Medical Case Reports

A n 18-year-old girl with no comorbidities died at the Government Thanjavur Medical College Hospital,  in Tamil Nadu, India,  on June 14.  Cause of death is COVID pneumonia, respiratory failure and cardiorespiratory arrest. The girl was admitted on June 14 at 7:15 am and declared dead at 2:30 pm the same day.  She had no fever at the time of admission, was conscious and had breathing difficulty. She was vaccinated with two doses of Covishield (Oxford/ Astrazeneca AZD1222) C19VAZ vaccine, formerly known as ChAdOx1 nCoV-1 ) and this was the first time she was infected by the virus. A June-28th report from Erie county , PA shows that some vaccinated and boosted individuals are dying from the latest variants of the virus.  Analysis of hospitalizations and deaths in the UK, showed  a significant increase in the case fatality rate (0.19% vs 0.41%; RR 2.11 [2.06-2.16], p<0.001) and odds of hospitalization  when comparing the period of February 28-May 1, 2...

A centenarian who had survived a hundred years of ups and downs of life died from breakthrough COVID-18 on Saturday, June 25th , 2022 .  He was suffering from multiple ailments like renal issues,  blood pressure, diabetes and was admitted to a private hospital where he tested positive for the virus. He was on liquid diet as was not able to eat properly. He died 7 days later.  Neither of his family members tested positive for SARS-Cov-2 The individual was vaccinated with two doses of Covaxin  -  also known as BBV152, a whole inactivated virus-based COVID-19 vaccine developed by Bharat Biotech in collaboration with the Indian Council of Medical Research - National Institute of Virology.  Currently India is experiencing the fourth wave of COVID-19 dominated by BA.2.75 (dubbed " Centaurus ", BA.5 and BA.4 A  very early analysis  of data from India by Raj Rajnarayanan indicates that BA.2.75 may have a growth advantage over BA.5. It is unclear, as yet...

I n line with results from a cohort study in Nordic countries , analyses of data from France show a significant risk and population burden of pericarditis following the second dose of the BNT162b2 and mRNA-1273 vaccine (Note that cases after third dose have been also reported) The study was based on data of the National Health Data System (SNDS) which covers more than 99% of the French population (67 million inhabitants) .  1612 cases of myocarditis and 1613 cases of pericarditis occurred in France in the period from May 12, 2021 to October 31, 2021. The largest associations are observed for myocarditis following mRNA-1273 vaccination in persons aged 18 to 24 years. Estimates of excess cases attributable to vaccination also reveal a substantial burden of both myocarditis and pericarditis across other age groups and in both males and females. REFERENCES Le Vu, Stéphane;  Bertrand, Marion;  Jabagi, Marie-Joelle;  Botton, Jérémie ; Drouin, Jérôme;  Baricault, Béra...

72% relative risk reduction, but very modest absolute risk reduction was observed for 4 vs 3 doses of COVID-19 vaccine (administered 4 months ago or earlier) in Israel. SARS-CoV-2 infection was detected among 4058 residents who received the fourth dose of the vaccine vs 4370 among residents who received 3 doses, yielding cumulative incidences of 17.6% vs 24.9%. There were 217 hospitalizations for COVID-19 of mild-to-moderate severity among the 4-dose recipients compared with 493 among the 3-dose recipients , yielding cumulative incidences of 0.9% and 2.8%, respectively.  The corresponding numbers of COVID-19 hospitalizations for severe illness were 108 and 259 , and the respective cumulative incidences were 0.5% and 1.5%. There were 39 COVID-19 related deaths among the fourth dose recipients vs 85 deaths among the 3-dose recipients, yielding a cumulative mortality of 0.2% vs 0.5% . The estimated effectiveness of the fourth dose against the Omicron variant found in this current stud...

Most cases of cardiovascular adverse events in vaccine recipients occur following the second dose.  Cases following the third dose of COVID-19 vaccines have been also reported. The risk was about the same as after the 2nd dose. We discussed a fatal case of a  26-year-old male who did not have any side effects from his two previous doses.  Here are two similar cases with subsequent resolution.  A 43-year-old female   with no past medical history presented with palpitations and shortness of breath started 2 days after receiving the third dose of BNT162b2 COVID-19 vaccine. No side effects of the vaccine were noted following the preceding two doses received five months prior. On presentation, her electrocardiogram showed rapid monomorphic ventricular tachycardia (VT) requiring a synchronized cardioversion (see  Figure ).  Laboratory blood tests showed normal complete blood count, elevated C-reactive protein up to 6.7 mg/dl, and high-sensitive troponin I ...

