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.


  • Erika Poggiali, Pau Mateo Ramos, Davide Bastoni, Andrea Vercelli, Andrea Magnacavallo

    COVID-19 (coronavirus disease 19) is an infectious disease caused by coronavirus SARS-CoV-2. Since its detection in China at the end of 2019, the novel coronavirus has rapidly spread throughout the world and has caused an international public health emergency. The most common manifestation is flu-like symptoms. Mild infections usually improve within a few days, but COVID-19 can cause severe pneumonia with acute respiratory distress syndrome and death. Gastrointestinal symptoms are less common but possible and more difficult to recognize as part of a COVID-19 syndrome. In line with the current opinion of the WHO, we strongly believe that preventive measures and early diagnosis of COVID-19 are crucial to interrupt virus spread and avoid local outbreaks. We report the cases of COVID-19 patients admitted to our Emergency Department who complained of gastrointestinal symptoms at admission.

  • Noel Lorenzo Villalba, Yasmine Maouche, Maria Belen Alonso Ortiz, Zaida Cordoba Sosa, Jean Baptiste Chahbazian, Aneska Syrovatkova, Pierre Pertoldi, Emmanuel Andres, Abrar-Ahmad Zulfiqar

    We describe two elderly patients evaluated at emergency departments for anosmia/dysgeusia in the absence of any other respiratory symptoms prior to or upon admission. In the current epidemiological context, clinical and biological work-up led to a diagnosis of COVID-19 infection. Unfortunately, one of the patients died during hospitalization, but the other recovered and was discharged.

  • Erika Poggiali, Davide Bastoni, Eva Ioannilli, Andrea Vercelli, Andrea Magnacavallo

    Coronavirus disease 19 (COVID-19) is a worldwide infection which was recently declared a global health emergency by the WHO Emergency Committee. The most common symptoms are fever and cough, which can progress to pneumonia, acute respiratory distress syndrome (ARDS) and/or end-organ failure. Risk factors associated with ARDS and death are older age, comorbidities (e.g., hypertension, diabetes, hyperlipidaemia), neutrophilia, and organ and coagulation dysfunction. Disseminated intravascular coagulation and coagulopathy can contribute to death. Anticoagulant treatment is associated with decreased mortality in severe COVID-19 pneumonia. In this report we describe two patients with COVID-19 pneumonia who developed venous thromboembolism.

  • Danny Epstein, Wisam Andrawis, Ari M Lipsky, Hiba Abu Ziad, Moshe Matan

    We describe a case of a young man admitted to due to mild COVID-19 infection. During his hospitalization in an isolation ward, he had no respiratory distress or fever but developed symptoms consistent with anxiety and insomnia. Despite the appropriate supportive intervention, on hospital day 7, he attempted suicide by jumping from the third-floor ward. The patient was urgently operated and transferred to level I trauma center under strict isolation. Our findings emphasize the importance of mental health aspects during the treatment of patients during the COVID-19 pandemic.

  • Damiano D’Ardes, Andrea Boccatonda, Cosima Schiavone, Francesca Santilli, Maria Teresa Guagnano, Marco Bucci, Francesco Cipollone

    The World Health Organization has declared novel coronavirus disease 2019 (COVID-19) an international public health emergency. We describe the case of a 92-year-old woman who was admitted to our unit with fever and chills with laboratory evidence of coinfection with SARS-CoV-2 and cytomegalovirus.

  • Venu Madhav Konala, Sreedhar Adapa, Vijay Gayam, Srikanth Naramala, Subba Rao Daggubati, Chetan Brahma Kammari, Avantika Chenna

    COVID-19, also called severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2), originated in Wuhan, China. It has caused significant morbidity and mortality worldwide and has been declared a global pandemic by the WHO. Influenza occurs mainly during the winter, with the burden of disease determined by several factors, including the effectiveness of the vaccine that season, the characteristics of the circulating viruses, and how long the season lasts. We describe the case of a 66-year-old woman who was diagnosed with influenza A and COVID-19 co-infection.

  • Elena Roca, Carlo Lombardi, Marco Campana, Oscar Vivaldi, Barbara Bigni, Bruno Bertozzi, Giovanni Passalacqua

    Objective: The availability of public health information for optimised supportive care is critical during the COVID-19 pandemic. We describe the first case of COVID-19 complicated by Takotsubo cardiomyopathy.
    Materials and Methods: We report the clinical, laboratory and radiological findings of a patient with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
    Results: The nasopharyngeal swab was positive for SARS-CoV-2 and x-ray images demonstrated pathognomonic pneumonia. The patient developed tachycardia and the echocardiogram confirmed the diagnosis of Takotsubo cardiomyopathy.
    Conclusions: Doctors should be aware of the need to thoroughly study this new infection in order to understand its underlying mechanisms and related complications.

