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1.
Medicine (Baltimore) ; 101(25): e29243, 2022 Jun 24.
Article in English | MEDLINE | ID: covidwho-1909028

ABSTRACT

RATIONALE: Coronavirus disease 2019 (COVID-19) is a systemic disease with major clinical manifestations in the respiratory system. However, thyroid involvement has also been reported. We present a case of hypothyroidism with ventricular tachycardia following diagnosis with COVID-19. PATIENT CONCERNS: A 77-year-old man was admitted to the isolation ward due to COVID-19. After respiratory support and medical treatment, the patient was successfully weaned off the ventilator. However, an episode of short-run ventricular tachycardia was detected, and primary hypothyroidism was also diagnosed. DIAGNOSIS: Ventricular tachycardia was detected by electrocardiography. INTERVENTIONS: Intravenous amiodarone administration and oral levothyroxine replacement. OUTCOMES: No arrhythmia detected following treatment. LESSONS: Awareness of the association between hypothyroidism and COVID-19 is important in preventing possible complications.


Subject(s)
Amiodarone , COVID-19 , Hypothyroidism , Tachycardia, Ventricular , Aged , Amiodarone/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Arrhythmias, Cardiac/complications , COVID-19/complications , Electrocardiography , Humans , Hypothyroidism/complications , Hypothyroidism/diagnosis , Hypothyroidism/drug therapy , Male , Tachycardia, Ventricular/complications , Tachycardia, Ventricular/etiology
2.
Travel Med Infect Dis ; 47: 102314, 2022.
Article in English | MEDLINE | ID: covidwho-1747537

ABSTRACT

COVID-19 is a severe acute respiratory syndrome. Recent reports showed that autoimmune thyroiditis might occur following COVID-19 infection. We aimed to review the literature to assess the prevalence, clinical features and outcome of autoimmune thyroid disorders triggered by COVID-19. We reviewed case reports, case series, and observational studies of autoimmune thyroiditis including Graves' disease, Hashimoto thyroiditis, and silent thyroiditis developed in COVID-19 patients by searching PubMed, SCOPUS and Web of Science and included in the systematic review. Our search yielded no prevalence study. We noted 20 reported cases: Fourteen cases of Graves' disease, 5 cases of hypothyroidism due to Hashimoto's thyroiditis and one case of postpartum thyroiditis. The majority (16/20, 80%) were middle-aged (mean age: 40 years) female patients. Autoimmune thyroiditis was diagnosed either concomitantly or 7-90 days after the COVID-19 infection. Eight out of 14 cases with Graves' disease had a known thyroid disorder and they were stable in remission. One out of 5 cases with Hashimoto's thyroiditis had known prior hypothyroidism. The majority of the patients achieved remission within 3 months. One patient with thyroid storm due to Graves' disease and one patient with myxedema coma have died. Current data suggest that COVID-19 may cause autoimmune thyroid disease or exacerbate the underlying thyroid disease in remission. It is reasonable to routinely assess the thyroid functions both in the acute phase and during the convalescence so as not to overlook a thyroid disorder and not to delay treatment especially in patients with preexisting autoimmune thyroid diseases.


Subject(s)
COVID-19 , Graves Disease , Hashimoto Disease , Hypothyroidism , Thyroiditis, Autoimmune , Thyroiditis , Adult , Female , Graves Disease/complications , Graves Disease/diagnosis , Hashimoto Disease/complications , Hashimoto Disease/epidemiology , Humans , Hypothyroidism/complications , Middle Aged , Thyroiditis/complications , Thyroiditis, Autoimmune/complications , Thyroiditis, Autoimmune/epidemiology
3.
Int J Infect Dis ; 116: 319-327, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1636444

