Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4104
C. Song, V. Bedi, B. C. Buragamadagu, J. Nair
Introduction: COVID-19 virus has been known to be a major cause of mortality secondary to cytokine storm and respiratory failure. Other manifestations include GI symptoms, loss of taste and smell and thromboembolism. Here we introduce a case of suspected COVID-19 induced viral myocarditis in an 86 year old woman. Case presentation: An 86-year-old female with no reported past medical history, not on daily medications, was brought in by ambulance after fall and unable to get up for many hours. On presentation, she was in mild distress due to left sided musculoskeletal pain, afebrile, tachycardic, tachypneic, and saturating at 93% on room air. Patient denied chest pain throughout her hospitalization. Tenderness in the left chest wall, left upper and lower extremities was elicited on physical examination. Labs obtained were significant for a creatine kinase of 37,000 IU/L and troponin I of 9.93ng/mL. EKG showed nonspecific T wave abnormalities, and prolonged QTC of 548ms. Chest x-ray showed multifocal pneumonia with no features suggestive of trauma. She was admitted to telemetry for further management of COVID-91 pneumonia and cardiac work up. Her troponin I peaked to 12.52ng/mL and she was treated with empiric intravenous heparin and aspirin. Echocardiogram shows global hypokinesis with left ventricular ejection fraction of 35-40%. Heart failure regimen with beta blocker and aldosterone receptor blocker were started. Rhabdomyolysis normalized with intravenous fluids. For COVID-19 pneumonia, she received dexamethasone and remdesivir and was weaned to 4L oxygen on discharge. Discussion:Viral myocarditis often results from a combination of direct viral injury and subsequent cellular immune activation. There is limited knowledge for COVID-19 associated viral myocarditis;most documented cases are from existing case reports, where most patients are male, and under the age of 70 years. Diagnosis is often challenging, as endomyocardial biopsy is often forgone in the setting of the ongoing pandemic and increased infection risk. Treatment for viral myocarditis involves heart failure management followed by directed therapy based on suspected etiology. Lymphocytic myocarditis, as seen in the setting of COVID-19, would typically involve immunosuppression in the form of glucocorticoids and intravenous immunoglobulin;although these regimens have yet to be extensively studied in COVID-19 associated myocarditis. As literature on this infection is rapidly evolving, it is vital to recognize and document suspected cases. This case helps to establish presentation of COVID-19 induced viral myocarditis and facilitate future understanding and raises awareness of this extrapulmonary presentation.
{"title":"Suspected COVID-19 Induced Acute Viral Myocarditis","authors":"C. Song, V. Bedi, B. C. Buragamadagu, J. Nair","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4104","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4104","url":null,"abstract":"Introduction: COVID-19 virus has been known to be a major cause of mortality secondary to cytokine storm and respiratory failure. Other manifestations include GI symptoms, loss of taste and smell and thromboembolism. Here we introduce a case of suspected COVID-19 induced viral myocarditis in an 86 year old woman. Case presentation: An 86-year-old female with no reported past medical history, not on daily medications, was brought in by ambulance after fall and unable to get up for many hours. On presentation, she was in mild distress due to left sided musculoskeletal pain, afebrile, tachycardic, tachypneic, and saturating at 93% on room air. Patient denied chest pain throughout her hospitalization. Tenderness in the left chest wall, left upper and lower extremities was elicited on physical examination. Labs obtained were significant for a creatine kinase of 37,000 IU/L and troponin I of 9.93ng/mL. EKG showed nonspecific T wave abnormalities, and prolonged QTC of 548ms. Chest x-ray showed multifocal pneumonia with no features suggestive of trauma. She was admitted to telemetry for further management of COVID-91 pneumonia and cardiac work up. Her troponin I peaked to 12.52ng/mL and she was treated with empiric intravenous heparin and aspirin. Echocardiogram shows global hypokinesis with left ventricular ejection fraction of 35-40%. Heart failure regimen with beta blocker and aldosterone receptor blocker were started. Rhabdomyolysis normalized with intravenous fluids. For COVID-19 pneumonia, she received dexamethasone and remdesivir and was weaned to 4L oxygen on discharge. Discussion:Viral myocarditis often results from a combination of direct viral injury and subsequent cellular immune activation. There is limited knowledge for COVID-19 associated viral myocarditis;most documented cases are from existing case reports, where most patients are male, and under the age of 70 years. Diagnosis is often challenging, as endomyocardial biopsy is often forgone in the setting of the ongoing pandemic and increased infection risk. Treatment for viral myocarditis involves heart failure management followed by directed therapy based on suspected etiology. Lymphocytic myocarditis, as seen in the setting of COVID-19, would typically involve immunosuppression in the form of glucocorticoids and intravenous immunoglobulin;although these regimens have yet to be extensively studied in COVID-19 associated myocarditis. As literature on this infection is rapidly evolving, it is vital to recognize and document suspected cases. This case helps to establish presentation of COVID-19 induced viral myocarditis and facilitate future understanding and raises awareness of this extrapulmonary presentation.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80480716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4088
E. Mascarenhas, L. S. Deere, C. Bojanowski
A 61-year old man was admitted to the intensive care unit for acute respiratory distress syndrome after presenting with four days of dyspnea. Chest imaging revealed diffuse ground glass opacities and he was found to be positive for SARS-CoV-2 infection. His hospital course was complicated by sequelae of coronavirus disease 2019 (COVID-19) including prolonged mechanical ventilation and renal failure requiring hemodialysis. He never received steroids or other immunosuppressive therapy. After one month, he developed new fevers and thick respiratory secretions. Repeat SARS-CoV-2 PCR at this time was negative. Repeat chest imaging revealed a new right upper lobe cavitary lesion. Differential diagnosis at that time included a developing lung abscess and invasive fungal infection. Tracheal cultures and non-bronchoscopic alveolar lavages were collected and serum galactomannan was sent. Due to ongoing need for mechanical ventilation and persistent secretions, empiric broad spectrum antibiotics and amphotericin B (to include mucormycosis coverage) were started. Cultures initially revealed mold finalized as Aspergillus fumigatus. Antifungal therapy was tailored to voriconazole. His fevers ultimately resolved, and he was weaned to minimal ventilator settings in preparation for tracheostomy. Invasive pulmonary aspergillosis is a serious infection that can cause severe systemic dysfunction. On imaging, aspergillosis can appear as solitary or multiple pulmonary nodules or masses with a halo, or reverse halo sign. Peripheral areas of consolidation, with or without cavitation, with adjacent pleural thickening and potentially direct invasion into the adjacent chest wall may be seen in advanced cases. Co-infection with aspergillosis in COVID-19 is a newly recognized phenomenon. There is ongoing discussion regarding appropriate evaluation and empiric, perhaps even prophylactic, use of antifungal therapy. Our case was diagnosed after presumed resolution of SARS-CoV-2 infection bringing to question the role for routine fungal disease evaluation in so-called recovered individuals with on-going respiratory compromise.
