COVID-19 is the infectious disease caused by a recently discovered SARS-CoV-2. Following an initial outbreak in December 2019 in Wuhan, China, the virus has spread globally culminating in the WHO declaring a pandemic on 11 March 2020. We present the case of a patient with an initial presentation of COVID-19 pneumonitis requiring mechanical ventilation for nearly 2 weeks and total admission time of 3 weeks. She was given prophylactic dose anticoagulation according to hospital protocol during this time. Following a week at home, she was readmitted with acute massive pulmonary embolism with severe respiratory and cardiac failure, representing the first such case in the literature.
A man in his 70s, admitted to intensive care unit following an out of hospital cardiac arrest, had a nasogastric (NG) tube inserted on admission. Correct placement of the NG tube had been confirmed using National Patient Safety Agency (NPSA) criteria and was used for feeding without incident. He remained intubated and ventilated throughout his stay. On day 9 his oxygen requirements increased with subsequent chest imaging revealing an incidental gastric perforation secondary to NG tube migration. The NG tube was removed intact and undamaged. The patient appeared to improve without sequelae from the perforation or signs of abdominal sepsis. Unfortunately his condition deteriorated due to a large right atrial thrombus and life sustaining treatments were withdrawn.
The case presented here is of a patient with longitudinally extensive transverse myelitis (LETM) due to neurosarcoidosis with very striking MRI appearances. Recognition of the MRI findings that strongly support a diagnosis of neurosarcoidosis may facilitate diagnosis and promote early treatment. A previously well, 29-year-old, UK born, Afro-Caribbean man presented with orchitis and a progressive mild tetraparesis with a high cervical sensory level. MRI revealed LETM from C2-C6 with avid ‘nodular’ enhancement. CSF was normal. Chest imaging revealed hilar lymphadenopathy. Serum ACE was markedly elevated at 180 U/L. Mediastinal node biopsy demonstrated necrotising granulomas. Institution of corticosteroids led to symptomatic improvement with follow-up planned to consider steroid-sparing strategies. Neurosarcoidosis can be challenging to diagnose. The gold standard test is histology but, where sarcoidosis is restricted to the central nervous system, obtaining tissue without risking permanent neurological impairment can be difficult. Recognising characteristic imaging features such as nodular or ‘trident’ enhancement can help distinguish neurosarcoid from other cuases of LETM.
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