ABSTRACT

BACKGROUND: It is not clear whether previous thyroid diseases influence the course and outcomes of COVID-19. METHODS: The study is a part of a multicentric cohort of patients with confirmed COVID-19 diagnosis from 37 hospitals. Matching for age, sex, number of comorbidities, and hospital was performed for the paired analysis. RESULTS: Of 7,762 patients with COVID-19, 526 had previously diagnosed hypothyroidism and 526 were matched controls. The median age was 70 years, and 68.3% were females. The prevalence of comorbidities was similar, except for coronary and chronic kidney diseases that were higher in the hypothyroidism group (p=0.015 and p=0.001). D-dimer levels were lower in patients with hypothyroid (p=0.037). In-hospital management was similar, but hospital length-of-stay (p=0.029) and mechanical ventilation requirement (p=0.006) were lower for patients with hypothyroidism. There was a trend of lower in-hospital mortality in patients with hypothyroidism (22.1% vs 27.0%; p=0.062). CONCLUSION: Patients with hypothyroidism had a lower requirement of mechanical ventilation and showed a trend of lower in-hospital mortality. Therefore, hypothyroidism does not seem to be associated with a worse prognosis.


Subject(s)
COVID-19 , Hypothyroidism , Aged , COVID-19 Testing , Female , Hospital Mortality , Humans , Hypothyroidism/complications , Hypothyroidism/epidemiology , Prognosis , Registries , SARS-CoV-2
4.
J Postgrad Med ; 67(3): 174-176, 2021.
Article in English | MEDLINE | ID: covidwho-1485286

ABSTRACT

Scleredema adultorum of Buschke is a rare disorder of the connective tissue, involving the skin. Here, we present a 61-year-old male, who is a known case of compensated liver cirrhosis with a past history of being treated for autoimmune thyrotoxicosis, who presented with complaints of alopecia, skin tightening, dry skin, pruritus, and woody indurated plaques on the skin of the upper back, shoulder, and arms. Skin biopsy of the arm revealed the characteristic features of scleredema. He was extensively evaluated for known literature-cited causes of scleredema, and the work up revealed a negative result. He was also found to be hypothyroid on presentation. Hence, we present a case of scleredema occurring in a patient with hypothyroidism and chronic liver disease, which to our knowledge is being described for the first time in literature.


Subject(s)
Hypothyroidism/complications , Liver Cirrhosis/complications , Scleredema Adultorum/diagnosis , Alopecia/etiology , Betamethasone/therapeutic use , COVID-19/drug therapy , Fusidic Acid/therapeutic use , Glucocorticoids/therapeutic use , Humans , Male , Middle Aged , Pruritus/etiology , Thyrotoxicosis/complications
5.
Diabetes Metab Syndr ; 15(6): 102312, 2021.
Article in English | MEDLINE | ID: covidwho-1474481

ABSTRACT

BACKGROUND AND AIMS: Coronavirus disease (COVID-19) still becomes a global burden that affected people in different groups. The aim of this study was to evaluate the association between thyroid disease and the outcome of COVID-19 patients. METHOD: This was a meta-analysis study from articles obtained through a systematic literature search to investigate the relationship between thyroid disease and COVID-19 outcomes. Composite poor outcomes comprised of severity, mortality, intensive care unit (ICU) admission, and hospitalization. RESULTS: A total of 31339 patients from 21 studies included in this study. Thyroid disorder was associated with increased composite poor outcome (risk ratio (RR) 1.87 [95% confidence interval (CI) 1.53, 2.27], p < 0.001; I2 = 84%, p < 0.01), this included higher disease severity (RR 1.92 [1.40, 2.63], p < 0.05; I2 = 86%, p < 0.01), ICU admission (RR 1.61 [1.12, 2.32], p > 0.05; I2 = 32%, p < 0.05), mortality (RR 2.43 [1.44, 4.13], p < 0.05; I2 = 83%, p < 0.01), and hospitalization (RR 1.28 [1.17, 1.39], p < 0.05; I2 = 0%, p < 0.96). Meta-regression analysis indicated that age (p = 0.002) was a significant influence that affects the association. Also, the presence of unspecified thyroid disease (RR 1.91 [1.38, 2.65], p < 0.05; I2 = 81%, p < 0.01) and hypothyroidism (RR 1.90 [1.45, 2.55], p < 0.05; I2 = 85%, p < 0.01) during admission were associated with poor outcomes. CONCLUSION: Thyroid abnormalities increased the risk of COVID-19 composite poor outcomes and were influenced by the patient's age. Abnormal thyroid and hypothyroidism, but not hyperthyroidism, were associated with poor COVID-19 outcomes.


