Case Report
We describe a 52 years old gentleman with a known case of diabetes mellitus (type II), presented to the emergency department of Hazm Mebaireek General Hospital in Doha, Qatar with symptoms suggestive of pneumonia associated with a lower abdominal pain and urine retention, Covid-19 was tested positive on the same day of admission.
KUB ultrasound showed right mild hydroureteronephrosis, left mild hydronephrosis, significant post-void residual urine (873 cc), and mild enlargement of the prostate (24 cc), hence urinary catheter was inserted, on the day of admission he reported lower limbs weakness, MRI spine and brain showed Subtle T2 hyperintense signals in the ventral horn of the grey matter in the thoracic cord T3-T10 (Figure 1), which represents viral myelitis with lower limb weakness. Lumbar puncture showed lymphocytic pleocytosis, normal protein, and glucose. COVID-19 PCR was negative in the Cerebrospinal fluid (CSF). Other viral panels, HIV serology, and autoimmune screening were negative. The baseline ECG was normal with sinus rhythm. Chest X-ray revealed right lower lobe infiltrate. Laboratory tests showed the following: Ferritin: 435.0 ug/L (Reference range 30 ug/L -553 ug/L), Interleukin-6: 97 pg/mL (Reference range ≤ 7 pg/mL), CRP: 78.6 mg/L (Reference range 0 mg/L - 5 mg/L), D-dimer: 23.57 mg/L (Reference range 0 mg/L – 0.49mg/L). Therefore, intravenous steroid (Methylprednisolone 1 gm daily for 3 days), acyclovir 700mg TID for 3 days, and a prophylactic dose of enoxaparin 40 mg subcutaneous OD, were started. Limbs physiotherapy and occupational therapy were commenced.
On day 5 of hospital admission, the patient had a sudden cardiac arrest with an initial rhythm of pulseless electrical activity (PEA). Pulmonary embolism was highly suspected, ECG showed new incomplete right bundle branch block (RBBB), so reteplase rTPA 50mg IV bolus was given, he was admitted to the intensive care unit (ICU), where he had multiple cardiac arrests, which were not successfully resuscitated, eventually his death was declared on the 6th day of hospital admission.