Concurrent myopathy and inflammatory cardiac disease in COVID-19 patients: a case series and literature review

Freund, Ophir; Eviatar, Tali; Bornstein, Gil

doi:10.1007/s00296-022-05106-3

Cited by 13 publications

(14 citation statements)

References 36 publications

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“…Extra‐pulmonary manifestations and concurrent diseases were prevalent in our study population and consistent with prior studies 19,20 . Extra‐pulmonary manifestations may either appear in more than one organ simultaneously or may be the sole initial presentation of COVID‐19 21,22 . Additional complications secondary to any infectious etiology, such as dehydration or diabetic ketoacidosis, also occur among COVID‐19 patients.…”

Section: Discussionsupporting

confidence: 87%

“…19,20 Extra-pulmonary manifestations may either appear in more than one organ simultaneously or may be the sole initial presentation of COVID-19. 21,22 Additional complications secondary to any infectious etiology, such as dehydration or diabetic ketoacidosis, also occur among COVID-19 patients. While these complications may be precipitated in part by the underlying infection, a delay in their treatment can still put the patient at risk.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic delays among COVID‐19 patients with a second concurrent diagnosis

Freund

Azolai

Sror

et al. 2023

Journal of Hospital Medicine

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Background: Little is known about the effect of a new pandemic on diagnostic errors. Objective: We aimed to identify delayed second diagnoses among patients presenting to the emergency department (ED) with COVID-19. Designs: An observational cohort Study. Settings and Participants: Consecutive hospitalized adult patients presenting to the ED of a tertiary referral center with COVID-19 during the Delta and Omicron variant surges. Included patients had evidence of a second diagnosis during their ED stay. Main Outcome and Measures: The primary outcome was delayed diagnosis (without documentation or treatment in the ED). Contributing factors were assessed using two logistic regression models.Results: Among 1249 hospitalized COVID-19 patients, 216 (17%) had evidence of a second diagnosis in the ED. The second diagnosis of 73 patients (34%) was delayed, with a mean (SD) delay of 1.5 (0.8) days. Medical treatment was deferred in 63 patients (86%) and interventional therapy in 26 (36%). The probability of an ED diagnosis was the lowest for Infection-related diagnoses (56%) and highest for surgical-related diagnoses (89%). Evidence for the second diagnosis by physical examination (adjusted odds ratios [AOR] 2.35, 95% confidence interval [CI] 1.20-4.68) or by imaging (AOR 2.10, 95% CI 1.16-3.79) were predictors for ED diagnosis. Low oxygen saturation (AOR 0.38, 95% CI 0.18-0.79) and cough or dyspnea (AOR 0.48, 95% CI 0.25-0.94) in the ED were predictors of a delayed second diagnosis.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Diagnostic delays among COVID‐19 patients with a second concurrent diagnosis

Freund

Azolai

Sror

et al. 2023

Journal of Hospital Medicine

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“…However, it remains unclear whether patients with IIMs after COVID-19 differ from those with traditional IIMs. While muscle damage, such as myalgia, myasthenia gravis, and elevated CK levels, is common in individuals with SARS-CoV-2 infection [13], our study found that cardiac damage is more prominent among patients with a history of SARS-CoV-2 infection who also have IIMs. This conclusion was supported by increases in cTnT and HBDH levels as well as scores re ecting cardiac disease activity.…”

Section: Discussioncontrasting

confidence: 46%

Idiopathic Inflammatory Myopathies in the Post-COVID-19 Era: A Spotlight on Cardiac Impairment