  • Tom van Kraaij, Rémy Mostard, Sofia Ramiro, Cesar Magro Checa, Christel van Dongen, Eric HJ van Haren, Jacqueline Buijs, Robert Landewé

    Younger patients with COVID-19 may experience an exaggerated immune response to SARS-CoV-2 infection and develop cytokine release syndrome (CRS), which may be life threatening. There is no proven antiviral therapy for COVID-19 so far, but profound immunosuppression has recently been suggested as a treatment for COVID-19-associated CRS. We present a case of life-threatening CRS caused by COVID-19 infection with a favourable response to immunosuppressive therapy with tocilizumab (TCZ). The rapid clinical and biochemical improvement following TCZ administration suggests that treatment with immunotherapy can be life-saving in selected patients with COVID-19-induced CRS.

  • Talal Asif, Zafar Ali

    We continue to learn about cardiac involvement in patients with COVID-19. These patients can develop acute coronary syndrome and severe myocarditis with a reduced ejection fraction. We describe two critically ill COVID-19 patients who developed ST elevation that resolved on repeat ECG without any intervention.

  • Marco Marando, Adriana Tamburello, Pietro Gianella

    We describe the clinical features and role of ultra-low-dose chest computed tomography and bronchoscopy in the diagnosis of COVID-19. In our patient, who was highly suggestive clinically and radiologically for COVID-19, we had two false-negative results for nasopharyngeal and oral swab reverse-transcriptase polymerase chain reaction (RT-PCR) assays for SARS-CoV-2. Eventually, we confirmed the diagnosis using bronchoscopy and bronchoalveolar lavage.

  • Christopher Hughes, Tom Nichols, Martin Pike, Christian Subbe, Salah Elghenzai

    Coronavirus disease 19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe the case of a 59-year-old man who presented with headache, hypertension and a single episode of fever with no other symptoms. He subsequently developed unilateral weakness. Computer tomography identified a cerebral venous sinus thrombosis (CVST). A subsequent test for COVID-19 was positive. This is the first report of CVST as a presenting symptom of COVID-19 infection.

  • Lia a Beccara, Carlotta Pacioni, Sara Ponton, Simone Francavilla, Antonio Cuzzolii

    A 52-year-old patient with SARS-CoV-2 was diagnosed with interstitial pneumonia and treated with darunavir/ritonavir, hydroxychloroquine, azithromycin and low molecular weight heparin (LMWH). After LMWH cessation, he developed superior mesenteric arterial thrombosis. An abdominal CT scan showed arterial thrombosis of vessels efferent of the superior mesenteric artery with bowel distension. COVID-19 may predispose to venous and arterial thromboembolism. Anticoagulation prophylaxis should be considered in hospitalized patients with COVID-19, and potential thromboembolism investigated in each symptomatic patient affected by SARS-CoV-2.

  • Adriana Tamburello, Giovanni Bruno, Marco Marando

    In December 2019, a novel coronavirus called SARS-CoV-2 was reported to be responsible for a cluster of acute atypical respiratory pneumonia cases in Wuhan, in Hubei province, China. The disease caused by this virus is called COVID-19 (coronavirus disease 2019). The virus is transmitted between humans and the outbreak was declared a pandemic by the World Health Organization (WHO) on 11 March 2020. Coagulopathy is a common abnormality in patients with COVID‐19 due to inflammation, hypoxia, immobilisation, endothelial damage and diffuse intravascular coagulation. However, the data on this topic are still limited. Here we report the case of a man presenting with pneumonia complicated by bilateral pulmonary embolism.

  • Talal Asif, Kameel Kassab, Fady Iskander, Tareq Alyousef

    We report a case of acute viral pericarditis and cardiac tamponade in a patient with COVID-19 to highlight the associated treatment challenges, especially given the uncertainty associated with the safety of standard treatment. We also discuss complications associated with delayed diagnosis in patients who potentially may need mechanical ventilation.

  • Noel Lorenzo-Villalba, Abrar-Ahmad Zulfiqar, Marc Auburtin, Marie Helene Schuhmacher, Alain Meyer, Yasmine Maouche, Olivier Keller, Emmanuel Andres

    We report three cases of severe thrombocytopenia during COVID-19 infection associated with either cutaneous purpura or mucosal bleeding. The initial investigations ruled out other causes of thrombocytopenia. Two of the patients were treated with intravenous immunoglobulins and eltrombopag, while the third recovered spontaneously. A good clinical and biological response was achieved in all patients leading to hospital discharge.

