Woldie Indryas L, Brown Ian G, Nwadiaro Nduka Francis, Patel Amit, Jarrar Mohammad, Quint Elise, Khokhotva Vladislav, Hugel Nicole, Winger Michael, Briskin Alexander
Windsor Regional Cancer Center, Windsor, ON, Canada.
Windsor Regional Hospital, Windsor, ON, Canada.
J Med Cases. 2020 Nov;11(11):362-365. doi: 10.14740/jmc3575. Epub 2020 Sep 23.
Since the initial reported outbreak of coronavirus disease 2019 (COVID-19), many unique case reports have been published in the medical literature. Here we report a complicated clinical course of a young patient with COVID-19 who presented initially with recurrent autoimmune hemolytic anemia (AIHA). He subsequently developed bilateral pulmonary emboli, and ultimately succumbed to encephalitis and cryptococcemia in the context of being treated with high dose immunosuppression for the AIHA. Combining immunosuppression with active COVID-19 infection presents some truly challenging diagnostic and management scenarios which this case summarizes and highlights very well. Based on this case, we propose some strategies on how to approach these difficult decisions while also recognizing the significant gaps that exist in such an evolving topic. Lastly, this case also represents a potentially novel presentation of secondary fungal infection of the central nervous system (CNS) related to COVID-19.
自首次报告2019冠状病毒病(COVID-19)疫情以来,医学文献中已发表了许多独特的病例报告。在此,我们报告一例COVID-19年轻患者的复杂临床病程,该患者最初表现为复发性自身免疫性溶血性贫血(AIHA)。随后,他出现双侧肺栓塞,并最终在因AIHA接受高剂量免疫抑制治疗的情况下死于脑炎和隐球菌血症。免疫抑制与活动性COVID-19感染相结合带来了一些极具挑战性的诊断和管理情况,本病例对此进行了很好的总结和突出。基于此病例,我们提出了一些应对这些艰难决策的策略,同时也认识到在这个不断发展的主题中存在的重大差距。最后,本病例还代表了与COVID-19相关的中枢神经系统(CNS)继发性真菌感染的一种潜在新表现。