COVID-19 Moderna Vaccine and Bilateral Pulmonary Embolism: Case Report

The pandemic of Coronavirus Disease 2019 (COVID-19) has created many problems in the entire world whether the disease itself, whether fighting back with limited treatment options and prevention tools. Owing to the escalating daily death rates from COVID-19, the development of a vaccine against this new disease was quite fast that the first authorized vaccine got approval less than a year after the onset of the pandemic. Data report different side effects of new COVID-19 vaccines including venous and arterial thrombotic events, vaccine-induced prothrombotic immune thrombocytopenia, vaccine-induced thrombosis with thrombocytopenia, and immune thrombocytopenia. Our case report highlights bilateral pulmonary embolism, six days after the first dose of the COVID-19 mRNA vaccine (Moderna) in a healthy gentleman.

Hypokalemic Paralysis Leading to Respiratory Failure: An Unusual Presentation of Sjogren’s Syndrome

Sjogren’s Syndrome (SS) is a chronic multisystemic autoimmune inflammatory disorder with predominant exocrine gland involvement resulting in dryness of the eyes and mouth. Among extra glandular manifestations, renal involvement is commonly seen, which can be in the form of Renal Tubular Acidosis (RTA). SS may at times present as mild hypokalaemia with distal RTA but severe hypokalemia resulting in respiratory failure is rare. Here we report a case of twenty-five-year-old female presenting in emergency room with flaccid quadriparesis and hypercapnic respiratory failure. Further evaluation revealed hypokalemia (Potassium (K+) 1.6mmol/L) with distal renal tubular acidosis along with a background of primary Sjogren’s Syndrome. We illustrate that the possibility of Sjogren’s Syndrome should be considered in a young female who present with rapidly progressive weakness, hypokalemia and distal renal tubular acidosis with respiratory failure.

Successful Bridging to Recovery Using the Prometheus® Liver Support in a Critical Ill COVID-19 Patient with Acute Liver Failure: A Case Report

Liver impairment is frequently reported in Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) infected patients and contributes to increased morbidity and mortality in critically ill Coronavirus disease-2019 (COVID-19) patients. We report of a 44-year-old male patient with hypoxic and cholestatic liver failure after an initially complicated course of COVID-19 pneumonia with moderate Acute Respiratory Distress Syndrome (ARDS), Acute Kidney Injury (AKI) stage 3 with Kidney Replacement Therapy (KRT), thromboembolic intestinal ischemia with subtotal colectomy and partial resection of the small intestine and septic shock. After considerable clinical improvement we initiated extracorporeal liver support due to progressive hyperbilirubinemia up to 25,3 mg/dl. Within 17 days we conducted 11 sessions of extracorporeal liver support by Fractionated Plasma Separation and Adsorption (FPSA; Prometheus®) until stabilization of liver function occurred. After 52 days of intensive care treatment and successful weaning from ventilation and KRT, the patient was transferred to an Intermediate Care (IMC) unit. To the best of our knowledge, this is the first report of a COVID-19 patient successfully treated with prolonged extracorporeal liver support. Extracorporeal procedures that support liver function should be considered as bridging to recovery in selected COVID-19 patients if liver failure presents a dominant organ dysfunction.

A Case of Necrotizing Fasciitis due to Group G Streptococcus with Amputation Avoided of the Affected Limb

Group G Streptococcus (GGS) causes toxic shock syndrome. Its incidence has been increasing in the elderly in recent years. The case is a female patient in her 60s, with rheumatoid arthritis, who developed necrotizing fasciitis in her right thigh. We administered antibacterial agents and debridement frequently at an early stage, followed by aggressive high-protein enteral nutrition and multidisciplinary treatment. During the course of treatment, the patient’s general condition temporarily deteriorated because of fecal contamination. We considered amputation of the lower limb and implantation of a stoma, but finally succeeded in preserving the limb by performing two skin grafts. The patient was able to walk and was discharged on day 66. GGS infection is a risk factor for elderly patients with underlying diseases such as malignancy or immunocompromised states. When necrotizing fasciitis due to fulminant streptococcal infection develops in a proximal limb, amputation of the limb is often necessary to save the patient’s life. In this case, a fulminant GGS infection developed in an immunocompromised patient with active rheumatoid arthritis. Although the risk of limb amputation was high, multidisciplinary treatment enabled functional preservation of the affected limb.