology , Systemic Inflammatory Response Syndrome/pathology , COVID-19/diagnostic imaging , COVID-19/physiopathology , COVID-19/virology , Child , Family , Gangrene/diagnostic imaging , Gangrene/pathology , Gangrene/physiopathology , Humans , Male , SARS-CoV-2/isolation & purification , Systemic Inflammatory Response Syndrome/diagnostic imaging , Systemic Inflammatory Response Syndrome/physiopathology , Systemic Inflammatory Response Syndrome/virology
2.
BMJ Case Rep ; 14(1)2021 Jan 26.
Article in English | MEDLINE | ID: covidwho-1050387

ABSTRACT

Novel COVID-19 continues to intrigue medical professionals with its varied presentations. Though it affects the respiratory tract primarily, thrombogenesis has been the Achilles' heel. A 44-year-old man diagnosed with COVID-19 presented with upper limb pain at a local hospital and was found to have thrombosis of the right axillary artery. Despite a successful embolectomy at the local hospital, there was re-occlusion of the axillary artery and the limb became ischaemic. He was referred to our institution by which time the limb became gangrenous above the elbow and had to be amputated. Extensive sloughing of the nerves was also seen in the local area. Hypercoagulability presenting with various manifestations is common in COVID-19 and needs early anticoagulation. We present this asymptomatic patient who lost a limb to this COVID-19 sequelae.


Subject(s)
Amputation , Arm/surgery , Axillary Artery , COVID-19/complications , Gangrene/surgery , Ischemia/surgery , Thrombosis/complications , Adult , Arm/blood supply , Arm/pathology , Axillary Artery/surgery , Embolectomy , Gangrene/etiology , Gangrene/pathology , Humans , Ischemia/etiology , Ischemia/pathology , Male , Recurrence , SARS-CoV-2 , Thrombosis/surgery
4.
World J Emerg Surg ; 15(1): 43, 2020 07 02.
Article in English | MEDLINE | ID: covidwho-621542

ABSTRACT

BACKGROUND: Since its first documentation, a novel coronavirus (SARS-CoV-2) infection has emerged worldwide, with the consequent declaration of a pandemic disease (COVID-19). Severe forms of acute respiratory failure can develop. In addition, SARS-CoV-2 may affect organs other than the lung, such as the liver, with frequent onset of late cholestasis. We here report the histological findings of a COVID-19 patient, affected by a tardive complication of acute ischemic and gangrenous cholecystitis with a perforated and relaxed gallbladder needing urgent surgery. CASE PRESENTATION: A 59-year-old Caucasian male, affected by acute respiratory failure secondary to SARS-CoV-2 infection was admitted to our intensive care unit (ICU). Due to the severity of the disease, invasive mechanical ventilation was instituted and SARS-CoV-2 treatment (azithromycin 250 mg once-daily and hydroxychloroquine 200 mg trice-daily) started. Enoxaparin 8000 IU twice-daily was also administered subcutaneously. At day 8 of ICU admission, the clinical condition improved and patient was extubated. At day 32, patient revealed abdominal pain without signs of peritonism at examination, with increased inflammatory and cholestasis indexes at blood tests. At a first abdominal CT scan, perihepatic effusion and a relaxed gallbladder with dense content were detected. The surgeon decided to wait and see the evolution of clinical conditions. The day after, conditions further worsened and a laparotomic cholecystectomy was performed. A relaxed and perforated ischemic gangrenous gallbladder, with a local tissue inflammation and perihepatic fluid, was intraoperatively met. The gallbladder and a sample of omentum, adherent to the gallbladder, were also sent for histological examination. Hematoxylin-eosin-stained slides display inflammatory infiltration and endoluminal obliteration of vessels, with wall breakthrough, hemorrhagic infarction, and nerve hypertrophy of the gallbladder. The mucosa of the gallbladder appears also atrophic. Omentum vessels also appear largely thrombosed. Immunohistochemistry demonstrates an endothelial overexpression of medium-size vessels (anti-CD31), while not in micro-vessels, with a remarkable activity of macrophages (anti-CD68) and T helper lymphocytes (anti-CD4) against gallbladder vessels. All these findings define a histological diagnosis of vasculitis of the gallbladder. CONCLUSIONS: Ischemic gangrenous cholecystitis can be a tardive complication of COVID-19, and it is characterized by a dysregulated host inflammatory response and thrombosis of medium-size vessels.


Subject(s)
Cholecystectomy/methods , Cholecystitis , Coronavirus Infections , Gallbladder , Gangrene , Omentum , Pandemics , Pneumonia, Viral , Spontaneous Perforation , Betacoronavirus/isolation & purification , COVID-19 , Cholecystitis/etiology , Cholecystitis/pathology , Cholecystitis/physiopathology , Cholecystitis/surgery , Coronavirus Infections/complications , Coronavirus Infections/immunology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Critical Care/methods , Gallbladder/blood supply , Gallbladder/diagnostic imaging , Gallbladder/pathology , Gangrene/etiology , Gangrene/pathology , Humans , Immunohistochemistry , Infarction/etiology , Infarction/pathology , Laparoscopy/methods , Male , Middle Aged , Omentum/blood supply , Omentum/pathology , Pneumonia, Viral/complications , Pneumonia, Viral/immunology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , SARS-CoV-2 , Spontaneous Perforation/diagnosis , Spontaneous Perforation/etiology , Spontaneous Perforation/physiopathology , Spontaneous Perforation/surgery , Thrombosis/etiology , Thrombosis/pathology , Treatment Outcome
5.
Eur Rev Med Pharmacol Sci ; 24(10): 5769-5771, 2020 May.
Article in English | MEDLINE | ID: covidwho-547467

ABSTRACT

OBJECTIVE: Coronavirus disease 2019 (COVID-19) related coagulopathy may be the first clinical manifestation even in non-vasculopathic patients and is often associated with worse clinical outcomes. CASE PRESENTATION: A 78 years old woman was admitted to the Emergency Unit with respiratory symptoms, confusion and cyanosis at the extremity, in particular at the nose area, hands and feet fingers. A nasal swab for COVID-19 was performed, which resulted positive, and so therapy with doxycycline, hydroxychloroquine and antiviral agents was started. At admission, the patient was hemodynamically unstable requiring circulatory support with liquids and norepinephrine; laboratory tests showed disseminated intravascular coagulation (DIC). During hospitalization, the clinical condition worsened and the cyanosis of the nose, fingers, and toes rapidly increased and became dried gangrene in three days. Subsequently, the neurological state deteriorated into a coma and the patient died. DISCUSSION: In severe cases, COVID-19 could be complicated by acute respiratory disease syndrome, septic shock, and multi-organ failure. This case report shows the quick development of dried gangrene in a non-vasculopathic patient, as a consequence of COVID-19's coagulopathy and DIC. CONCLUSIONS: In our patient, COVID-19 related coagulopathy was associated with poor prognosis.


Subject(s)
Coronavirus Infections/diagnosis , Gangrene/diagnosis , Pneumonia, Viral/diagnosis , Acute Disease , Aged , Antiviral Agents/therapeutic use , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/drug therapy , Coronavirus Infections/pathology , Coronavirus Infections/virology , Disseminated Intravascular Coagulation/diagnosis , Disseminated Intravascular Coagulation/etiology , Doxycycline/therapeutic use , Female , Fingers/pathology , Gangrene/pathology , Humans , Hydroxychloroquine/therapeutic use , Nasal Cavity/virology , Nose/pathology , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , SARS-CoV-2 , Severity of Illness Index
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