# ent

id: cord-257884-5exwwxin
type: TAXON
entity:
  coxsackie enterovirus herpes simplex cytomegalovirus H 1 N 1 respiratory syncytial virus parvovirus B19


id: cord-288608-2y5626qf
type: PROTEIN
entity:
  anticoagulant antibody anticardiolipin antibody anti B 2 glycoprotein 1 antibody anti Ro antibody anti La antibody anti Sm antibody anti ribonucleoprotein antibody anti Jo 1 antibody ribosomal autoantibody anticentromere antibody


id: cord-263530-t9ryky6f
type: GGP
entity:
  herpes simplex encephalitis COVID 19 associated meningoencephalitis complicated with intracranial hemorrhage a case report We would like to thank Dr Raheel Ahmed for his assistance in direct patient care as well as Dr Maria Khan for the final review of the article The contributors of this work include YMK


id: cord-279989-swsxez0a
type: GGP
entity:
  limbs 9 10 11 12 The average age of the patients was 49 years range 24 78 years Two cases were from the USA and other reports came from Italy Iran Japan and Germany In five out of the six patients there was no prior history of seizures or a family history of epilepsy All initially developed symptoms of SARS CoV 2


id: cord-300183-z3fwtwqb
type: LAW
entity:
  COVID 19 Delayed Presentation of Acute ST Segment Elevation Myocardial Infarction Complicated with Heart Failure


id: cord-281121-pleula62
type: CHEBI
entity:
  glucose Herpes simplex virus types 1 and 2 New disease DNA varicella zoster virus DNA enterovirus RNA


id: cord-341246-fz66z2p2
type: PROTEIN
entity:
  troponin I 37 00 pg mL normal 26 20 and N terminal pro b type natriuretic peptide NT proBNP 1312 00 pg mL normal 115 00 Nasopharyngeal swab reverse transcription PCR RT


# bib

id: cord-257691-oka9d03h
title: Contained aortic rupture in a term pregnant patient during the COVID-19 pandemic
author: Bogaert, Kelly
date: 2020-09-15
txt: ./txt/cord-257691-oka9d03h.txt
cache: ./cache/cord-257691-oka9d03h.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1136/bcr-2020-238370
doi: 10.1136/bcr-2020-238370
summary:
  This case discusses the presentation and diagnosis of a patient with an acute contained thoracic aortic aneurysm rupture at 38 weeks of gestation, after presenting with throat pain and syncope during the COVID-19 pandemic. This case discusses the presentation and diagnosis of a patient with an acute contained thoracic aortic aneurysm rupture at 38 weeks of gestation, after presenting with throat pain and syncope during the COVID-19 pandemic. 1 3 7 We present the case of a patient diagnosed with an acute aortic rupture at term during the COVID-19 pandemic. 17 The TTE findings seen in this case, along with the patient''s history of syncope, were the predominant clinical clues for the cardiology team to determine the diagnosis of aortic aneurysm rupture. Aortic dissection and rupture are rare occurrences in pregnant patients, and require a high index of clinical suspicion given the similarity of symptoms with other pathologies during pregnancy, particularly during the COVID-19 pandemic.

abstract:
  Aortic dissection and rupture is a rare occurrence in pregnant and postpartum patients. This case discusses the presentation and diagnosis of a patient with an acute contained thoracic aortic aneurysm rupture at 38 weeks of gestation, after presenting with throat pain and syncope during the COVID-19 pandemic. The patient underwent emergent caesarean delivery for non-reassuring fetal heart tracing, following which continued syncope workup revealed an aortic aneurysm and pericardial effusion. Diagnosis in this case was finalised with multimodality imaging, including transthoracic echocardiogram, and the patient underwent surgical aortic repair.


id: cord-257839-kfzc4pwq
author: Ferguson, Katie
date: 2020-08-03
txt: ./txt/cord-257839-kfzc4pwq.txt
cache: ./cache/cord-257839-kfzc4pwq.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32747597/
doi: 10.1136/bcr-2020-237460
summary:
  We present this case to highlight the extensive COVID-19-associated thrombotic complications that can occur, even despite periods of high-dose prophylactic and therapeutic anticoagulation. In recent case series, elevated D-dimer levels were reported in 43% 6 of the patients and were associated with disease severity and increased mortality. 5 Findings that shed new light on the possible pathogenesis of a disease or an adverse effect Several case series exist which explore the incidence of venous and arterial thrombosis in patients with COVID-19. 10 The latter includes a study of 10 ICU patients with COVID-19 pneumonia in whom D-dimer levels and viscoelastic measures reduced in response to increased prophylactic dosing. [11] [12] [13] Twitter Nathaniel Quail @DrNatQuail and Kevin G Blyth @kevingblyth Acknowledgements Dr Joe Sarvesvaran''s care and compassion were integral to this patient''s journey to recovery and we would like to acknowledge his support with writing this case report, and for selecting the key images to include.

title:
  COVID-19 associated with extensive pulmonary arterial, intracardiac and peripheral arterial thrombosis

abstract:
  We describe a patient with COVID-19 who developed simultaneous pulmonary, intracardiac and peripheral arterial thrombosis. A 58-year-old man, without major comorbidity, was admitted with a 14-day history of breathlessness. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection was confirmed by laboratory testing. Initial imaging revealed COVID-19 pneumonia but no pulmonary thromboembolism (PTE) on CT pulmonary angiography (CTPA). The patient subsequently developed respiratory failure and left foot ischaemia associated with a rising D-dimer. Repeat CTPA and lower limb CT angiography revealed simultaneous bilateral PTE, biventricular cardiac thrombi and bilateral lower limb arterial occlusions. This case highlights a broad range of vascular sequalae associated with COVID-19 and the fact that these can occur despite a combination of prophylactic and treatment dose anticoagulation.


id: cord-257884-5exwwxin
title: Acute pericarditis as a primary presentation of COVID-19
author: Kumar, Rajesh
date: 2020-08-18
txt: ./txt/cord-257884-5exwwxin.txt
cache: ./cache/cord-257884-5exwwxin.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32816925/
doi: 10.1136/bcr-2020-237617
summary:
  We report a case whose first manifestation of COVID-19 was pericarditis, in the absence of respiratory symptoms, without any serious complications. We present a case where pericarditis, in the absence of the classic COVID-19 signs or symptoms, is the only evident manifestation of the disease. 1 2 Chest pain in COVID-19 may have cardiac causes, including acute coronary syndrome, pericarditis and myocarditis. 3 We present the first described case of acute pericarditis in the absence of initial respiratory symptoms secondary to COVID-19. 7 To our knowledge this is the first case where COVID-19 presents as pericarditis, in the absence of evident respiratory or myocardial involvement. This case highlights the importance of recognising COVID-19 infection with atypical clinical presentations such as pericarditis and non-specific ECG changes, and coordination with healthcare team regarding prompt isolation to decrease the risk of transmission of the virus and if any need of early hospitalisation.

abstract:
  The COVID-19 pandemic is a highly contagious viral illness which conventionally manifests primarily with respiratory symptoms. We report a case whose first manifestation of COVID-19 was pericarditis, in the absence of respiratory symptoms, without any serious complications. Cardiac involvement in various forms is possible in COVID-19. We present a case where pericarditis, in the absence of the classic COVID-19 signs or symptoms, is the only evident manifestation of the disease. This case highlights an atypical presentation of COVID-19 and the need for a high index of suspicion to allow early diagnosis and limit spread by isolation.