{"title":"Invasive Pulmonary Aspergillosis in the Recovery Phase of COVID-19","authors":"E. Mascarenhas, L. S. Deere, C. Bojanowski","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4088","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4088","url":null,"abstract":"A 61-year old man was admitted to the intensive care unit for acute respiratory distress syndrome after presenting with four days of dyspnea. Chest imaging revealed diffuse ground glass opacities and he was found to be positive for SARS-CoV-2 infection. His hospital course was complicated by sequelae of coronavirus disease 2019 (COVID-19) including prolonged mechanical ventilation and renal failure requiring hemodialysis. He never received steroids or other immunosuppressive therapy. After one month, he developed new fevers and thick respiratory secretions. Repeat SARS-CoV-2 PCR at this time was negative. Repeat chest imaging revealed a new right upper lobe cavitary lesion. Differential diagnosis at that time included a developing lung abscess and invasive fungal infection. Tracheal cultures and non-bronchoscopic alveolar lavages were collected and serum galactomannan was sent. Due to ongoing need for mechanical ventilation and persistent secretions, empiric broad spectrum antibiotics and amphotericin B (to include mucormycosis coverage) were started. Cultures initially revealed mold finalized as Aspergillus fumigatus. Antifungal therapy was tailored to voriconazole. His fevers ultimately resolved, and he was weaned to minimal ventilator settings in preparation for tracheostomy. Invasive pulmonary aspergillosis is a serious infection that can cause severe systemic dysfunction. On imaging, aspergillosis can appear as solitary or multiple pulmonary nodules or masses with a halo, or reverse halo sign. Peripheral areas of consolidation, with or without cavitation, with adjacent pleural thickening and potentially direct invasion into the adjacent chest wall may be seen in advanced cases. Co-infection with aspergillosis in COVID-19 is a newly recognized phenomenon. There is ongoing discussion regarding appropriate evaluation and empiric, perhaps even prophylactic, use of antifungal therapy. Our case was diagnosed after presumed resolution of SARS-CoV-2 infection bringing to question the role for routine fungal disease evaluation in so-called recovered individuals with on-going respiratory compromise.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80518726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4108
M. A. Popescu-Hagen, A. Ichim, A. Cristea, D. Zaharia, M. Oprea, G. Ciolan
Mycobacterium kansasii is a nontuberculous mycobacterium which leads to a chronic pulmonary infection that resembles pulmonary tuberculosis. Symptoms of pulmonary infection with M kansasii may include cough, sputum production, weight loss, breathlessness, chest pain, hemoptysis and fever or sweats.The paper presents the case of a 30-year-old woman, confirmed with moderate SARS-COV2 infection at a county hospital and transferred to "Marius Nasta" Institute for Pneumology for specialty treatment. At admission, the CT exam reveals multiple "tree in bud" lesions and cavity lesions located at the RUL level. Bacteriological examinations for the genus mycobacterium were initially negative, but from the bronchial aspirate, the bacteriological examination was BAAR positive. Genetic testing confirmed mycobacterium infection. Resistance to H, R was not detected. According to the national protocol, antibiotic treatment is initiated with Isoniazid, Rifampicin, Ethambutol and Pyrazinamide. The patient tolerated the treatment well throughout the hospitalization period, as there were no interactions between the treatment for SARS-COV2 and the antibiotic one. Due to the favorable evolution, the patient is discharged one month after starting treatment. As recommendations, the patient must present herself at the territorial TB clinic, in order to continue the antibiotic treatment for up to 6 months.At two months, the culture shows infection with mycobacterium kansassi, thus the treatment is modified by administering Rifampicin, Etambutol and Azithromycin. Following the administration of the new treatment, the lung lesions show regression. In the case of mycobacterium kansassi infections, the treatment will be continued for up to 12 months. The evolution of M. kansassi infection may be influenced by various factors, but in this case the moderate SARS-COV2 infection, cured in 3 weeks, did not influence the favourable evolution. Also, the absence of shortness of breath, as well as the compliance and absence of treatment resistance were keen factors in the evolution under treatment.In conclusion, the patient was initially admitted to the hospital for a moderate COVID-19 infection. The routine CT exam was also suggestive for a possible other pathology, and follow-up tests and examinations led to the discovery of an infection with M. kansassi. The SARS-COV-2 infection had favourable evolution under treatment and was cured in 3 weeks, but the treatment for M. kansassi is long-term and may have effects on the patients' psychology, as well as by the presence of adverse reactions, not following the treatment can be fatal with death occurring in 50% of cases.