Two more cases of hepatitis/colitis and hepatitis/MIS-C to add to the  January post .  New report describes a case similar to previously published  case reports of hepatitis after COVID-19 vaccination.  This article reports a case of hepatitis and colitis in a 52-year-old woman who was undergoing immunotherapy and was HBV positive 10 days after receiving the first Pfizer-BioNTech COVID-19 vaccine dose. Because both ICIs and the COVID-19 vaccines stimulate the immune response, the authors hypothesized that these vaccines may increase the incidence of irAEs during ICI treatment. There is a complex interplay between the immune-mediated reaction triggered by the vaccination and PD-L1 co-administration. Another case describes a 17-year-old female hospitalized for a history of fever, asthenia, cough, anorexia, abdominal pain, and vomiting. The patient has a positive familial history for autoimmune disorders (inflammatory bowel diseases, connective tissue diseases, and m...

  A 48-year-old woman complained of a tickle sensation in the throat and dyspnea 30 minutes after being administered the first dose of the Moderna coronavirus disease 2019 (COVID-19) vaccine. The patient had no history of hypertension, anxiety, or panic disorder. Forty-five minutes after the vaccination, stridor was noted, and the patient developed severe hypertension with a blood pressure of 197/153 mmHg. The patient also had tachycardia, cervical angioedema, and nausea, which occurred in a short period of time, indicating type I hypersensitivity reaction, that is, an anaphylactic reaction.  The patient had persistent nausea, conjunctival hyperemia, facial swelling, and nonpruritic angioedema in the neck.  The patient was diagnosed with Brighton classification Level 1 anaphylaxis caused by COVID-19 vaccination. For managing the patient, two intramuscular adrenaline injections, famotidine, chlorpheniramine, metoclopramide, and methylprednisolone were administered via int...

Quarantines, masking and physical distancing measures are needed to stop  Covid-19 pandemic  and save lives, but as the crisis drags on, new health challenges arise.    A 57-year-old female working as a kitchen aide had a history of migraine without aura since she was a teenager. Her past medical history included gastroesophageal reflux disease, a pituitary microadenoma and dyslipidemia. Before COVID-19, the characteristics of the pain were bifrontal, pulsatile and of moderate to strong intensity, with nausea, vomiting and photophobia. The frequency was 1 - 2 times per month, with relief provided by common pain medication such as ibuprofen. The pain was triggered by fatigue, cold weather and skin stimulation caused by hair accessories, caps, hats and glasses.  Her allodynia symptom checklist ASC12  was scored as 7 (sensitivity to necklace, glasses, tight clothes, ponytail, hair combing and exposure to cold), before March 2020 , when she began to work ...

A 22-year-old Black male with a past medical history of morbid obesity and diabetes mellitus contracted COVID-19 in January 2021. He was managed conservatively as an outpatient with no known complications. Several months following the infection, he obtained the COVID-19 (mRNA-1273) initial and booster vaccines (May and October 2021). One month after the booster vaccine dose the developed left lower quadrant abdominal pain.  The patient underwent computed tomography (CT) scan of the abdomen/pelvis, which demonstrated a new infarction of the left kidney.  Cardiac magnetic resonance imaging (MRI) was performed, which showed a severely dilated left ventricle with severely reduced function. His hospital course was complicated by decompensated heart failure and persistent cardiogenic shock initially requiring ionotropic support and ultimately mechanical support. Despite 43 days of mechanical and ionotropic support, his cardiomyopathy did not improve and required placement of a durab...

We observed cases of transient global amnesia (TGA) after the 1st or 3rd dose of a COVID-19 vaccine in the elderly population of our study .   Recent review of  reports from the World Health Organization VigiBase ®  ideitified 289 TGA cases associated with a COVID-19 vaccine.  The  Pfizer-BioNTech COVID-19 Vaccine, also known as COMIRNATY® or  Tozinameran was mostly represented (147, 50.8%), followed by t he Oxford/AstraZeneca or ChAdOx1-S AZD1222 (69, 23,8%), Moderna -  SPIKEVAX,  elasomeran - (60, 20.8%), and JNJ-78436735 (12, 4.2%).  Cerebrovascular, inflammatory, or migrainous mechanisms may underlie this association. Yet, numerous confounding factors cannot be tackled with this approach, and causality cannot be ascertained.  Here is an exemplar medical case : Two weeks after receiving the first dose of ChAdOx1 nCov-19 vaccine, a disease-free 38-year-old woman experienced acute onset of abnormal symptoms, such as amnesia, incoh...