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1.
Pediatr Dermatol ; 38(5): 1359-1360, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1505904

ABSTRACT

Whether affecting children or adults, SARS-CoV-2 infection (COVID-19) can have multi-organ involvement mediated by an inflammatory cascade. Immunoglobulin A (IgA) is one of the key components of the inflammatory cascade that can lead to endothelial injury and inflammation. IgA vasculitis or Henoch-Schönlein purpura (HSP) has been rarely reported in the context of COVID-19. In this report, we highlight a case of HSP occurring 2 days after diagnosis of COVID-19 in a 16-year-old boy, who presented with palpable purpura of the lower extremities and buttocks, diffuse abdominal pain, hemoptysis, and hematochezia. He was treated with oral prednisolone with rapid clinical improvement.


Subject(s)
COVID-19 , Purpura, Schoenlein-Henoch , Adolescent , Child , Humans , Male , Pain , Prednisolone/therapeutic use , Purpura, Schoenlein-Henoch/complications , Purpura, Schoenlein-Henoch/diagnosis , Purpura, Schoenlein-Henoch/drug therapy , SARS-CoV-2
2.
BMJ Case Rep ; 14(9)2021 Sep 07.
Article in English | MEDLINE | ID: covidwho-1467682

ABSTRACT

An 82-year-old man with a history of herpes simplex keratitis 40 years previously presented with recurrence, 1 day following vaccination for novel COVID-19. His condition worsened despite topical treatment with ganciclovir gel. A diagnosis of herpetic stromal keratitis was made, requiring systemic aciclovir, topical prednisolone, moxifloxacin and atropine, and oral doxycycline. He improved clinically on treatment, with some residual corneal scarring. Visual acuity improved from 6/36 corrected at presentation, to 6/24 following treatment. Clearly, public and personal health benefits from vaccination are hugely important and we would not suggest avoiding vaccination in such patients. It is, however, important for ophthalmic providers to be aware of the rare potential for reactivation of herpetic eye disease following vaccination to enable prompt diagnosis and treatment.


Subject(s)
COVID-19 , Keratitis, Herpetic , Acyclovir/therapeutic use , Aged, 80 and over , Antiviral Agents/adverse effects , Humans , Keratitis, Herpetic/chemically induced , Keratitis, Herpetic/diagnosis , Keratitis, Herpetic/drug therapy , Male , Prednisolone/therapeutic use , SARS-CoV-2 , Vaccination/adverse effects
3.
Respir Res ; 22(1): 245, 2021 Sep 15.
Article in English | MEDLINE | ID: covidwho-1412433

ABSTRACT

BACKGROUND: We performed a multicenter, randomized open-label trial in patients with moderate to severe Covid-19 treated with a range of possible treatment regimens. METHODS: Patients were randomly assigned to one of three regimen groups at a ratio of 1:1:1. The primary outcome of this study was admission to the intensive care unit. Secondary outcomes were intubation, in-hospital mortality, time to clinical recovery, and length of hospital stay (LOS). Between April 13 and August 9, 2020, a total of 336 patients were randomly assigned to receive one of the 3 treatment regimens including group I (hydroxychloroquine stat, prednisolone, azithromycin and naproxen; 120 patients), group II (hydroxychloroquine stat, azithromycin and naproxen; 116 patients), and group III (hydroxychloroquine and lopinavir/ritonavir (116 patients). The mean LOS in patients receiving prednisolone was 5.5 in the modified intention-to-treat (mITT) population and 4.4 days in the per-protocol (PP) population compared with 6.4 days (mITT population) and 5.8 days (PP population) in patients treated with Lopinavir/Ritonavir. RESULTS: The mean LOS was significantly lower in the mITT and PP populations who received prednisolone compared with populations treated with Lopinavir/Ritonavir (p = 0.028; p = 0.0007). We observed no significant differences in the number of deaths, ICU admission, and need for mechanical ventilation between the Modified ITT and per-protocol populations treated with prednisolone and Lopinavir/Ritonavir, although these outcomes were better in the arm treated with prednisolone. The time to clinical recovery was similar in the modified ITT and per-protocol populations treated with prednisolone, lopinavir/ritonavir, and azithromycin (P = 0.335; P = 0.055; p = 0.291; p = 0.098). CONCLUSION: The results of the present study show that therapeutic regimen (regimen I) with low dose prednisolone was superior to other regimens in shortening the length of hospital stay in patients with moderate to severe COVID-19. The steroid sparing effect may be utilized to increase the effectiveness of corticosteroids in the management of diabetic patients by decreasing the dosage.


