Splenic Abscess: A Rare Complication of Bacterial Pneumonia.

Splenic abscess is a rare condition with potentially life-threatening evolution. Hematogenous spread is the most common cause of splenic abscess. Contiguous spread after bacterial pneumonia has rarely been reported in the literature. Early diagnosis can be made by a combination of imaging modalities and clinical features. The successful management of splenic abscess includes timely medical therapy, computed tomography (CT)-guided percutaneous aspiration, and splenectomy. In this report, we discuss a rare case of splenic abscess after hospitalization for bacterial pneumonia. The aim of this case report is to raise awareness about this rare complication so that prompt and appropriate management can be quickly performed to prevent severe outcomes.

Phase 1 study of safety, pharmacokinetics, and antiviral activity of SARS-CoV-2 neutralizing monoclonal antibody ABBV-47D11 in patients with COVID-19.

ABBV-47D11 is a neutralizing monoclonal antibody that targets a mutationally conserved hydrophobic pocket distal to the ACE2 binding site of SARS-CoV-2. This first-in-human safety, pharmacokinetics, and antiviral pharmacodynamic assessment in patients with COVID-19 provide an initial evaluation of this antibody that may allow further development. This multicenter, randomized, double-blind, and placebo-controlled single ascending dose study of ABBV-47D11 (180, 600, or 2400 mg) as an intravenous infusion, was in hospitalized and non-hospitalized (confined) adults with mild to moderate COVID-19. Primary outcomes were grade 3 or higher study drug-related adverse events and infusion-related reactions. Secondary outcomes were pharmacokinetic parameters and concentration-time profiles to Day 29, immunogenicity (anti-drug antibodies), and antiviral activity (change in RT-PCR viral load) from baseline to Days 15 and 29. ABBV-47D11 single doses up to 2400 mg were safe and tolerated and no safety signals were identified. The pharmacokinetics of ABBV-47D11 were linear and showed dose-proportional increases in serum concentrations with ascending doses. The exploratory anti-SARS-CoV-2 activity revealed a reduction of viral load at and above the 600 mg dose of ABBV-47D11 regardless of patient demographics and baseline characteristics, however; because of the high inter-individual variability and small sample size a statistical significance was not reached. There is potential for anti-SARS-CoV-2 activity with ABBV-47D11 doses of 600 mg or higher, which could be evaluated in future clinical trials designed and powered to assess viral load reductions and clinical benefit.

When Influenza, Bacterial Pneumonia, and COVID-19 Co-exist.

In the United States, influenza virus and bacterial pneumonia are known to be the leading causes of hospitalization in the winter season. Although healthcare workers are knowledgeable about the management of these co-infections, with the coronavirus disease 2019 (COVID-19) global pandemic that occurred in 2019, a significant change has occurred. The symptoms and clinical manifestations of COVID-19 are similar to that of influenza virus and bacterial pneumonia which can present a unique challenge for healthcare workers. Many reports are available for influenza virus and bacterial pneumonia but none about influenza, bacterial pneumonia, and COVID-19 co-infection. Here, we present the case of a patient who was admitted with COVID-19, influenza, and bacterial pneumonia co-infection, along with his clinical characteristics, laboratory findings, treatment plan, and outcomes.

Functionality of Monoclonal Antibody Therapy in SARS-CoV-2.

The coronavirus disease 2019 (COVID-19) pandemic emerged as a world crisis in 2019 and started a global search for optimal therapeutic regimen including vaccines, antiviral agents, and recently monoclonal antibody therapy. Clinical trials are currently underway for the efficacy of several neutralizing monoclonal antibodies against COVID-19. The evolution of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with immune evasion capacity has created a challenge for the healthcare workers with urgent need for prospective studies to determine functionality of monoclonal antibody therapy and their role in the reduction of hospitalization for disease severity. Herein, we report three cases of COVID-19 during the beginning of the spread of Omicron variants that were hospitalized after treatment with monoclonal antibody therapy in the emergency department. All the patients showed progression of the disease on imaging and were treated with dexamethasone, remdesivir and anticoagulation based on the symptoms and contraindications. Two of the patients recovered and were discharged with out-patient follow-up; however, one patient expired in the hospital. Monoclonal antibody therapy is a promising treatment to limit the progression of COVID-19 and reduce the hospital strain specifically in small community hospitals. Limited information is available about their efficacy in the new viral variants. These cases emphasize the need of future prospective study and randomized controlled trials to illustrate the utilization of monoclonal antibodies as a therapeutic modality in patients infected with the variants of SARS-CoV-2.

An Unusual Case of Secondary Hemophagocytic Lymphohistiocytosis in a Patient Diagnosed With Triple Infection: COVID-19, HIV, and Histoplasmosis.

