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Published on: December 19, 2020
A Fatal Extrapulmonary Manifestation of COVID-19
Chad L Harris1, Supraja Achuthanandan1, Kiran Para1
1Internal Medicine, Maimonides Medical Center, Brooklyn, USA.
Abstract:
Coronavirus disease 2019 (COVID-19) grew to pandemic proportions in 2020. Research has shown that the causative virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), uses the angiotensin-converting enzyme II (ACE-II) receptor to attack host cells. These ACE-II receptors are present essentially in all organs, acting as a route of entry for SARS-CoV-2 to cause a wide variety of manifestations. There is growing research showing the neurologic effects of COVID-19. There have been several cases of encephalopathy, stroke, and encephalitis associated with COVID-19, however, intraventricular hemorrhages (IVH) have rarely been reported. Here we present a case of an IVH in the setting of COVID-19. A 32-year-old male with no past medical history, and not taking any medications, presented to the emergency room after acute onset loss of consciousness. Inflammatory markers were elevated, and computerized tomographic (CT) of the head and chest showed an intraventricular hemorrhage and bilateral interstitial infiltrates, respectively. Although possibly coincidental, this may represent a rare extrapulmonary fatal manifestation of COVID-19. With the growing evidence of neurologic presentations in patients with COVID-19, clinicians should maintain a high index of suspicion for COVID-19 to cause fatal extrapulmonary manifestations.
Insights
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause rare, fatal neurological complications like intraventricular hemorrhage (IVH). This case highlights the need for vigilance regarding COVID-19
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has demonstrated diverse clinical manifestations.
- The virus utilizes the ACE-II receptor, prevalent in various organs, as a cellular entry point.
- Neurological complications of COVID-19 are increasingly recognized, including encephalopathy, stroke, and encephalitis.
Observation:
- A rare case of intraventricular hemorrhage (IVH) associated with COVID-19 is presented.
- A 32-year-old male with no prior medical history presented with sudden loss of consciousness.
- CT scans revealed IVH and bilateral interstitial infiltrates, indicative of COVID-19.
Findings:
- The patient exhibited elevated inflammatory markers.
- The intraventricular hemorrhage represents a rare, potentially fatal extrapulmonary manifestation of COVID-19.
- While potentially coincidental, the association warrants further investigation.
Implications:
- Clinicians must maintain a high index of suspicion for severe neurological complications in COVID-19 patients.
- This case underscores the potential for fatal extrapulmonary manifestations of SARS-CoV-2 infection.
- Further research is needed to understand the mechanisms linking COVID-19 to IVH.
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