Subject(s)
COVID-19/drug therapy , Glucocorticoids/therapeutic use , Prednisolone/therapeutic use , Adult , Aged , Antiviral Agents/therapeutic use , COVID-19/diagnosis , COVID-19/mortality , COVID-19/virology , Drug Therapy, Combination , Female , Glucocorticoids/adverse effects , Hospital Mortality , Humans , Intensive Care Units , Intubation, Intratracheal , Iran , Length of Stay , Male , Middle Aged , Prednisolone/adverse effects , Severity of Illness Index , Time Factors , Treatment Outcome
5.
Cornea ; 40(9): 1204-1206, 2021 Sep 01.
Article in English | MEDLINE | ID: covidwho-1343730

ABSTRACT

PURPOSE: The purpose of this study was to report 2 patients with anterior scleritis manifesting after coronavirus disease 2019 (COVID-19). METHODS: The patients with confirmed COVID-19 developed anterior scleritis after their systemic symptoms were markedly improved. A thorough systemic workup identified no underlying autoimmune diseases. Ocular characteristics and safety and efficacy of systemic immunosuppressive therapy were evaluated. RESULTS: Case 1 was a 67-year-old woman who presented with necrotizing anterior scleritis in both eyes 3 weeks after the onset of COVID-19. One-week treatment with topical betamethasone and oral prednisolone (65 mg daily) did not result in improvement, so she was started on intravenous cyclophosphamide and subcutaneous adalimumab in addition to oral prednisolone. Necrotizing scleritis was gradually improved over 3 months. Case 2 was a 33-year-old man who presented with sectoral anterior scleritis in his right eye 2 weeks after the onset of COVID-19. He was started on topical betamethasone and oral prednisolone (85 mg daily). One week later, all signs and symptoms disappeared, and topical and oral corticosteroids were gradually tapered off over 2 weeks. There was no recurrence of respiratory symptoms or active scleritis in any cases after discontinuation of treatment. CONCLUSIONS: These cases suggest that COVID-19 can be associated with anterior scleritis, which responds to immunosuppressive and biologic agents. Ophthalmologists should consider anterior scleritis in patients with COVID-19 who present with ocular pain and redness during the convalescent phase of the illness.


Subject(s)
COVID-19/diagnosis , Eye Infections, Viral/diagnosis , SARS-CoV-2/isolation & purification , Scleritis/diagnosis , Adalimumab/therapeutic use , Adult , Aged , Anti-Inflammatory Agents/therapeutic use , COVID-19/drug therapy , COVID-19/virology , COVID-19 Nucleic Acid Testing , Cyclophosphamide/therapeutic use , Eye Infections, Viral/drug therapy , Eye Infections, Viral/virology , Female , Humans , Immunosuppressive Agents/therapeutic use , Infusions, Intravenous , Infusions, Subcutaneous , Male , Prednisolone/therapeutic use , SARS-CoV-2/genetics , Scleritis/drug therapy , Scleritis/virology
7.
Taiwan J Obstet Gynecol ; 60(5): 945-948, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1336975