id: cord-259108-16lqa84n
title: Guttate psoriasis secondary to COVID-19
author: Gananandan, Kohilan
date: 2020-08-11
txt: ./txt/cord-259108-16lqa84n.txt
cache: ./cache/cord-259108-16lqa84n.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32784237/
doi: 10.1136/bcr-2020-237367
abstract: nan
summary:
  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) RNA was detected from a nasopharyngeal swab confirming COVID-19 infection. When I looked up COVID-19 as a cause for guttate psoriasis, I realised this had not been previously reported, so I was keen to collaborate as a co-author to report this new association. 3 This is the first case reported of an acute guttate flare of chronic psoriasis secondary to confirmed COVID-19 infection. Respiratory virus infection triggers acute psoriasis flares across different clinical subtypes and genetic backgrounds org/ 0000-0002-7903-5243Learning points ► Guttate psoriasis manifests as multiple drop-like well circumscribed erythematous papules and is commonly associated with acute, particularly streptococcal, infection. ► Severe acute respiratory syndrome coronavirus 2 was identified as the infective precipitant in this case and further such cases may emerge as we learn more about the clinical manifestations of the COVID-19 illness.


id: cord-259250-ybfyiykz
title: Guillain-Barré syndrome associated with COVID-19 disease
author: Korem, Sindhuja
date: 2020-09-21
txt: ./txt/cord-259250-ybfyiykz.txt
cache: ./cache/cord-259250-ybfyiykz.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32958554/
doi: 10.1136/bcr-2020-237215
summary:
  In this case report, we describe the symptoms of a patient infected with SARS-CoV-2 whose clinical course was complicated with Guillain-Barré syndrome (GBS). In this case report, we describe the symptoms of a patient infected with SARS-CoV-2 whose clinical course was complicated with Guillain-Barré syndrome (GBS). To date, there are only 12 published cases of COVID-19-related Guillain-Barré syndrome (GBS). 4 Increasing reports of neurologic manifestations of COVID-19 are emerging, but only a few cases of GBS associated with this virus have been established. The case series by Mao et al in Wuhan, China, was one of the first studies that showed neurologic manifestations in patients with COVID-19. 15 There Guillain-Barré syndrome (GBS) should be considered in patients with peripheral nervous system symptoms. Guillain-Barré syndrome following COVID-19: new infection, old complication? Guillain Barre syndrome associated with COVID-19 infection: a case report

abstract:
  Clinical manifestations of COVID-19 are known to be variable with growing evidence of nervous system involvement. In this case report, we describe the symptoms of a patient infected with SARS-CoV-2 whose clinical course was complicated with Guillain-Barré syndrome (GBS). We present a case of a 58-year-old woman who was initially diagnosed with COVID-19 pneumonia due to symptoms of fever and cough. Two weeks later, after the resolution of upper respiratory tract symptoms, she developed symmetric ascending quadriparesis and paresthesias. The diagnosis of GBS was made through cerebrospinal fluid analysis and she was successfully treated with intravenous immunoglobulin administration.


id: cord-263530-t9ryky6f
title: Cerebrospinal fluid confirmed COVID-19-associated encephalitis treated successfully
author: Kamal, Yasmine Mohamed
date: 2020-09-16
txt: ./txt/cord-263530-t9ryky6f.txt
cache: ./cache/cord-263530-t9ryky6f.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32938656/
doi: 10.1136/bcr-2020-237378
summary:
  ► Abdominal CT was normal ► Brain MRI with contrast, performed after 2 weeks to comply with our hospital''s protocol that only allows COVID-19-negative patient to get in contact with the MRI machine, revealed abnormal signal intensity in the temporal lobe cortex bilaterally in a rather symmetrical fashion. Seven hundred and fifty milligrams of intravenous acyclovir sodium, three times per day, was started empirically before the cerebrospinal fluid (CSF) results were obtained, addressing the possibility of herpes simplex virus (HSV) I and II encephalitis. The early suspicion of COVID-19 encephalitis and performing the appropriate CSF studies was the key to establishing the correct diagnosis and timely management. ► A red flag of the possibility of COVID-19 encephalitis should be raised whenever patients present with abnormal behaviour, acute psychosis, confusion state or drowsiness.

abstract:
  The COVID-19 pandemic that attracted global attention in December 2019 is well known for its clinical picture that is consistent with respiratory symptoms. Currently, the available medical literature describing the neurological complications of COVID-19 is gradually emerging. We hereby describe a case of a 31-year-old COVID-19-positive patient who was admitted on emergency basis. His clinical presentation was primarily neurological, rather than the COVID-19’s classical respiratory manifestations. He presented with acute behavioural changes, severe confusion and drowsiness. The cerebrospinal fluid analysis was consistent with COVID-19 encephalitis, as well as the brain imaging. This experience confirms that neurological manifestations might be expected in COVID-19 infections, despite the absence of significant respiratory symptoms. Whenever certain red flags are raised, physicians who are involved in the management of COVID-19 should promptly consider the possibility of encephalitis. Early recognition of COVID-19 encephalitis and timely management may lead to a better outcome.


id: cord-269703-d3yv9mcl
title: PTSD and bipolar II disorder in Fukushima disaster relief workers after the 2011 nuclear accident
author: Hori, Arinobu
date: 2020-09-17
txt: ./txt/cord-269703-d3yv9mcl.txt
cache: ./cache/cord-269703-d3yv9mcl.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1136/bcr-2020-236725
doi: 10.1136/bcr-2020-236725
summary:
  The complex and harsh experience provoked a hypomanic response such as elated feelings with increased energy, decreased need for sleep and an increase in goal-directed activity, which allowed him to continue working, even though he was adversely affected by the disaster. Thereafter, we considered the characteristics of mental health problems that emerge in disaster-relief workers, a long time after the disaster, and the conditions and treatments necessary for recovery. Thereafter, we considered the characteristics of mental health problems that emerge in disaster-relief workers, a long time after the disaster, and the conditions and treatments necessary for recovery. Post-traumatic stress disorder (PTSD) and depression significantly impair the social functioning of those affected and are often recognised as the most visible mental health effects on survivors, as was the case with the Great East Japan Earthquake (GEJE) of 2011. The GEJE, which was followed by the nuclear accidents, left the affected areas severely damaged and required the victims to contribute as disaster-relief workers for a long period.

abstract:
  The global threat posed by the COVID-19 pandemic has highlighted the need to accurately identify the immediate and long-term postdisaster impacts on disaster-relief workers. We examined the case of a local government employee suffering from post-traumatic stress disorder (PTSD) and bipolar II disorder following the Great East Japan Earthquake. The complex and harsh experience provoked a hypomanic response such as elated feelings with increased energy, decreased need for sleep and an increase in goal-directed activity, which allowed him to continue working, even though he was adversely affected by the disaster. However, 3.5 years later, when he suffered further psychological damage, his PTSD symptoms became evident. In addition to treating mood disorders, trauma-focused psychotherapy was required for his recovery. Thereafter, we considered the characteristics of mental health problems that emerge in disaster-relief workers, a long time after the disaster, and the conditions and treatments necessary for recovery.


id: cord-275699-hdmeyomt
title: Morphology of COVID-19–affected cells in peripheral blood film
author: Singh, Aminder
date: 2020-05-27
txt: ./txt/cord-275699-hdmeyomt.txt
cache: ./cache/cord-275699-hdmeyomt.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32467125/
doi: 10.1136/bcr-2020-236117
abstract: nan
summary:
  Peripheral blood films showing various neutrophils with C-shaped, fetus-like COVID nuclei (black arrowheads) with aberrant nuclear projections (blue arrowhead). Peripheral blood films showing activated monocytes with prominent cytoplasmic vacuolisation and a few granules (small red arrow). Her complete blood count (CBC) showed leucocytosis with neutrophilia, relative lymphocytopaenia, and monocytopaenia initially with subsequent improvement in the number of monocytes on the fifth day onwards. Most of the lymphocytes were seen as large granular lymphocytes (LGL) with round to indented nuclei, condensed chromatin, prominent nucleoli in a few, along with abundant pale blue cytoplasm with distinct variably sized azurophilic granules (figure 2). ► COVID-19 viral effects on leucocytes are associated with characteristic changes that can be readily identified on PBF and can be easily and serially monitored, which could help in the diagnosis, prognostication and treatment protocols.


