Medical Case Reports

A 71-year-old male presented with two days’ shortness of breath, myalgias, and chills in March 2021.  His temperature was 99.0 °F and heart rate was 108 beats/minute. The patient had received two doses of the COVID-19 vaccine four weeks apart, with the second dose 16 days prior to admission. Laboratory exams were significant for lymphopenia and acute kidney injury (AKI).  His brain natriuretic peptide (BNP) level was found to be elevated (an indicator of heart failure). A chest X-ray showed cardiomegaly with pulmonary vascular engorgement and an electrocardiogram showed an atrial-sensed, ventricular-paced rhythm. 5 years prior the patient received an orthotopic heart transplant. The biopsy ruled out rejection. He also had a history of obesity, hypertension, unprovoked deep vein thrombosis, and dual chamber pacemaker. The patient was started on dexamethasone and remdesevir and his tacrolimus dose was adjusted to maintain therapeutic serum levels. The patient’s AKI improved...

There were four fatalities among 65  fully vaccinated and boosted ( FV&B )  COVID-19 patients at an acute-care hospital system in Southeastern Michigan. In the FV&B cohort that required ICU-level care (n=11), 7 (63.6%) were male with a median age of 71 (66.5, 76.5). 5 (45.5%) were vaccinated with three consecutive Pfizer immunizations, 4 (36.4%) received three doses of the Moderna vaccine, and 2 (18.2%) received two Janssen vaccines. 4 (36.4%) died, 3 (27.2%) were discharged to a Skilled Nursing Facility (SNF), and 2 (18.2%) were discharged home. This data was collected b etween August 12th, 2021 and December 6th, 2021, for 4,571 patients with a primary diagnosis of COVID-19 who required inpatient treatment at an acute-care hospital system in Southeastern Michigan. Of the 4,571 encounters requiring hospitalization, 65(1.4%) were FV&B and 2,935(64%) were UV Despite older age (median 74 vs 58 years old), higher rate of pre-existing ESRD (18.5% vs 1.8%), higher ...

Among the 54 fully vaccinated patients who developed COVID-19 (data from  ClinicalTrials.gov  study NCT04354701 ) , 35 (65%) were hospitalized, 10 (19%) were admitted to ICU or required MV, and 7 (13%) died within 30 days. Comparable rates were observed in the unvaccinated group. The primary endpoint was 30-day all-cause mortality among fully vaccinated patients compared to the unvaccinated population after Inverse Probability of Treatment Weighting (IPTW) to adjust for baseline clinical variables. SFollowing IPTW, t here was no statistical difference in 30-day mortality between the fully vaccinated patients compared to the unvaccinated cohort Adjusted Odds Ratio (AOR) 1·08, 95% CI: 0·41-2·82. Increased 30-day mortality was associated with lymphopenia (AOR 1·68, 95% CI: 1·11-2·55), the presence of comorbid conditions (mCCI of 1 vs 0: AOR 1·66, 95% CI: 1·07-2·59 and mCCI ≥2 vs 0: AOR 2·10, 95% CI: 1·36-3·24), worse performance status (ECOG PS 1 vs 0: AOR 2·26, 95% CI: 1·25-4·06...

A 76-y-old male individual with end-stage kidney disease secondary to IgA nephropathy who underwent kidney transplantation with antithymocyte globulin induction 6 y prior presented with exertional dyspnea. His physical examination suggested that he did not need a close medical attention and  chest X-ray did not demonstrate any acute findings.  He was discharged with a 6-d course of glucocorticoid therapy.  When he presented again,  Chest X-ray showed an interstitial opacity in the left lower lung. His SARS-CoV-2 PCR test was positive but antibody was not detectable. Despite all efforts, he continued to decompensate and died on the seventh day after admission. He completed a 2-dose series of COVID-19 vaccine (mRNA-1273, Moderna; Cambridge, MA) at the recommended 4-wk interval and received the second dose in mid-February  Case Report: Severe COVID-19 in a Kidney Transplant Recipient Without Humoral Response to SARS-CoV-2 mRNA Vaccine Series Masaaki Yamada , M...

Two fatal breakthrough infections reported for  sufferers of Systemic Autoimmune Rheumatic Diseases (SARDs). They were 57 (vaccinated with Pfizer/Biontech) and 78 (Moderna) per supplementary table .   Among the 16 SARD patients who had breakthrough COVID-19 infections, 93% presented with symptoms. The most common symptoms reported by these individuals included fever, cough, and malaise, which affected 56%, 44%, and 38% of the patients, respectively. Six of the 16 patients were hospitalized, of which four required supplemental oxygen and one required mechanical ventilation.  Two (13%) patients died; both deceased patients had received rituximab and had interstitial lung disease Clinical characteristics and outcomes of COVID-19 breakthrough infections among vaccinated patients with systemic autoimmune rheumatic diseases Claire Cook   1 ,  Naomi J Patel   1   2 ,  Kristin M D'Silva   1   2 ,  Tiffany Y-T Hsu   2   3 ,...