TP47. TP047 COVID AND ARDS CASE REPORTS最新文献

{"title":"An Interesting Case of COVID-19 Induced Hypercoagulability Manifesting as Pulmonary Embolism and Apical Left Ventricular Thrombus","authors":"A. Azhar, A. Bk, O. Hadzipasic","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2441","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2441","url":null,"abstract":"Introduction: Recent data demonstrates a strong correlation between COVID-19 and hypercoagulability with the spectrum of thromboembolic manifestations, including deep vein thrombosis and pulmonary embolism (PE). Here we present a unique case of COVID-19 associated hypercoagulability manifesting as both PE and apical left ventricular (LV) thrombosis in the absence of underlying coronary artery disease (CAD). Case: A 71-year-old female with a diagnosis of mild COVID-19 pneumonia presented with worsening fatigue, cough, shortness of breath, and chest heaviness on the thirteenth day of her illness. The patient was hypoxic on presentation requiring 3 L supplemental oxygen. Laboratory analysis showed an extremely high D-dimer level (greater than 20,000 ng/mL). Hence, computed tomography angiography of the chest was performed, showing evidence of right lower lobe segmental and subsegmental PE along with bilateral multifocal consolidation. Incidentally, the imaging demonstrated a filling defect within the apex of LV, transcending into further cardiac workup. Initial troponin was elevated at 0.04 ng/mL, and electrocardiogram showed sinus rhythm without any acute ST-T wave changes. Transthoracic echocardiography confirmed the presence of large, sessile, mobile, 1.3 x 2.1 cm LV thrombus but normal LV systolic function, ejection fraction, and no evidence of regional wall motion abnormalities. However, due to ongoing chest heaviness, the decision was made to perform a diagnostic left heart catheterization, which showed insignificant CAD. The patient received treatment with convalescent plasma, Remdesivir, and dexamethasone as per our institutional protocol and started on unfractionated heparin for anticoagulation. She was discharged on enoxaparin as per the patient's preference on a stable condition with close cardiology follow up. DiscussionLV thrombosis is a well-known complication of LV dysfunction associated with ischemic cardiomyopathy. While PE is an established phenomenon of COVID- 19 induced hypercoagulability, thrombus formation within the cardiac chamber is rarely reported. As cardiovascular complications such as acute myocardial injury, myocarditis, and cardiomyopathy are substantially reported in COVID-19, through this case report, we highlight the rare presentation of COVID 19 hypercoagulability with LV thrombus in the absence of predisposing cardiac conditions such as myocardial infarction or atrial fibrillation. Although the mechanism remains unclear, endothelial dysfunction eliciting local myocardial inflammation and blood stasis is a plausible explanation. Early recognition of LV thrombus and treatment with anticoagulation is of paramount importance to reducing stroke risk and systemic embolization. The detection of LV thrombus mandates anticoagulation with warfarin or heparin due to insufficient evidence to support the use of direct oral anticoagulants.","PeriodicalId":181364,"journal":{"name":"TP47. TP047 COVID AND ARDS CASE REPORTS","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124083678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not Forgotten by Novel Disease: COVID-19 Complicated by Lemierre’s Syndrome","authors":"J. Wang, S. Young","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2460","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2460","url":null,"abstract":"Introduction: Lemierre's syndrome is an extremely rare disease that generally occurs in young, healthy adults and is characterized by oropharyngeal infection followed by septic thrombophlebitis of the internal jugular vein. We present a case of COVID-19 infection complicated by acute mastoiditis with concomitant Lemierre's syndrome. Case Presentation: A 57-year-old male with obesity and asthma presented with worsening dyspnea after diagnosis of COVID-19 three days prior. The patient was febrile to 101 degrees Fahrenheit and hypoxemic requiring 15 liters supplemental oxygen. CT chest showed severe multifocal bilateral pulmonary opacities and initial blood cultures were negative. He received dexamethasone, remdesivir, and convalescent plasma but clinical status deteriorated with progression of respiratory and renal failure. The patient was eventually intubated and a left internal jugular central venous catheter was placed for renal replacement therapy. Hospital course was further complicated by new onset atrial fibrillation with RVR, for which amiodarone and heparin infusions were started. Four days later, the patient developed intermittent fevers and was found to have Fusobacterium nucleatum bacteremia. Doppler ultrasound showed thrombosis of the left internal jugular vein consistent with Lemierre's syndrome. Physical exam did not exhibit neck edema, induration or dental infection, but CT head and chest revealed acute bilateral