Extrapulmonary Manifestations of SARS-CoV-2: A Report of 3 Cases and a Literature Review

Abstract

Background COVID-19 disease, caused by the SARS-CoV-2 virus, has been one of the greatest challenges in modern medicine. It is mostly known to affect the pulmonary system, leading to pneumonia and acute respiratory distress syndrome, but there is a growing body of evidence of extrapulmonary manifestations of COVID-19 disease. Case Reports This article presents 3 cases of various extrapulmonary symptoms of COVID-19 disease and a literature review of similar clinical cases. Two patients had a medical history of living-donor kidney transplantation, and 1 patient was a kidney donor. We present symptoms, diagnostic processes, laboratory and imaging results, and treatment approach. Patient 1 was 29-year-old woman with new-onset diabetes mellitus due to SARS-CoV-2, which required temporary insulin treatment. Patient 2 was a 34-year-old man with fever, chronic fatigue, back pain, and abdominal pain. Imagining showed acalculous cholecystitis, epiploic appendagitis of the right colic flexure, and inflammation of pericardial fat pad in the left cardiophrenic angle. Coagulopathy due to COVID-19 was the most probable cause of the described processes. Therapeutic doses of low-molecular-weight heparin were administered. Patient 3 was a 68-year-old male kidney donor who had painless, nodular, reddening lesions on both shins, accompanied by itching on both shins and recurrent fever. The diagnosis of erythema nodosum during COVID-19 was made. After treatment with low-molecular-weight heparin, significant decreases of symptoms were observed. Conclusions We conclude that SARS-CoV-2 infection can have a varied course and can involve other systems and organs. Physicians should be aware of possible extrapulmonary symptoms associated with infection with this virus. Correct diagnosis is a prerequisite for proper treatment and prevention of unexpected complications.

Acalculous Cholecystitis in COVID-19 Patients: A Narrative Review

“…Several reports in the literature have described the presentation of acute cholecystitis in COVID-19 patients, with most of them being case reports and letters to the editor and some case series ( Table 1 ) [ 10 , 19 , 20 , 21 , 22 , 91 , 92 , 94 , 95 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 ].…”

“…Several reports in the literature have described the presentation of acute cholecystitis in COVID-19 patients, with most of them being case reports and letters to the editor and some case series (Table 1) [10,[19][20][21][22]91,92,94,95,[100][101][102][103][104][105][106][107][108][109][110][111][112][113][114]. Bruni et al, described the first case of histopathological findings of an acute ischemic gangrenous cholecystitis as a late complication in a COVID-19 [95].…”