In this study, we present a unique instance of a patient who developed hemophagocytic lymphohistiocytosis secondary to a triple infection with coronavirus disease 2019 (COVID-19), HIV, and histoplasmosis. We emphasize the proinflammatory dysregulations driving the severity of COVID-19 infection in this setting and highlight the importance of early diagnosis and targeted therapy of underlying conditions as a method to increase the chance of survival.

Severe Gastroparesis Flare: Is COVID-19 the Inciting Factor?

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has emerged as a public health hazard. It is commonly associated with respiratory symptoms including fever, cough and sore throat. Viral infections have historically been implicated in the exacerbations of gastrointestinal (GI) disorders. Coronavirus disease 2019 (COVID-19) has been associated with GI manifestations including diarrhea and vomiting. However, exacerbation of underlying functional GI disorders has been rarely reported with SARS-CoV-2 infection. Herein we report a case of a 31-year-old female with acute gastroparesis flare secondary to COVID-19 which was refractory to pharmacological therapy.

Varicella-Zoster Virus Reactivation in AIDS Patient After Pfizer-BioNTech COVID-19 Vaccine.

Since early 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected millions of individuals and changed the face of medicine. As the fight against COVID continues, there is still unclear long term effects; although as time passes, more and more is being updated, in regards to the risks of exposure, length of recovery, outcomes of those infected, effectiveness of vaccines, and both expected and unique side effects of both the virus and vaccines, all in an array of individuals. This paper will review a unique topic of the SARS-CoV-2 virus and the abnormal immune response in a young patient. This case is unique due to the fact that there have been an abundance of side effects reported that are associated with the virus that affects every organ system, yet very few have affected the neurological and integumentary (skin) system. This case emphasizes the reactivation of a Herpes/Varicella-Zoster virus (VZV) in a young male shortly after he received the Pfizer-BioNTech COVID-19 vaccine. The other interesting aspect about this case is the patient's immunocompromised state, as he was diagnosed with HIV several years before this viral reactivation occurred. The interesting aspect about this was trying to understand whether the VZV was truly reactivated because of an overly stressful immune reaction in response to the Pfizer-BioNTech COVID-19 vaccine or was it mainly due to the patient's already weak immune system, or even a combination of both? The in-depth review will evaluate whether there should be more done in regards to bringing more awareness about potential side effects and preparing for a VZV reactivation and/or other dermatological complications after being vaccinated. This presentation could also simply be a very unique, isolated case, and that each individual should have no hesitations regarding the Pfizer-BioNTech COVID-19 vaccine.

Remdesivir for Severe Coronavirus Disease 2019 (COVID-19) Versus a Cohort Receiving Standard of Care.

BACKGROUND: We compared the efficacy of the antiviral agent, remdesivir, versus standard-of-care treatment in adults with severe coronavirus disease 2019 (COVID-19) using data from a phase 3 remdesivir trial and a retrospective cohort of patients with severe COVID-19 treated with standard of care. METHODS: GS-US-540-5773 is an ongoing phase 3, randomized, open-label trial comparing two courses of remdesivir (remdesivir-cohort). GS-US-540-5807 is an ongoing real-world, retrospective cohort study of clinical outcomes in patients receiving standard-of-care treatment (non-remdesivir-cohort). Inclusion criteria were similar between studies: patients had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, were hospitalized, had oxygen saturation ≤94% on room air or required supplemental oxygen, and had pulmonary infiltrates. Stabilized inverse probability of treatment weighted multivariable logistic regression was used to estimate the treatment effect of remdesivir versus standard of care. The primary endpoint was the proportion of patients with recovery on day 14, dichotomized from a 7-point clinical status ordinal scale. A key secondary endpoint was mortality. RESULTS: After the inverse probability of treatment weighting procedure, 312 and 818 patients were counted in the remdesivir- and non-remdesivir-cohorts, respectively. At day 14, 74.4% of patients in the remdesivir-cohort had recovered versus 59.0% in the non-remdesivir-cohort (adjusted odds ratio [aOR] 2.03: 95% confidence interval [CI]: 1.34-3.08, P < .001). At day 14, 7.6% of patients in the remdesivir-cohort had died versus 12.5% in the non-remdesivir-cohort (aOR 0.38, 95% CI: .22-.68, P = .001). CONCLUSIONS: In this comparative analysis, by day 14, remdesivir was associated with significantly greater recovery and 62% reduced odds of death versus standard-of-care treatment in patients with severe COVID-19. CLINICAL TRIALS REGISTRATION: NCT04292899 and EUPAS34303.

Dilemma of Anticoagulation Therapy in Mild or Asymptomatic COVID-19 Cases.

Severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) infection can be a life-threatening disease, which has emerged as a public health hazard. Thrombotic events have been reported in hospitalized patients with severe disease however scarce data is available regarding the screening of thromboembolic disease and pulmonary embolism in those with mild or asymptomatic infection. Herein, we describe the development of pulmonary embolism in two asymptomatic patients with COVID-19 and suggest the need for close monitoring and anticoagulation to prevent this life-threatening complication.