mastoiditis and new right upper lobe abscess. Despite removal of internal jugular venous catheter, continued anticoagulation, and initiation of broad spectrum antibiotics, the patient developed worsening multiorgan failure and septic shock requiring vasopressors. He ultimately underwent PEA arrest and did not survive resuscitation. Discussion: Lemierre's syndrome is a rare condition with an estimated worldwide incidence of one in 1 million and a high mortality between 5% to 18%. The most common pathogen is Fusobacterium necrophorum. Moreover, our patient had elevated risk of thrombosis from COVID-19 and a recently placed central venous catheter. As providers increasingly care for patients with COVID-19, early recognition and management of this rare complication is paramount to reduce mortality. Fusobacterium bacteremia should lead to a high index of suspicion for timely diagnosis and treatment of Lemierre's syndrome.","PeriodicalId":181364,"journal":{"name":"TP47. TP047 COVID AND ARDS CASE REPORTS","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132338561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guillain-Barre Syndrome Related to Coronavirus Disease-2019 (COVID-19) Infection","authors":"M. S. Rahi, K. Amoah, K. Gunasekaran, M. Buscher","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2472","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2472","url":null,"abstract":"Guillain-Barre syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy that occurs following a viral or bacterial infection and vaccination. A 61-year-old male with a past medical history significant for hypertension, hyperlipemia, nephrolithiasis, and Coronavirus Disease-2019 (COVID-19) infection 17 days prior presented to the emergency department with complaints of numbness, tingling, and weakness in all four extremities for one day. He endorsed fatigue but denied nausea, vomiting, diarrhea, fever, cough, or shortness of breath. He denied headache, dizziness, vision change, hearing change, speech, or swallowing problems. On examination, he was afebrile with a heart rate of 120 beats/minute, respiratory rate of 18 breaths/minute, blood pressure of 124/98 mm of Hg, and oxygen saturation of 96% while breathing ambient air. He had reduced sensation to light touch in all four extremities. His bilateral upper and lower extremity flexor strength was 4/5. His bilateral upper extremity extensor strength was 3/5. He had bilateral patellar, triceps, and biceps areflexia. He had marked difficulty moving from reclined to sitting position. He was unable to stand. His primary laboratory examination was unremarkable except for mild leukocytosis of 11,400/μL and D-dimer of 3.91 mg/L. A lumbar puncture was performed, revealing one white blood cell, 60 red blood cells, normal glucose, and 97 mg/dL of protein consistent with albumin-cytologic dissociation. His HIV antibody screen and Ganglioside GM antibodies (IgG and IgM) were negative. He had no urge to urinate or bowel movements. His clinical picture was consistent with Guillain-Barre syndrome with evidence of autonomic involvement. Treatment with intravenous immunoglobulin (IVIG) 400 mg/kg daily for five days was initiated. Adequate hydration was maintained to mitigate the risk of thrombosis from IVIG and COVID-19 infection. Negative inspiratory force (NIF) measurements were performed daily and were normal. By day 4 of treatment patient noticed a mild improvement in strength and sensation in all four extremities, and urinary retention resolved. He was discharged to acute care rehab with close neurology follow up. In a recent report of five patients from Italy, the mean day of GBS onset was eight, and none had autonomic symptoms. We report a case of GBS associated with COVID-19 infection with onset at day 17 and the presence of autonomic symptoms like sinus tachycardia, urinary retention and constipation. IVIG or plasma exchange is the mainstay of treatment with similar efficacy. Adequate hydration should be maintained as both IVIG and COVID-19 infection increases the risk of thrombosis.","PeriodicalId":181364,"journal":{"name":"TP47. TP047 COVID AND ARDS CASE REPORTS","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132273870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumothorax in COVID19 Intubated Patients: A Case Series","authors":"S. Chandna, M. Shah, G. Aftab, Ankit Agrawal, B. Yegneswaran, H. Rana","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2440","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2440","url":null,"abstract":"Introduction Pneumothorax is a rare complication among mechanically ventilated patients and is even higher in patients with high positive end-expiratory pressure (PEEP). Herein we describe a case series of nine patients who were intubated due to acute respiratory disease syndrome (ARDS) secondary to coronavirus disease 2019 (COVID-19) and developed pneumothorax in due course. Case Description Nine patients with COVID-19 pneumonia who were on ventilators and eventually developed pneumothorax were analyzed retrospectively and outcomes were studied. The characteristics of patients like age, gender, and body