Case Study Finds Covid-19 Infection Can Impact Identical Twi
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While COVID-19 illness carries with it a wide array of presentations, those sharing the same household, same age, same sex, same workplace, same exposure source, not to mention the exact same genetic make-up, might have a similar Covid-19 experience. Apparently not so. A report published in Annals of Internal Medicine presented a case of identical adult male twins who developed Covid-19 in Italy back in March 2020.

They shared the same home address and worked in the same workplace, ruling out the variable of daily environmental exposure differences. They were simultaneously exposed to one person later known to be infected with coronavirus. They had the same BMI, and neither was obese. Neither smoked, and neither had any prior medical conditions.

They presented on the same day with fever, dry cough, shortness of breath, and fatigue. Viral PCR’s were tested and noted to demonstrate a similar viral load. Their blood pressures and oxygen levels were almost identical, and their laboratory tests were also quite similar. The two were treated at the same hospital by the same medical team with the same interventions on arrival.

But soon after hospital admission, one twin was monitored and then discharged to home after recuperating, but the other developed increased respiratory problems necessitating treatment in the intensive care unit. He required intubation and mechanical ventilation. He then became even more severely ill, developing a bacterial infection and septic shock. He did eventually have a full recovery, but was in the hospital for over one month while his identical twin was back to his pre-Covid health.

While it is certainly feasible for family members living in the same house, working from the same home, presenting with very similar medical histories and sharing the same source of coronavirus exposure to have vastly different clinical courses, these people are usually not identical twins. This rare case of identical twins with identical environments and identical coronavirus source with initially extremely similar manifestations of the disease has not previously been documented.

The likely explanation to this divergent Covid-19 saga is that even identical twins, also known as monozygotic, can, and often do, have genetic variance. The field of epigenetics involves the study of variable gene expression in the setting of identical genes. Identical twins where one develops a malignancy and the other does not, despite neither carrying a gene putting them at risk, have been studied for years. And in decades prior, twins separated at birth have been studied to assess the concept of “nature versus nurture” in issues such as psychiatric disorders, temperament, and health outcomes.

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