Thyroid storm in a pregnant woman with COVID-19 infection: A case report and review of literatures

BACKGROUNDThe severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been found to be responsible for the recent global pandemic known as coronavirus disease 2019 (COVID-19). SARS-CoV-2 infections not only result in significant respiratory symptoms but also cause several extrapulmonary manifestations, such as thrombotic complications, myocardial dysfunction and arrhythmia, thyroid dysfunction, acute kidney injury, gastrointestinal symptoms, neurological symptoms, ocular symptoms, and dermatological complications. We present the first documented case of thyroid storm in a pregnant woman precipitated by SARS-CoV-2.CASE SUMMARYA 42-year-old multiparous woman at 35 + 2 wk of gestation visited the emergency room (ER) with altered mentation, seizures, tachycardia, and high fever. The patient showed no remarkable events in the prenatal examination, and the nasopharyngeal COVID-19 polymerase chain reaction (PCR) test was positive two days before the ER visit. The results of laboratory tests, such as liver function test, serum electrolytes, blood glucose, blood urea nitrogen, and creatinine, were all within the normal ranges. However, the thyroid function test showed hyperthyroidism, and the nasopharyngeal COVID-19 PCR test was positive, as expected. No specific findings were observed on the brain computed tomography, and there were no signs of lateralization on neurological examination. Fetal heartbeat and movement were good, and there were no significant uterine contractions. The initial impression was atypical eclampsia. However, the patient''s condition worsened, and a cesarean section was performed under general anesthesia; a healthy boy was delivered, and 12 h after delivery, the patient''s seizures disappeared and consciousness was restored. The patient was referred to an endocrinologist for hyperthyroidism, and a thyroid storm with Graves'' disease was diagnosed. Here, SARS-CoV-2 was believed to be the trigger for the thyroid storm, considering that the patient tested positive for COVID-19 two days before the seizures.CONCLUSIONIn pregnant women presenting with seizures or changes in consciousness, the possibility of a thyroid storm should be considered. There are various causes for a thyroid storm, but given the recent pandemic, it is necessary to bear in mind that the thyroid storm may be precipitated by COVID-19.     

COVID-19 presenting as complete heart block: A case report

Rationale: COVID-19 has a wide range of clinical presentations requiring a high index of suspicion for diagnosing patients presenting with extrapulmonary manifestations. Among them, patients with cardiovascular involvement have a high mortality. Patient's concerns: A 50-year-old male patient with COVID-19 infection presented with multiple syncopal episodes, myalgia, and mild respiratory symptoms. Diagnosis: Mild COVID-19 infection with complete heart block. Interventions: Temporary pacing followed by permanent pacemaker insertion 10 days after the onset. Outcomes: The patient was managed as per COVID-19 protocol in an isolation ward, and his condition improved but remained pacemaker dependent until a repeat RT-PCR for COVID-19 tested negative, after which he was shifted back to the cardiac care unit for permanent pacemaker insertion. The patient was discharged after inflammatory markers were normal and clinical condition was completely stable. Lessons: COVID-19 has a wide range of clinical presentations, and extrapulmonary manifestations, especially, cardiovascular involvement can not be ignored.     

经血来源干细胞临床应用研究进展

经血来源干细胞是一种经血来源的间充质干细胞,具有来源丰富、无创获取、易分离培养、增殖率高、传代次数较多、低免疫原性、无伦理争议等独特优势,目前被广泛用于各种疾病治疗的研究中,表现出良好的治疗潜力,临床应用前景广阔。但在经血来源干细胞成为临床常规治疗前,仍有很多问题亟待解决,现将经血来源干细胞的临床应用进展综述如下。     