mass index (BMI) were compared. Past medical history including smoking history was taking into consideration as well. We compared the total number of days on the ventilator, the highest PEEP they received, and the ventilator day when pneumothorax developed. Treatment: Cases 1,2,3,5,8 and 9 were treated with high dose steroids, hydroxychloroquine, tocilizumab, and convalescent plasma. Case 9 was treated with remdesivir. Case 7 received a high dose of steroids and hydroxychloroquine. Cases 4 and 6 were treated only with hydroxychloroquine. All patients died at the end of their hospital stay. Discussion Patients with COVID19 are at a higher risk of pneumothorax due to severe inflammation. It can be seen in any stage of the disease and might not be associated with the severity of the illness. Bullae formation and pneumothorax can be seen in previously healthy lungs. In our case-series of patients with COVID-19 who developed a pneumothorax, the mortality was noted to be 100%. The majority of patients were non-smokers and had no history of lung disease. Only one patient was a former smoker and had chronic obstructive pulmonary disease. High PEEP & low Fraction of inspired oxygen (FiO2) strategy is commonly used in patients with ARDS who are on a ventilator. As per NIH NHLBI ARDS Clinical Network Mechanical Ventilation Protocol, patients with ARDS and mechanical ventilation can be managed with 2 strategies: high PEEP, low FiO2, or low PEEP, high FiO2. Literature suggests that there is no significant difference between the outcomes in the two strategies. COVID-19 is a new illness with no specific guidelines on the management of ventilators. Intensivists should be cautious while maintaining PEEP in such patients and all efforts should be made to prevent pneumothorax. High FiO2 and low PEEP strategy should be considered while managing patients with COVID19 who are on a ventilator. There is a need for large-scale studies to co-relate with these outcomes.","PeriodicalId":181364,"journal":{"name":"TP47. TP047 COVID AND ARDS CASE REPORTS","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125200675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Post-SARS-CoV2 Multisystem Inflammatory Syndrome Mimicking Kawasaki Disease Shock Syndrome in a Young Adult","authors":"P. Willard, M. Montalvo, K. Kapoor, D. Grinnan","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2469","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2469","url":null,"abstract":"Introduction: Long term sequelae of SARS-CoV2 infections are currently being investigated. Previously described long term sequelae include cerebral vascular accidents, liver and kidney disease, and psychological disease, albeit without a consistent pattern of presentation. Recently, several cases have been published regarding multisystem inflammatory syndrome in children following known SARS-CoV2 infection. There has been one reported case of post-infectious Kawasaki-like illness in an adult. We present a patient with a similar multisystem inflammatory reaction, giving support for a Kawasaki-like disease in adults post-SARS-CoV2. Case description: A 27-year-old male with history of mild SARS-CoV2 infection one month prior without respiratory distress presented with fevers, abdominal pain, vomiting, and headache. Physical exam revealed injected bilateral conjunctiva, cheilitis, cervical lymphadenopathy, nuchal rigidity, a morbilliform rash on chest and hands, bilateral hand edema, and suprapubic tenderness. An abdominal CT scan suggested pyelonephritis and prostatitis. Hepatocellular and cholestatic markers were elevated without serological evidence of viral hepatitis. ESR, CRP, ferritin, LDH, d-dimer, and IL-6 were all elevated. SARS-CoV2 PCR was negative but IgG was positive. Blood, urine, and lumbar puncture studies were negative for bacterial, fungal, viral, and tick-borne evidence of infection. Rheumatologic workup was unremarkable. He developed hypotension requiring vasopressor support. ECG was notable for new-onset atrial fibrillation and echocardiogram showed systolic dysfunction with global hypokinesis with an ejection fraction of 45-50%. Cardiac MRI did not show evidence of myocarditis or infiltrative disease. Morning cortisol was low consistent with adrenal insufficiency and started on hydrocortisone. All his symptoms began to resolve with steroid therapy. One month after discharge, he was found to be in normal sinus rhythm. He experienced full resolution of his symptoms other than visual field disturbances with occasional floaters deemed to be of unknown etiology following complete neurologic and ophthalmologic workup. Repeat echocardiogram continued to show global systolic dysfunction with an ejection fraction of 40-45%. The patient continued on goal directed medical therapy and hydrocortisone therapy. Discussion: Post inflammatory conditions secondary to SARS-CoV2 have not been well described in adults. We present a patient whose post SARS-CoV2 inflammatory syndrome mimics the known pediatric post-inflammatory state, including characteristic timing, exam and laboratory findings, and resolution with steroid therapy. Further description