  • Damiano D'Ardes, Andrea Boccatonda, Ilaria Rossi, Michela Pontolillo, Giulio Cocco, Cosima Schiavone, Francesca Santilli, Maria Teresa Guagnano, Marco Bucci, Francesco Cipollone

    In December 2019, an outbreak of a new coronavirus (SARS-CoV-2) was reported in Hubei province in China. The disease has since spread worldwide and the World Health Organization declared it a pandemic on 11 March 2020. We describe the case of a 65-year-old woman who clinically recovered from COVID-19 but showed persistent infection with SARS-CoV-2 for 51 days.

  • Hassan H Allam, Abdulhalim Jamal Kinsara, Tareq Tuaima, Shadwan Alfakeh

    Background: Very limited information is available on pericardial effusion as a complication of COVID-19 infection. There are no reports regarding pericardial fluid findings in COVID-19 patients.
    Case description: We describe a 41-year-old woman, with confirmed COVID-19, who presented with a large pericardial effusion. The pericardial fluid was drained. We present the laboratory findings to improve knowledge of this virus.
    Discussion: We believe this is the first such reported case. Findings suggested the fluid was exudative, with remarkably high lactate dehydrogenase and albumin levels. We hope our data provide additional insight into the diagnosis and therapeutic options for managing this infection.

  • Pedro Antunes Meireles, Filipe Bessa, Pedro Gaspar, Inês Parreira, Virgílio Dias Silva, Catarina Mota, Lourdes Alvoeiro

    Coronavirus disease 2019 (COVID-19) is a multisystemic condition caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with manifestations ranging from mild upper respiratory symptoms to cytokine storm causing acute respiratory distress syndrome. Pancreatic exocrine tissue and endocrine islets both express angiotensin-converting enzyme 2 (ACE2), the proven receptor for SARS-CoV-2 cell internalization. An increase in pancreatic enzymes has been increasingly recognized in patients with COVID-19, but little is known about the real prevalence of acute pancreatitis in this population. We report a case of acute acalculous pancreatitis in a COVID-19 patient.

  • Maria Cristina Pasqualetto, Eleonora Secco, Manuele Nizzetto, Moreno Scevola, Lorella Altafini, Alberto Cester, Fausto Rigo

    Patients affected by COVID-19 pneumonia may develop stress cardiomyopathy, also known as Takotsubo syndrome (TTS), at different stages during the disease and with different degrees of left ventricular dysfunction. We describe three cases of TTS in COVID-19-positive patients with different clinical presentations and outcomes. One of them died, while in the other two coronary angiography confirmed the diagnosis but was postponed until after pneumonia resolution because of the risk of virus spread.

  • Parminder Kaur, Sahitya Posimreddy, Balraj Singh, Firas Qaqa, Habib A Habib, Michael Maroules, Fayez Shamoon

    The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic that developed in late 2019 and early 2020 has caused thousands of deaths and has had an enormous impact on our health systems and economies. Coronavirus disease 2019 (COVID-19) complications include disseminated coagulation and thrombosis, but, to the best of our knowledge, the literature to date on these manifestations has been limited. Herein, we report an unusual presentation in a 43-year-old man with a medical history of diabetes and hypertension who presented with dyspnoea and acute pain in his right leg and was found to have acute limb ischaemia and diabetic ketoacidosis. Our case adds to the literature regarding arterial thrombosis in COVID-19.

  • Yael Becher, Leonid Goldman, Nadav Schacham, Irina Gringauz, Dan Justo

    The diagnosis of pulmonary embolism is challenging in symptomatic COVID-19 patients since shortness of breath, chest pain, tachycardia, tachypnoea, fever, oxygen desaturation and high D-dimer blood levels might be features of both diseases. We present two COVID-19 patients in whom pulmonary embolism was suspected (and diagnosed) due to a discrepancy between an increase in D-dimer blood levels and a decrease in C-reactive protein blood levels over time. We believe that an opposite change in the blood levels of both biomarkers over time may be used as a novel method to predict pulmonary embolism in COVID-19 patients.

  • Francois Maurier, Benoit Godbert, Julie Perrin

    We describe an overweight COVID-19 patient with respiratory distress preceded by anosmia/dysgeusia with no lung injury shown on CT, angio-CT or ventilation/perfusion scans. Orthopnoea and paradoxical abdominal respiration were identified. Phrenic paralysis, demonstrated by examination of patient breathing, and on x-ray while standing breathing in and out, explained the respiratory distress. This is a rare and previously undescribed neurological complication of COVID-19 infection caused by vagus nerve injury.