Thymosin as a possible therapeutic drug for COVID-19: A case report

BACKGROUNDThere are no effective antiviral therapies for coronavirus disease 2019 (COVID-19) at present. Although most patients with COVID-19 have a mild or moderate course of disease, up to 5%-10% of patients may have a serious and potentially life-threatening condition, indicating an urgent need for effective therapeutic drugs. The therapeutic effect of thymosin on COVID-19 has not been previously studied. In this paper, for the first time we report a case of thymosin treatment of COVID-19.CASE SUMMARYA 51-year-old man with imported COVID-19 was admitted with definite symptoms of chest tightness, chest pain, and fatigue. The polymerase chain reaction results for severe acute respiratory syndrome coronavirus 2 were negative. The antibody test was positive, confirming the diagnosis of COVID-19. As many orally administered drugs were not well tolerated due to gastrointestinal symptoms, an emergency use of thymosin, a polypeptide consisting of 28 amino acids, was administered by injection. Finally, after the implementation of the treatment program, symptoms and lung imaging improved significantly.CONCLUSIONIn this case report, it is confirmed that thymosin may help alleviate the severity of COVID-19 symptoms.     

Pulmonary contusion mimicking COVID-19: A case report

BACKGROUND Coronavirus disease 2019(COVID-19)is a major public health emergency with obvious characteristics of human-to-human transmission,and there are infective asymptomatic carriers.Early identification and proper management of patients with COVID-19 are important.Features in chest computed tomography(CT)can facilitate identifying newly infected individuals.However,CT findings of some lung contusions are similar to those of COVID-19,as shown in the present case.CASE SUMMARY A 46-year-old woman was admitted to hospital for backache and foot pain caused by a fall injury 1 d before hospitalization.She was suspected of having COVID-19,since there was a confirmed COVID-19 case near her residence.But she had no fever,cough,chest tightness,difficult breathing,nausea,vomiting,or diarrhea,etc.On physical examination,the lower posterior chest of both sides showed dullness on percussion and moist rales at the end of inspiration on auscultation.The white blood cell count and lymphocyte count were 10.88×109/L and 1.04×109/L,respectively.CT performed on February 7,2020 revealed that both lungs were scattered with patchy ground-glass opacity.The patient was diagnosed with pulmonary contusion with thoracic spinal fracture(T12),calcaneal fracture,and pelvic fracture.On day 9 after conservative treatment,her condition was alleviated.On review of the chest CT,the previous shadows were significantly reduced.CONCLUSION Differential diagnosis of lung contusion and COVID-19 must be emphasized.Both conditions require effective prompt actions,especially COVID-19.     

Lung abscess as a secondary infection of COVID-19: A case report and literature review

A 16-year-old male was admitted with persistent fever, diarrhea, and anorexia 8 days after the diagnosis of coronavirus disease-2019 (COVID-19). Radiological examination of the lungs showed a cavitary lesion with an air-fluid level, but no apparent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. The lesion was diagnosed as a lung abscess after COVID-19. Treatment with antimicrobials was initiated, which attenuated symptoms and the lung lesion. Specific pathogens were not detected despite repeated sputum cultures, which suggested that lung abscess was caused by oral bacteria as a secondary infection of COVID-19. To date, several cases of lung abscess as a complication of COVID-19 have been reported. However, the majority of cases occurred after intubation to treat COVID-19, and there have been no cases involving young adults. This healthy young patient may have developed lung abscess due to COVID-19.     

Bronchoscopy for diagnosis of COVID-19 with respiratory failure: A case report

BACKGROUNDAlthough the imaging features of coronavirus disease 2019 (COVID-19) are starting to be well determined, what actually occurs within the bronchi is poorly known. Here, we report the processes and findings of bronchoscopy in a patient with COVID-19 accompanied by respiratory failure.CASE SUMMARYA 65-year-old male patient was admitted to the Hainan General Hospital on February 3, 2020 for fever and shortness of breath for 13 d that worsened for the last 2 d. The severe acute respiratory syndrome coronavirus 2 nucleic acid test was positive. Routine blood examination on February 28 showed a white blood cell count of 11.02 × 10⁹/L, 86.9% of neutrophils, 6.4% of lymphocytes, absolute lymphocyte count of 0.71 × 10⁹/L, procalcitonin of 2.260 ng/mL, and C-reactive protein of 142.61 mg/L. Oxygen saturation was 46% at baseline and turned to 94% after ventilation. The patient underwent video bronchoscopy. The tracheal cartilage ring was clear, and no deformity was found in the lumen. The trachea and bilateral bronchi were patent, while the mucosa was with slight hyperemia; no neoplasm or ulcer was found. Moderate amounts of white gelatinous secretions were found in the dorsal segment of the left inferior lobe, and the bronchial lumen was patent after sputum aspiration. The right inferior lobe was found with hyperemia and mucosal erosion, with white gelatinous secretion attachment. The patient’s condition did not improve after the application of therapeutic bronchoscopy.CONCLUSIONFor patients with COVID-19 and respiratory failure, bronchoscopy can be performed under mechanical ventilation to clarify the airway conditions. Protection should be worn during the process. Considering the risk of infection, it is not necessary to perform bronchoscopy in the mild to moderate COVID-19 patients.     