of similar presentations is needed to better gauge the incidence of this inflammatory syndrome in young adults.","PeriodicalId":181364,"journal":{"name":"TP47. TP047 COVID AND ARDS CASE REPORTS","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122548629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From a Cotton Bud to a Pool of Blood COVID-19 Testing, A Double-Edged Sword?","authors":"W. Meng, R. Miller, S. Pate, S. Nanavati, R. Patel, A. Khatatneh, A. Samuel, M. Ismail, L. Prabhakar, M. Halabiya, W. Grist, R. Yelisetti, J. Mathew","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2442","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2442","url":null,"abstract":"Introduction: Coronavirus Disease 2019 (COVID-19) testing has grown exponentially in the United States since the dawn of the pandemic, with the vast majority of samples being obtained via nasopharyngeal swab. Although convenient and widely used, the test itself carries potential adverse effects, particularly those at high risk of bleeding. We present a patient who developed several arrays of complications after being tested for COVID-19 using the nasal swab sampling technique. Case Presentation: An 80-yo female presented from home with a complaint of hematuria. Her past medical history includes rheumatic heart disease status post repair on warfarin, atrial fibrillation and stroke. Vital signs were normal. She had benign head and neck exam, clear lung sounds, an irregular heart rhythm and a normal abdominal exam. Labs were at baseline with hemoglobin of 10.4. Chest x-ray and CT abdomen were unremarkable. She received a PCR nasopharyngeal swab in the emergency room and subsequently developed profuse epistaxis. Initial nasal packing and Afrin sprays failed to control the bleeding and she required emergent intubation for airway protection. She also needed vasopressors due to hypotension. Repeat hemoglobin was 7.5 and lactic acid was 10.4. Bleeding eventually stopped after continuous nasal packing, transfusional support and IV vitamin K. In the following days, she developed fever, leukocytosis and lung infiltrates. She received empiric antibiotic coverage, although no growth from cultures. Endoscopy findings were consistent with ischemic colitis. Later, she stabilized hemodynamically but was unable to be liberated from the ventilator. She was discharge to a long-term care facility after 43 days of stay. Discussion: Nasopharyngeal swabs are the mainstay of testing for COVID-19, however, little has been discussed regarding its procedural risks. Common adverse effects include headaches, nasal pain, ear discomfort and rhinorrhea. Recent studies have suggested that the incidence of epistaxis can be as high as 10% after the test. Alternatively, multiple research centers, including Yale and University of Illinois have released promising data on saliva-based testing. Their evidence supported high sensitivity comparable to the nasopharyngeal method with simpler and safer nature. Also, the saliva-based testing can be done at home, which is believed to reduce healthcare cost and lower the risk of cross infection. This case vividly demonstrates that even the most common procedure can result in devastating outcomes. As such, health care providers should be cognizant of these complications and consider alternative testing method when possible.","PeriodicalId":181364,"journal":{"name":"TP47. TP047 COVID AND ARDS CASE REPORTS","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121551787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Euglycemic Diabetic Ketoacidosis, SGLT-2 Inhibitors and COVID-19; The Murphy Law of COVID-19","authors":"A. Hassan, H. Salat, A. Ahmed, T. Khan","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2448","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2448","url":null,"abstract":"Euglycemic Diabetic ketoacidosis (DKA) is a rare complication in type II Diabetic patients who are taking sodiumglucose cotransporter-2 (SGLT-2) inhibitors. We present a case of euglycemic DKA in a type II diabetic patient taking SGLT-2 inhibitors with a positive Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV2) infection that was diagnosed early and treated with subcutaneous short-acting insulin. A 57-year-old man presented to our emergency department for sudden fall and dysarthria with a few days history of shortness of breath, fever and nausea. CT head at presentation showed segmental occlusion of right internal carotid artery(ICA). Nasal swab was positive with SARS-CoV2 PCR. Initial labs remarkable for bicarbonate of 17 meq/L, arterial pH 7.14 with an anion gap of 17 and PCO2 was 41. His serum blood glucose was 248mg/dl and lactate at 1.0 mmol/L. His past medical history was significant for type II diabetes (on Empagliflozin and Metformin) and extensive coronary artery disease with multiple stents, on dual anti-platelet therapy (DAPT). He underwent interventional radiology (IR) guided thrombectomy of right ICA and was admitted to ICU for post-stroke care. Due to aforementioned labs, we immediately checked his serum ketones which were elevated at 0.58mmol/L and the diagnosis of euglycemic-DKA