Characteristics, Comorbidities, and Outcomes in a Multicenter Registry of Patients With Human Immunodeficiency Virus and Coronavirus Disease 2019.

BACKGROUND: People living with human immunodeficiency virus (HIV) may have numerous risk factors for acquiring coronavirus disease 2019 (COVID-19) and developing severe outcomes, but current data are conflicting. METHODS: Health-care providers enrolled consecutively, by nonrandom sampling, people living with HIV (PWH) with lab-confirmed COVID-19, diagnosed at their facilities between 1 April and 1 July 2020. Deidentified data were entered into an electronic Research Electronic Data Capture (REDCap) system. The primary endpoint was a severe outcome, defined as a composite endpoint of intensive care unit (ICU) admission, mechanical ventilation, or death. The secondary outcome was the need for hospitalization. RESULTS: There were 286 patients included; the mean age was 51.4 years (standard deviation, 14.4), 25.9% were female, and 75.4% were African American or Hispanic. Most patients (94.3%) were on antiretroviral therapy, 88.7% had HIV virologic suppression, and 80.8% had comorbidities. Within 30 days of testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 164 (57.3%) patients were hospitalized, and 47 (16.5%) required ICU admission. Mortality rates were 9.4% (27/286) overall, 16.5% (27/164) among those hospitalized, and 51.5% (24/47) among those admitted to an ICU. The primary composite endpoint occurred in 17.5% (50/286) of all patients and 30.5% (50/164) of hospitalized patients. Older age, chronic lung disease, and hypertension were associated with severe outcomes. A lower CD4 count (<200 cells/mm3) was associated with the primary and secondary endpoints. There were no associations between the ART regimen or lack of viral suppression and the predefined outcomes. CONCLUSIONS: Severe clinical outcomes occurred commonly in PWH with COVID-19. The risks for poor outcomes were higher in those with comorbidities and lower CD4 cell counts, despite HIV viral suppression. CLINICAL TRIALS REGISTRATION: NCT04333953.

A Case Series of SARS-CoV-2 and Influenza Co-infection.

The novel coronavirus 2019, a disease associated with SARS-CoV-2 infections has resulted in significant morbidity and mortality across the globe. In the United States, influenza has been one of the leading causes of hospitalization during the winter season. To date, the co-infection of SARS-CoV-2 and influenza virus has created a unique challenge for healthcare workers, especially during the cold season. Both viruses have similar clinical presentation and transmission characteristics. Many reports are available for either SARS-CoV-2 and influenza individual infections, but limited data are available for the co-infection. Herein, we present a case series of five cases of SARS-CoV-2 and influenza co-infection as well as their clinical characteristics, laboratory findings, management, and outcome.

Ipsilateral Zoster Ophthalmicus Post COVID-19 Vaccine in Healthy Young Adults.

Herpes zoster ophthalmicus (HZO), which is an ophthalmological emergency, accounts for 10%-20% of all Herpes zoster (HZ) cases. HZ infection in COVID-19 vaccinated individuals who are immunocompetent can be attributed to vaccine-induced immunomodulation allowing the varicella-zoster virus (VZV) to escape from the dorsal root ganglia. Another theory is similar to immune reconstitution syndrome (IRS). HZ infection in a young immunocompetent individual is a rare entity. As per our literature review, only four cases have been reported thus far. We are reporting two cases of two young individuals with no known risk factors who developed ipsilateral HZO after receiving the COVID-19 vaccination. The increasing incidence of HZ cases post COVID-19 vaccine indicates that this is not a mere coincidence. Awareness must be created among physicians, as well as the general population, for early recognition and early antiviral usage, which can halt the progression of the disease and thus prevent debilitating complications.

Roles and Interplay of SARS-CoV-2 Serology With Clinical Stages of Disease in COVID-19.

Background Currently, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology is recommended only for seroprevalence. We think it could be useful in differentiating coronavirus disease 2019 (COVID-19) stages, which could in terms of helping improve our therapeutic interventions. Methods The medical records of adult patients admitted to the hospital with probable COVID-19 were extracted and analyzed. We excluded patients with no serology and no clear outcome at the end of data collection. Patient demographics, medical history, and biochemical and clinical data were retrieved. Results A total of 202 patients were included; 57% were males, the majority were Hispanic (45%), followed by African Americans (22%). Hypertension is the most common comorbidity, followed by diabetes mellitus and chronic kidney disease. We classified them into three groups based on their serology: subacute stage (47 patients) with both immunoglobulin M (IgM) and IgG negative; acute stage (116 patients) with IgM positive and late-stage (39 patients) with IgM negative and IgG positive. We found that elevated lactate dehydrogenase (LDH) and ferritin were present in the IgM+ and IgM-/IgG+ subgroups (p-value of 0.0061 and p-value 0.0013, respectively) while C-reactive protein (CRP) and D-dimer were more elevated in the IgM-/IgG- and IgM+ subgroups (P <0.0001 and p-value of 0.0452, respectively). The IgM+ group had the worst prognosis, with high mortality despite receiving remdesivir and dexamethasone. Conclusion Our findings suggest that the use of serology in patients hospitalized with COVID-19 could predict prognosis; this will need to be validated in a larger prospective study.