ABSTRACT

OBJECTIVE: Coronavirus-2019 (COVID-19) is a global health crisis. Although pregnant women are a vulnerable population during the infectious pandemics, extremely rare cases of pregnant women infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are described in Taiwan. We share our experience to manage a pregnant women with COVID-19 in the third trimester and subsequent delivery at term. CASE REPORT: A 43-year-old woman presented with sore throat, cough and rhinorrhea was diagnosed as laboratory-confirmed SARS-CoV-2 infection at the 35 gestational weeks (GW). During the hospitalization, the disease progressed with a need of oxygen supplement and prednisolone therapy. She was discharged uneventfully at 37 GW. Finally, she delivered a female baby with Apgar score of 8-9 points at 38 GW by cesarean section due to the deformity of pelvic cavity resulted from previous surgery for pelvic bone tumor. Both mother and her offspring (without SARS-CoV-2 infection) were discharged uneventfully. CONCLUSION: Our report adds the growing body of experience toward management of pregnant women with SARS-CoV-2 infection. Decision making of timing and method of delivery is regarding to individualized condition and hospital setting.


Subject(s)
COVID-19 , Cesarean Section , Pregnancy Complications, Infectious , Pregnancy Trimester, Third , Adult , Apgar Score , COVID-19/therapy , Female , Glucocorticoids/therapeutic use , Humans , Infant, Newborn , Oxygen Inhalation Therapy , Prednisolone/therapeutic use , Pregnancy , Pregnancy Complications, Infectious/therapy
8.
Clin Neurol Neurosurg ; 208: 106834, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1333310

ABSTRACT

Several neurological presentations have been reported following coronavirus 2019 (COVID-19) infection. This case report describes three myasthenia gravis (MG) patients presented following COVID-19 infection. We report three adult patients with myasthenic Gravis and COVID-19 infection. The patients are between 38 and 61 years old. Case 1 is a 61-year-old woman with progressive dysphagia, nasal speech, ocular ptosis, diplopia, and proximal muscle weakness for 10 days. She had a COVID-19 infection 6 weeks ago. Case 2 is a 57-year-old man with clinical symptoms of muscular fatigability, diplopia, ptosis, and dysphagia for a week and a positive COVID-19 infection 10 days ago. Case 3 is a 38-year-old woman with fatigability, ptosis, dysphagia, and a diagnosis of COVID-19 infection 4 weeks ago. All patients had a positive RT-PCR for COVID-19 infection by nasopharyngeal swab test and a high-level acetylcholine receptor antibody in the serum. All patients were treated with pyridostigmine and prednisolone with a favorable outcome. MG may appear following COVID-19 infection, and the role of molecular mimicry and latent MG activation should be considered the cause of the disease onset.


Subject(s)
COVID-19/complications , Myasthenia Gravis/virology , Adult , Anti-Inflammatory Agents/therapeutic use , Autoantibodies/blood , Autoantibodies/immunology , Autoantigens/immunology , COVID-19/immunology , Cholinesterase Inhibitors/therapeutic use , Female , Humans , Male , Middle Aged , Myasthenia Gravis/drug therapy , Myasthenia Gravis/immunology , Prednisolone/therapeutic use , Receptors, Cholinergic/immunology , SARS-CoV-2/immunology
9.
J Autoimmun ; 123: 102710, 2021 09.
Article in English | MEDLINE | ID: covidwho-1330939

ABSTRACT

The development of autoimmune diseases has been reported after SARS-CoV-2 infection. Vaccination against SARS-CoV-2 could also trigger auto-immunity, as it has been described with other vaccines. An aberrant immune response induced by molecular mimicry and bystander activation, especially in predisposed individuals, is a potential mechanism. We report the case of a 76-year-old woman with Hashimoto thyroiditis and prior COVID-19 infection who developed severe autoimmune hepatitis (with typical features including strongly positive anti-smooth muscle antibody and markedly elevated immunoglobulins G, as well as typical histological findings) following SARS-CoV-2 vaccination (mRNA-1273 SARS-CoV-2 vaccine, Moderna®). The link between SARS-CoV-2 vaccination and the development of autoimmune diseases needs to be further investigated. Although a causality relationship cannot be proven, caution may be warranted when vaccinating individuals with known autoimmune diseases.