Subject(s)
COVID-19/complications , Hypothyroidism/complications , Humans , Regression Analysis
6.
J Autoimmun ; 123: 102688, 2021 09.
Article in English | MEDLINE | ID: covidwho-1293901

ABSTRACT

Unprecedented loss of life due to the COVID pandemic has necessitated the development of several vaccines in record time. Most of these vaccines have received approval without being extensively whetted for their adverse effect and efficacy profiles. Most adverse effects have been mild, nonetheless, more serious thromboembolic events have also been reported. Autoimmune hepatitis (AIH) can occur in predisposed individuals where an immune mediated reaction against hepatocytes is triggered by environmental factors. Vaccines are a very rare cause of AIH. We report two such cases of AIH triggered by COVID (Covishield) vaccination. While one patient made an uneventful recovery, another succumbed to the liver disease. Ours is the first report of Covishield vaccination related AIH and second ever after any form of COVID vaccination. We hope that our report does not deter COVID vaccination drives. However, we also hope to raise awareness of its potential side effects and the increased role of pharmacovigilance in guiding treatment.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Hepatitis, Autoimmune/etiology , Pandemics , SARS-CoV-2/immunology , Vaccination/adverse effects , Adult , Fatal Outcome , Female , Hepatitis B, Chronic/complications , Hepatitis, Autoimmune/immunology , Hepatitis, Autoimmune/pathology , Humans , Hypothyroidism/complications , Jaundice/etiology , Male , Middle Aged , Models, Immunological , Pharmacovigilance
7.
J Med Case Rep ; 15(1): 95, 2021 Feb 24.
Article in English | MEDLINE | ID: covidwho-1102350

ABSTRACT

BACKGROUND: We report a high-risk case of a coronavirus disease 19 (COVID-19)-positive patient with comorbidities including diabetes mellitus (DM), hypertension (HTN), hypothyroidism and chronic kidney disease (CKD), treated successfully using an integrative therapy plan based on Ayurveda and Yoga, along with government-mandated compulsory modern western medicine (MWM) treatment. Recently, some evidence has been emerging on the use of Ayurveda for treatment of COVID-19. The classical texts of Ayurvedic medicine such as Charaka Samhita and Sushruta Samhita contain descriptions of pandemics of similar proportions and describe them as Janapadoddhvansa, meaning the destruction of communities, along with their causes and treatment. CASE PRESENTATION: The case reported herein is a 55-year-old man from Delhi, India, with confirmed (tested) COVID-19, who first took MWM for 7 days before seeking integrative therapy. The patient has comorbidities including DM, HTN, hypothyroidism and CKD and had developed symptoms including fever (which was resolved by the time integrative therapy was started), sore throat, dry cough, body aches, weakness, bad taste and smell, and heaviness in the abdomen. Based on the patient's symptoms and comorbidities, a treatment plan including Ayurvedic medicines, Yoga protocol, dietary recommendations and lifestyle modifications was prescribed by a registered Ayurveda doctor and a Yoga consultant. The patient started experiencing improvement in all the symptoms within 2 days after starting the treatment; he reported approximately [Formula: see text] relief from the symptoms after 5 days, and almost complete relief within 9 days. Also, the blood sugar levels (both fasting blood sugar [FBS] and postprandial blood sugar [PPBS]) exhibited significant improvement after 5 days, and decreased to within the normal range within 12 days. Besides relief in symptoms, the patient's real-time reverse transcription polymerase chain reaction (RT-PCR) test done on the 19th day returned negative results. CONCLUSIONS: Integrative therapy was found to be effective in mitigating the symptoms of COVID-19 in this patient with multiple comorbidities. Moreover, a significant improvement in blood sugar levels (not under control with modern medicine) was also achieved. Integrative therapy based on the classical texts of Ayurveda and Yoga may offer a promising and scalable treatment option for COVID-19 patients. A case series or a suitably designed randomized controlled trial is needed to assess its efficacy.