{"title":"Management of Atypical TB During the COVID-19 Pandemic","authors":"M. A. Popescu-Hagen, A. Ichim, A. Cristea, D. Zaharia, M. Oprea, G. Ciolan","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4108","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4108","url":null,"abstract":"Mycobacterium kansasii is a nontuberculous mycobacterium which leads to a chronic pulmonary infection that resembles pulmonary tuberculosis. Symptoms of pulmonary infection with M kansasii may include cough, sputum production, weight loss, breathlessness, chest pain, hemoptysis and fever or sweats.The paper presents the case of a 30-year-old woman, confirmed with moderate SARS-COV2 infection at a county hospital and transferred to \"Marius Nasta\" Institute for Pneumology for specialty treatment. At admission, the CT exam reveals multiple \"tree in bud\" lesions and cavity lesions located at the RUL level. Bacteriological examinations for the genus mycobacterium were initially negative, but from the bronchial aspirate, the bacteriological examination was BAAR positive. Genetic testing confirmed mycobacterium infection. Resistance to H, R was not detected. According to the national protocol, antibiotic treatment is initiated with Isoniazid, Rifampicin, Ethambutol and Pyrazinamide. The patient tolerated the treatment well throughout the hospitalization period, as there were no interactions between the treatment for SARS-COV2 and the antibiotic one. Due to the favorable evolution, the patient is discharged one month after starting treatment. As recommendations, the patient must present herself at the territorial TB clinic, in order to continue the antibiotic treatment for up to 6 months.At two months, the culture shows infection with mycobacterium kansassi, thus the treatment is modified by administering Rifampicin, Etambutol and Azithromycin. Following the administration of the new treatment, the lung lesions show regression. In the case of mycobacterium kansassi infections, the treatment will be continued for up to 12 months. The evolution of M. kansassi infection may be influenced by various factors, but in this case the moderate SARS-COV2 infection, cured in 3 weeks, did not influence the favourable evolution. Also, the absence of shortness of breath, as well as the compliance and absence of treatment resistance were keen factors in the evolution under treatment.In conclusion, the patient was initially admitted to the hospital for a moderate COVID-19 infection. The routine CT exam was also suggestive for a possible other pathology, and follow-up tests and examinations led to the discovery of an infection with M. kansassi. The SARS-COV-2 infection had favourable evolution under treatment and was cured in 3 weeks, but the treatment for M. kansassi is long-term and may have effects on the patients' psychology, as well as by the presence of adverse reactions, not following the treatment can be fatal with death occurring in 50% of cases.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81259005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4098
R. Reddy, K. Chen, A. Wellikoff
Introduction: COVID-19 has a variable clinical presentation ranging from flu-like symptoms to respiratory failure. Most patients have a mild form of disease and often recover at home over a period of weeks. For some, the highest morbidity of COVID-19 may not be associated with the acute phase of the disease, but rather the longstanding post-viral pulmonary fibrosis. Case Description: A 49-year-old man with a past medical history of coronary artery disease, obstructive sleep apnea, hypertension, and type two diabetes mellitus presented to the emergency department with a four-day history of fever, nausea, and diarrhea. He denied cough or dyspnea. Chest radiograph revealed bibasilar ground glass opacifications. He was positive for severe acute respiratory syndrome coronavirus 2 by polymerase chain reaction testing. His oxygen saturation was 95% on room air and he was discharged home without treatment. Over the following days, he developed a dry cough and mild dyspnea, but he did not desaturate on room air. He was prescribed a short course of steroids by his outpatient pulmonologist. He gradually improved over the course of two weeks and he was never hospitalized. Computed tomography (CT) of the chest 10 weeks after diagnosis revealed bilateral patchy ground glass opacities in all lobes and interstitial components with architectural distortion in the lower lobes (Image 1). A pulmonary function test performed 12 weeks after diagnosis showed an FVC 83%, FEV1 85%, TLC 75%, RV 37%, and DCLO 88%. The patient continued to experience mild dyspnea with exertion 2 months after the resolution of the infection. Conclusion: Pulmonary fibrosis is not a post-viral phenomenon limited to severe cases of COVID-19 and can occur following mild presentations managed at home. Thus far, risk factors for the development of pulmonary fibrosis secondary to COVID-19 have been reported to be advanced age, disease severity, length of intensive care unit stay, smoking, and alcoholism. Our case report calls for a re-evaluation of these risk factors. While pharmaceutical treatments are typically only administered to hospitalized patients, there may be basis for treating mild cases with the intent of preventing post-viral pulmonary fibrosis. Further, outpatient clinicians may consider monitoring for changes in pulmonary architecture with pulmonary function tests or high-resolution CT scans in all recovered COVID-19 patients regardless of symptom severity.
