Transient Leukopenia Induced by Combination Therapy for Severe SARS-CoV-2 Pneumonia.

Treatment strategies for patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to be heavily researched and ever-changing. Recent data has suggested that combination therapy with dexamethasone, remdesivir and baricitinib could decrease the severity and length of illness in patients with severe SARS-CoV-2. However; the data regarding the safety and side effects related to this combination therapy are limited to case reports. The purpose of this case report is to highlight a potentially life-threatening side effect of one or all medications mentioned above. LEARNING POINTS: Current National Institutes of Health treatment guidelines recommend remdesivir for patients with a high risk of progression. In patients requiring minimal supplemental oxygen, remdesivir or dexamethasone monotherapy is recommended, while in patients requiring high-flow oxygen or non-invasive ventilation, dexamethasone monotherapy or dexamethasone plus remdesivir is recommended. Baricitinib or tocilizumab can be added in patients requiring oxygen supplementation.Clinicians should be aware of transient leukocytopenia that can be induced with combination therapy of dexamethasone, remdesivir and baricitinib during the early phase of treatment of SARS-CoV-2 patients.The evaluation approach for leukopenia should consider autoimmune disorders, inflammatory diseases, infections, malignancy, and medication and toxin exposure.

Spontaneous large liver haematoma with extensive intraperitoneal bleeding in a patient with COVID-19 infection.

Thrombotic complications during COVID-19 infections occur frequently, and anticoagulants to prevent and treat deep vein thrombosis appear to have a good safety profile in these patients. In addition, haemorrhagic complications during COVID-19 infections have also been reported. Hepatic inflammation can occur in COVID-19 infections as a direct consequence of cellular infection and cytopathy. Spontaneous subcapsular hepatic haematoma is extremely rare and can be life-threatening.A woman in her 40s presented to the hospital with fever and shortness of breath and was diagnosed with COVID-19 infection with respiratory failure requiring intubation. On day 49 of hospitalisation, she developed melena and acute anaemia; her haemoglobin dropped from 97g/L (9.7g/dL) to 56g/L (5.6g/dL). Abdominal and pelvic CT scans showed a large subcapsular liver haematoma with retroperitoneal extension. The patient received blood transfusions and remained haemodynamically stable. She was eventually extubated and discharged home.

The Gaisbock syndrome after COVID-19 pneumonia.

In 1905, Felix Gaisbock, MD, described a syndrome in patients with hypertension, elevated hematocrit levels, plethoric appearances, and no splenomegaly. He postulated this relative erythrocytosis was due to stress. In this case report, a 40-year-old Caucasian man with obesity was admitted with recurrent deep vein thrombosis and increasing oxygen requirements 2 weeks after hospitalization with COVID-19 pneumonia. This patient had a 10-year history of untreated hypertension and erythrocytosis. He had a ruddy appearance, a normal erythropoietin level, and a negative JAK2 V617 mutation. In this case, Gaisbock syndrome was suspected.