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2.
Saudi J Kidney Dis Transpl ; 32(3): 865-868, 2021.
Article in English | MEDLINE | ID: covidwho-1662745

ABSTRACT

After its discovery in Wuhan, China, in December 2019, coronavirus disease 2019 (COVID-19) has now become a pandemic in a short period. The kidney involvement is frequently reported, especially in critically ill hospitalized patients. Multiple mechanisms have been proposed for this damage range from direct invasion, cytokine storm, and hemodynamic derangements. Although COVID-19 has been described to have association with hypercoagulable state and thromboembolic events in major blood vessels, renal infarction due to COVID-19 infection is a rare occurrence. We here report a rare case of renal infarction due to COVID-19 infection. This patient initially presented with COVID pneumonia with acute kidney injury. Later on during evaluation of his gastrointestinal complaints, he was detected to have renal infarction by computed tomography angiography.


Subject(s)
Acute Kidney Injury/etiology , COVID-19/complications , Infarction/diagnostic imaging , Infarction/etiology , COVID-19 Nucleic Acid Testing , Computed Tomography Angiography , Critical Illness , Humans , Kidney/diagnostic imaging , Male , Middle Aged , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2
3.
Nagoya J Med Sci ; 83(4): 883-891, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1562255

ABSTRACT

A 76-year-old woman was admitted to the emergency room of Nagano Municipal Hospital with the complain of severe back pain. Chest and abdominal enhanced computed tomography scans showed bilateral adrenal infarction and minute pulmonary nodules, but she had no respiratory symptoms. After admission, a family member of the patient was found to have been in close contact with a coronavirus disease 2019 (COVID-19) patient. Thus, polymerase chain reaction and antigen tests of severe acute respiratory syndrome coronavirus 2 were conducted, and both tests returned positive. D-dimer levels were normal on admission but increased 2 days thereafter. Anticoagulation therapy and steroid replacement were started, and the patient improved over about two weeks. One month after the onset of adrenal infarction, a rapid adrenocorticotropic hormone loading test was conducted, which revealed that the primary adrenal insufficiency due to adrenal infarction might have been caused by the COVID-19 infection. This case was rare and suggestive of adrenal infarction with COVID-19, which usually presents at the severe stage. In patients with COVID-19, attention should be paid to the onset of thrombosis, even with mild respiratory infection. We also suggest that patients with thrombosis should be suspected of having COVID-19 even in the absence of respiratory infectious symptoms in a situation of COVID-19 epidemic.


Subject(s)
Adrenal Glands/blood supply , COVID-19/complications , Infarction , Thrombosis/etiology , Aged , COVID-19/blood , COVID-19/diagnosis , COVID-19 Nucleic Acid Testing , Female , Humans , Infarction/etiology , Respiratory Tract Infections , SARS-CoV-2/isolation & purification
4.
J Infect Chemother ; 28(2): 326-328, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1517342

ABSTRACT

COVID-19 is an infection which can present with various clinical manifestations. While it affects respiratory tract primarily, several other manifestations including gastrointestinal involvements have been reported. The prevalence of all gastrointestinal complaints is approximately 17 percent and diarrhea, nausea/vomiting and abdominal pain are the most common symptoms. In COVID-19, acute abdominal pain requiring surgical evaluation and abdominal imaging is uncommon and there is also a lack of knowledge about COVID-19 related gastrointestinal complications. Here, we report a case of mild COVID-19 infection complicated by omental infarction during the course of the illness.


Subject(s)
COVID-19 , Gastrointestinal Diseases , Humans , Infarction/diagnostic imaging , Infarction/etiology , SARS-CoV-2 , Vomiting
7.
Turk Kardiyol Dern Ars ; 49(3): 233-236, 2021 04.
Article in English | MEDLINE | ID: covidwho-1181749

ABSTRACT

As the COVID-19 pandemic continues, its novel complications are being increasingly recognized, and new mechanisms of the disease are being unraveled. Aortic free-floating thrombus is exceptionally rare, and prompt diagnosis is vital to alleviate its detrimental end organ effects. We present a patient who was previously discharged owing to COVID-19 pneumonia, admitted with acute onset of lower limb pain, and was diagnosed with aortic free-floating thrombus ended up with embolic events. Clinicians should be aware of COVID-19-related thromboembolic complications, and close monitoring of patients with risk factors is vital for a timely and accurate diagnosis and management.