secondary to SGLT-2 inhibitor use was made. Since the metabolic acidosis and ketonemia were still fairly in the early stages, we decided to manage it with subcutaneous short-acting insulin. The anion gap was closed within the next 12 hours. Euglycemic DKA is a known complication of SGLT-2 inhibitors with high morbidity and mortality. The reported incidence of euglycemic DKA with empagliflozin is 0.2 to 0.6 per 1,000 patient-years. Recently, a few case reports have been published sharing a correlation with SARS-CoV2 infection. This infection causes a state of profound inflammation and stress, making lab values in these patients widely deranged which can muddle the clinical picture. Since this infection also worsens the glycosuria seen with the use of SGLT-2 inhibitors, ICU physicians must pay close attention to this complication in diabetic patients. We propose that the incidence of developing euglycemic DKA with SGLT-2 inhibitor use may be higher in SARS-CoV2 infection and more research may prove a positive correlation between the two.","PeriodicalId":181364,"journal":{"name":"TP47. TP047 COVID AND ARDS CASE REPORTS","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125699344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methanol Toxicity: An Unintended Consequence of the COVID-19 Pandemic","authors":"K. M. Calhoun, K. Goel, J. A. Hippensteel","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2433","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2433","url":null,"abstract":"Introduction: Although “parent alcohols” such as methanol and ethylene glycol are relatively non-toxic, they can lead to profound toxicity after being metabolized by alcohol dehydrogenase. Methanol poisoning is characterized by a high anion gap metabolic acidosis and can have a variety of central nervous system manifestations ranging from inebriation to coma and seizures, with afferent pupillary defect a sign of advanced methanol poisoning. Early recognition and treatment are key. Here we present a case of severe methanol toxicity secondary to hand sanitizer ingestion early in the COVID-19 pandemic. Case: A 54-year-old man with a history of alcohol use disorder presented to the Emergency Department after being found down and unresponsive near the front door of his home. Earlier that day he was “acting strange” according to his girlfriend. She left their home to get help, and upon her return found him in the front yard unresponsive and having seizure activity. Upon arrival to the Emergency Department he was afebrile, hypotensive, and tachycardic. He was unresponsive so he was emergently intubated. Physical exam was significant for asymmetric, dilated, and fixed pupils. Labs were significant for a bicarbonate of 5, potassium of 7.2, an anion gap of 28, and an osmolar gap of 177. His methanol level was 396. Despite dialysis he progressed to multi organ failure and his family decided to transition to comfort care, soon after which he expired. After further questioning it was discovered that he had been drinking hand sanitizer in an effort to get intoxicated as they were out of alcohol in the house. The bottle found in the home was reported to the FDA. Upon their review it was removed from store shelves due to methanol contamination and potential risk to others. It is believed that this brand of hand sanitizer was a new brand sold during the COVID-19 pandemic shortage and had a false ingredient label. Discussion: This patient had many of the characteristic signs and symptoms of methanol poisoning and was an unfortunate example of how devastating the outcome can be. However, it also highlights how the COVID-19 pandemic has had many unintentional medical consequences as a result of socioeconomic health disparities, the challenge of treating substance abuse disorder, and poorly regulated consumer products.","PeriodicalId":181364,"journal":{"name":"TP47. TP047 COVID AND ARDS CASE REPORTS","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123990919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ECMO for Severely Morbidly Obese Patient with COVID-19","authors":"J. Minoff, E. Abo‐salem, G. Kamel","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2457","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2457","url":null,"abstract":"Introduction It was traditionally taught that extracorporeal membrane oxygenation (ECMO) should be avoided in the morbidly obese due to the higher risk of mortality. Recently, a few case reports have shown that the mortality risk among this population is not significantly different than in the general population, though there may be selection bias. Veno-venous (VV) ECMO has been a useful technique to improve mortality among those afflicted with the severest forms of acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia, caused by the SARS-CoV-2 virus. Case reports of ECMO therapy for ARDS due to COVID-19 in the severely morbidly obese are lacking. This is a case of a male with a body mass index (BMI) of 75 who suffered from severe ARDS and was treated with VV-ECMO successfully. Case A 54-year-old male with a past medical history of severely morbid obesity (BMI of 