SESSION TITLE: Medical Student/Resident Chest Infections Posters
SESSION TYPE: Med Student/Res Case Rep Postr
PRESENTED ON: October 18-21, 2020
INTRODUCTION: COVID-19 is a disease caused by the SARS-CoV-2 virus that was first detected in December 2019 in Wuhan, China. According to the World Health Organization Situation Report-75, the virus has spread to multiple countries and led to greater than 1 million cases of infection and greater than 50,000 deaths. It has been declared a global pandemic. As we are learning, COVID-19 commonly presents with fevers, chills, dry cough, shortness of breath and respiratory symptoms. The presence of these symptoms can que medical personnel into the possibility of a COVID-19 infection. However, syncope as the initial presenting symptom is an atypical presentation of COVID-19 that has been reported by only one case report (Tape et al.) recently.
CASE PRESENTATION: A 65 year old male with a past medical history of hypertension presented to the emergency room for a syncopal episode following a bowel movement. He admitted to preceding diaphoresis, hitting his head and then suffered epistaxis thereafter. In addition to his chief complaint, he endorsed 1 week of intermittent fevers, chills, myalgia, dry cough and diarrhea. Regarding his medical history, he denied previous surgeries or a family history of stroke or myocardial infarction. He admitted to moderate alcohol consumption, consumes several beers per week. He works as a jeweler by trade. On presentation, he was afebrile, tachycardic and saturating at 98% on room air. Non contrast CT Head was performed and was unremarkable. Chest XR was normal. Blood work showed no leukocytosis or elevated transaminases. Chemistry panel was significant for hyponatremia at 127 mEq/L. Influenza and legionella were negative. SARS-CoV-2 NAAT was positive. Isolation precautions were not instituted until 24 hours after admission. Patient was managed with supportive care and discharged with clear instructions regarding self-isolation and follow-up.
DISCUSSION: It is well known that SARS-CoV-2 presents with lower respiratory tract symptoms, typically with respiratory distress. Syncope however, has been rarely attributed to the COVID-19 clinical presentation. A recent review (Li et al.) suggested that SARS-CoV-2 may have the potential to enter the central nervous system and may play a secondary role in respiratory failure. Although further studies and trials are required to delineate the complicated neuroinvasive aspects of SARS-CoV-2, there is an immediate need for sharing knowledge of this disease as more atypical presentations are brought to attention.
CONCLUSIONS: This case describes a patient who was neither febrile nor hypoxic on initial presentation, had normal chest X-ray findings, and presented with syncope as a chief complaint. The rarity of this presentation makes it unique.
Reference #1: Tap? C, Byrd KM, Aung S, Lonks JR, Flanigan TP, Rybak NR. COVID-19 in a Patient Presenting with Syncope and a Normal Chest X-ray. R I Med J 2020 Mar 26;103(3):50-51
Reference #2: Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, et al. COVID-19 in Critically Ill Patients in the Seattle Region - Case Series. N Engl J Med 2020 Mar 30. doi: 10.1056/NEJMoa2004500
Reference #3: Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may be at least partially responsible for the respiratory failure of COVID-19 patients. J Med Virol 2020 Feb 27. doi: 10.1002/jmv.25728
DISCLOSURES: No relevant relationships by Robert Elliott, source=Web Response
No relevant relationships by Arabhi Nagasunder, source=Web Response
No relevant relationships by Thien Nguyen, source=Web Response