Leukemoid Reaction in a Severe COVID-19 Patient.

Leukemoid reaction is defined by a leukocyte level above 50 x 103/µL with a predominance of mature neutrophils and the presence of immature granulocytic forms in the peripheral blood (left shift). We report a case of a 36-year-old woman with severe coronavirus disease 2019 (COVID-19) infection admitted to the ICU with a leukocytosis of 70.9 x 103/µL white blood cells (WBC) throughout her hospitalization. A left shift with bandemia along with toxic granulations was also noticed and further investigation excluded more commonly known causes. A presumptive diagnosis of leukemoid reaction was made secondary to COVID-19 infection; however, it could not be confirmed since workup for lymphoproliferative disorders could not be performed as the patient passed away. The leukemoid reaction could be associated with severe COVID-19 infection; however, more data are needed to evaluate this association.

Posterior Reversible Encephalopathy Syndrome Associated With Coarctation of the Aorta.

Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome characterized by acute encephalopathy due to different medical conditions. This syndrome may present with a wide spectrum of neurological symptoms including headache, disorders of consciousness, visual changes, seizures, and focal neurological deficits, in addition to nonspecific symptoms such as nausea and vomiting. Neuroimaging findings of bilateral cortical and subcortical brain edema involving the parieto-occipital regions are a hallmark of the disease. We present a case report of an eight-year-old boy who complained of headache and vomiting for 20 days until the discovery of severely high blood pressure (BP). He developed altered mental status, hemiplegia, loss of visual field, and seizure, requiring transfer to the intensive care unit. Magnetic resonance imaging of the brain showed hyperintense signals in the bilateral cortical and subcortical parieto-occipital areas. The BP measure of the extremities recognized a hypertensive upper extremity and normotensive lower extremity, and an MRI angiography was consistent with coarctation of the aorta (CoA). The fundoscopic exam showed no abnormalities. The diagnosis was kept as PRES secondary to a hypertensive emergency. Later, stenting of the aorta was performed, improving overall symptoms leaving a sequel loss of peripheral vision.

Acute Urticaria as the First Symptom of COVID-19: A Case Report.

During the SARS-CoV-2 pandemic, various rashes associated with COVID-19 infection have been reported, including urticaria. Urticaria is a limited and usually benign condition, presenting as pruritic wheals, with or without edema. A 39-year-old woman presented with a pruritic rash on her arms spreading to her trunk and face over two days, followed by headache, nausea, vomiting, abdominal discomfort, diarrhea, myalgia, arthralgia, anosmia, and dyspepsia for three days. Fever, dry cough, and odynophagia started on the day of the consult. The patient had a history of hypertension but denied a history of atopic conditions, similar previous presentations, or recent ingestion of new medications. SARS-CoV-2 COVID-19 PCR testing was positive. She was prescribed oral antihistamine for the itching and was discharged. During a follow-up after two weeks, the patient was asymptomatic with complete resolution of the rash on day 7 of symptoms. Knowing the cutaneous manifestations of COVID-19 can aid in the early identification of this disease and prevent misdiagnosis. The presence of cutaneous manifestations in COVID-19 is suggested to be related to disease severity, but data are needed to study any prognostic value of dermatologic manifestations in COVID-19.