Subject(s)
Autoantibodies/immunology , COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Hepatitis, Autoimmune/etiology , SARS-CoV-2/immunology , Vaccination/adverse effects , Aged , Azathioprine/therapeutic use , Carcinoma, Transitional Cell/complications , Causality , Disease Susceptibility , Female , Hashimoto Disease/complications , Hepatitis, Autoimmune/drug therapy , Hepatitis, Autoimmune/immunology , Hepatitis, Autoimmune/pathology , Hepatitis, Chronic/complications , Hepatitis, Chronic/pathology , Humans , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , Prednisolone/therapeutic use , Urinary Bladder Neoplasms/complications
10.
Cornea ; 40(8): 1067-1069, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1303954

ABSTRACT

ABSTRACT: We present 2 cases of striking stromal corneal infiltrates months after COVID-19 infection. While we cannot prove that these infiltrates are caused by or directly related to COVID-19, we did not find any other plausible cause that could explain these ophthalmic signs. In these cases, the ongoing process was detected in relatively early stages due to scheduled visits with patients and responded positively to prednisolone acetate 1% ophthalmic suspension. However, we do not know the response to treatment in more advanced cases.


Subject(s)
COVID-19/diagnosis , Corneal Diseases/diagnosis , Corneal Stroma/pathology , Eye Infections, Viral/diagnosis , SARS-CoV-2 , COVID-19/drug therapy , COVID-19/virology , COVID-19 Nucleic Acid Testing , Corneal Diseases/drug therapy , Corneal Diseases/virology , Eye Infections, Viral/drug therapy , Eye Infections, Viral/virology , Female , Glaucoma, Open-Angle/diagnosis , Glucocorticoids/therapeutic use , Humans , Immune Complex Diseases/diagnosis , Immune Complex Diseases/drug therapy , Immune Complex Diseases/virology , Male , Middle Aged , Prednisolone/therapeutic use , SARS-CoV-2/immunology , Uveitis/diagnosis
11.
Am J Med Sci ; 362(3): 303-307, 2021 09.
Article in English | MEDLINE | ID: covidwho-1237591

ABSTRACT

Subacute thyroiditis (SAT) is a self-limiting thyroid dysfunction of viral origin. Relatively little is known about its occurrence in SARS CoV-2 infected COVID-19 patients. Herein, we report a case of SAT in a 58-year-old patient that was apparently triggered by infection with SARS CoV-2. Clinical, laboratory and imaging features of the patient are presented. The patient was vitally stable with a slightly tender and warm thyroid gland, which was painful on swallowing. His free thyroxine (FT4) was elevated, thyroid stimulating hormone (TSH) was below normal and free triiodothyronine (FT3) was in the physiological range. Previous thyroid exam conducted as a part of routine annual physical checkup was normal. The patient was put on prednisolone and recovered completely within three weeks.


Subject(s)
COVID-19/complications , Neck Pain/etiology , SARS-CoV-2 , Thyroiditis, Subacute/etiology , Anti-Inflammatory Agents/therapeutic use , C-Reactive Protein/analysis , COVID-19/blood , COVID-19/drug therapy , Glucocorticoids/therapeutic use , Humans , Male , Middle Aged , Neck Pain/blood , Neck Pain/drug therapy , Prednisolone/therapeutic use , Thyroiditis, Subacute/blood , Thyroiditis, Subacute/drug therapy , Thyrotropin/blood , Thyroxine/blood , Triiodothyronine/blood
12.
Pediatr Hematol Oncol ; 38(7): 663-668, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1216504

ABSTRACT

Patients with coronavirus disease 2019 (COVID-19) from novel coronavirus (SARS-CoV-2) infection may present with immune thrombocytopenia (ITP). Multisystem inflammatory syndrome in children (MIS-C) is a serious complication of SARS-CoV-2 causing systemic organ dysfunction. This case series presents the first reported cases of patients who developed ITP following MIS-C, while completing corticosteroid tapers. These patients responded to standard of care therapies for ITP and had appropriate platelet count recovery. We emphasize the importance of careful monitoring of those recovering from COVID-19 or MIS-C, to proactively identify clinical and laboratory abnormalities, in addition to long-term cardiovascular sequelae.


