Co-infection of dengue and COVID-19

65,male,presented with fever with chills since 3 days,found thrombocytopenia.heodynamicaly stable,started treatment considering viral hemorrhagic fever.dengue negative. 3days later,patient developed cough dyspnea,and chills.spo2 92%,and with o2 it's 96%.2 d Echo screening normal. day1 and day 3 CXR,ct thorax,serial lab reports displayed.what are possible reasons for it?

70 hypertensive,M,presented with dry cough, progressive dyspnea ,fever since 3 days,s po2 was 93%,o n 7th oct ,responded well to antibiotics, bronchodilators and antiviral with supportive therapy,and discharged. his serial cxrays,ct thorax films and lab reports enclosed. he has corse crepts since admission which are still persisted with dry cough.otherwise improved.what could be cause?plz discuss.

A 75-year old man with a history of hypertension, hemorrhagic cerebral infarction one year before, right-sided hemiparesis, and atrial fibrillation was brought to my hospital because of suspicious COVID-19 infection. He was seen in the ER because of a few days of dyspnea which became progressed and bad clinical condition. 7 days before the current presentation patient fell from its bed, and after that, he started to feel pain in his right part of the chest. He also noticed purple discoloration of his feet and left hand, which was painful and progressed further during the next days. He started to have DYSPNOEA, which also progressed. CBC: showed leukocytosis (26,9) and chest X-ray was described as bilateral pneumonia. On exam, the patient was alert, disoriented in time, immobile on the bed, with an obvious right hemiparesis, afebrile, tachypneic (R: 24/min), and bradycardic (P: 55/min), hypoxic (SpO2: 80%), with normal blood pressure. PHYSICAL EXAMINATION: showed dusky purple discoloration of both feet and fingers of the left hand. The patient's right feet showed some darker areas, which could be hematomas. CHEST EXAMINATION: showed the painful right side & we spotted the fracture of the 7th rib. Auscultation of lungs revealed bilateral inspiratory crackles, predominantly on the right side. The heart rhythm was regularly-regular. The rest of the examination was unremarkable. LAB ANALYSIS: revealed elevated urea (11,1) and creatinine (371), hypoalbuminemia (22), elevated LDH (705), and slightly elevated CK (201). The CRP was elevated (272,5), and coagulation panel was highly abnormal - aPTT 85,1s, PT 15%, INR >6,0, fibrinogen 2,4, and D-dimer 162 (normal <0,5). My (differential) diagnosis list for this patient was: - Fat embolism - Warfarin overdose - Bilateral pneumonia - Sepsis He didn't have any criteria for COVID-19, and also, its clinical presentation and disease course was not consistent with COVID-19 infection. The patient was transferred to ICU for further treatment. What do you say on this? I am mostly inclined to fat embolism in the first place, which was complicated, but I do not have experience with this diagnosis. What is your opinion on this case, what would be your further diagnostics and treatment?

40yrs/F presented to ED with C/o Severe Respiratory distress and altered mental status.Patient started noticing symptoms 5 days after operated for hysterectomy (Uterine fibroid) at some other hospital.Emergently intubated after acute respiratory failure,patient had to be deeply sedated and paralysed. O/e - Crackles and wheezes,BP -140/80,PR -72,Spo2 -98,Temp -103°F. DIAGNOSIS AND SUGGEST MANAGEMENT PLAN?

Covid19 pneumonia 40 years old male patient (bank employee) with a history of coughing for 2 weeks, becomes febrile 2 days before presentation, the fever is responsive to acetaminophen, then chills and myalgia becomes apparent and he develops dyspnea on exertion. when he presented with ill-looking, fever and chills were significant, his vitals were PR 100, RR 20, peripheral O2 sat 85%, BP 140/90, sublingual Temp 39.5. He had DOE and on chest exam, he had coarse crackles all over both lungs. we immediately admitted this patient giving him nasal oxygenation by cannula, IV fluids, paracetamol IV administration , ABG was done pCO2 42, HCO3 22, pH 7.38, paO2 83. we requested a chest CT scan and yup , multiple patchy ground glass opacities infiltrating the peripherals, thus the patient was isolated immediately, multiple nasal swab specimens were sent for rtPCR. CBC was done . mild leukocytosis with no lymphopenia, no thrombocytopenia ... procalcitonin undetectable.. crp 2+ ... renal, hepatic and cardiac markers were all within normal ranges . the patient was then marked as covid19 pneumonia after the second rtPCR test.( first one negative) hydroxychloroquine 400 mg bid then 200 mg bid and azithromycin 500 mg stat and 250 mg daily were continued for 10 days ... no ECG abnormality was noted. the patient remained in a plateau phase, fever disappeared after 5 days, nasal oxygenation discontinued, only some mild dyspnea and mild cough were noted before discharge ( after 10 days) ... He was lucky, as i have seen people with this presentation undergoing intubation and have a poor outcome.