{"title":"The Worst May Be Yet to Come - Post-Viral Pulmonary Fibrosis in a COVID-19 Patient with Mild Symptoms","authors":"R. Reddy, K. Chen, A. Wellikoff","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4098","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4098","url":null,"abstract":"Introduction: COVID-19 has a variable clinical presentation ranging from flu-like symptoms to respiratory failure. Most patients have a mild form of disease and often recover at home over a period of weeks. For some, the highest morbidity of COVID-19 may not be associated with the acute phase of the disease, but rather the longstanding post-viral pulmonary fibrosis. Case Description: A 49-year-old man with a past medical history of coronary artery disease, obstructive sleep apnea, hypertension, and type two diabetes mellitus presented to the emergency department with a four-day history of fever, nausea, and diarrhea. He denied cough or dyspnea. Chest radiograph revealed bibasilar ground glass opacifications. He was positive for severe acute respiratory syndrome coronavirus 2 by polymerase chain reaction testing. His oxygen saturation was 95% on room air and he was discharged home without treatment. Over the following days, he developed a dry cough and mild dyspnea, but he did not desaturate on room air. He was prescribed a short course of steroids by his outpatient pulmonologist. He gradually improved over the course of two weeks and he was never hospitalized. Computed tomography (CT) of the chest 10 weeks after diagnosis revealed bilateral patchy ground glass opacities in all lobes and interstitial components with architectural distortion in the lower lobes (Image 1). A pulmonary function test performed 12 weeks after diagnosis showed an FVC 83%, FEV1 85%, TLC 75%, RV 37%, and DCLO 88%. The patient continued to experience mild dyspnea with exertion 2 months after the resolution of the infection. Conclusion: Pulmonary fibrosis is not a post-viral phenomenon limited to severe cases of COVID-19 and can occur following mild presentations managed at home. Thus far, risk factors for the development of pulmonary fibrosis secondary to COVID-19 have been reported to be advanced age, disease severity, length of intensive care unit stay, smoking, and alcoholism. Our case report calls for a re-evaluation of these risk factors. While pharmaceutical treatments are typically only administered to hospitalized patients, there may be basis for treating mild cases with the intent of preventing post-viral pulmonary fibrosis. Further, outpatient clinicians may consider monitoring for changes in pulmonary architecture with pulmonary function tests or high-resolution CT scans in all recovered COVID-19 patients regardless of symptom severity.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90934691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4092
W. Johnson
Introduction: Cavitary lesions have a very broad differential diagnosis. Some case studies have shown COVID19 to cause cavitary lesions1,2 and others have shown COVID19 to cause pneumothorax3. We describe a case report of a young man with no significant past medical history who was hospitalized for COVID19 pneumonia and was subsequently developed a pneumothorax. Case Report: A 39-year-old male presented to the hospital for acute onset shortness of breath. On admission, he was found to have right-sided pneumothorax and a pigtail catheter was placed with a proper expansion of the right lung. Approximately one month previously, he had been admitted for mild COVID19 pneumonia and successfully treated with dexamethasone and was discharged home with stable condition.On further evaluation, chest CT revealed multiple cavitary lesions with one large cavitation in the inferior right upper lobe with prominent mediastinal and hilar nodes. Quantiferon gold, AFB x3, and mycobacterium complex PCR were all negative. Fungitell, 1-3 B-D gluten, and coccioides antibodies were also negative. The patient had no other suggestive features to warrant vasculitis or malignancy evaluation. Discussion:The importance of this case is recognizing the late sequela of COVID19 pneumonia such as cavitary lesions and pneumothorax as seen with our patient. Some studies showed the development of pneumothorax associated with COVID19 but no previous studies showed the development of these findings in a patient without any past pulmonary history3. We attributed the development of cavitary lesions to covid19 and subsequently, because of that, the patient developed pneumothorax. Conclusion: It is important to consider the long term sequela of COVID19 pneumonia especially in those we consider to have mild disease. It is important to minimize potential severe consequences such as pneumothorax which occurred due to intense coughing as seen with our patient.
{"title":"Caution with Mild COVID19 Pneumonia: A Case of Cavitary Lesions and Pneumothorax in a Young Male with No Past Medical History","authors":"W. Johnson","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4092","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4092","url":null,"abstract":"Introduction: Cavitary lesions have a very broad differential diagnosis. Some case studies have shown COVID19 to cause cavitary lesions1,2 and others have shown COVID19 to cause pneumothorax3. We describe a case report of a young man with no significant past medical history who was hospitalized for COVID19 pneumonia and was subsequently developed a pneumothorax. Case Report: A 39-year-old male presented to the hospital for acute onset shortness of breath. On admission, he was found to have right-sided pneumothorax and a pigtail catheter was placed with a proper expansion of the right lung. Approximately one month previously, he had been admitted for mild COVID19 pneumonia and successfully treated with dexamethasone and was discharged home with stable condition.On further evaluation, chest CT revealed multiple cavitary lesions with one large cavitation in the inferior right upper lobe with prominent mediastinal and hilar nodes. Quantiferon gold, AFB x3, and mycobacterium complex PCR were all negative. Fungitell, 1-3 B-D gluten, and coccioides antibodies were also negative. The patient had no other suggestive features to warrant vasculitis or malignancy evaluation. Discussion:The importance of this case is recognizing the late sequela of COVID19 pneumonia such as cavitary lesions and pneumothorax as seen with our patient. Some studies showed the development of pneumothorax associated with COVID19 but no previous studies showed the development of these findings in a patient without any past pulmonary history3. We attributed the development of cavitary lesions to covid19 and subsequently, because of that, the patient developed pneumothorax. Conclusion: It is important to consider the long term sequela of COVID19 pneumonia especially in those we consider to have mild disease. It is important to minimize potential severe consequences such as pneumothorax which occurred due to intense coughing as seen with our patient.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76671588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4110