Tocilizumab and Thromboembolism in COVID-19: A Retrospective Hospital-Based Cohort Analysis.

Background Tocilizumab, an interleukin-6 (IL-6) receptor antagonist, has been used in patients with coronavirus disease 2019 (COVID-19) as an anti-cytokine agent. IL-6 also plays a complex role in hemostasis and thrombosis. We observed a transient elevation of D-dimer in our patients who received tocilizumab, which triggered this study. Methods A retrospective hospital-based cohort analysis of patients with confirmed COVID-19 who received tocilizumab during the study period of March 15, 2020, to May 20, 2020, was conducted. We retrieved demographic, clinical, and laboratory data, and patients who were receiving therapeutic anticoagulation therapy prior to tocilizumab administration were excluded. Descriptive analysis was performed, and the cause of death and trends of D-dimer and inflammatory markers were studied. Results Out of the 436 confirmed COVID-19 patients admitted during the study period, 24 met the inclusion criteria. Their median age was 47.5 years. They were 18 males and 6 females; 15 patients survived and nine expired. Of the group that survived, 12 received therapeutic anticoagulation. Of the seven patients who did not receive therapeutic anticoagulation, four expired (one from sepsis and three probably from thromboembolic complications) compared to five deaths in the 17 patients who received therapeutic anticoagulation (four from sepsis and one possibly from thromboembolic complications). Conclusions The interplay between IL-6, IL-6 receptor antagonist, and venous thromboembolism is complex. We observed a transient elevation of D-dimer in COVID-19 patients who received tocilizumab, and a trend toward increased death secondary to thromboembolism. This observation is novel and highlights the potential thrombophilic side effects of tocilizumab.

Coronavirus Disease 2019 Infection as a Risk Factor for Infective Endocarditis.

Infective endocarditis (IE) is associated with relatively high morbidity and mortality and several risk factors have been identified in the past. Several predisposing factors for IE have been recognized in the literature, depending on the type of bacteria. Coronavirus disease 2019 (COVID-19) infection causes coagulopathy-associated complications and damage to many organ systems due to the inflammatory response induced by this viral infection. COVID-19 emerged only about a year ago and there are many unknown post-COVID-19 complications at this time. Here, we present the case of Streptococcus mitis IE in a patient with no prior predisposing factors other than diagnosis with COVID-19 a month ago.

A Case of Co-occurrence of COVID-19 and Group A Streptococcal Pharyngitis.

Coronavirus disease 2019 (COVID-19) has swept the world with over hundred million of cases and millions of deaths. Upper respiratory tract symptoms including acute pharyngitis are the common symptoms of COVID-19, with a reported incidence of about 5%-17.4%. Group A Streptococcus (GAS) pharyngitis is a common cause of bacterial pharyngitis, with highest incidence between age 5 and 15, and it can still occur in adults with peak incidence at age 40. Herein, we report a case of co-occurrence of GAS and COVID-19 in a middle-aged man who presented with fever, sore throat, cough, and runny nose. To the best of our knowledge, we are the first to report this unique co-occurrence. Our case report aimed to raise the awareness among physician particularly in ambulatory and emergency department of not to have a singular focus on COVID-19 and forget to screen patient with acute pharyngitis for GAS.

Marantic Endocarditis Associated with COVID-19: A Rare Case Report of a Potentially Deadly Disease.

Coronavirus disease 2019 (COVID-19) has overwhelmed healthcare globally with millions of cases and over 2 million deaths worldwide. The hypercoagulable state associated with COVID-19 is a well-recognized complication that carries a poor prognosis. Marantic endocarditis, or non-bacterial thrombotic endocarditis (NBTE), is caused by a sterile vegetation on the cardiac valves resulting from the deposition of fibrin and platelet aggregates. It is highly associated with the hypercoagulable and acquired inflammatory states. Herein, we report a unique and rare case of COVID-19 presenting with NBTE. LEARNING POINTS: COVID-19 has caused a major global pandemic, with high morbidity and mortality.One of the complications of COVID-19 infection is a hypercoagulable state.To the best of our knowledge, we present only the second case of marantic endocarditis in a patient with COVID-19, in the hope of raising awareness among physicians of this potential rare association.