Retroperitoneal and abdominal bleeding in anticoagulated COVID-19 hospitalized patients: Case series and brief literature review

BACKGROUND Hospitalized and severely ill coronavirus disease 2019(COVID-19) patients necessitate prophylactic or therapeutic anticoagulation to minimize the risk of thrombosis at different sites. Life-threatening bleeding complications include spontaneous iliopsoas hematoma, peritoneal bleeding, and extra-abdominal manifestations such as intracranial hemorrhage.CASE SUMMARY Bleeding in the abdominal wall results in less severe complications than seen with iliopsoas hematoma or peritoneal bleedin...     

Junctional bradycardia in a patient with COVID-19: A case report

BACKGROUNDCardiac arrhythmias, including bradyarrhythmias, have been described as manifestations of coronavirus disease 2019 (COVID-19). Herein, we present a case of junctional bradycardia secondary to possible sinus node dysfunction in a patient with COVID-19.CASE SUMMARYThe patient was a 32-year-old woman with no significant medical history. On the third day of hospitalization, she developed junctional bradycardia while being hemodynamically stable. The episodes of nodal dysrhythmia with a low heart rate persisted for the next few days and were associated with elevated levels of systemic inflammatory markers. The patient received antiviral and anti-inflammatory treatments for the viral infection but no antiarrhythmic medications. She had a normal sinus rhythm on day 12.CONCLUSIONCardiac rhythm monitoring, focusing on the association between cardiac arrhythmias and the systemic inflammatory response, is important in COVID-19 patients.     

COVID-19 patient with an incubation period of 27 d: A case report

BACKGROUNDAs a highly contagious disease, coronavirus disease 2019 (COVID-19) is wreaking havoc around the world due to continuous spread among close contacts mainly via droplets, aerosols, contaminated hands or surfaces. Therefore, centralized isolation of close contacts and suspected patients is an important measure to prevent the transmission of COVID-19. At present, the quarantine duration in most countries is 14 d due to the fact that the incubation period of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is usually identified as 1-14 d with median estimate of 4-7.5 d. Since COVID-19 patients in the incubation period are also contagious, cases with an incubation period of more than 14 d need to be evaluated. CASE SUMMARYA 70-year-old male patient was admitted to the Department of Respiratory Medicine of The First Affiliated Hospital of Harbin Medical University on April 5 due to a cough with sputum and shortness of breath. On April 10, the patient was transferred to the Fever Clinic for further treatment due to close contact to one confirmed COVID-19 patient in the same room. During the period from April 10 to May 6, nucleic acid and antibodies to SARS-CoV-2 were tested 7 and 4 times, respectively, all of which were negative. On May 7, the patient developed fever with a maximum temperature of 39℃, and his respiratory difficulties had deteriorated. The results of nucleic acid and antibody detection of SARS-CoV-2 were positive. On May 8, the nucleic acid and antibody detection of SARS-CoV-2 by Heilongjiang Provincial Center for Disease Control were also positive, and the patient was diagnosed with COVID-19 and reported to the Chinese Center for Disease Control and Prevention. CONCLUSIONThis case highlights the importance of the SARS-CoV-2 incubation period. Further epidemiological investigations and clinical observations are urgently needed to identify the optimal incubation period of SARS-CoV-2 and formulate rational and evidence-based quarantine policies for COVID-19 accordingly.