Subject(s)
COVID-19/complications , Purpura, Thrombocytopenic, Idiopathic/etiology , Systemic Inflammatory Response Syndrome/complications , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Aspirin/therapeutic use , COVID-19/blood , COVID-19/therapy , Child , Disease Management , Glucocorticoids/therapeutic use , Humans , Infant , Male , Methylprednisolone/therapeutic use , Platelet Count , Prednisolone/therapeutic use , Purpura, Thrombocytopenic, Idiopathic/blood , Purpura, Thrombocytopenic, Idiopathic/therapy , Systemic Inflammatory Response Syndrome/blood , Systemic Inflammatory Response Syndrome/therapy
13.
J Pediatric Infect Dis Soc ; 10(4): 543-546, 2021 Apr 30.
Article in English | MEDLINE | ID: covidwho-1211412

ABSTRACT

Down syndrome (DS) predisposes to severe immunologic reaction secondary to infectious triggers. Here, we report a pediatric DS patient with coronavirus disease 2019 (COVID-19) who developed a hyperinflammatory syndrome, severe acute respiratory distress syndrome, and secondary hemophagocytic lymphohistiocytosis requiring pediatric intensive care unit admission and treatment with steroids, intravenous immunoglobulin, and remdesivir. Investigations into genetic susceptibilities for COVID-19 and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated complications warrant systematic clinical and scientific studies. We report a pediatric Down syndrome patient with coronavirus disease 2019 (COVID-19) who developed secondary hemophagocytic lymphohistiocytosis requiring treatment with steroids, intravenous immunoglobulin, and remdesivir. Investigations into genetic susceptibilities for COVID-19-associated complications warrant systematic clinical and scientific studies.


Subject(s)
COVID-19/complications , Down Syndrome/complications , Lymphohistiocytosis, Hemophagocytic/virology , Systemic Inflammatory Response Syndrome/virology , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/virology , COVID-19 Testing , Child, Preschool , Critical Care , Genetic Predisposition to Disease , Glucocorticoids/therapeutic use , Humans , Immunoglobulins, Intravenous/therapeutic use , Lymphohistiocytosis, Hemophagocytic/diagnosis , Lymphohistiocytosis, Hemophagocytic/drug therapy , Male , Prednisolone/therapeutic use , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/drug therapy
16.
CEN Case Rep ; 10(4): 494-499, 2021 11.
Article in English | MEDLINE | ID: covidwho-1152139

ABSTRACT

The novel coronavirus disease 2019 (COVID-19) is a respiratory infection that has received much attention due to its rapid expansion. Currently, it has been revealed that patients with underlying disease, especially those with kidney disease are more prone to develop complications. Some studies associate kidney transplantation as a risk factor for COVID-19 progression; however, epidemiologic data that demonstrate this are amazingly rare. Considering the importance of the topic, we report on six kidney transplant recipients (median age 47 [41-55]) with confirmed or clinically suspected COVID-19. The most common admission presentations were fever (83.3%), dyspnea, and myalgia. At baseline, immunosuppressive therapy was ceased, prednisolone dose was increased, and all patients received antiviral treatment including hydroxychloroquine and umifenovir. After a median follow-up of 11.5 days from admission, six patients (100%) developed acute kidney injury (AKI), 50% required intensive care unit (ICU) admission, and two patients (33.3%) deceased as a result of deterioration in respiratory status. Overall, these findings demonstrate that respiratory involvement may be a risk indicator of in-hospital mortality in kidney recipients with COVID-19. In addition, AKI development in kidney recipients with COVID-19 is of utmost importance given the higher AKI occurrence in these patients compared with others. Therefore, more intensive attention should be paid to kidney transplant recipients with COVID-19.


