Post COVID Inflammation Syndrome: Different Manifestations C
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Though the COVID infection is acute, it can trigger several inflammatory pathways. Though pathophysiology of immune response is unclear, there are reports of several post-infection complications including reactive arthritis and post-infection fibrosis. The present study deals with a case series on post COVID inflammation syndrome involving non-specific inflammation and retinal vasculitis.

CRAO following COVID

A 66-year-old male suffering from leucoderma was referred for evaluation and management of rashes over the legs, polyarthritis and sudden unilateral blurring of vision following COVID infection. Further investigations revealed that he had elevated D dimer and ferritin levels, but negative for antiphospholipid antibody (APLA), ANA, and ANCA. The ophthalmic evaluation suggested bilateral panuveitis along with right eye central retinal artery occlusion (CRAO) with retinitis and macular vessel vasculitis. Based on the history, examination findings and investigations, a diagnosis of post-COVID hyperinflammatory syndrome was made. He was initiated with pentoxifylline 400 mg, aspirin 75 mg, and before tapering dose of deflazacort 36 mg per day along with oral anticoagulant acenocoumarol 1 mg/day. The treatment has contributed to the partial improvement of vision and the patient is being followed-up.

Cases linked to arthritis

A 78-year-old male with a history of diabetes mellitus and bronchial asthma on regular treatment presented with fever for 20 days, and pain and swelling along with burning sensation in both lower limbs . Further investigation revealed that he had elevated CRP, ESR, D dimer, lactic acid dehydrogenase, ferritin. He was positive for COVID IgG antibody (6.8 mg/dL). On the basis of history and investigation, diagnosis of hyperinflammatory syndrome following COVID infection was made. He was started with anti-inflammatory medication celecoxib 200 mg twice daily.

A 31-year-old lady presented with multiple joint pain for past one week, following an episode of fever with chills 25 days ago. Fever was treated by a local physician with antipyretics and a course of antibiotics. Fever subsided in 3 days and the patient continued to have malaise and developed polyarthritis 3 weeks later involving both large and small joints of upper and lower limbs. Polyarthritis had features of inflammatory arthritis with early morning stiffness and restriction of movement. On evaluation, her ESR was raised with low hemoglobin, however other seromarkers like RF, anti-CCP, ANA were negative. COVID IgG was positive suggesting post-COVID-19 arthritis. She was treated with celecoxib and responded well.

A 39-year-old female presented with fever and chills for around one and half months. Subsequently, she developed polyarthritis involving both small and large joints predominantly affecting the feet. She also had a persistent severe generalised weakness with malaise following fever episode. Since the previous investigation revealed that she was negative for chikungunya IgG. Clinical investigations revealed that she had raised ESR and CRP, with other seromarkers like RF, anti-CCP, ANA being negative. However, she was found to be positive for COVID IgG testing. She was diagnosed to have post-COVID-19 arthritis and was initiated with hydroxychloroquine 200 mg twice a day with anti-inflammatory drugs.

Dr. T●●●●z H●●●●●●i and 5 others like this5 shares
Dr. S●●●●●●●N J●●●●●●●●●N
Dr. S●●●●●●●N J●●●●●●●●●N Anaesthesiology
Very informative. Thanks.
Dec 5, 2020Like