A. Clark, M. Burton, U. Nazir, L. Thomas
Since the onset of the coronavirus disease 2019 (COVID-19) due to the SARS-CoV-2 virus, recommendations for diagnostics and therapeutics have rapidly evolved. The World Health Organization recommends nucleic acid amplification testing (NAAT) such as reverse transcriptase PCR (RT-PCR) as the standard for COVID-19, with a sensitivity of 95%. However, many factors can affect the results including timing of test, specimen quality, specimen handling, pooling specimens, and other technical reasons, resulting in false negatives. The case below describes a patient with a clinical presentation concerning for COVID-19 despite three negative RT-PCR tests and highlights the importance of treating patients based on their entire clinical impression rather than a single data point. A 53-year-old Hispanic male with no medical history presented to the hospital with 4 days of dyspnea and cough. He was admitted to the intensive care unit with acute hypoxemic respiratory failure requiring heated high flow nasal cannula. No associated fever, myalgias, anosmia, diarrhea, and he denied any known ill contacts, inhalation exposures or prior smoking history. Laboratory workup was notable for thrombocytosis, lymphopenia, elevated ferritin, C-reactive protein, D-dimer and lactate dehydrogenase as commonly seen with COVID-19. Infectious screen resulted with negative SARS-CoV-2 PCR by nasal swab, negative respiratory viral panel, negative HIV PCR, and negative fungal pneumonia screen. Imaging showed bilateral ground-glass opacities consistent with multifocal pneumonia (figure). He was started on a 5-day course of antibiotics for community acquired pneumonia and given high suspicion for COVID-19 pneumonia was started on dexamethasone 6mg daily with a plan to repeat SARS-CoV-2 testing. Repeat SARS-CoV-2 PCR was negative on hospital day 2 and 4 but SARS-CoV-2 antibody was positive on hospital day 6 (10 days after symptom onset). Given the positive antibody test and clinical course consistent with COVID-19 pneumonia, he was continued on dexamethasone for a total of 10 days, completed a 5-day course of remdesivir, and received 1 unit of convalescent plasma with clinical improvement. He was discharged home on hospital day 15 with supplemental oxygen. With increasing rates of infection with the SARS-CoV-2 virus, it becomes critically important to quickly and accurately diagnose patients. While RT-PCR has high sensitivity, there are still several factors that affect the accuracy and may result in false-negative results with potential implications such as delay in treatment and failure to quarantine. This case highlights the importance to treat patients based on a comprehensive clinical impression rather than a single test result.
{"title":"COVID 19 Testing Cannot Replace Clinical Judgement","authors":"A. Clark, M. Burton, U. Nazir, L. Thomas","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4110","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4110","url":null,"abstract":"Since the onset of the coronavirus disease 2019 (COVID-19) due to the SARS-CoV-2 virus, recommendations for diagnostics and therapeutics have rapidly evolved. The World Health Organization recommends nucleic acid amplification testing (NAAT) such as reverse transcriptase PCR (RT-PCR) as the standard for COVID-19, with a sensitivity of 95%. However, many factors can affect the results including timing of test, specimen quality, specimen handling, pooling specimens, and other technical reasons, resulting in false negatives. The case below describes a patient with a clinical presentation concerning for COVID-19 despite three negative RT-PCR tests and highlights the importance of treating patients based on their entire clinical impression rather than a single data point. A 53-year-old Hispanic male with no medical history presented to the hospital with 4 days of dyspnea and cough. He was admitted to the intensive care unit with acute hypoxemic respiratory failure requiring heated high flow nasal cannula. No associated fever, myalgias, anosmia, diarrhea, and he denied any known ill contacts, inhalation exposures or prior smoking history. Laboratory workup was notable for thrombocytosis, lymphopenia, elevated ferritin, C-reactive protein, D-dimer and lactate dehydrogenase as commonly seen with COVID-19. Infectious screen resulted with negative SARS-CoV-2 PCR by nasal swab, negative respiratory viral panel, negative HIV PCR, and negative fungal pneumonia screen. Imaging showed bilateral ground-glass opacities consistent with multifocal pneumonia (figure). He was started on a 5-day course of antibiotics for community acquired pneumonia and given high suspicion for COVID-19 pneumonia was started on dexamethasone 6mg daily with a plan to repeat SARS-CoV-2 testing. Repeat SARS-CoV-2 PCR was negative on hospital day 2 and 4 but SARS-CoV-2 antibody was positive on hospital day 6 (10 days after symptom onset). Given the positive antibody test and clinical course consistent with COVID-19 pneumonia, he was continued on dexamethasone for a total of 10 days, completed a 5-day course of remdesivir, and received 1 unit of convalescent plasma with clinical improvement. He was discharged home on hospital day 15 with supplemental oxygen. With increasing rates of infection with the SARS-CoV-2 virus, it becomes critically important to quickly and accurately diagnose patients. While RT-PCR has high sensitivity, there are still several factors that affect the accuracy and may result in false-negative results with potential implications such as delay in treatment and failure to quarantine. This case highlights the importance to treat patients based on a comprehensive clinical impression rather than a single test result.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74335106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4082
K. Luoma, D. Crouch
Introduction: Co-infections in hospitalized patients are associated with higher mortality. The rate of co-infection in COVID-19 at the time of hospitalization is estimated at around 10%, but the long-term impact of SARS-CoV-2 on the immune system following the initial infectious period is unknown. Here we describe the case of a previously healthy patient hospitalized with coccidioides pulmonary infection following mild COVID-19 disease. Case: A 52-year-old man with no significant past medical history presented to the hospital with worsening non-productive cough, left-sided pleuritic chest pain, fevers, chills and sweats. Four weeks prior to presentation, he was diagnosed with COVID-19 pneumonia. He experienced respiratory symptoms for 7 days and then made a full recovery. Ten days later, he developed a new cough. He was found to have a new infiltrate on chest radiograph and was treated with two courses of oral antibiotics without improvement. CT chest was done and found to be concerning for a "fungal ball" and he subsequently presented to Jacobs Medical Center. He denied occupational exposures or smoking history. He was born in Ohio, and moved to California at age 3. Chest CT showed a left lower lobe mass-like consolidation with central necrosis, trace