SEQUELAE OF COVID-19 COUGH: A RARE LIFE-THREATENING PRESENTATION

ABSTRACT

SESSION TITLE Management of COVID-19-Induced Complications SESSION TYPE Rapid Fire Case Reports PRESENTED ON 10/19/2022 1245 pm - 145 pm INTRODUCTION: Rib fractures are an infrequent consequence of severe cough. In some patients, undetected rib fractures can lead to life-threatening outcomes. We bring to light a case of uncontrolled cough associated with COVID-19 infection resulting in multiple rib fractures that were missed in 2 hospital visits and subsequently diagnosed when the patient presented in acute distress and at high risk of decompensation from a hemothorax and a diaphragmatic hernia that required expedited evaluation, ICU admission, and surgical intervention. CASE PRESENTATION This is a case of a 73 years old male who presented with shortness of breath and worsening dry cough of 4 weeks duration. He was seen in the ED 3 weeks previously for severe right-sided chest pain that was evaluated by a CT chest that did not reveal any acute findings. He was discharged home on pain medications. He had a repeat admission in 2 days and was diagnosed with acute hypoxic respiratory failure secondary to COVID-19 infection. CT abdomen was done for continued right upper quadrant pain which showed an upper abdominal wall hernia. He was discharged with instructions to follow up with outpatient surgery for hernia repair. In the interim, the patient continued to have excessive dry cough, progressively worsening shortness of breath, and bruising over the right abdominal wall and back. He returned to the ED where he was found to be hypoxic, and hypotensive. Imaging studies revealed a large right pleural effusion, fracture of the right sixth rib and seventh rib, and herniation of the hepatic flexure of the colon into the chest. He was subsequently admitted to the cardiothoracic ICU and underwent flexible bronchoscopy, right VATS, evacuation of hemothorax, complete decortication, and repair of diaphragmatic hernia. DISCUSSION: This case is an unusual presentation of an amalgamation of complications resulting from an unrelenting cough that prompted rapid recognition and swift action. Cough-induced complications are rare but can be life-threatening. Various imaging studies can be pursued to avoid a delay in diagnosis. CONCLUSIONS: Persistent cough is a common complication of COVID-19 infection. A clinician should have a high index of suspicion for rib fractures, diaphragmatic hernia, and hemothorax in a patient with persistent or progressive symptoms. Reference #1 Camarillo-Reyes LA, Marquez-Córdova RI, Surani S, Varon J. Hemothorax induced by severe cough An unusual presentation. SAGE Open Med Case Rep. 2019;72050313X19846043. Published 2019 Apr 26. doi10.1177/2050313X19846043 Reference #2 Daccache A, Haddad J, Ghanem A, Feghali EJ, El Osta B. Cough-induced rib fracture in a smoker a case report. J Med Case Rep. 2020;14(1)147. Published 2020 Sep 5. doi10.1186/s13256-020-02497-4 DISCLOSURES No relevant relationships by Navya Akula No relevant relationships by Sanjana Chetana Shanmukhappa No relevant relationships by Muhammad Ahmed Malik No relevant relationships by Aqsa Malik No relevant relationships by Fahd Shaukat