Dear Friends of EJCRIM,
we know that the COVID-19 epidemic is giving you a hard time. Please keep on fighting this virus, your efforts and work are irreplaceable in this very moment.
In order to spread awareness of the various COVID-19 manifestations, EJCRIM is now offering a Fast Track and the waiver of the publication fee for case reports and case series that touch this particular topic. The reports will be quickly peer-reviewed and published for free upon acceptance, so that the all internists and acute medicine doctors can take advantage of the immediate, shared knowledge.
Case reports are the quickest mean to share and to have your peers benefit from (vicarious) experience. Share yours.
The program will be in place until June, 1 2020. COVID-19 articles will be treated as fast track but not all submitted articles will be elegible for the fee waiver. Priority will be given to articles coming from the new epicentre, South America, as per WHO news conference held on Fri 22 May.
Please do not hesitate to reach out to the Editorial Office in case of doubts.
Introduction: Viral infections can induce autoimmune diseases in susceptible patients. SARS-CoV-2 has been associated with the development of rheumatic disease, especially small vessel vasculitis and arthritis. Typically, onset occurs days to weeks after the antigenic challenge and in patients with mild COVID-19. We report a case of large vessel vasculitis (LVV) temporally related to SARS-CoV-2 infection.
Case description: An otherwise healthy 19-year-old woman presented with fatigue, malaise, and chest and low back pain. The symptoms had begun 5 weeks earlier and 1 month after mild SARS-CoV-2 infection. Serological work-up revealed a marked proinflammatory state and anaemia without signs of infectious or autoimmune disease. Computerized tomography revealed thickening and blurring of the perivascular fat of the descending thoracic and abdominal aorta, progressing along the proximal iliac and renal arteries. Fluorodeoxyglucose positron emission tomography confirmed inflammatory activity. Symptoms and laboratory values normalized after prednisolone treatment.
Discussion: Recent SARS-CoV-2 infection may be a trigger for LVV, including Takayasu arteritis, as well as other rheumatic diseases. A prompt and thorough differential diagnosis is essential to exclude aortitis and LVV mimickers. Moreover, physicians should be aware of the potential spectrum of systemic and autoimmune diseases that could be precipitated by SARS-CoV-2 infection. This will allow timely diagnosis and treatment, with significant improvement in prognosis.
Background: Massive haemoptysis is a rare symptom ofcoronavirus disease 2019 (COVID-19). Management can be very challenging due to the lack of clear recommendations.
Case description: We report a case of massive recurrent haemoptysis in a young patient who tested positive for COVID-19 with successful management using endovascular embolization.
Discussion: Life-threatening massive haemoptysis has rarely been reported as the only manifestation of COVID-19. Embolisation was the therapeutic option chosen to manage this emergency.
Graves’ disease is an autoimmune disorder that results in hyperthyroidism, caused by autoantibodies to the thyrotropin receptor (TRAbs) stimulating thyroid hormone synthesis, giving rise to a variety of systemic manifestations such as goitre, dermatopathy and orbitopathy.
The authors present the case of a 28-year-old man admitted to hospital for a 3-week history of fatigue, shortness of breath, palpitations and diffuse goitre, after recent mild SARS-CoV-2 infection. Laboratory investigation revealed hyperthyroidism with TRAbs elevation. Thyroid ultrasound confirmed a diffusely heterogeneous and irregular thyroid gland and a nodular image below the sternal notch. Thyroid scintigraphy excluded the nodule and confirmed a Graves’ disease pattern. Following the initiation of methimazole, the patient had complete resolution of symptoms and normalization of thyroid values.
The results suggest a possible association between Graves’ disease and SARS-CoV-2 infection acting as a trigger. Graves’ disease is an important differential diagnosis to keep in mind when patients present with hyperthyroidism after COVID-19 disease.
The mRNA-1273 SARS-CoV-2 vaccine received emergency use authorization in December 2021. We present a case of myasthenia gravis (MG) which became clinically apparent following vaccination against SARS-CoV-2. A 30-year-old man developed acute onset diplopia, 2 days after receiving his first mRNA-1273 vaccination against SARS-CoV-2. He reported blurred vision with horizontally displaced images, which worsened with increased eye strain. Diplopia resolved when one eye was covered. He also had fatigable arm weakness, but denied dysphagia, dysarthria, dysphonia or dyspnoea. On examination, he had left-sided ptosis and esotropia at rest which worsened with sustained upward gaze and prolonged focus. He also had fatigable weakness of neck flexion and extension (4+/5), and generalized, fatigable weakness (4/5). His single-breath count was 38. Cranial nerves, sensory examination and deep tendon reflexes were normal. A 2-min ice-pack test and neostigmine test temporarily improved his diplopia and ptosis. The acetylcholine receptor (AChR) antibody was borderline high and muscle-specific tyrosine kinase (MuSK) antibody was negative. Chest CT and brain MRI with contrast were unremarkable. The patient was diagnosed with MG and oral pyridostigmine and prednisone therapy were initiated.