  • Sadettin Uslu

    Cytokine release syndrome (CRS) is a systemic inflammatory response that can be triggered by many factors such as infections. CRS in patients with coronavirus disease 2019 (COVID-19) is life-threatening and can occur very rapidly after COVID-19 diagnosis. Tocilizumab (TCZ), an interleukin‐6 (IL-6) inhibitor, may ameliorate the CRS associated with severe COVID‐19 and thus improve clinical outcomes. We present a case of life-threatening CRS caused by COVID-19 infection successfully treated with TCZ.

  • Maria Carolina dos Santos Sousa Duarte Seabra, Barbara Silva, Vitor Fagundes, João Rocha, Luís Nogueira, Mari Mesquita

    We describe the case of an 84-year-old female patient admitted due to an embolic stroke and non-anticoagulated AF. Her admission symptoms were sensory-motor aphasia and severe right limb paresis with an NIHSS score of 24. The diagnosis of embolic stroke (namely, total anterior circulation infarct; TACI) was made. Her stroke was extensive so she was not started on anticoagulation. During hospitalization, new embolic events occurred and a concomitant diagnosis of COVID-19 was made with progressive respiratory dysfunction followed by multiorgan failure. The patient died despite appropriate treatment.

  • Iris Duroi, Frederik Van Durme, Tony Bruyns, Sofie Louage, Alex Heyse

    Severe COVID-19 may predispose to both venous and arterial thrombosis. We describe a patient with acute ischaemic stroke while suffering from COVID-19 and respiratory failure, necessitating mechanical ventilation. Deep sedation may delay diagnosis..

  • Erika Poggiali, Andrea Vercelli, Teresa Iannicelli; Valentina Tinelli; Laura Celoni, Andrea Magnacavallo

    We describe the case of a male patient admitted to our emergency department during the Italian COVID-19 epidemic, for progressive worsening dyspnoea. A diagnosis of pneumothorax and diffuse interstitial lung involvement was promptly made by lung ultrasound and confirmed by an HRCT scan. A chest CT scan also showed diffuse emphysema, as observed in chronic obstructive pulmonary disease (COPD), and small consolidations in the lower lobes, suggestive for COVID-19 pneumonia...

  • Mariana Santos Leite Pessoa, Carla Franco Costa Lima, Ana Carla Farias Pimentel, José Carlos Godeiro Costa Júnior, Jorge Luis Bezerra Holanda

    The literature suggests that COVID-19 provokes arterial and venous thrombotic events, although the mechanism is still unknown. In this study, we describe patients with confirmed coronavirus infection associated with multisystemic infarction, focusing on splenic infarction. More data are required to elucidate how COVID-19 and thrombotic disease interact and so that preventive and early diagnosis strategies can be developed.

  • Andrea Boccatonda, Eugenia Ianniello, Damiano D'Ardes, Giulio Cocco, Fabrizio Giostra, Claudio Borghi, Cosima Schiavone

    Thromboembolic disease is strongly associated with, or even an integral part of, COVID-19 pneumonia. Indeed, endothelial/microvascular damage to pulmonary capillaries seems to be the main trigger of the pneumonia. Here we report a case of pulmonary embolism in a COVID-19 patient with an atypical clinical presentation. Blood gas analysis and lung ultrasound allowed the correct diagnosis to be reached.

  • Sabine Revuz, Nathalie Vernier, Leilah Saadi, Julien Campagne, Sophie Poussing, François Maurier

    We described three COVID-19-infected patients with profound immune thrombocytopenia causing haemorrhagic mucocutaneous complications. We conclude that an immune mechanism was responsible as common causes were excluded. Since corticoids were considered harmful in the circumstances, the patients were successfully treated with intravenous immunoglobulins without later relapse.

  • Catarina Sousa Gonçalves, Nuno Alexandre de Sousa Reis Carreira, Dúlio Teixeira Passos, Ana Luísa Barbosa, Ana Maria Baltazar, Alexandra Wahnon, Ana Mafalda Abrantes, Pedro Miguel Garrido, Teresa Ferreira, Marisa Teixeira Silva, Lourdes Alvoeiro

    COVID-19 is the clinical expression of the highly contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection. Most patients have mild symptoms, but a significant proportion have severe or critical disease, which can include cardiac injury, sepsis, acute kidney failure and respiratory failure. It is also worth highlighting the increasing number of reported COVID-19 cases with dermatological disease/manifestations. The cutaneous clinical spectrum is wide and includes maculopapular, urticarial, varicelliform and petechial rashes, pseudo perniosis, livedo reticularis, and pityriasis rosea-like, violaceous and pustular lesions. Until the physiological mechanism is fully understood, it is important to describe these manifestations, which could help identify a typical pattern. This report describes a cutaneous manifestation in a COVID-19 patient.