pleural effusion, and mediastinal lymphadenopathy. Initial laboratory evaluation revealed a leukocytosis to 17 that was neutrophil predominant. Over the next 5 days, his absolute eosinophil count climbed from 400 to 1100. COVID-19 PCR testing at the time of admission was negative. During bronchoscopy, there were two submucosal nodules in the distal trachea and left mainstem bronchus and bronchoalveolar lavage (BAL) was obtained from the left lower lobe. Cytopathic review of the BAL fluid revealed acute inflammation and spherules consistent with Coccidioides immitis. The BAL cell count revealed 21% eosinophils and fungal cultures grew coccidioides. Coccidioides IgM was positive, while IgG was negative. He was initiated on fluconazole therapy with rapid resolution of fevers and improvement in his cough and pleuritic chest pain. Discussion: This is a classic presentation of acute coccidioidomycosis infection involving a lobar necrotizing pneumonia, peripheral and BAL eosinophilia, bronchial submucosal nodules, positive serum IgM antibodies, fungal cultures, and cytopathologic exam. This case highlights the possibility that patients with COVID-19 infection are at increased risk of developing subsequent infections. It will be important for providers to remain vigilant for opportunistic infections at the time of presentation and in the period following COVID-19 infection.
{"title":"Opportunistic Coccidioides Pulmonary Infection Following COVID-19 Pneumonia","authors":"K. Luoma, D. Crouch","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4082","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4082","url":null,"abstract":"Introduction: Co-infections in hospitalized patients are associated with higher mortality. The rate of co-infection in COVID-19 at the time of hospitalization is estimated at around 10%, but the long-term impact of SARS-CoV-2 on the immune system following the initial infectious period is unknown. Here we describe the case of a previously healthy patient hospitalized with coccidioides pulmonary infection following mild COVID-19 disease. Case: A 52-year-old man with no significant past medical history presented to the hospital with worsening non-productive cough, left-sided pleuritic chest pain, fevers, chills and sweats. Four weeks prior to presentation, he was diagnosed with COVID-19 pneumonia. He experienced respiratory symptoms for 7 days and then made a full recovery. Ten days later, he developed a new cough. He was found to have a new infiltrate on chest radiograph and was treated with two courses of oral antibiotics without improvement. CT chest was done and found to be concerning for a \"fungal ball\" and he subsequently presented to Jacobs Medical Center. He denied occupational exposures or smoking history. He was born in Ohio, and moved to California at age 3. Chest CT showed a left lower lobe mass-like consolidation with central necrosis, trace pleural effusion, and mediastinal lymphadenopathy. Initial laboratory evaluation revealed a leukocytosis to 17 that was neutrophil predominant. Over the next 5 days, his absolute eosinophil count climbed from 400 to 1100. COVID-19 PCR testing at the time of admission was negative. During bronchoscopy, there were two submucosal nodules in the distal trachea and left mainstem bronchus and bronchoalveolar lavage (BAL) was obtained from the left lower lobe. Cytopathic review of the BAL fluid revealed acute inflammation and spherules consistent with Coccidioides immitis. The BAL cell count revealed 21% eosinophils and fungal cultures grew coccidioides. Coccidioides IgM was positive, while IgG was negative. He was initiated on fluconazole therapy with rapid resolution of fevers and improvement in his cough and pleuritic chest pain. Discussion: This is a classic presentation of acute coccidioidomycosis infection involving a lobar necrotizing pneumonia, peripheral and BAL eosinophilia, bronchial submucosal nodules, positive serum IgM antibodies, fungal cultures, and cytopathologic exam. This case highlights the possibility that patients with COVID-19 infection are at increased risk of developing subsequent infections. It will be important for providers to remain vigilant for opportunistic infections at the time of presentation and in the period following COVID-19 infection.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74377982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4074
F. Tariq, D. Pau
Introduction: COVID-19 has a wide range of clinical manifestations involving multiple organ systems. There have been a few cases in the literature that demonstrate the association between COVID-19 and hypertriglyceridemia in the setting of treatment with tocilizumab. We report, to our knowledge, the first known series of patients with critical illness resulting from COVID-19, who developed severe hypertriglyceridemia in the absence of treatment with tocilizumab. Description: Case 1: A 57-year-old male with end-stage renal disease, diabetes mellitus, and hypertension was admitted to the hospital with worsening shortness of breath due to COVID-19. He was initially managed with conservative measures including supplemental oxygen on the medical floor but required transfer to the ICU for worsening hypoxemia necessitating invasive mechanical ventilation. The patient developed a lipemic serum on hospital day 8. His triglyceride level was noted to be 3160mg/dl, with a baseline level of 224mg/dl 1-year prior. Patient deteriorated rapidly and expired before appropriate treatment measures for his hypertriglyceridemia could be implemented. Case 2: A 73-year-old male with pulmonary fibrosis and coronary artery disease was admitted to the hospital with shortness of breath due to COVID-19. He was managed with remdesivir and dexamethasone on the medical floor, but deteriorated further and required invasive mechanical ventilation and continuous renal replacement therapy. Patient developed lipemic serum on hospital day 19 and was found to have a triglyceride level of 1757mg/dl, with a baseline level of 173mg/dl 1-year prior. Patient was started on an insulin infusion but continued to deteriorate and expired on hospital day 20. Case 3: A 47-year-old hypertensive male patient was admitted with worsening shortness of breath due to COVID-19. He was initially treated with dexamethasone and supplemental oxygen but deteriorated and required invasive mechanical ventilation as well as continuous renal replacement therapy. He was noted to have a lipemic serum on hospital day 14 and was found to have a triglyceride level of 945mg/dl. Patient was managed with an insulin infusion with subsequent improvement in his levels. Patient had a prolonged hospitalization and required tracheostomy but has since made a full recovery including the recovery of his renal function, and has returned to work. Image below shows the lipemic serum of our patient: Discussion: These cases suggest an association between severe COVID-19 and hypertriglyceridemia in the absence of treatment with tocilizumab. Further studies are needed to determine whether this association truly exists, its implications on prognosis, and to determine optimal management strategies.