We present a case of newly diagnosed MG after administration of mRNA-1273 vaccination against SARS-CoV-2. Although there has been long-standing discussion regarding the potential for vaccines to exacerbate autoimmune conditions, data remain sparse and consensus has not been reached. Consequently, this case is important to make providers aware of potential side effects of a novel vaccine, and may also help guide the selection of vaccination candidates and monitoring parameters.
COVID-19 vaccines were introduced soon after the COVID-19 pandemic emerged in 2020. Various side effects were reported worldwide, including several types of common systemic side effects such as fever and general fatigue. Reports of other rare manifestations also emerged. We report the case of an adult male with a rare systemic syndrome mimicking lymphoma after he had received the first dose of an mRNA-based COVID-19 vaccine. After nearly 6 months of investigation with suspicion for an infection or malignancy, all symptoms resolved, laboratory tests normalized, and imaging showed no sign of active disease.
SARS-CoV-2 infection can present in different clinical forms, most commonly as bilateral pneumonia, but also with pericardial/myocardial involvement. Cardiac involvement in COVID-19 is associated with worse outcomes.
The authors report a case of myopericarditis as the primary manifestation of SARS-CoV-2 infection in a 20-year-old male patient with no known cardiovascular (CV) disorders or risk factors.
The patient presented with pleuritic chest pain and high fever, with no respiratory symptoms. Electrocardiogram (ECG) and echocardiogram changes were consistent with pericarditis; concomitant elevation of cardiac enzymes revealed myocardial involvement. The patient had a slow but favourable evolution with no apparent impact on cardiac function. Other causes of myopericarditis were excluded and SARS-CoV-2 admitted as the most likely aetiological agent.
This case highlights possible cardiac involvement in SARS-CoV-2 infection with little or no pulmonary disease in a young healthy patient. Such systemic and potentially troublesome manifestations of COVID-19 are increasingly being described.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), is associated with a high incidence of thrombotic complications involving both the arterial and the venous systems. However, concurrent arterial and venous thrombosis is extremely rare. Herein, we present the case of a 75-year-old male patient with severe COVID-19 who developed bilateral renal artery thrombosis and pulmonary embolism during the disease course. To our knowledge, this is the first such case described in the literature.
Paediatric inflammatory multisystem syndrome (PIMS) is associated with SARS-CoV-2 infection in patients aged 19 years or below according to World Health Organization (WHO) criteria. The condition is characterised by fever, inflammation and organ dysfunction. PIMS mimics Kawasaki disease or toxic shock syndrome. As SARS-CoV-2 infection is a global pandemic, clinicians need to be aware of the conditions associated with it.
We present the case of 18-year-old woman who was admitted with multi-organ failure requiring admission to the intensive care unit. The differential diagnosis included toxic shock syndrome, Kawasaki disease and PIMS. The overall picture fit the criteria for PIMS but the patient had a negative polymerase chain reaction (PCR) test for SARS-CoV-2, which presented additional diagnostic difficulties. As the PCR test was negative, IgG antibodies against SARS-CoV-2 were measured to detect past infection and tested positive. The patient was diagnosed with PIMS as she met the WHO criteria after other differential diagnoses were excluded. She was successfully treated with methylprednisolone and intravenous immunoglobulin (IVIG).
A 57-year-old man presented to the outpatient clinic with tremor, palpitations, weight loss and fatigue 1 week after receiving the first dose of the Oxford-AstraZeneca SARS-CoV-2 vaccine (ChAdOx1 nCoV-19). Laboratory studies showed a suppressed TSH with elevated total and free T4. Thyroid peroxidase and thyroglobulin antibodies were elevated but thyrotropin receptor autoantibodies were indeterminate. Thyroid scintigraphy with technetium Tc-99m pertechnetate revealed increased diffuse, symmetric uptake. The patient was treated with thiamazole 15 mg three times a day and propranolol with resolution of his symptoms and normalization of his thyroid function tests until discontinuation of the antithyroid drug 6 months after symptom onset.
Penile Mondor’s disease is a rare condition characterised by superficial thrombophlebitis of the penis which is usually self-limiting. The cause is often unknown. The AstraZeneca ChAdOx1-S vaccine has been found to cause a hypercoagulable state, which is well documented. This case report describes a man who presented with Mondor’s disease following ChAdOx1-S vaccination with no other risk factors.