id: cord-276938-hv2ttwr8
title: Acute immune thrombocytopaenic purpura in a patient with COVID-19 and decompensated cirrhosis
author: Artru, Florent
date: 2020-07-07
txt: ./txt/cord-276938-hv2ttwr8.txt
cache: ./cache/cord-276938-hv2ttwr8.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32641442/
doi: 10.1136/bcr-2020-236815
summary:
  We report on a patient with coronavirus disease 2019 (COVID-19) and decompensated cirrhosis who experienced a favourable outcome of severe immune thrombocytopaenic purpura (ITP) after administration of intravenous immunoglobulin and high-dose dexamethasone. We report on a patient with coronavirus disease 2019 (COVID-19) and decompensated cirrhosis who experienced a favourable outcome of severe immune thrombocytopaenic purpura (ITP) after administration of intravenous immunoglobulin and high-dose dexamethasone. Published data suggest that poor outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is related to an excessive inflammatory reaction. Laboratory tests performed over the next days showed a rapid decrease of platelet count from baseline values around 70 g/L (chronic moderate thrombocytopaenia due to liver disease and hypersplenism) to a nadir of 1 x10 9 /L (figure 1). ► Treatment of ITP in the context of coronavirus disease 2019 (COVID-19) with high-dose dexamethasone and intravenous immunoglobulin (IVIG) appears to be effective.

abstract:
  We report on a patient with coronavirus disease 2019 (COVID-19) and decompensated cirrhosis who experienced a favourable outcome of severe immune thrombocytopaenic purpura (ITP) after administration of intravenous immunoglobulin and high-dose dexamethasone. The present case suggests that it is reasonable to evoke ITP in case of profound thrombocytopaenia in a patient with COVID-19.


id: cord-276984-npgalqoz
title: Uneventful case of COVID-19 in a kidney transplant recipient
author: Dahl Mathiasen, Victor
date: 2020-07-20
txt: ./txt/cord-276984-npgalqoz.txt
cache: ./cache/cord-276984-npgalqoz.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1136/bcr-2020-237427
doi: 10.1136/bcr-2020-237427
summary:
  Kidney transplant recipients have been reported at a particularly high risk of severe COVID-19 illness due to chronic immunosuppression and coexisting conditions. Kidney transplant recipients have been reported at a particularly high risk of severe COVID-19 illness due to chronic immunosuppression and coexisting conditions. Fourteen days after admission, the patient still had discrete coughing and intermittent fever, and was referred to a COVID-19 drive-in test unit for an oropharyngeal swab, which was positive for SARS-CoV-2 RNA using PCR. We present a case of mild COVID-19 in a patient in immunosuppressive therapy due to kidney transplantation. Tacrolimus and prednisolone were continued in our patient, although recently published data show that immunosuppressive therapy is often discontinued in kidney transplant recipients. 4 Immunosuppressive therapy was relatively modest in this case, while other risk factors favouring a severe course of COVID-19, such as hypertension, chronic kidney disease and obesity, were present.

abstract:
  Kidney transplant recipients have been reported at a particularly high risk of severe COVID-19 illness due to chronic immunosuppression and coexisting conditions. Yet, here we describe a remarkably mild case of COVID-19 in a 62-year-old female who had a kidney transplantation 10 years earlier due to autosomal dominant polycystic kidney disease. The patient was admitted for 1 day; immunosuppressive therapy with tacrolimus and low-dose prednisolone was continued; and the patient recovered successfully without the use of antiviral agents or oxygen therapy. The case demonstrates that kidney transplant recipients are not necessarily severely affected by COVID-19. Withdrawal of immunosuppressive therapy could be associated with poorer outcomes and should not be implemented thoughtlessly.


id: cord-279989-swsxez0a
title: Non-convulsive status epilepticus: COVID-19 or clozapine induced?
author: Sokolov, Elisaveta
date: 2020-10-04
url: https://doi.org/10.1136/bcr-2020-239015
doi: 10.1136/bcr-2020-239015
abstract:
  We present a case of non-convulsive status epilepticus in a 57-year-old woman with a schizoaffective disorder, without an antecedent seizure history, with two possible aetiologies including SARS-CoV-2 infection and clozapine uptitration. We discuss the presentation, investigations, differential diagnosis and management. In particular, we focus on the electroencephalogram (EEG) findings seen in this case and the electroclinical response to antiepileptic medication. We review the literature and discuss the relevance of this case to the SARS-CoV-2 global pandemic. We emphasise the importance of considering possible neurological manifestations of SARS-CoV-2 infection and highlight seizure disorder as one of the possible presentations. In addition, we discuss the possible effects of clozapine on the electroclinical presentation by way of possible seizure induction as well as discuss the possible EEG changes and we highlight that this needs to be kept in mind especially during rapid titration.


id: cord-281121-pleula62
title: Guillain-Barré syndrome presenting with COVID-19 infection
author: Ameer, Nasir
date: 2020-09-14
txt: ./txt/cord-281121-pleula62.txt
cache: ./cache/cord-281121-pleula62.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32928835/
doi: 10.1136/bcr-2020-236978
summary:
  At least four cases of Guillain-Barré syndrome have been reported in the literature with concurrent COVID-19 illness in whom respiratory signs appeared a few days after the onset of neurological signs. During the current pandemic, presence of concurrent COVID-19 infection needs to be considered in patients presenting with Guillain-Barré syndrome. Here, we report a case of a patient with COVID-19 who presented with Guillain-Barré syndrome. 7 There have been at least 12 cases reported in the literature as of 2 May 2020 linking Guillain-Barré syndrome with SARS-CoV-2 (COVID-19). 18 Our patient developed signs of Guillain-Barré syndrome before COVID-19 respiratory symptoms started on day 4 of weakness. ► If neurological manifestations of COVID-19 infection could appear before respiratory symptoms, it would be of utmost importance to use effective personal protective equipment, in particular for aerosol-generating procedures such as spirometry, in patients presenting with Guillain-Barré syndrome.

abstract:
  A construction worker in his 30s presented three times in 4 days with progressive upper and then lower limb weakness. On the first two occasions he had no systemic symptoms, but on the third presentation he had fever and cough, starting from day 4 of weakness. Examination identified weakness in all four limbs and areflexia, suggesting a peripheral neuromuscular disorder. Investigations were consistent with Guillain-Barré syndrome and additional COVID-19 (SARS-CoV-2) infection. The patient improved after immunoglobulin treatment. At least four cases of Guillain-Barré syndrome have been reported in the literature with concurrent COVID-19 illness in whom respiratory signs appeared a few days after the onset of neurological signs. With the incubation period for COVID-19 respiratory symptoms believed to be up to 14 days, it is possible that neurological symptoms could develop before respiratory and other symptoms. During the current pandemic, presence of concurrent COVID-19 infection needs to be considered in patients presenting with Guillain-Barré syndrome.


id: cord-281733-bsq0ewac
title: Left gonadal vein thrombosis in a patient with COVID-19-associated coagulopathy
author: Veyseh, Maedeh
date: 2020-09-07
txt: ./txt/cord-281733-bsq0ewac.txt
cache: ./cache/cord-281733-bsq0ewac.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1136/bcr-2020-236786
doi: 10.1136/bcr-2020-236786
summary:
  We report an unusual case of ovarian vein thrombosis and pulmonary embolism associated with COVID-19 presenting with abdominal pain. We report an unusual case of ovarian vein thrombosis and pulmonary embolism associated with COVID-19 presenting with abdominal pain. To our knowledge, this is the first reported case of COVID-19 with absent respiratory symptoms and presentation with venous thrombosis in an unusual location. To our knowledge, this is the first reported case of COVID-19 with absent respiratory symptoms and presentation with venous thrombosis in an unusual location. 8 9 Our patient was distinctive in terms of presentation as she lacked the common respiratory symptoms, rather acute venous thrombosis in an unusual location prompted the diagnosis of COVID-19. 1 24 In summary, we present an interesting case with an unusual presentation of COVID-19 who presented with abdominal pain and no significant respiratory symptoms and was diagnosed with thrombosis of the left ovarian vein.