{"title":"Severe Hypertriglyceridemia in Critically Ill Patients with COVID-19","authors":"F. Tariq, D. Pau","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4074","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4074","url":null,"abstract":"Introduction: COVID-19 has a wide range of clinical manifestations involving multiple organ systems. There have been a few cases in the literature that demonstrate the association between COVID-19 and hypertriglyceridemia in the setting of treatment with tocilizumab. We report, to our knowledge, the first known series of patients with critical illness resulting from COVID-19, who developed severe hypertriglyceridemia in the absence of treatment with tocilizumab. Description: Case 1: A 57-year-old male with end-stage renal disease, diabetes mellitus, and hypertension was admitted to the hospital with worsening shortness of breath due to COVID-19. He was initially managed with conservative measures including supplemental oxygen on the medical floor but required transfer to the ICU for worsening hypoxemia necessitating invasive mechanical ventilation. The patient developed a lipemic serum on hospital day 8. His triglyceride level was noted to be 3160mg/dl, with a baseline level of 224mg/dl 1-year prior. Patient deteriorated rapidly and expired before appropriate treatment measures for his hypertriglyceridemia could be implemented. Case 2: A 73-year-old male with pulmonary fibrosis and coronary artery disease was admitted to the hospital with shortness of breath due to COVID-19. He was managed with remdesivir and dexamethasone on the medical floor, but deteriorated further and required invasive mechanical ventilation and continuous renal replacement therapy. Patient developed lipemic serum on hospital day 19 and was found to have a triglyceride level of 1757mg/dl, with a baseline level of 173mg/dl 1-year prior. Patient was started on an insulin infusion but continued to deteriorate and expired on hospital day 20. Case 3: A 47-year-old hypertensive male patient was admitted with worsening shortness of breath due to COVID-19. He was initially treated with dexamethasone and supplemental oxygen but deteriorated and required invasive mechanical ventilation as well as continuous renal replacement therapy. He was noted to have a lipemic serum on hospital day 14 and was found to have a triglyceride level of 945mg/dl. Patient was managed with an insulin infusion with subsequent improvement in his levels. Patient had a prolonged hospitalization and required tracheostomy but has since made a full recovery including the recovery of his renal function, and has returned to work. Image below shows the lipemic serum of our patient: Discussion: These cases suggest an association between severe COVID-19 and hypertriglyceridemia in the absence of treatment with tocilizumab. Further studies are needed to determine whether this association truly exists, its implications on prognosis, and to determine optimal management strategies.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76375011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4113
A. E. Martínez, L. F. Enciso, J. Piraquive, G. Diaz, P. Torres, C. Rodríguez
INTRODUCTION: due to the fact that lung disease due to SARS COV 2 infection is of recent appearance and the lack of knowledge about its natural history, it is not clear the moment of adequate follow-up by diagnostic images, this being suggested after 3 months of the onset of the symptoms according to the evolution of the patient. We present the variation of image findings of a patient with severe COVID-19 pneumonia. DESCRIPTION:we present the case of a 56-year-old male patient who required initial hospitalization of 14 days because of symptoms secondary to multilobar severe pneumonia due to SARS-COV-2 infection with initial tomographic findings of classic pattern given by ground glass opacities of subpleural distribution predominantly in the lower lobes. The patient was discharged with low flow oxygen supplementation and attended the pulmonology consultation a month later reporting improvement in dyspnea with medical research council score grade 1 and complete withdrawal of oxygen support. A control chest computed tomography was taken 6 weeks since initial evaluation reporting subpleural bullae of recent appearance in the upper and lower right lobe with diameters of up to 80 mm. It was also described a small residual laminar pneumothorax adjacent to the lingula with pleural effusion with apparent septae. Given these findings, an intervention by thoracic surgery was requested who decided to schedule a surgical procedure and performed a new control image corresponding to 8 weeks from the initial one with findings of complete and spontaneous resolution of the pneumothorax as well as the pleural effusion although persistence of the bullas. It was decided there was not required further interventions and patient was discharged from follow-up.DISCUSSION: SARS-CoV2 infection manifests itself in different patterns of lung damage and can have long term pulmonary sequelae that are only identified with judicious and strict follow-up during the first months after infection. Nevertheless, the British Thoracic Society (BTS) has recommended the first image follow-up to be preformed after 3 months of the initial symptoms because of the high incidence of image alterations in that period of time and lesser probability of occult malignancy. This case described a rare presentation of lung damage with equally spontaneous resolution of the complications confirming the timeframe proposed by the BTS.