Subject(s)
Acute Kidney Injury/epidemiology , COVID-19/immunology , Hospital Mortality/trends , Kidney Transplantation/adverse effects , Transplant Recipients/statistics & numerical data , Acute Kidney Injury/etiology , Adult , Antimalarials/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Disease Progression , Female , Glucocorticoids/therapeutic use , Humans , Hydroxychloroquine/therapeutic use , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Indoles/therapeutic use , Intensive Care Units/statistics & numerical data , Iran/epidemiology , Male , Middle Aged , Outcome Assessment, Health Care , Prednisolone/therapeutic use , Risk Factors , SARS-CoV-2/genetics
17.
Indian J Ophthalmol ; 69(4): 985-986, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1138826

ABSTRACT

A 32-year-old man with a clear and compact graft following a penetrating keratoplasty 6 years back, developed an episode of acute graft rejection, coinciding with the COVID-19 disease. Subsequent to the infection with the novel coronavirus, he developed symptoms of acute graft rejection concurrent with the development of respiratory distress and peak systemic symptoms. This was the phase of cytokine storm as evidenced by the raised inflammatory markers in his blood tests. Such a case of acute corneal graft rejection coinciding with SARS-CoV-2 infection has been reported only once in the literature and this unique association needs to be researched further.


Subject(s)
COVID-19/diagnosis , Corneal Diseases/diagnosis , Eye Infections, Viral/diagnosis , Graft Rejection/diagnosis , Keratoplasty, Penetrating , SARS-CoV-2 , Acute Disease , Adult , COVID-19/drug therapy , COVID-19/virology , COVID-19 Nucleic Acid Testing , Cataract Extraction , Corneal Diseases/drug therapy , Corneal Diseases/virology , Cytokines/blood , Eye Infections, Viral/drug therapy , Eye Infections, Viral/virology , Glucocorticoids/therapeutic use , Graft Rejection/drug therapy , Graft Rejection/virology , Humans , Incidence , Inflammation Mediators/blood , Lens Implantation, Intraocular , Male , Pneumonia, Viral/blood , Prednisolone/therapeutic use , Visual Acuity
18.
Int J Infect Dis ; 105: 756-762, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1135367

ABSTRACT

OBJECTIVES: Disease severity, previous medications and immunosuppressive agents could affect the antibody response against SARS-CoV-2. This study aimed to analyze variables affecting the humoral response to SARS-CoV-2. METHODS: This prospective cohort study included adult patients who recovered from COVID-19 and were admitted to a COVID-19 follow-up unit. Eight patient groups were defined in accordance with the results of thoracic computed tomography (CT), SARS-CoV-2 PCR test, and tocilizumab or anakinra use during active disease. Anti-S IgG antibodies were determined by ELISA in serum samples. Anti-S positive and negative cases were compared. RESULTS: A total of 518 patients were included in the study. SARS-CoV-2 IgG antibodies were positive in 82.8% of patients. SARS-CoV-2 PCR positivity, extent of lung involvement on CT, and time to antibody testing were independently associated with antibody positivity. Tocilizumab, anakinra or prednisolone use was not a factor affecting the antibody response. The rate of antibody response and sample/CO values among antibody-positive patients showed a linear relationship with the extent of lung involvement on CT. CONCLUSIONS: The use of tocilizumab, anakinra and prednisolone for COVID-19 did not affect the antibody response against SARS-CoV-2. The main driver of antibody response among patients with COVID-19 was the extent of pulmonary involvement on CT.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Antibodies, Viral/blood , COVID-19/drug therapy , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Prednisolone/therapeutic use , SARS-CoV-2/immunology , Antibodies, Viral/immunology , Cohort Studies , Drug Therapy, Combination , Female , Humans , Immunoglobulin G/blood , Immunoglobulin G/immunology , Male , Middle Aged , Multivariate Analysis , Prospective Studies , Severity of Illness Index , Tomography, X-Ray Computed
19.
BMJ Case Rep ; 14(2)2021 Feb 04.
Article in English | MEDLINE | ID: covidwho-1066842