Subject(s)
COVID-19/therapy , Integrative Medicine/methods , Medicine, Ayurvedic/methods , Yoga , COVID-19/complications , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/therapy , Humans , Hypertension/complications , Hypertension/therapy , Hypothyroidism/complications , Hypothyroidism/therapy , Male , Middle Aged , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/therapy , Treatment Outcome
8.
J Med Case Rep ; 15(1): 87, 2021 Feb 18.
Article in English | MEDLINE | ID: covidwho-1090620

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19), the global pandemic that has spread throughout the world, is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Given the limited scientific evidence on the manifestations and potential impact of this virus on pregnancy, we decided to report this case. CASE PRESENTATION: The patient was a 38 year-old Iranian woman with a triplet pregnancy and a history of primary infertility, as well as hypothyroidism and gestational diabetes. She was hospitalized at 29 weeks and 2 days gestational age due to elevated liver enzymes, and finally, based on a probable diagnosis of gestational cholestasis, she was treated with ursodeoxycholic acid. On the first day of hospitalization, sonography was performed, which showed that biophysical scores and amniotic fluid were normal in all three fetuses, with normal Doppler findings in two fetuses and increased umbilical artery resistance (pulsatility index [PI] > 95%) in one fetus. On day 4 of hospitalization, she developed fever, cough and myalgia, and her COVID-19 test was positive. Despite mild maternal symptoms, exacerbated placental insufficiency occurred in two of the fetuses leading to the rapid development of absent umbilical artery end-diastolic flow. Finally, 6 days later, the patient underwent cesarean section due to rapid exacerbation of placental insufficiency and declining biophysical score in two of the fetuses. Nasopharyngeal swab COVID-19 tests were negative for the first and third babies and positive for the second baby. The first and third babies died 3 and 13 days after birth, respectively, due to collapsed white lung and sepsis. The second baby was discharged in good general condition. The mother was discharged 3 days after cesarean section. She had no fever at the time of discharge and was also in good general condition. CONCLUSIONS: This was a complicated triplet pregnancy, in which, after maternal infection with COVID-19, despite mild maternal symptoms, exacerbated placental insufficiency occurred in two of the fetuses, and the third fetus had a positive COVID-19 test after birth. Therefore, in cases of pregnancy with COVID-19 infection, in addition to managing the mother, it seems that physicians would be wise to also give special attention to the possibility of acute placental insufficiency and subsequent fetal hypoxia, and also the probability of vertical transmission.


Subject(s)
COVID-19/physiopathology , Fetal Hypoxia/physiopathology , Placental Insufficiency/physiopathology , Pregnancy Complications, Infectious/physiopathology , Pregnancy, Triplet , Adult , COVID-19/complications , Cesarean Section , Cholestasis, Intrahepatic , Diabetes, Gestational , Female , Fetal Hypoxia/etiology , Hemorrhage , Hospitalization , Humans , Hypothyroidism/complications , Infant, Newborn , Infant, Premature , Infectious Disease Transmission, Vertical , Iran , Lung Diseases , Male , Middle Cerebral Artery/diagnostic imaging , Neonatal Sepsis , Placental Insufficiency/diagnostic imaging , Placental Insufficiency/etiology , Pregnancy , Pregnancy Complications , Pregnancy Trimester, Third , Pulsatile Flow , SARS-CoV-2 , Severity of Illness Index , Ultrasonography, Doppler , Ultrasonography, Prenatal , Umbilical Arteries/diagnostic imaging , Vascular Resistance
9.
BMJ Case Rep ; 14(1)2021 Jan 28.
Article in English | MEDLINE | ID: covidwho-1054632

ABSTRACT

We report an interesting case of a 38-year-old woman presenting with reverse Takotsubo syndrome (TTS) secondary to an Addisonian crisis, her second such episode. A few years prior, she had presented with typical TTS in the setting of Addisonian crisis; diagnostic work-up revealing Auto-Immune Polyglandular Syndrome Type II (APS II). We believe this to be the first case report of typical and variant phenotypes of TTS in a patient with APS II. The pathogenic link between these two conditions is explored. In patients presenting with Addisonian crises and refractory shock, the possibility of concurrent TTS should be considered. TTS muddies the diagnostic waters and poses therapeutic challenges as outlined.


