Multisystemic Manifestations of COVID-19 in a 37 Year Old Nigerian Man: A Case Report

Abstract

Severe Acute Respiratory Syndrome corona virus-2 (SARSCoV-2) also known as COVID-19 primarily affects the respiratory system. There are however atypical presentations that involve other systems. This report aims to highlight the clinical features of a patient who presented to the eye clinic with complaints of blurry vision and binocular diplopia. Ocular examination unaided distant visual acuity was 6/6 in the right eye and 6/4 in the left eye. The near visual acuity was N5 in each eye at 33 cm. Ocular motility showed right esotropia of about 60 prism diopters due to an isolated right abducens nerve palsy and unexplained bilateral disc edema. Investigations for a suspected optic neuritis were carried out. Due to his bizarre symptoms, a nasopharyngeal swap was also taken for SARS-CoV-2 polymerase chain reaction. The COVID-19 test came out positive and the other test results were essentially normal. The patient subsequently developed rashes one week after a diagnosis of COVID-19 was made. A brain magnetic resonance imaging (MRI) performed in the fifth week showed features of small vessel ischemia. The patient was seen fortnightly during the follow up period. His vital signs, oxygen saturation, visual acuity testing, OCT and skin examination were performed and the signs and symptoms resolved in the order of their onset over a three month period without any medications for COVID-19. An informed consent was obtained from the patient and ethical approval was gotten from the Health Research Ethics Committee (HREC) of the hospital following the tenets of the Helsinki on studies involving human subjects.