Cheng,

Li,

et al. 2023

Preprint

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Background As the COVID-19 pandemic progresses, there have been reports of a syndrome involving multisystem organ damage following the immune response to the virus. However, it remains unclear whether patients with specific autoimmune diseases, such as idiopathic inflammatory myopathies (IIMs), exhibit a predisposition to unique pathological damage and whether their clinical phenotypes are altered by COVID-19. Methods This study was a retrospective case‒control study that included 62 patients with IIMs who had a prior history of COVID-19 (prior COVID-19, PC) and 52 patients without such a history (no prior COVID-19, NPC). Medical histories, laboratory examinations, and echocardiography data were compared between the two groups. Additionally, we investigated the potential molecular mechanisms underlying the association between COVID-19 and post infection clinical phenotypes in IIMs using publicly available transcriptome databases. Results Compared to the NPC group, patients in the PC group exhibited a higher prevalence of cardiopulmonary symptoms, including palpitation and dyspnea, as well as elevated levels of pulmonary and cardiovascular myositis activity assessment visual analog scales (MYOACT)/myositis intention-to-treat activity index (MITAX), cardiac troponin T, and hydroxybutyrate dehydrogenase (HBDH). Echocardiographic analysis revealed larger left atrium (LA) dimensions, interventricular septum (IVS) thickness, and an increased ratio of peak velocity of left ventricular early-diastolic fast filling to the velocity of early diastolic myocardial movement at mitral ring (E/e’) in the PC group compared to the NPC group. Transcriptional data analysis based on public databases revealed that various mechanisms, including collagen matrix proliferation, regulation of the calcium ion pathway, oxidative stress, cell proliferation, and inflammatory molecules, collectively contribute to the pathogenesis of IIMs and COVID-19 infection. Conclusion Patients with IIMs exhibit more pronounced myocardial damage and impaired cardiac diastolic function following COVID-19, thereby offering valuable insights for the clinical management of IIMs patients and potential avenues for further investigation into the long-term consequences of COVID-19.

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“…SARS-CoV-2 can also cause a wide variety of extrapulmonary symptoms owing to its inflammatory effects. For example, cardiac (myocarditis, pericardial effusion, shock), renal (glomerulonephritis), hematological (thrombocytopenic purpura, anemia), neurological (Guillain–Barré syndrome, meningoencephalitis, optic neuritis), and musculoskeletal (myositis, arthritis) complications have been reported[ 10 , 27 - 31 ].…”

Section: Discussionmentioning

confidence: 99%

Thyroid storm in a pregnant woman with COVID-19 infection: A case report and review of literatures

Kim¹,

Yang²,

Park³

et al. 2023

World J Clin Cases

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BACKGROUND The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been found to be responsible for the recent global pandemic known as coronavirus disease 2019 (COVID-19). SARS-CoV-2 infections not only result in significant respiratory symptoms but also cause several extrapulmonary manifestations, such as thrombotic complications, myocardial dysfunction and arrhythmia, thyroid dysfunction, acute kidney injury, gastrointestinal symptoms, neurological symptoms, ocular symptoms, and dermatological complications. We present the first documented case of thyroid storm in a pregnant woman precipitated by SARS-CoV-2. CASE SUMMARY A 42-year-old multiparous woman at 35 + 2 wk of gestation visited the emergency room (ER) with altered mentation, seizures, tachycardia, and high fever. The patient showed no remarkable events in the prenatal examination, and the nasopharyngeal COVID-19 polymerase chain reaction (PCR) test was positive two days before the ER visit. The results of laboratory tests, such as liver function test, serum electrolytes, blood glucose, blood urea nitrogen, and creatinine, were all within the normal ranges. However, the thyroid function test showed hyperthyroidism, and the nasopharyngeal COVID-19 PCR test was positive, as expected. No specific findings were observed on the brain computed tomography, and there were no signs of lateralization on neurological examination. Fetal heartbeat and movement were good, and there were no significant uterine contractions. The initial impression was atypical eclampsia. However, the patient's condition worsened, and a cesarean section was performed under general anesthesia; a healthy boy was delivered, and 12 h after delivery, the patient's seizures disappeared and consciousness was restored. The patient was referred to an endocrinologist for hyperthyroidism, and a thyroid storm with Graves' disease was diagnosed. Here, SARS-CoV-2 was believed to be the trigger for the thyroid storm, considering that the patient tested positive for COVID-19 two days before the seizures. CONCLUSION In pregnant women presenting with seizures or changes in consciousness, the possibility of a thyroid storm should be considered. There are various causes for a thyroid storm, but given the recent pandemic, it is necessary to bear in mind that the thyroid storm may be precipitated by COVID-19.

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Concurrent myopathy and inflammatory cardiac disease in COVID-19 patients: a case series and literature review

Cited by 13 publications

References 36 publications

Diagnostic delays among COVID‐19 patients with a second concurrent diagnosis

Diagnostic delays among COVID‐19 patients with a second concurrent diagnosis

Idiopathic Inflammatory Myopathies in the Post-COVID-19 Era: A Spotlight on Cardiac Impairment

Thyroid storm in a pregnant woman with COVID-19 infection: A case report and review of literatures

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