Subject(s)
Addison Disease/drug therapy , Hydrocortisone/therapeutic use , Medication Adherence , Polyendocrinopathies, Autoimmune/drug therapy , Takotsubo Cardiomyopathy/physiopathology , Addison Disease/complications , Adult , Disease Progression , Echocardiography , Female , Humans , Hypothyroidism/complications , Hypothyroidism/drug therapy , Polyendocrinopathies, Autoimmune/complications , Recurrence , Respiratory Tract Infections/complications , Takotsubo Cardiomyopathy/diagnosis , Takotsubo Cardiomyopathy/etiology , Thyroxine/therapeutic use
10.
Front Endocrinol (Lausanne) ; 11: 606723, 2020.
Article in English | MEDLINE | ID: covidwho-1000076

ABSTRACT

Purpose: COVID-19 (Coronavirus Disease 2019) was first reported in December 2019 and quickly swept across China and around the world. Levels of anxiety and depression were increased among pregnant women during this infectious pandemic. Thyroid function is altered during stressful experiences, and any abnormality during early pregnancy may significantly affect fetal development and pregnancy outcomes. This study aimed to determine whether the COVID-19 pandemic induces thyroid hormone changes in early pregnant women. Methods: This study comprised two groups of pregnant women in Shanghai in their first trimester - those pregnant women before the COVID-19 outbreak from January 20, 2019, to March 31, 2019 (Group 1) and those pregnant during the COVID-19 outbreak from January 20, 2020, to March 31, 2020 (Group 2). All women were included if they had early pregnancy thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4), total triiodothyronine (TT3), and total thyroxine (TT4) concentrations, thyroid peroxidase (TPO) antibody or thyroglobulin antibody (TgAb) available and did not have a history of thyroid diseases or received thyroid treatment before or during pregnancy. We used propensity score matching to form a cohort in which patients had similar baseline characteristics. Results: Among 3338 eligible pregnant women, 727 women in Group 1 and 727 in Group 2 had similar propensity scores and were included in the analyses. Pregnant women in Group 2 had significantly higher FT3 (5.7 vs. 5.2 pmol/L, P<0.001) and lower FT4 (12.8 vs. 13.2 pmol/L, P<0.001) concentrations compared with those in Group 1. Pregnant women in Group 2 were more likely to develop isolated hypothyroxinemia (11.6% vs. 6.9%, OR, 1.75 [95% CI, 1.20-2.53], P=0.003) than those in Group 1 but had a significantly lower risk of TgAb positivity (12.0% vs. 19.0%, OR, 0.58 [95% CI, 0.43-0.78], P<0.001). Conclusion: Pregnant women in their first trimester in Shanghai during the COVID-19 outbreak were at an increased risk of having higher FT3 concentrations, lower FT4 concentrations, and isolated hypothyroxinemia. The association between thyroid hormones, pregnancy outcomes, and the COVID-19 outbreak should be explored further.


