The pulmonary effects of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus that causes coronavirus disease (COVID-19), are well documented; however, more evidence is needed to understand its effect on multiple organ systems. We present the case of a 69-year-old male with dyspnea for two weeks and bilateral conjunctivitis who tested positive for SARS-CoV-2. He was found to be hypoxic, requiring supplemental oxygen. On hospital day two, he complained of worsening left eye pain with the development of a left lower eyelid ulcer. He underwent a CT of facial bones, which showed findings consistent with pre-septal cellulitis and abscess. Samples from bilateral conjunctival secretions and left lower eyelid ulcer tested positive for herpes simplex virus-1 (HSV-1), and negative for SARS-CoV-2. He received supportive care, antibiotics, and famciclovir with almost complete resolution of his ocular complaints. This case illustrates an atypical COVID-19 presentation and raises concern as to how this virus modulates the immune system, allowing for concurrent viral infections.
Pancytopenia and neutropenia due to COVID-19 is rare. Here we report a case of neutropenia as a sequela of COVID-19 with concern bone marrow infiltration. The patient was successfully treated with granulocyte colony-stimulating factor (GCSF).
The limited availability of donor organs worldwide, has provoked a surge in the need for implantable left ventricular assist devices (LVADs) mainly as a bridge to heart transplantation or destination therapy. The rate of complications from LVAD use is also increasing, impacting morbidity, mortality, and costs. LVAD infections due to nontuberculous mycobacteria (NTM) are exceedingly rare, yet very difficult to treat. Here we present three cases of Mycobacterium abscessus LVAD infections. To our knowledge, only two other cases have been documented.
The COVID-19 pandemic presented myriad of unprecedented and daunting ethical dilemmas to healthcare workers, patients, their families, and the public health. Here we present a case of a 42-years-old Hispanic female with underlying hematological malignancy that developed severe SARS-COV-2 infection amidst the pandemic. This case illustrates some remarkable ethical dilemmas during pandemic times, including the lack of advanced directive planning, the repercussions of restricting family visits, and what ethics in crisis and moral injury entails. Identifying the ethical challenges emerging from the pandemic will assist physicians and other providers in making proper decisions and maintaining the best standard of care.
Background The emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to many proposed treatments for COVID-19 induced cytokine release syndrome (CRS). We aimed to investigate the treatment response of Tocilizumab (TZB), an Interleukin-6 (IL-6) inhibitor in this single center study. Methods A retrospective chart review in COVID-19 patients was conducted from 03/18/20 - 05/20/20. Patients with PCR confirmed COVID-19 who received TZB were included. Variables included dose and timing of TZB, trend of acute phase reactants, time to improved oxygenation and defervescence, 30-day mortality, and hospital/intensive care unit (ICU) length of stay (LOS). Descriptive statistics were used. Results Twelve patients received TZB at least once during the study period. Median patient age was 51.5 years (interquartile range (IQR), 34–87), and mean body weight of 109 kg (SD = 33.8). At time of admission, mean day of illness was 6.6 days (SD = 3.3) into their illness. All patients received a standardized TZB dose of 400 mg, and 2 patients received a second dose. Nine out of 11 patients (75%) had elevated median IL-6 baseline levels of 38.3 (IQR < 5- 96.22). The average CRS score was elevated at 3.3 at the time of TZB administration. All patients who received TZB were on supplemental oxygen, and 58% were mechanically ventilated. A decrease in oxygen requirement in 24 hours was seen in mechanically ventilated patients (71%) compared to those not on mechanical ventilation (20%). Median ICU days were 17.5 (IQR, 3–39), and median LOS days were 21.5 (IQR 8–46). All patients had sustained decreases in CRP post-TZB administration. Almost half of patients (42%) were treated for bacterial pneumonia post TZB and 3 (25%) patients were treated for herpes simplex virus (HSV) reactivation. Majority (92%) of patients received additional COVID-19 therapies such as hydroxychloroquine, convalescent plasma, or remdesivir. During the study period only one patient expired. Conclusion Our findings suggest that TZB may have a role in mechanically ventilated patients in decreasing oxygen requirement. However larger randomized studies are needed to understand which patients would benefit the most. Our study also highlights secondary infections and HSV reactivation in TZB patients. Disclosures All Authors: No reported disclosures
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