abstract:
  COVID-19 disease is a viral illness that predominantly causes pneumonia and severe acute respiratory distress syndrome. The endothelial injury and hypercoagulability secondary to the inflammatory response predisposes severely ill patients to venous thromboembolism. The exact mechanism of hypercoagulability is still under investigation, but it is known to be associated with poor prognosis. The most common thrombotic complication reported among these patients is pulmonary embolism. To our knowledge, gonadal vein thrombosis is an uncommon phenomenon that has not been reported in the setting of COVID-19-associated coagulopathy. We report an unusual case of ovarian vein thrombosis and pulmonary embolism associated with COVID-19 presenting with abdominal pain. To our knowledge, this is the first reported case of COVID-19 with absent respiratory symptoms and presentation with venous thrombosis in an unusual location.


id: cord-285579-gvgt55o4
title: Rare complication of COVID-19 presenting as isolated headache
author: Asif, Rehan
date: 2020-10-29
url: https://www.ncbi.nlm.nih.gov/pubmed/33122242/
doi: 10.1136/bcr-2020-239275
abstract:
  An 18-year-old man presented with persistent isolated headache 2 weeks after recovering from acute COVID-19 illness. Extensive cerebral venous sinus thrombosis (CVST) was detected on CT venogram despite him having no other thrombotic risk factors. CVST can complicate COVID-19. A high index of clinical suspicion is warranted as it can often have a subtle presentation with paucity of neurological symptoms.


id: cord-288608-2y5626qf
title: An interesting case of small vessel pathology following coronavirus infection
author: Ramadan, Shadi M
date: 2020-09-07
url: https://doi.org/10.1136/bcr-2020-237407
doi: 10.1136/bcr-2020-237407
abstract:
  Vasculitis is a descriptive term for a wide variety of conditions characterised by inflammation of the blood vessels that may occur as a primary process or secondary to an underlying disease. Occlusive vasculopathy is a different clinical entity characterised by skin changes and ulceration of the lower extremities because of thrombosis of the small vessels of the dermis and is usually associated with pre-thrombotic conditions. Both conditions can be confirmed or excluded by skin biopsy. We report the case of a 63-year-old woman presenting with upper and lower respiratory tract symptoms followed by a vasculitic rash on both legs. The patient underwent extensive radiological and laboratory investigations that were negative apart from positive coronavirus OC43. A biopsy of the skin was performed. Considering the clinical presentation and the investigations performed, the diagnosis of small vessel vasculopathy following coronavirus OC43 has been suggested by the authors.


id: cord-291642-xfkdxnfb
author: Howley, Fergal
date: 2020-10-10
url: https://www.ncbi.nlm.nih.gov/pubmed/33040042/
doi: 10.1136/bcr-2020-239269
title:
  Late presentation of ‘Lemierre’s syndrome’: how a delay in seeking healthcare and reduced access to routine services resulted in widely disseminated Fusobacterium necrophorum infection during the global COVID-19 pandemic

abstract:
  The SARS-CoV-2 outbreak has disrupted the delivery of routine healthcare services on a global scale. With many regions suspending the provision of non-essential healthcare services, there is a risk that patients with common treatable illnesses do not receive prompt treatment, leading to more serious and complex presentations at a later date. Lemierre’s syndrome is a potentially life-threatening and under-recognised sequela of an oropharyngeal or dental infection. It is characterised by septic embolisation of the gram-negative bacillus Fusobacterium necrophorum to a variety of different organs, most commonly to the lungs. Thrombophlebitis of the internal jugular vein is frequently identified. We describe an atypical case of Lemierre’s syndrome involving the brain, liver and lungs following a dental infection in a young male who delayed seeking dental or medical attention due to a lack of routine services and concerns about the SARS-CoV-2 outbreak.


id: cord-295527-d5laummv
title: Prolonged RNA shedding of the 2019 novel coronavirus in an asymptomatic patient with a VP shunt
author: El-Baba, Firas
date: 2020-09-14
txt: ./txt/cord-295527-d5laummv.txt
cache: ./cache/cord-295527-d5laummv.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1136/bcr-2020-237720
doi: 10.1136/bcr-2020-237720
summary:
  title: Prolonged RNA shedding of the 2019 novel coronavirus in an asymptomatic patient with a VP shunt A 33-year-old man with paranoid schizophrenia and a ventriculoperitoneal (VP) shunt was sent to our institution from an inpatient psychiatric facility due to concerns for the 2019 novel coronavirus (COVID-19). A 33-year-old man with paranoid schizophrenia and a ventriculoperitoneal (VP) shunt was sent to our institution from an inpatient psychiatric facility due to concerns for the 2019 novel coronavirus . A 33-year-old man with paranoid schizophrenia and a ventriculoperitoneal (VP) shunt was sent to our institution from an inpatient psychiatric facility due to concerns for the COVID-19. ► A VP shunt may predispose individuals to prolonged viral shedding of the novel coronavirus. Factors associated with prolonged viral RNA shedding in patients with coronavirus disease 2019 (COVID-19) Persistent viral shedding lasting over 60 days in a mild COVID-19 patient with ongoing positive SARS-CoV-2

abstract:
  A 33-year-old man with paranoid schizophrenia and a ventriculoperitoneal (VP) shunt was sent to our institution from an inpatient psychiatric facility due to concerns for the 2019 novel coronavirus (COVID-19). Per the facility, the patient had a fever and non-productive cough. On admission, the patient was afebrile and lacked subjective symptoms. A RNA reverse transcriptase PCR (RNA RT-PCR) test for COVID-19 was positive. A chest X-ray contained a small patchy opacity in the right middle lobe and another in the retrocardiac region concerning for pneumonia. Inflammatory markers were mildly elevated. He remained COVID-19 positive and asymptomatic for 36 days. This case details one asymptomatic carrier’s course with persistently positive COVID-19 nasopharyngeal swabs. It demonstrates that a VP shunt could be a possible predisposition for prolonged viral shedding.


id: cord-296619-uhhndp0a
title: Coinfection with SARS-CoV-2 and influenza A virus
author: Kondo, Yuki
date: 2020-07-01
txt: ./txt/cord-296619-uhhndp0a.txt
cache: ./cache/cord-296619-uhhndp0a.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32611659/
doi: 10.1136/bcr-2020-236812
summary:
  We reported a case of severe acute respiratory syndrome coronavirus 2 and influenza A virus coinfection. We reported a case of severe acute respiratory syndrome coronavirus 2 and influenza A virus coinfection. We report a case of coinfection with SARS-CoV-2 and influenza A virus in a patient with pneumonia in Japan. The patient with both COVID-19 and influenza virus infection presented similar clinical characteristics with COVID-19 only. Initial considerations for this patient who presented acutely with fever and cough include infection with a common virus (rhinoviruses, non-SARS-CoV-2 coronaviruses and influenza virus) and communityacquired pneumonia. 3 The clinical characteristics of patients with both COVID-19 and influenza virus infection were similar to those of COVID-19 cases. ► There was no significant difference in rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with and without other pathogens. The clinical characteristics of pneumonia patients coinfected with 2019 novel coronavirus and influenza virus in Wuhan

abstract:
  Since December 2019, coronavirus disease 2019 (COVID-19) has been an international public health emergency. The possibility of COVID-19 should be considered primarily in patients with new-onset fever or respiratory tract symptoms. However, these symptoms can occur with other viral respiratory illnesses. We reported a case of severe acute respiratory syndrome coronavirus 2 and influenza A virus coinfection. During the epidemic, the possibility of COVID-19 should be considered regardless of positive findings for other pathogens.