75), hypertension, diabetes mellitus type II, and obstructive sleep apnea presented to the emergency room with three days of fatigue, cough and dyspnea. His initial vitals revealed a fever of 101.3F, 30 breaths per minute, and hypoxia requiring 4 L O2 via nasal cannula. Initial chest xray demonstrated bilateral multifocal opacities. COVID-19 PCR testing was positive. The patient was started on dexamethasone, remdesivir, and convalescent plasma. He was also treated for community acquired pneumonia. The patient, initially admitted to the floor, continued to decompensate with worsening hypoxia requiring BIPAP and was transferred to the intensive care unit (ICU) three days after admission. Due to persistent oxygen saturations in the mid-80s on CPAP of 20 with FiO2 of 100%, patient was intubated eight days after admission. He continued to decompensate with saturations in the 70s despite maximum inhaled epoprostenol and VV-ECMO was initiated. His ECMO course was without significant events and was decannulated fifteen days after initiation. His course was complicated by an acute kidney injury which eventually required dialysis, as well as prolonged encephalopathy. Stroke work-up was negative. The patient remained ventilator dependent, underwent a tracheostomy and was discharged to a long-term acute care hospital fifty-six days after admission. He eventually was decannulated at the long-term acute care hospital. Discussion This case describes a successful VV-ECMO therapy in a severely morbidly obese 54 year-old male with ARDS due to COVID-19, which has not been previously described in case reports. Obesity should not be considered a contraindication for VV-ECMO in a select group of patients.","PeriodicalId":181364,"journal":{"name":"TP47. TP047 COVID AND ARDS CASE REPORTS","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122848815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not Out of the Woods Yet: A Case of Multisystem Inflammatory Syndrome Due to COVID-19 in an Adult","authors":"T. Homan, C. Homan","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2471","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2471","url":null,"abstract":"Introduction Multisystem inflammatory syndrome (MIS) is a hyperinflammatory disorder seen in patients with history of COVID-19 infection. It is most commonly seen in children (MIS-C) and is rare in adults (MIS-A). We report a case of MIS-A with multiorgan failure in a previously healthy patient who had recently recovered from COVID-19. Case Presentation A 29-year-old Caucasian male with no medical history presented with fever to 103 degrees Fahrenheit, headache, syncope, and vomiting for 3 days. He had been diagnosed with COVID-19 five weeks prior and recovered without complication. Patient was seen in the ED the previous day for fever and neck stiffness, at which time he had a negative repeat COVID-19 test and unremarkable lumbar puncture. Physical exam was normal. Labs revealed WBC 13.4, platelets 90, AST 92, ALT 120, total bilirubin 1.7, ferritin 1,033, CRP 312, and procalcitonin 1.35. Initial imaging revealed gallbladder sludge and inflammation of the mesentery and distal ileum with adenopathy. Patient was started on broad-spectrum antibiotics. However, over the next 3 days, he developed an oxygen requirement up to 6 liters, tachycardia, increasing liver function tests, and acute kidney injury. Procalcitonin trended up to 16.03. Infectious workup was negative. CTA chest revealed right upper lobe pulmonary emboli, bilateral pleural effusions, and pulmonary edema. Pro-BNP was 24,554. Echocardiogram showed ejection fraction (EF) 45-50%, enlarged right ventricle, and small pericardial effusion. Patient was started on a heparin drip, without improvement. Diuresis was attempted but limited by hypotension. He was ultimately treated with dexamethasone, resulting in rapid improvement. Discussion The pathophysiology of MIS-A is poorly understood but is thought to be due to immune dysregulation. This may be a post-infectious process or could be due to persistent infection outside of the upper respiratory system, as SARS-CoV-2, the virus that causes COVID-19, is known to affect other organs, such as the heart, liver, kidneys, and gastrointestinal system. MIS-A usually occurs 2-5 weeks after the patient has COVID-19. It disproportionately affects minority groups. Common presenting symptoms include fever, chest pain, dyspnea, myalgias, and gastrointestinal and dermatologic symptoms. Inflammatory markers (e.g., CRP, ferritin, D-dimer) are elevated. Severe dysfunction of at least one extrapulmonary organ system (e.g., cardiac dysfunction, hypotension, acute kidney or liver injury, thromboembolism) must be present. The mainstay of treatment is corticosteroids;intensive care admission, mechanical ventilation, vasopressor or inotrope support, and hemodialysis may also be required. The majority of patients with MIS-A survive. The long-term effects are unknown.","PeriodicalId":181364,"journal":{"name":"TP47. TP047 COVID AND ARDS CASE REPORTS","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126699214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}