Subject(s)
COVID-19/complications , Infarction/etiology , Ischemia/etiology , Kidney/blood supply , Lower Extremity/blood supply , Thromboembolism/etiology , Aortic Diseases/diagnosis , Aortic Diseases/etiology , Humans , Infarction/diagnosis , Ischemia/diagnosis , Male , Middle Aged , SARS-CoV-2 , Thromboembolism/diagnosis , Thrombosis/diagnosis , Thrombosis/etiology
8.
J Clin Neurosci ; 87: 89-91, 2021 May.
Article in English | MEDLINE | ID: covidwho-1120247

ABSTRACT

Coronavirus disease (COVID-19) has a number of emerging neurological manifestations in addition to pneumonia and respiratory distress. In what follows, we describe a case of a previously healthy young man with severe COVID-19 who subsequently developed an acute flaccid paralysis. Work up revealed a lesion in his cervical spinal cord concerning for spinal infarction or transverse myelitis. He received empiric pulsed steroids without improvement. Taken together, we felt his presentation was most consistent with spinal cord infarction in the setting of critical illness with COVID-19. We believe this is a rare case of spinal cord stroke associated with COVID-19.


Subject(s)
COVID-19/complications , COVID-19/diagnostic imaging , Cervical Cord/diagnostic imaging , Infarction/diagnostic imaging , Infarction/etiology , Adult , Humans , Male , Spinal Cord Ischemia/diagnostic imaging , Spinal Cord Ischemia/etiology
11.
Neuroradiol J ; 34(3): 245-248, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1041845

ABSTRACT

The severe acute respiratory syndrome coronavirus disease 2019 (COVID-19) pandemic, became rapidly recognised by variable phonotypic expressions that involve most major body organs. Neurological complications of severe acute respiratory syndrome coronavirus disease are increasingly encountered in patients with COVID-19 infection, more frequently in patients with severe infection, and develop as a consequence of the neurotropic potential of this virus, secondary cytokine storm and acquired syndrome of COVID-19 coagulopathy. Spinal cord involvement after COVID-19 more commonly includes infectious transverse myelitis, para and post infection myelopathy and, rarely, spinal cord ischaemia related to increased coagulopathy with thromboembolic consequences. We herein report a COVID-19-positive patient with increased coagulopathy and vertebral artery thrombosis leading to posterior circulation and subsequent spinal cord infarction.


Subject(s)
COVID-19/complications , Infarction/etiology , Spinal Cord Ischemia/etiology , Adult , Blood Coagulation Disorders/blood , Blood Coagulation Disorders/etiology , Diffusion Magnetic Resonance Imaging , Humans , Male , Thrombosis/blood , Thrombosis/etiology , Vertebral Artery
12.
Infez Med ; 28(4): 611-615, 2020 Dec 01.
Article in English | MEDLINE | ID: covidwho-950503

ABSTRACT

The prothrombotic state contributes to diverse and devastating prognoses of severe COVID-19. We describe a unique COVID-19 case with concomitant splenic and renal infarcts. Based on this, clinicians should have a low threshold to suspect a diagnosis of deep vein thrombosis/pulmonary embolism (DVT/PE), especially in the abdominal visceral region if a patient comes in several days after a COVID-19 diagnosis with abdominal pain. Whether or not empiric full dose anticoagulation is needed in patients without definite diagnosis of thromboembolism is still controversial. Further studies need to be done; meanwhile, we advocate the use of regular dose thromboprophylaxis in all hospitalized patients and therapeutic anticoagulation only when there is a confirmed diagnosis of thromboembolism.