id: cord-296950-9dldbs6o
title: COVID-19-associated meningoencephalitis treated with intravenous immunoglobulin
author: El-Zein, Rayan S
date: 2020-09-06
txt: ./txt/cord-296950-9dldbs6o.txt
cache: ./cache/cord-296950-9dldbs6o.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1136/bcr-2020-237364
doi: 10.1136/bcr-2020-237364
summary:
  Neurologic manifestations in patients infected with SARS-CoV-2 have been reported such as anosmia, ageusia, ataxia, seizures, haemorrhagic necrotising encephalopathy, and Guillain-Barré syndrome. The SARS-CoV-2 CSF PCR was negative; however, a high index of suspicion remained due to the temporal relationship of his current symptoms and the recent COVID-19 pneumonia. Our report describes a case of encephalitis associated with SARS-CoV-2 which showed clinical improvement with IVIg therapy. Moriguchi et al 5 described what appears to be the first case of COVID-19-associated meningoencephalitis presenting with convulsions and confirmed with a positive SARS-CoV-2 CSF PCR; their patient had abnormal MRI findings of the medial temporal lobe and was treated with favipiravir. Paniz-Mondolfi et al 6 reported a case of COVID-19-associated pneumonia in a 74 years old with Parkinson''s who succumbed to his illness on day 11; however, SARS-CoV-2 was found in the brain capillary endothelium and neuronal cell bodies on postmortem examination.

abstract:
  A 40-year-old man presented with altered mental status after a recenthospitalisation for COVID-19 pneumonia. Cerebrospinal fluid (CSF) analysis showed lymphocytosis concerning for viral infection. The CSF PCR for SARS-CoV-2 was negative, yet this could not exclude COVID-19 meningoencephalitis. During hospitalisation, the patient’s mentation deteriorated further requiring admission to the intensive care unit (ICU). Brain imaging and electroencephalogram (EEG) were unremarkable. He was, thus, treated with intravenous immunoglobulin (IVIg) for 5 days with clinical improvement back to baseline. This case illustrates the importance of considering COVID-19’s impact on the central nervous system (CNS). Haematogenous, retrograde axonal transport, and the effects of cytokine storm are the main implicated mechanisms of CNS entry of SARS-CoV-2. While guidelines remain unclear, IVIg may be of potential benefit in the treatment of COVID-19-associated meningoencephalitis.


id: cord-297693-lqyc49t6
title: 80-year-old man with dyspnoea and bilateral groundglass infiltrates: an elusive case of COVID-19
author: Samec, Matthew J
date: 2020-05-27
txt: ./txt/cord-297693-lqyc49t6.txt
cache: ./cache/cord-297693-lqyc49t6.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1136/bcr-2020-236069
doi: 10.1136/bcr-2020-236069
summary:
  COVID-19 is a novel viral infection caused by severe acute respiratory syndrome-coronavirus-2 virus, first identified in Wuhan, China in December 2019. COVID-19 is a novel viral infection caused by severe acute respiratory syndrome-coronavirus-2 virus, first identified in Wuhan, China in December 2019. We present a case of a patient with minimal respiratory symptoms but prominent bilateral groundglass opacities in a ''crazy paving'' pattern on chest CT imaging and a negative initial infectious workup. We present a case of a patient with minimal respiratory symptoms but prominent bilateral groundglass opacities in a ''crazy paving'' pattern on chest CT imaging and a negative initial infectious workup. The case was reviewed with the institutional infection prevention and control team who recommended repeating SARS-CoV-2 PCR 48 hours from the initial test. 14 There have been three published case reports of initially negative COVID-19 PCR tests in patients subsequently new disease determined to have COVID-19 infection.

abstract:
  COVID-19 is a novel viral infection caused by severe acute respiratory syndrome-coronavirus-2 virus, first identified in Wuhan, China in December 2019. COVID-19 has spread rapidly and is now considered a global pandemic. We present a case of a patient with minimal respiratory symptoms but prominent bilateral groundglass opacities in a ‘crazy paving’ pattern on chest CT imaging and a negative initial infectious workup. However, given persistent dyspnoea and labs suggestive of COVID-19 infection, the patient remained hospitalised for further monitoring. Forty-eight hours after initial testing, the PCR test was repeated and returned positive for COVID-19. This case illustrates the importance of clinical vigilance to retest patients for COVID-19, particularly in the absence of another compelling aetiology. As COVID-19 testing improves to rapidly generate results, selective retesting of patients may uncover additional COVID-19 cases and strengthen measures to minimise the spread of COVID-19.


id: cord-300183-z3fwtwqb
author: Ahmed, Taha
date: 2020-08-25
txt: ./txt/cord-300183-z3fwtwqb.txt
cache: ./cache/cord-300183-z3fwtwqb.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32843473/
doi: 10.1136/bcr-2020-237817
summary:
  Moreover, a comprehensive review of literature is performed to illustrate the potential factors delaying and decreasing timely presentations and interventions for time-dependent medical emergencies like ST-segment elevation myocardial infarction (STEMI). Moreover, a comprehensive review of literature is performed to illustrate the potential factors delaying and decreasing timely presentations and interventions for time-dependent medical emergencies like ST-segment elevation myocardial infarction (STEMI). There is a delay and decrease in presentations and timely interventions for medical emergencies like STEMI during the current era of COVID-19 crisis. ► Several community and healthcare-system-related factors delay and decrease the presentation and intervention for time-dependent non-communicable diseases such as STsegment elevation myocardial infarction (STEMI) in the era of COVID-19 crisis. Delayed Presentation of Acute ST Segment Elevation Myocardial Infarction Complicated with Heart Failure in the Period of COVID-19 Pandemic -Case Report Complication of late presenting STEMI due to avoidance of medical care during the COVID-19 pandemic

title:
  Community and healthcare system-related factors feeding the phenomenon of evading medical attention for time-dependent emergencies during COVID-19 crisis

abstract:
  The current COVID-19 crisis has significantly impacted healthcare systems worldwide. There has been a palpable increase in public avoidance of hospitals, which has interfered in timely care of critical cardiovascular conditions. Complications from late presentation of myocardial infarction, which had become a rarity, resurfaced during the pandemic. We present two such encounters that occurred due to delay in seeking medical care following myocardial infarction due to the fear of contracting COVID-19 in the hospital. Moreover, a comprehensive review of literature is performed to illustrate the potential factors delaying and decreasing timely presentations and interventions for time-dependent medical emergencies like ST-segment elevation myocardial infarction (STEMI). We emphasise that clinicians should remain vigilant of encountering rare and catastrophic complications of STEMI during this current era of COVID-19 pandemic.


id: cord-309236-p4c2d5y3
title: Spontaneous tension pneumothorax and acute pulmonary emboli in a patient with COVID-19 infection
author: Khurram, Ruhaid
date: 2020-08-11
txt: ./txt/cord-309236-p4c2d5y3.txt
cache: ./cache/cord-309236-p4c2d5y3.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32784238/
doi: 10.1136/bcr-2020-237475
summary:
  We exhibit a case of a 64-year-old man with suspected COVID-19 pneumonia who presented acutely to the emergency department with tension pneumothorax and acute pulmonary emboli. Routine blood test results on admission were as follows: haemoglobin: 129 g/L; white cell count: 11.2×10 9 /L; platelets: 538×10 9 /L; neutrophils: Following initial management for the tension pneumothorax, a repeat chest radiograph demonstrated lung re-expansion with a small residual pneumothorax, but with no mediastinal shift; peripheral ground glass airspace opacities were accentuated, in keeping with COVID-19 infection (figure 2). The chest drain was removed on day 3 of admission following the CTPA findings of iatrogenic pneumatocoele, and a repeat chest radiograph showed significant reinflation of the right lung with no residual pneumothorax. To our knowledge, we have reported the first documented case of a patient with COVID-19 pneumonia presenting with both spontaneous tension pneumothorax and acute pulmonary emboli. ► Spontaneous pneumothorax and acute pulmonary emboli are important coexisting respiratory pathologies to consider on a background of COVID-19 infection.

