ATYPICAL CLINICAL PRESENTATION OF COVID 19, HEMIPLEGIA,PNEUMONIA,MODS

Good morning dear friends and fellow colleagues, Today I want to share my experience regarding an Atypical Covid 19 manifestations in Indian scenario. A 42 year old male Patient had Type 2 DM and HTN since last 2 years with history of right hemiplegia with dysarthria since 20 days which was preceded by fever for 8 days for which he was admitted in State COVID Government General Hospital and was discharged after 12 days with out any improvement. HRCT chest findings are multiple Ground Glass Opacities, GGOs in bilateral lung fields, CORAD Score was 18/25. CT brain findings are chronic lacunar infarcts and white matter ischemic changes. Rapid antigen test is negative done at Government General Hospital instead of RT PCR. RTPCR is not done . Patient' s son came for the first time to our clinic with all these reports. His blood sugars are terribly out of control with stage 4 DKD. Now he is totally bedridden with bedsores. He is not able to take oral feeds also. Feeding done through Ryles tube. Covid 19 manifests not only with routine manifestations, ischemic stroke followed by MODS also. Out of more than 3,000 COVID 19 cases we both had seen since last 6 months probably this case is a very different with atypical presentation and it took us more than an hour to put this case in a Chronological way as it was very difficult for us to get the information from the wife and son of the patient as they were totally denying the positivity of COVID 19. They wanted to conceal everything from us and when we ordered CT Brain and HRCT Chest, then they took out the films & such is the intelligence of the attendants of the patients. We told them about the poor prognosis keeping the above mentioned comorbidities. With regards, Dr Sepuri Tirumala Devi

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Atypical COVID-19 presentation in indian scenario. Nicely handled the case - under these circumstances. It is really - praiseworthy that Dr Sepuri Krishna Mohan and Dr Sepuri Tirumala Devi have seen more than 3000 COVID-19 patients in last 6 months. I just would add a little bit 1.It is now certain that most the COVID-19 mortalities are in COVID-19 patients with CO - morbidities like T2DM , hypertension, IHD , CKD , CLD , HIV , Hepatitis B and C . 2.Mortality rate is very less in young COVID-19 patients with no - co - morbidities 3.These these any patient who comes in medical ED - irrespective of the symptoms- he should be immediately tested for COVID-19 4.There is also stigma attached with COVID-19 disease- as that family is socially boycotted - that is why - in this case the attendants were hiding the history of COVID-19 5.Rapid advances are coming in understanding the COVID-19 disease and new protocols are being followed and tests like CBC , CRP , ESR , S.Ferritin, D- Dimer , X- ray chest , HRCT have become of paramount importance 6 New terminologies are being used like CORADS SCORE and CT - severity score on HRCT chest 7.No longer there is role of Azithromycin, HCQS, Ivermectin, Doxycycline, BCG , Lopinavir /Ritonavir 8 Current treatment is restricted to LMWH Dexamethasone Remdesivir Ventilatory support- Non - invasive and mechanical ventilation Treatment of septic shock with parenteral antibiotics, inotropes THANKS

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Really it was the most challenging case in our clinical practice after Mauriac Syndrome. Literally took us more than one hour to elicit the proper history from the very intelligent patient's attendants wife & son. Though the prognosis is poor still we genetated our own style of prescription on their request. We will keep you updated what's going to happen.

Congrats for an excellent case .Such cases increase our awareness of the spectrum of presentation. My questions are 1) Was RTPCR for Covid done in this case ? There is no mention of it in this write up. 2) When patient is a case of HTN, DM ,and CT shows lacunar infarcts and white matter ischemic changes, is it likely that this case is a straightforward atherosclerotic / hypertensive stroke ? 3) It is practice now to equate CT chest findings to RTPCR for COVID. Sometimes CT findings are alone available and CORAD values are available early, and RTPCR is not done ,because results are not available early . How reliable are CT chest findings in diagnosis of Covid pneumonia ,in the absence of RTPCR for COVID? Experience is limited, and time alone will give us a correct answer ..

Interesting case unexplained fever always r/0 sarscov2 with cp score

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Vary informative topic Thank you so much Doctor

Thank you for sharing u r experience mam

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Very useful

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