ABSTRACT

A previously healthy 40-year-old man was referred to our emergency department with pruritic skin lesions and dyspnoea. Laboratory investigation revealed hypereosinophilia. Further diagnostic work-up confirmed the diagnosis of idiopathic hypereosinophilic syndrome (iHES), a rare myeloproliferative disease with a heterogeneous clinical presentation. We describe a unique case with cardiac, pulmonary, hepatic and cutaneous involvement at time of presentation. This case accentuates the importance of an extensive multidisciplinary diagnostic work-up, since iHES is a condition with potential rapid progressive multiorgan failure which requires prompt analysis and treatment. In addition, this case emphasises the importance of being aware of tunnel vision, especially during the COVID-19 pandemic, which might give rise to an increased risk of missing rare diagnoses. Our patient was treated with prednisolone, after which both his clinical condition and eosinophil concentrations markedly improved.


Subject(s)
Hypereosinophilic Syndrome/diagnosis , Hypereosinophilic Syndrome/pathology , Adult , Anti-Inflammatory Agents/therapeutic use , Biopsy/methods , COVID-19/diagnosis , Diagnosis, Differential , Dyspnea/complications , Eosinophils/pathology , Humans , Hypereosinophilic Syndrome/complications , Hypereosinophilic Syndrome/drug therapy , Male , Prednisolone/therapeutic use , SARS-CoV-2 , Skin Diseases/complications , Skin Diseases/diagnosis , Tomography, X-Ray Computed/methods , Treatment Outcome
20.
BMJ Case Rep ; 14(1)2021 Jan 18.
Article in English | MEDLINE | ID: covidwho-1066835

ABSTRACT

SARS-CoV-2 is the cause of COVID-19. Since the outbreak and rapid spread of COVID-19, it has been apparent that the disease is having multi-organ system involvement. Still its effect in the endocrine system is not fully clear and data on cortisol dynamics in patients with COVID-19 are not yet available. SARS-CoV-2 can knock down the host's cortisol stress response. Here we present a case of a 51-year-old man vomiting for 10 days after having confirmed COVID-19 infection. He had hypotension and significant hyponatraemia. Work-up was done including adrenocorticotropic hormone stimulation test. He was diagnosed as suffering from adrenal insufficiency and started on steroids with subsequent improvement in both blood pressure and sodium level. COVID-19 can cause adrenal insufficiency. Clinicians must be vigilant about the possibility of an underlying relative cortisol deficiency in patients with COVID-19.


Subject(s)
Adrenal Insufficiency/physiopathology , COVID-19/physiopathology , Hyponatremia/physiopathology , Hypotension/physiopathology , Acidosis/blood , Acidosis/physiopathology , Acidosis/therapy , Adrenal Insufficiency/blood , Adrenal Insufficiency/diagnosis , Adrenal Insufficiency/drug therapy , COVID-19/blood , Fluid Therapy , Glucocorticoids/therapeutic use , Humans , Hydrocortisone/blood , Hyponatremia/blood , Hyponatremia/therapy , Hypophosphatemia/blood , Hypophosphatemia/physiopathology , Hypophosphatemia/therapy , Hypotension/therapy , Male , Middle Aged , Pituitary-Adrenal Function Tests , Prednisolone/therapeutic use , SARS-CoV-2 , Vomiting/physiopathology , Water-Electrolyte Imbalance/blood , Water-Electrolyte Imbalance/physiopathology , Water-Electrolyte Imbalance/therapy
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