abstract:
  The COVID-19 pandemic has had a significant impact on the structure and operation of healthcare services worldwide. We highlight a case of a 64-year-old man who presented to the emergency department with acute dyspnoea on a background of a 2-week history of fever, dry cough and shortness of breath. On initial assessment the patient was hypoxic (arterial oxygen saturation (SaO(2)) of 86% on room air), requiring 10 L/min of oxygen to maintain 98% SaO(2). Examination demonstrated left-sided tracheal deviation and absent breath sounds in the right lung field on auscultation. A chest radiograph revealed a large right-sided tension pneumothorax which was treated with needle thoracocentesis and a definitive chest drain. A CT pulmonary angiogram demonstrated segmental left lower lobe acute pulmonary emboli, significant generalised COVID-19 parenchymal features, surgical emphysema and an iatrogenic pneumatocoele. This case emphasises the importance of considering coexisting alternative diagnoses in patients who present with suspected COVID-19.


id: cord-311232-hhfdqhx1
title: Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct
author: Yang, Yunfei
date: 2020-11-04
url: https://www.ncbi.nlm.nih.gov/pubmed/33148560/
doi: 10.1136/bcr-2020-238422
abstract:
  A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset diplopia and vertical gaze palsy. Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation.


id: cord-315288-fcx4q6mp
title: Tracheal swab from front of neck airway for SARS-CoV-2; a bronchial foreign body
author: Hussain, Mohammed Hassan
date: 2020-08-27
txt: ./txt/cord-315288-fcx4q6mp.txt
cache: ./cache/cord-315288-fcx4q6mp.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1136/bcr-2020-237787
doi: 10.1136/bcr-2020-237787
summary:
  We report the case of a bronchial foreign body, following a tracheostomy site swab for SARS-CoV-2, aiming to raise awareness and vigilance. We report the case of a bronchial foreign body, following a tracheostomy site swab for SARS-CoV-2, aiming to raise awareness and vigilance. This case highlights the need for clear guidance on how samples for SARS-CoV-2 are taken from patients with front of neck airways (laryngectomy/tracheοstomy) and the potential pitfalls involved. This case highlights the need for clear guidance on how samples for SARS-CoV-2 are taken from patients with front of neck airways (laryngectomy/tracheοstomy) and the potential pitfalls involved. Patients with front of neck airways, either in the form of a laryngectomy or tracheostomy stoma site, present a challenge in terms of testing for SARS-CoV-2. There is a need for clear guidance on how to test patients with front of neck airways for SARS-CoV-2.

abstract:
  We report the case of a bronchial foreign body, following a tracheostomy site swab for SARS-CoV-2, aiming to raise awareness and vigilance. A qualified nurse was performing a routine SARS-CoV-2 swab on a 51-year-old woman, fitted with a tracheostomy in the recent past following a craniotomy. This was part of the discharging protocol to a nursing home. During the sampling, part of the swab stylet snapped and was inadvertently dropped through the tracheostomy site. Initial CT imaging was reported as showing no signs of a foreign body but some inflammatory changes. Bedside flexible endoscopy through the tracheostomy site revealed the swab in a right lobar bronchus. This was subsequently removed by flexible bronchoscopy. This case highlights the need for clear guidance on how samples for SARS-CoV-2 are taken from patients with front of neck airways (laryngectomy/tracheοstomy) and the potential pitfalls involved.


id: cord-327370-zo0n8wf6
author: Vadukul, Prakash
date: 2020-09-13
txt: ./txt/cord-327370-zo0n8wf6.txt
cache: ./cache/cord-327370-zo0n8wf6.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1136/bcr-2020-238168
doi: 10.1136/bcr-2020-238168
summary:
  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. 1 This case examines aspects of COVID-19 emphasising the increased thrombogenicity seen during infection and the potential need for extended anticoagulation following recovery particularly in those patients with severe illness and pre-existing risk factors. 18 Initial data suggest that patients with complicated COVID-19 infection have nearly three times the concentration of IL-6 compared with those exhibiting less severe disease. 24 The International Society for Thrombosis and Haemostasis suggests that prophylactic treatment with LMWH is prudent in all patients with COVID-19, particularly with severe disease or Findings that shed new light on the possible pathogenesis of a disease or an adverse effect extreme derangements in clotting parameters. 2 Compared with other populations, patients with COVID-19 appear to have higher incidences of VTE particularly with deranged clotting markers, critical care admission or reduced mobility.

title:
  Massive pulmonary embolism following recovery from COVID-19 infection: inflammation, thrombosis and the role of extended thromboprophylaxis

abstract:
  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.


id: cord-331193-33cyvidx
title: Neurotropism of SARS-CoV-2: COVID-19 presenting with an acute manic episode
author: Mawhinney, Jamie A
date: 2020-06-14
txt: ./txt/cord-331193-33cyvidx.txt
cache: ./cache/cord-331193-33cyvidx.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1136/bcr-2020-236123
doi: 10.1136/bcr-2020-236123
summary:
  Psychiatric assessment found features consistent with acute mania, and he was detained under the Mental Health Act. This case indicates the need to consider COVID-19 in a wider series of clinical presentations and to develop a validated assay for SARS-CoV-2 in the cerebrospinal fluid. Psychiatric assessment found features consistent with acute mania, and he was detained under the Mental Health Act. This case indicates the need to consider COVID-19 in a wider series of clinical presentations and to develop a validated assay for SARS-CoV-2 in the cerebrospinal fluid. [9] [10] [11] [12] This article outlines a case of COVID-19 presenting with an acute manic episode necessitating emergency intubation and discusses potential mechanisms for the development of neuropsychiatric disease. ► The neuroinvasive potential of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (neurotropism) has been reported, but the pathophysiology remains unclear with uncertainty over its long-term consequences.

abstract:
  A 41-year-old man with no significant medical history presented with acute behavioural disruption on the background of a 1-day history of severe headache and a 10-day history of dry cough and fever. He was sexually disinhibited with pressured speech and grandiose ideas. His behaviour worsened, necessitating heavy sedation and transfer to intensive care for mechanical ventilation despite no respiratory indication. Investigations confirmed that he was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neuroimaging and a lumbar puncture were normal. Initial screening for SARS-CoV-2 in the cerebrospinal fluid was negative although no validated assay was available. The patient’s mental state remained abnormal following stepdown from intensive care. Psychiatric assessment found features consistent with acute mania, and he was detained under the Mental Health Act. This case indicates the need to consider COVID-19 in a wider series of clinical presentations and to develop a validated assay for SARS-CoV-2 in the cerebrospinal fluid.


id: cord-331517-o5ejfq86
title: Guillain-Barré syndrome after COVID-19 in Japan
author: Hirayama, Takehisa
date: 2020-10-29
txt: ./txt/cord-331517-o5ejfq86.txt
cache: ./cache/cord-331517-o5ejfq86.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33122241/
doi: 10.1136/bcr-2020-239218
summary:
  We report the first case of Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 infection in Japan. In previous reports, most patients with SARS-CoV-2-infection-related GBS had lower limb predominant symptoms, and antiganglioside antibody tests were negative. Our findings support the notion that non-immune abnormalities such as hyperinflammation following cytokine storms and microvascular disorders due to vascular endothelial damage may lead to neurological symptoms in patients with SARS-CoV-2 infection. 4 In the present report, we discuss a case of axonal-type GBS associated with SARS-CoV-2 infection, where the patient was tested for various antiganglioside antibodies. Furthermore, we review the cases of SARS-CoV-2-infection-related GBS reported to date, in order to provide insight into the clinical characteristics and pathological mechanisms underlying the disease. In conclusion, our report supports the notion that patients with GBS associated with SARS-CoV-2 infection tend to test negative for antiganglioside antibodies. ► Patients with Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 infection may test negative for many known antiganglioside antibodies.

