COVID 19-Seizing the Host, an Unusual Presentation

Abstract

at a party a week ago in New Rochelle, he lost 3 of his friends last week because of the COVID-19 infection. Everyone at the party except 2 people was tested positive for COVID-19. Since then the patient has been under stress and delusional thinking that he will die. For high suspicion of COVID-19, his test was sent and he was started on Azithromycin and Plaquenil. On the second day of admission, the rapid response was called because the patient became unresponsive. He was not responding to painful stimuli and his lower lip was shaking. His blood pressure was highly elevated. There was a concern of stroke, stat CT head was repeated which did not show any acute hemorrhage and infarct, and then Electroencephalogram (EEG) showed seizure spikes. His sodium level was 133 meq/L. He was loaded with Levetiracetam and started on Phenytoin. At this point there was a concern that the patient might have encephalitis secondary to COVID-19, his Lumbar puncture was done but it was a dry tap. MRI of the head did not show any encephalitic changes. The patient slowly regained his consciousness. The next day he developed diarrhea, started complaining of cough, and was fixated that he has developed pneumonia and needed treatment. We repeated his chest x-ray which showed no focal lung infiltrate. Unfortunately, he left against medical advice saying that he does not want to get an infection in the hospital. If his test result comes back positive he should be called. A day later, his test came back positive, he was updated and his family brought him to the hospital. According to the family, the day before coming back to the hospital, he passed out three times. During second admission his chest X-ray showed bibasilar infiltrates, D-dimers were also elevated. With the concern of pulmonary embolism as a complication of COVID-19, his CTA chest was done. CTA of the chest showed pulmonary emboli within the right main pulmonary artery as well as segmental and sub-segmental arterial branches of the right upper, right lower, and left upper lobes. It also showed multiple scattered ground-glass densities bilaterally which more pronounced as compared to the prior imaging on his previous admission. In addition to Levonox, he was restarted on Azithromycin, Plaquenil, and anti-epileptics (Levetiracetum and Lacosamide). EEG was repeated which was now negative for seizure. Throughout his hospital stay, he never became hypoxic, his mentation improved, he was closely observed until his inflammatory markers started to trend Introduction