Subject(s)
COVID-19 , Pandemics , Pregnancy/blood , Thyroid Hormones/blood , Adolescent , Adult , China/epidemiology , Cohort Studies , Female , Humans , Hypothyroidism/complications , Hypothyroidism/drug therapy , Pregnancy Complications/drug therapy , Pregnancy Outcome , Propensity Score , Socioeconomic Factors , Thyroid Function Tests , Young Adult
11.
Ann Cardiol Angeiol (Paris) ; 69(5): 247-254, 2020 Nov.
Article in French | MEDLINE | ID: covidwho-844017

ABSTRACT

BACKGROUND AND AIM: Angiotensin converting enzyme (ACE) type 2 is the receptor of SARSCoV-2 for cell entry into lung cells. Because ACE-2 may be modulated by ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), there are concern that patients treated with ACEIs and ARBs are at higher risk for COVID-19 infection or severity. This study sought to analyse the association of severe forms of COVID-19 and mortality with hypertension and a previous treatment with ACEI and ARB. METHODS: Prospective follow-up of 433 consecutive patients hospitalised for COVID-19 pneumonia confirmed by PCR or highly probable on clinical, biological, and radiological findings, and included in the COVHYP study. Mortality and severe COVID-19 (criteria: death, intensive care unit, or hospitalisation >30 days) were compared in patients receiving or not ACEIs and ARBs. Follow-up was 100% at hospital discharge, and 96.5% at >1month. RESULTS: Age was 63.6±18.7 years, and 40%) were female. At follow-up (mean 78±50 days), 136 (31%) patients had severity criteria (death, 64 ; intensive care unit, 73; hospital stay >30 days, 49). Hypertension (55.1% vs 36.7%, P<0.001) and antihypertensive treatment were associated with severe COVID-19 and mortality. The association between ACEI/ARB treatment and COVID-19 severity criteria found in univariate analysis (Odds Ratio 1.74, 95%CI [1.14-2.64], P=0.01) was not confirmed when adjusted on age, gender, and hypertension (adjusted OR1.13 [0.59-2.15], P=0.72). Diabetes and hypothyroidism were associated with severe COVID-19, whereas history of asthma was not. CONCLUSION: This study suggests that previous treatment with ACEI and ARB is not associated with hospital mortality, 1- and 2-month mortality, and severity criteria in patients hospitalised for COVID-19. No protective effect of ACEIs and ARBs on severe pneumonia related to COVID-19 was demonstrated.


Subject(s)
Angiotensin II Type 2 Receptor Blockers/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Antihypertensive Agents/therapeutic use , Betacoronavirus , Coronavirus Infections/mortality , Hypertension/drug therapy , Pneumonia, Viral/mortality , Aged , Aged, 80 and over , Analysis of Variance , Angiotensin II Type 2 Receptor Blockers/adverse effects , Angiotensin-Converting Enzyme 2 , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Antihypertensive Agents/adverse effects , COVID-19 , Coronavirus Infections/epidemiology , Critical Care/statistics & numerical data , Diabetes Mellitus , Female , France/epidemiology , Hospitalization , Humans , Hypothyroidism/complications , Length of Stay/statistics & numerical data , Male , Middle Aged , Pandemics , Peptidyl-Dipeptidase A , Pneumonia, Viral/epidemiology , Prospective Studies , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index
12.
Front Endocrinol (Lausanne) ; 11: 565, 2020.
Article in English | MEDLINE | ID: covidwho-769199

ABSTRACT

Coronavirus diseases (COVID-19) is associated with high rates of morbidity and mortality and worse outcomes have been reported for various morbidities. The impact of pre-existing hypothyroidism on COVID-19 outcomes remains unknown. The aim of the present study was to identify a possible association between hypothyroidism and outcomes related to COVID-19 including hospitalization, need for mechanical ventilation, and all-cause mortality. All patients with a laboratory confirmed COVID-19 diagnosis in March 2020 in a large New York City health system were reviewed. Of the 3703 COVID-19 positive patients included in present study, 251 patients (6.8%) had pre-existing hypothyroidism and received thyroid hormone therapy. Hypothyroidism was not associated with increased risk of hospitalization [Adjusted Odds Ratio (ORadj): 1.23 (95% Confidence Interval (CI): 0.88- 1.70)], mechanical ventilation [ORadj: 1.17 (95% CI: 0.81-1.69)] nor death [ORadj: 1.07 (95% CI: 0.75-1.54)]. This study provides insight into the role of hypothyroidism on the outcomes of COVID-19 positive patients, indicating that no additional precautions or consultations are needed. However, future research into the potential complications of COVID-19 on the thyroid gland and function is warranted.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/therapy , Hypothyroidism/complications , Hypothyroidism/therapy , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Adult , Aged , Aged, 80 and over , COVID-19 , Cohort Studies , Coronavirus Infections/mortality , Female , Hospitalization/statistics & numerical data , Humans , Hypothyroidism/mortality , Male , Middle Aged , New York City/epidemiology , Pandemics , Pneumonia, Viral/mortality , Respiration, Artificial , Retrospective Studies , Risk , Thyroid Hormones/therapeutic use , Treatment Outcome
13.
J Neurol Sci ; 417: 117053, 2020 10 15.
Article in English | MEDLINE | ID: covidwho-665223