abstract:
  We report the first case of Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 infection in Japan. A 54-year-old woman developed neurological symptoms after SARS-CoV-2 infection. We tested for various antiganglioside antibodies, that had not been investigated in previous cases. The patient was diagnosed with GBS based on neurological and electrophysiological findings; no antiganglioside antibodies were detected. In previous reports, most patients with SARS-CoV-2-infection-related GBS had lower limb predominant symptoms, and antiganglioside antibody tests were negative. Our findings support the notion that non-immune abnormalities such as hyperinflammation following cytokine storms and microvascular disorders due to vascular endothelial damage may lead to neurological symptoms in patients with SARS-CoV-2 infection. Our case further highlights the need for careful diagnosis in suspected cases of GBS associated with SARS-CoV-2 infection.


id: cord-333227-849bm17h
title: Angioedema, ACE inhibitor and COVID-19
author: Grewal, Ekjot
date: 2020-09-09
txt: ./txt/cord-333227-849bm17h.txt
cache: ./cache/cord-333227-849bm17h.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32912894/
doi: 10.1136/bcr-2020-237888
summary:
  Here, we report a case of a 57-year-old man, unknowingly with COVID-19, who presented to the emergency department with tongue swelling, shortness of breath and difficulty in speaking following 4 months taking benazepril, an ACE inhibitor. 23 The presentation of this case report is similar to our own: nonpitting oedema of the lower face in the absence of pruritus, leucocytosis with relative lymphopenia, elevated inflammatory markers and resolution of symptoms within 48 hours, although the marked difference is the chronic use of ACE inhibitor, whereas our patient began his medication 4 months prior to admission. An impairment of cytokine degradation, evident by an increase in the level of C-reactive protein, has been implicated as being the primary mechanism of angioedema under the use of ACE inhibitor drugs, 28 which greatly resembles the dramatic release of proinflammatory cytokines caused Findings that shed new light on the possible pathogenesis of a disease or an adverse effect by SARS-CoV-2 infection.

abstract:
  SARS-CoV-2, the virus responsible for COVID-19, binds to the ACE2 receptors. ACE2 is thought to counterbalance ACE in the renin-angiotensin system. While presently it is advised that patients should continue to use ACE inhibitors or angiotensin receptor blockers, questions still remain as to whether adverse effects are potentiated by the virus. Here, we report a case of a 57-year-old man, unknowingly with COVID-19, who presented to the emergency department with tongue swelling, shortness of breath and difficulty in speaking following 4 months taking benazepril, an ACE inhibitor. Finally, we also describe possible pathways that exist for SARS-CoV-2 to interact with the mechanism behind angioedema.


id: cord-333998-z2zahfv9
title: Rhabdomyolysis and acute kidney injury in severe COVID-19 infection
author: Taxbro, Knut
date: 2020-09-02
url: https://doi.org/10.1136/bcr-2020-237616
doi: 10.1136/bcr-2020-237616
abstract:
  We report the case of a 38-year-old man who presented to the emergency department with fever, myalgia, nausea, vomiting, dry cough, breathlessness and abdominal pain. He was admitted due to hypoxaemia and was diagnosed with SARS-CoV-2 and was subsequently referred to the intensive care unit for intubation and mechanical ventilation. Severe rhabdomyolysis and acute kidney injury developed 4 days later and were suspected after noticing discolouration of the urine and a marked increase in plasma myoglobin levels. Treatment included hydration, forced diuresis and continuous renal replacement therapy. In addition to the coronavirus disease acute respiratory distress syndrome, he was diagnosed with possible SARS-CoV-2-induced myositis with severe rhabdomyolysis and kidney failure. The patient survived and was discharged from intensive care after 12 days, returning home 23 days after hospitalisation, fully mobilised with a partially restored kidney function.


id: cord-337809-bxvgr6qg
author: Xiong, Yong
date: 2020-05-04
txt: ./txt/cord-337809-bxvgr6qg.txt
cache: ./cache/cord-337809-bxvgr6qg.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32371416/
doi: 10.1136/bcr-2020-235302
summary:
  Our observations suggest the importance of preventing family transmission and the efficacy of current integrated treatment for mild/ moderate pneumonia in COVID-19 cases. Our observations suggest the importance of preventing family transmission and the efficacy of current integrated treatment for mild/ moderate pneumonia in COVID-19 cases. [2] [3] [4] [5] [6] [7] [8] This report describes the epidemiological and clinical features of coronavirus disease (COVID-19) among three members of a family following SARS-CoV-2 infection. On 10 and 11 January 2020, a family of three, comprising the father (65 years), the mother (61 years) and the son (38 years), were admitted to the Department of Infectious Disease at the Zhongnan Hospital of Wuhan University with symptoms of cough and fever. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China

title:
  Family cluster of three recovered cases of pneumonia due to severe acute respiratory syndrome coronavirus 2 infection

abstract:
  The coronavirus disease (COVID-19) outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wuhan, China, in late 2019 and has affected more than 1 270 000 people worldwide. The numbers of reported cases continue to rise and threaten global health. Transmissions among family members are frequently observed, although the route of transmission is partially known. Here we report three cases of SARS-CoV-2 infection within one family. Sequencing of the S gene of the viral genome showed 100% identity among samples, suggesting that the same strain caused the infection. Following treatment with oseltamivir and short-term methylprednisolone combined with symptomatic management, all three patients recovered within 3 weeks, as evidenced by the disappearance of their symptoms, clearance of pulmonary infiltrates and consecutive negative molecular diagnostic test findings. Our observations suggest the importance of preventing family transmission and the efficacy of current integrated treatment for mild/moderate pneumonia in COVID-19 cases.


id: cord-337878-hiylqqie
title: Atypical case of COVID-19 in a critically unwell 5-week old infant
author: Namasivayam, Abirami
date: 2020-09-14
txt: ./txt/cord-337878-hiylqqie.txt
cache: ./cache/cord-337878-hiylqqie.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32928837/
doi: 10.1136/bcr-2020-237142
summary:
  To our knowledge, he is the youngest reported case in the UK to require mechanical ventilation and intensive care treatment as a direct result of COVID-19 following horizontal transmission. 4 A larger nationwide study investigating 134 paediatric cases across China reported that 76% cases had fever, 64.9% cases presented as acute upper respiratory tract infection, 26.9% as mild pneumonia and 1.5% cases were critical; unfortunately, the specific age groups and comorbidities were not reported. At present there are few reports of paediatric patients requiring intensive care support with confirmed COVID-19. This case demonstrates the need for vigilance in considering COVID-19 infection in infants presenting with less discriminatory symptoms such as lethargy or reduced feeding. Dong et al report a case series of 2135 paediatric patients with confirmed and suspected coronavirus; infants (<1 year) were noted to be particularly vulnerable.

abstract:
  The effect of COVID-19 by SARS-CoV-2 on the paediatric population remains an evolving mystery. Early reports from China stated that children seem to be unharmed by its dangerous effects, yet more recently there has been evidence of a systemic inflammatory response in a small number of children who are affected. We discuss a 5-week-old male infant who presented atypically with severe COVID-19 infection. To our knowledge, he is the youngest reported case in the UK to require mechanical ventilation and intensive care treatment as a direct result of COVID-19 following horizontal transmission. This case has generated several learning points with regard to atypical presentations of COVID-19 and identifying a potential cohort of ‘at risk’ infants. We also highlight a number of new challenges that have arisen for paediatricians and anaesthetists providing airway management for infants with SARS-CoV-2.