{"title":"Imagenological Evolution of Pulmonary Secuelae After SARS CoV2 Infection","authors":"A. E. Martínez, L. F. Enciso, J. Piraquive, G. Diaz, P. Torres, C. Rodríguez","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4113","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4113","url":null,"abstract":"INTRODUCTION: due to the fact that lung disease due to SARS COV 2 infection is of recent appearance and the lack of knowledge about its natural history, it is not clear the moment of adequate follow-up by diagnostic images, this being suggested after 3 months of the onset of the symptoms according to the evolution of the patient. We present the variation of image findings of a patient with severe COVID-19 pneumonia. DESCRIPTION:we present the case of a 56-year-old male patient who required initial hospitalization of 14 days because of symptoms secondary to multilobar severe pneumonia due to SARS-COV-2 infection with initial tomographic findings of classic pattern given by ground glass opacities of subpleural distribution predominantly in the lower lobes. The patient was discharged with low flow oxygen supplementation and attended the pulmonology consultation a month later reporting improvement in dyspnea with medical research council score grade 1 and complete withdrawal of oxygen support. A control chest computed tomography was taken 6 weeks since initial evaluation reporting subpleural bullae of recent appearance in the upper and lower right lobe with diameters of up to 80 mm. It was also described a small residual laminar pneumothorax adjacent to the lingula with pleural effusion with apparent septae. Given these findings, an intervention by thoracic surgery was requested who decided to schedule a surgical procedure and performed a new control image corresponding to 8 weeks from the initial one with findings of complete and spontaneous resolution of the pneumothorax as well as the pleural effusion although persistence of the bullas. It was decided there was not required further interventions and patient was discharged from follow-up.DISCUSSION: SARS-CoV2 infection manifests itself in different patterns of lung damage and can have long term pulmonary sequelae that are only identified with judicious and strict follow-up during the first months after infection. Nevertheless, the British Thoracic Society (BTS) has recommended the first image follow-up to be preformed after 3 months of the initial symptoms because of the high incidence of image alterations in that period of time and lesser probability of occult malignancy. This case described a rare presentation of lung damage with equally spontaneous resolution of the complications confirming the timeframe proposed by the BTS.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81108385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4114
S. Patel, F. Patel
A 20-year-old asymptomatic Caucasian female has been screened to the clinic for COVID-19 testing due to the recent pandemic. She works in the primary care clinic where covid-19 patients are not seen. She has a past medical history of diabetes Mellitus and thyroid nodule. Her vitals are Temp 96.2 F, BP 123/89, RR 18, spo2 99% on air. On physical examination, her nasal turbinates were pale bilaterally, with no throat congestion. She denies any cough, congestion, fever, muscle aches, shortness of breath, sore throat, loss of taste, or smell sensation. On Investigation: Early march IgG antibody positive for covid-19 and in late May, she was tested positive for RT-PCR covid-19 without symptoms both times. On both occasions, she was working with healthcare workers without strict preventive protocols, who came negative for tests. Her family and close contacts tested negative for COVID-19. Diagnosis: Asymptomatic covid 19 carriers. Treatment: Close monitoring for symptoms. Discussion: Over the last year, the COVID-19 pandemic has caused significant concern worldwide due to its rapid spread. There are few notable symptomatic cases that are hospitalized and two months after discharge, they still tested positive on the RT-PCR COVID-19 test. It means they are a dormant carrier for COVID-19. But, in our case, the patient was asymptomatic and positive for COVID-19 antibody and RT-PCR test. Surprisingly, all healthcare workers in the clinic came negative on repeated testing. We presumed that she encountered some covid-19 strain, which remains dormant in the body and non-contagious. We need further studies to evaluate the COVID-19 dormant stage like hepatitis-B and tuberculosis.
{"title":"COVID-19: An Asymptomatic Carrier","authors":"S. Patel, F. Patel","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4114","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4114","url":null,"abstract":"A 20-year-old asymptomatic Caucasian female has been screened to the clinic for COVID-19 testing due to the recent pandemic. She works in the primary care clinic where covid-19 patients are not seen. She has a past medical history of diabetes Mellitus and thyroid nodule. Her vitals are Temp 96.2 F, BP 123/89, RR 18, spo2 99% on air. On physical examination, her nasal turbinates were pale bilaterally, with no throat congestion. She denies any cough, congestion, fever, muscle aches, shortness of breath, sore throat, loss of taste, or smell sensation. On Investigation: Early march IgG antibody positive for covid-19 and in late May, she was tested positive for RT-PCR covid-19 without symptoms both times. On both occasions, she was working with healthcare workers without strict preventive protocols, who came negative for tests. Her family and close contacts tested negative for COVID-19. Diagnosis: Asymptomatic covid 19 carriers. Treatment: Close monitoring for symptoms. Discussion: Over the last year, the COVID-19 pandemic has caused significant concern worldwide due to its rapid spread. There are few notable symptomatic cases that are hospitalized and two months after discharge, they still tested positive on the RT-PCR COVID-19 test. It means they are a dormant carrier for COVID-19. But, in our case, the patient was asymptomatic and positive for COVID-19 antibody and RT-PCR test. Surprisingly, all healthcare workers in the clinic came negative on repeated testing. We presumed that she encountered some covid-19 strain, which remains dormant in the body and non-contagious. We need further studies to evaluate the COVID-19 dormant stage like hepatitis-B and tuberculosis.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79811181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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