Subject(s)
COVID-19/complications , Infarction/etiology , Kidney/blood supply , SARS-CoV-2 , Splenic Infarction/etiology , COVID-19/diagnostic imaging , Humans , Infarction/diagnostic imaging , Kidney/diagnostic imaging , Male , Middle Aged , Splenic Infarction/diagnostic imaging
13.
Ann Thorac Surg ; 111(3): e183-e184, 2021 03.
Article in English | MEDLINE | ID: covidwho-797517

ABSTRACT

Patients with severe coronavirus disease 2019 from infection with severe acute respiratory syndrome coronavirus 2 mount a profound inflammatory response and are predisposed to thrombotic complications. Pulmonary vein thrombosis is a rare disease process resulting in pulmonary congestion, infarction, and potential mortality. This report describes a patient with coronavirus disease 2019 requiring venovenous extracorporeal membrane oxygenation for hypoxic respiratory failure who developed hemorrhagic infarction of the right lower lobe. During emergency exploration the patient was found to have a right inferior vein thrombosis and marked lobar hemorrhage mandating lobectomy.


Subject(s)
COVID-19/complications , Hemoptysis/surgery , Infarction/surgery , Lung/blood supply , Pneumonectomy/methods , Adult , COVID-19/epidemiology , Hemoptysis/etiology , Humans , Infarction/etiology , Lung/surgery , Male , Pandemics
14.
Am J Transplant ; 21(3): 1345, 2021 03.
Article in English | MEDLINE | ID: covidwho-744691
15.
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
17.
Am J Transplant ; 20(11): 3221-3224, 2020 11.
Article in English | MEDLINE | ID: covidwho-457000

ABSTRACT

The novel coronavirus disease 2019 (COVID-19) is associated with increased risk of thromboembolic events, but the extent and duration of this hypercoagulable state remain unknown. We describe the first case report of renal allograft infarction in a 46-year-old kidney-pancreas transplant recipient with no prior history of thromboembolism, who presented 26 days after diagnosis of COVID-19. At the time of renal infarct, he was COVID-19 symptom free and repeat test for SARS-CoV-2 was negative. This case report suggests that a hypercoagulable state may persist even after resolution of COVID-19. Further studies are required to determine thromboprophylaxis indications and duration in solid organ transplant recipients with COVID-19.


Subject(s)
Infarction/etiology , Kidney Failure, Chronic/surgery , Kidney Transplantation , Kidney/blood supply , Pancreas Transplantation/adverse effects , Transplant Recipients , COVID-19 , Humans , Infarction/diagnosis , Kidney Failure, Chronic/epidemiology , Male , Middle Aged , Pandemics , Tomography, X-Ray Computed , Ultrasonography
18.
Am J Kidney Dis ; 76(3): 431-435, 2020 09.
Article in English | MEDLINE | ID: covidwho-436397

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a contagious life-threatening infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recent findings indicate an increased risk for acute kidney injury during COVID-19 infection. The pathophysiologic mechanisms leading to acute kidney injury in COVID-19 infection are unclear but may include direct cytopathic effects of the virus on kidney tubular and endothelial cells, indirect damage caused by virus-induced cytokine release, and kidney hypoperfusion due to a restrictive fluid strategy. In this report of 2 cases, we propose an additional pathophysiologic mechanism. We describe 2 cases in which patients with COVID-19 infection developed a decrease in kidney function due to kidney infarction. These patients did not have atrial fibrillation. One of these patients was treated with therapeutic doses of low-molecular-weight heparin, after which no further deterioration in kidney function was observed. Our findings implicate that the differential diagnosis of acute kidney injury in COVID-19-infected patients should include kidney infarction, which may have important preventive and therapeutic implications.


Subject(s)
Acute Kidney Injury/diagnostic imaging , Betacoronavirus , Coronavirus Infections/diagnostic imaging , Infarction/diagnostic imaging , Kidney/blood supply , Kidney/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Acute Kidney Injury/drug therapy , Acute Kidney Injury/etiology , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Diagnosis, Differential , Heparin, Low-Molecular-Weight/pharmacology , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Infarction/drug therapy , Infarction/etiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/drug therapy , SARS-CoV-2
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