Rationale: Syncope is described as the loss of consciousness and postural muscle tone with a short duration and fast onset. Micturition syncope can be caused by abnormal vasovagal response or by the dysfunction of the blood pressure regulating mechanism, which occurs before, during, or immediately after urination. Patient concerns: We present 4 cases of COVID-19 hospitalized in the Department of Infectious Diseases of the Academic Emergency Hospital Sibiu, Romania, cases that presented micturition syncope. Diagnoses: During hospitalization, patients confirmed with SARS-Cov-2 infection using real time reverse transcriptase-polymerase chain reaction (RT-PCR) assay, presented micturition syncope in different stages of the infection (at the beginning and in the second week of evolution). Interventions: Other causes of syncope such as adrenal insufficiency secondary to corticosteroids treatment, cardiac rhythm disorders, neurological impairment, dehydration, vasoactive medication, malignancies, pulmonary hypertension and coughing were excluded. The treatment of SARS-CoV-2 infection was performed following the local and national guidelines. Outcomes: The clinical course of all 4 patients diagnosed with COVID-19 and micturition syncope was favorable. To our knowledge, micturition syncope in COVID-19 patients has yet not been reported by other authors. Lessons: To our knowledge, micturition syncope associated with the evolution of COVID-19, has yet not been reported by other authors.
Background The cutaneous manifestations of SARS-CoV-2 have been insufficiently covered in the literature. Methods We retrospectively analyzed 39 patients, admitted in our hospital, all with confirmed SARS-CoV-2 infection, patients that associated during the hospitalization or in the convalescence period various skin manifestations. Results We admitted in our hospital from March 23 until September 12, 2020, 39 cases of SARS-CoV-2 infected patients which were identified with intra-infectious rash or with lesions ofcutaneous vasculitis during convalescence. The most common cutaneous manifestation are erythematous and erythematous papular rash. 27 of the 39 documented patients had anosmia (69.2%), 26 patients had ageusia (66.7%), 34 patients presented pneumonia (87.2%), 24 patients had intra-infectious enterocolitis (61.5%). Skin biopsies were rarely performed in these patients. Furthermore, we are reporting two performed biopsies with the histopathological and immunohistochemistry changes of this selected cases of erythematous rash and erythema multiforme-like lesions. Both skin biopsies reveal an early fibrous remodeling of the dermis, suggesting similar changes that occur in the lungs or in other tissues in this disease. Conclusions The correlation of the skin lesions in SARS-CoV-2 infection with anosmia, ageusia and enteritis does not seem to be accidental, but associated with a similar response to ACE2 receptor expression in these tissues.
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