Table 1.
Summary of main extra-pulmonary manifestations of SARS, Influenza, MERS, and COVID-19
| Organ/system | Condition | Main finding | Method |
|---|---|---|---|
| Kidney | Acute kidney injury | Acute tubular necrosis [1, 4, 12] | Pathology [1, 4, 12] |
| Proteinuria | Acute kidney injury [2, 3, 5–7] | Laboratory analysis (increase in serum creatinine ± proteinuria) [2, 3, 5–7] | |
| Cell apoptosis [9] | In vitro, ex vivo, and in vivo molecular, genetic, and pathology studies [9] | ||
| Endocrine | Hypocortisolism | Increased serum lipids [13] | Lipid and metabolic profile, gas chromatography–mass spectrometry, and liquid chromatography–mass spectrometry [13] |
| Hypothyroidism | |||
| Pancreatic islet cells injury | |||
| Pancreatitis | |||
| Binding of SARS Coronavirus-1 to its receptor damages islets cells [14] | Immunohistochemical staining of affected tissues from donors | ||
| Decreased serum cortisol levels [15] | Laboratory analysis [15] | ||
| Elevated serum lipase and amylase [16, 17] | Laboratory analysis [16, 17] | ||
| Liver | Increased transaminases | Increased viral load in parenchymal and endothelial cells | Pathology analysis [20] |
| Portal inflammation | Eosinophilic bodies, balloon-like hepatocytes, apoptosis [20] | ||
| Hepatocyte apoptosis | Increased DPP-4 receptor facilitating viral infection [21] | Biopsy, immunohistochemical analysis [21] | |
| Pancreas | Increased serum pancreatic enzymes | Edema and swelling of pancreas with peripancreatic stranding on CT and MRI (Fig. 1) | CT |
| Neuromuscular | Encephalopathy | White matter high signal intensity on FLAIR | MRI and CT |
| Seizures | Low CT attenuation on corpus callosum and deep white matter | ||
| Cerebral ischemia | Microhemorrhages [49] | ||
| Myelitis | High signal intensity on cerebellum and diffusely in subcortical white matter, basal ganglia [45–51] | ||
| Peripheral neuropathy | Meningeal enhancement [50] | ||
| Myositis | Perfusion abnormalities [50] | ||
| Cranial nerve and spinal nerve root enhancement [51] | |||
| Cardiovascular | Myocarditis | Arterial thrombosis and pulmonary thromboembolism | CT, MRI, PET, echocardiography |
| Myocardial infarction | Myocarditis, pericarditis [53–69] | ||
| Pericarditis | |||
| Coagulopathy | |||
| Perinatal | Miscarriage | Premature prelabor rupture of membranes | Clinical and Obstetric findings |
| Preterm premature membrane rupture | Preterm birth | ||
| Growth Restriction | Preeclampsia | ||
| Preeclampsia | Fetal growth restriction [70] |