id: cord-338689-4u1ezk64
title: COVID-19 presenting with diarrhoea and hyponatraemia
author: Ata, Fateen
date: 2020-06-07
txt: ./txt/cord-338689-4u1ezk64.txt
cache: ./cache/cord-338689-4u1ezk64.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32513768/
doi: 10.1136/bcr-2020-235456
summary:
  We present a young man with diarrhoea, abdominal pain and hyponatraemia who turned out to be positive for COVID-19. We present a young man with diarrhoea, abdominal pain and hyponatraemia who turned out to be positive for COVID-19. COVID-19 is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). ► We recommend studies to evaluate the effectiveness of stool PCR for severe acute respiratory syndrome coronavirus 2 if initial nasopharyngeal PCR is negative and suspicion remains high. 4 Gastrointestinal symptoms such as diarrhoea, abdominal pain and vomiting have been previously seen with acute viral respiratory infections and reported recently as rare manifestations of COVID-19. 15 Our patient had acute hyponatraemia, abdominal pain and diarrhoea with minimal Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China Clinical and virological factors associated with gastrointestinal symptoms in patients with acute respiratory infection: a two-year prospective study in general practice medicine

abstract:
  COVID-19 is a viral disease with a high infectivity rate. The full spectrum of the disease is not yet understood. This understanding may help in limiting potential exposure. We present a young man with diarrhoea, abdominal pain and hyponatraemia who turned out to be positive for COVID-19.


id: cord-341246-fz66z2p2
author: Bhattacharyya, Pranab J
date: 2020-09-28
txt: ./txt/cord-341246-fz66z2p2.txt
cache: ./cache/cord-341246-fz66z2p2.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32988978/
doi: 10.1136/bcr-2020-239104
abstract: nan
summary:
  title: Takotsubo cardiomyopathy in early term pregnancy: a rare cardiac complication of SARS-CoV-2 infection A 32-year-old primigravida at a 38-week gestation was initially admitted in cardiology isolation ward on referral by her local obstetrician for inferolateral ST-segment elevation on ECG (figure 1A) which was obtained for complaints of New York Heart Association functional class II symptoms with palpitations of a 3-day duration. As typified by this index case, TTC can mimic acute ST-segment elevation myocardial infarction and is considered to be a reversible form of cardiomyopathy characterised by a complete recovery of RWMA and LV function within weeks of presentation. 2 This is the first reported case of TTC in pregnancy as a manifestation of SARS-CoV-2 infection during this ongoing pandemic. ► The presentation of takotsubo cardiomyopathy can mimic STsegment elevation myocardial infarction but in the absence of angiographic evidence of significant obstructive coronary artery disease.

title:
  Takotsubo cardiomyopathy in early term pregnancy: a rare cardiac complication of SARS-CoV-2 infection


id: cord-341919-8gnthufw
author: Basi, Saajan
date: 2020-08-23
url: https://www.ncbi.nlm.nih.gov/pubmed/32843381/
doi: 10.1136/bcr-2020-235920
title:
  Clinical course of a 66-year-old man with an acute ischaemic stroke in the setting of a COVID-19 infection

abstract:
  A 66-year-old man was admitted to hospital with a right frontal cerebral infarct producing left-sided weakness and a deterioration in his speech pattern. The cerebral infarct was confirmed with CT imaging. The only evidence of respiratory symptoms on admission was a 2 L oxygen requirement, maintaining oxygen saturations between 88% and 92%. In a matter of hours this patient developed a greater oxygen requirement, alongside reduced levels of consciousness. A positive COVID-19 throat swab, in addition to bilateral pneumonia on chest X-ray and lymphopaenia in his blood tests, confirmed a diagnosis of COVID-19 pneumonia. A proactive decision was made involving the patients’ family, ward and intensive care healthcare staff, to not escalate care above a ward-based ceiling of care. The patient died 5 days following admission under the palliative care provided by the medical team.


id: cord-341948-9w8od50e
author: Scott, Michael
date: 2020-08-11
txt: ./txt/cord-341948-9w8od50e.txt
cache: ./cache/cord-341948-9w8od50e.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1136/bcr-2020-237169
doi: 10.1136/bcr-2020-237169
summary:
  title: Rare encounter: hydrocoele of canal of Nuck in a Scottish rural hospital during the COVID-19 pandemic We report the case of a 32-year-old woman who presented with reducible indirect inguinal hernia and a challenging constellation of symptoms, signs and radiographic findings. We report the case of a 32-year-old woman who presented with reducible indirect inguinal hernia and a challenging constellation of symptoms, signs and radiographic findings. We aim to provide insights into surgical patient management for a rare entity during the COVID-19 outbreak, from the unique perspective of a small rural hospital in Scotland. We aim to provide insights into surgical patient management for a rare entity during the COVID-19 outbreak, from the unique perspective of a small rural hospital in Scotland. Surgery simultaneously forms the definitive management of hydrocoele of canal of Nuck as well as providing an intraoperative, revised diagnosis. ► Radiology and ultrasonography findings distinguish hydrocoele of canal of Nuck from inguinal hernias.

title:
  Rare encounter: hydrocoele of canal of Nuck in a Scottish rural hospital during the COVID-19 pandemic

abstract:
  We report the case of a 32-year-old woman who presented with reducible indirect inguinal hernia and a challenging constellation of symptoms, signs and radiographic findings. Surgical approach superseded conservative management when the patient’s abdomen became acute, with a rising lactate and haemodynamic instability. Specifically, the presence of a fluid collection was concerning for sinister acute pathology. Our patient was rediagnosed intraoperatively with hydrocoele of canal of Nuck. This so-called ‘female hydrocoele’ is an eponymous anatomical rarity in general surgery, presenting as an inguinolabial swelling with variable clinical profile. Hydrocoele of canal of Nuck takes origin from failure of transitory reproductive anlagen to regress and is thus analogous to patent processus vaginalis. Its true incidence is speculative, with just several hundred cases globally. We aim to provide insights into surgical patient management for a rare entity during the COVID-19 outbreak, from the unique perspective of a small rural hospital in Scotland.


id: cord-346246-2phtdgh4
title: Subacute thyroiditis associated with COVID-19
author: Mattar, Shaikh Abdul Matin
date: 2020-08-25
url: https://doi.org/10.1136/bcr-2020-237336
doi: 10.1136/bcr-2020-237336
abstract:
  We report a case of a hospitalised patient with COVID-19 who developed subacute thyroiditis in association with SARS-COV-2 infection. The patient presented with tachycardia, anterior neck pain and thyroid function tests revealing hyperthyroidism together with consistent ultrasonographic evidence suggesting subacute thyroiditis. Treatment with corticosteroids resulted in rapid clinical resolution. This case illustrates that subacute thyroiditis associated with viruses such as SARS-CoV-2 should be recognised as a complication of COVID-19 and considered as a differential diagnosis when infected patients present with tachycardia without evidence of progression of COVID-19 illness.


id: cord-346345-jc9bq0zu
title: COVID-19-associated brief psychotic disorder
author: Smith, Colin M
date: 2020-08-11
url: https://www.ncbi.nlm.nih.gov/pubmed/32784244/
doi: 10.1136/bcr-2020-236940
abstract:
  A 36-year-old previously healthy woman with no personal or family history of mental illness presented with new-onset psychosis after a diagnosis of symptomatic COVID-19. Her psychotic symptoms initially improved with antipsychotics and benzodiazepines and further improved with resolution of COVID-19 symptoms. This is the first case of COVID-19-associated psychosis in a patient with no personal or family history of a severe mood or psychotic disorder presenting with symptomatic COVID-19, highlighting the need for vigilant monitoring of neuropsychiatric symptoms in these individuals.


id: cord-355146-6rat5j64
title: Use of awake proning to avoid invasive ventilation in a patient with severe COVID-19 pneumonitis
author: Whittemore, Paul
date: 2020-08-03
url: https://www.ncbi.nlm.nih.gov/pubmed/32747596/
doi: 10.1136/bcr-2020-236586
abstract:
  A 60-year-old man with swab-positive COVID-19 and extensive ground-glass change seen on CT imaging was successfully managed on our COVID-19 high-dependency unit with only low-flow oxygen and strict awake proning instructions. He was successfully weaned off oxygen entirely without any requirement for non-invasive or invasive ventilation and made a recovery to be discharged home after an 18-day hospital stay.