ABSTRACT

BACKGROUND: The COVID-19 pandemic presents two main concerns for patients with myasthenia gravis (MG); chronic immunosuppression may put them at greater risk, and some proposed treatments for COVID-19 could cause MG exacerbation. CASE DESCRIPTION: We present three patients with generalized seropositive MG who developed COVID-19. All patients had a favorable outcome, with only one patient experiencing exacerbation. In this case, exacerbation began before COVID-19; she required ICU admission, non-invasive ventilatory support, and received hydroxychloroquine, lopinavir and ritonavir which were well tolerated. One patient received IVIG in place of scheduled plasma exchange. CONCLUSION: Outcome was favorable in all cases despite immunosuppressive therapy, use of experimental COVID-19 medication and switching of plasma exchange for IVIG.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Myasthenia Gravis/complications , Pandemics , Pneumonia, Viral/complications , Adult , Aged , Azithromycin/therapeutic use , COVID-19 , Coronavirus Infections/drug therapy , Diabetes Mellitus, Type 2/complications , Female , Humans , Hydroxychloroquine/therapeutic use , Hypertension/complications , Hypothyroidism/complications , Immunocompromised Host , Immunoglobulins, Intravenous/therapeutic use , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Lopinavir/therapeutic use , Male , Myasthenia Gravis/drug therapy , Myasthenia Gravis/therapy , Plasmapheresis , Pneumonia, Viral/drug therapy , Ritonavir/therapeutic use , SARS-CoV-2 , Treatment Outcome
14.
Stroke ; 51(9): e223-e226, 2020 09.
Article in English | MEDLINE | ID: covidwho-656606

ABSTRACT

BACKGROUND AND PURPOSE: Ischemic infarction of the corpus callosum is rare and infarction isolated to the corpus callosum alone rarer still, accounting for much <1% of ischemic stroke in most stroke registries. About half of callosal infarctions affect the splenium. METHODS: During a 2-week period, at the height of the coronavirus disease 2019 (COVID-19) pandemic in New York City, 4 patients at Montefiore Medical Center in the Bronx were found to have ischemic lesions of the splenium of the corpus callosum, 2 with infarction isolated to the corpus callosum. RESULTS: All patients tested positive for COVID-19 and 3 had prolonged periods of intubation. All had cardiovascular risk factors. Clinically, all presented with encephalopathy and had evidence of coagulopathy and raised inflammatory markers. CONCLUSIONS: Infarction of the splenium of the corpus callosum is exceedingly rare and a cluster of such cases suggests COVID-19 as an inciting agent, with the mechanisms to be elucidated.


Subject(s)
Cerebral Infarction/complications , Cerebral Infarction/pathology , Coronavirus Infections/complications , Corpus Callosum/pathology , Pneumonia, Viral/complications , Aged , Aged, 80 and over , Brain Ischemia/complications , Brain Ischemia/pathology , COVID-19 , Diabetes Complications/complications , Fatal Outcome , Female , Humans , Hypertension/complications , Hypothyroidism/complications , Inflammation/blood , Intubation, Intratracheal , Middle Aged , Pandemics , Risk Factors , Stroke/etiology , Stroke/pathology , Stroke Rehabilitation
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