  • Orivaldo Alves Barbosa, Talita Guimarães Andrade, Maria Danielly de Almeida Sousa, José Walter Correia

    Infection with SARS-CoV-2 causes critical disease in approximately 5% of affected patients, particularly the elderly, hypertensive, obese and immunocompromised. Patients with haematological cancer, including chronic lymphocytic leukaemia (CLL), are particularly at risk of complications. Very rarely, patients with extreme leukocytosis may develop spurious hypoxemia, or pseudohypoxemia, which confuses the diagnosis of complications and can lead to intervention errors. We report the case of a patient with CLL, severe infection with SARS-CoV-2 and pseudohypoxemia.

  • Noel Lorenzo-Villalba, Yasmine Maouche, Aneska Syrovatkova, Felix Pham, Jean-Baptiste Chahbazian, Pierre Pertoldi, Emmanuel Andrès, Abrar-Ahmad Zulfiqar

    We describe the case of a patient hospitalized for acute decompensated heart failure in a standard medical ward. During hospitalization, he was diagnosed with COVID-19 and transferred to a special unit. The clinical course was marked by worsening of the respiratory disease, the development of right parotiditis and thrombosis of the left internal jugular vein. Therapeutic anticoagulation was initiated and 2 days later, the minimal dermatoporosis lesions previously present in the upper extremities evolved to haemorrhagic bullae with intra-bullae blood clots and dissecting haematomas...

  • Christel van Dongen, Marlou Janssen, Robrecht van der Horst, Dave van Kraaij, Ralph Peeters, Leon van den Toorn, Remy Mostard

    COVID-19 is a novel viral disease caused by SARS-CoV-2. The mid- and long-term outcomes have not yet been determined. COVID-19 infection is increasingly being associated with systemic and multi-organ involvement, encompassing cytokine release syndrome and thromboembolic, vascular and cardiac events. The patient described experienced unusually rapid development of pulmonary hypertension (PH) and right ventricular failure after recent severe COVID-19 pneumonia with cytokine release syndrome, which initially was successfully treated with methylprednisolone and tocilizumab...

  • Giuseppe Di Tano, Luigi Moschini, Marco Loffi, Gianluca Galeazzi, Sophie Testa, Gian Battista Danzi

    We report the case of a patient with chronic atrial fibrillation who was recently hospitalized for severe COVID-19 pneumonia. Four weeks after discharge he experienced an episode of an acute pulmonary embolism while on rivaroxaban therapy with adequate drug plasma levels, and in the absence of strong predisposing risk factors...

  • Maria Cristina Pasqualetto, Andrea Corrado, Eleonora Secco, Fabio Graceffa, Fausto Rigo

    Patients with COVID-19 pneumonia can develop heart problems and may also may be susceptible to proarrhythmia, virus-related issues such as fever, stress, electrolyte disturbance and adverse effects from the use of antiviral drugs. We report a transient Brugada-like ECG pattern without ongoing fever in a 57-year-old man, admitted with a diagnosis of COVID-19 pneumonia, who did not have syncope or a family history of sudden cardiac death.

  • Vincenza Giugno, Giulia Di Marzio, Andrea Domanico, Esterita Accogli

    Clinical experience and scientific articles have shown that patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be paucisymptomatic or asymptomatic at the time of diagnosis. In this paper, we will discuss two paucisymptomatic patients with blood tests suggestive for SARS-CoV-2 infection but with repeated negative nasopharyngeal swabs and without typical features of COVID-19 pneumonia on chest high-resolution computed tomography. In these cases, lung ultrasound helped to raise clinical suspicion of COVID-19 pneumonia and facilitate diagnosis.

  • Yvon Ruch, Charlotte Kaeuffer, Aurélien Guffroy, Nicolas Lefebvre, Yves Hansmann, François Danion

    Background: In June 2020, a large randomised controlled clinical trial in the UK found that dexamethasone was effective in reducing the number of deaths in patients with severe coronavirus disease 2019 (COVID-19).
    Case description: We describe a patient with rapid worsening of COVID-19 pneumonia and its dramatic improvement under corticosteroids. Discussion: Corticosteroids could be useful in patients with an inflammatory profile, considering that acute respiratory distress syndrome may be the consequence of cytokine storm syndrome.



To assist all health workers and researchers working under this threat we offer this Resource Centre. This resource brings together new COVID-19 content from across the web, publishers and scientific associations. This list is being constantly updated.