PDF(Pubmed)
Abstract：
COVID-19 usually presents with classic signs and symptoms, but it can involve multiple systems in atypical cases. SARS-CoV-2 has a complex interaction with the host immune system leading to atypical manifestations. In our case, a 32-year-old male patient presented with fatigue, sores on hands and feet, headache, productive cough with blood-tinged mucus, conjunctival hyperemia, purpuric rash on hands and feet, and splinter hemorrhages of fingernails for 2 weeks. The patient\'s SARS-CoV-2 antigen and PCR test were positive. Chest X-ray showed mixed density perihilar opacities in both lungs. Computed tomography of the chest showed extensive airspace opacities in both lungs, suggesting COVID-19 multifocal, multilobar pneumonitis. A renal biopsy indicated limited thrombotic microangiopathy and tubulointerstitial nephritis, for which he was started on steroids, and his renal functions gradually improved. He tested positive for C-ANCA during an immune workup. He was discharged with a steroid taper for nephritis. Once the taper reached less than 10 mg/day, he developed acute scleritis and a new pulmonary cavitary lesion of 6 cm. The biopsy via bronchoscopy revealed acute inflammatory cells with hemosiderin-laden macrophages. He was restarted on systemic steroids for scleritis after failing topical steroids, which incidentally also reduced the size of the cavitary lesion, indicating an immune component. Our case demonstrates the involvement of kidneys and vasculitis of the skin, sclera, and lungs by COVID-19. The patient\'s symptoms were not explained by any diseases other than COVID-19. Atypical cases of COVID-19 disease with multifocal systemic symptoms involving the skin, sclera, lungs, and kidneys should be high on differentials. Early recognition and intervention may decrease hospital stays and morbidity.
摘要：
COVID-19通常表现为典型的体征和症状，但在非典型病例中可能涉及多个系统。SARS-CoV-2与宿主免疫系统具有复杂的相互作用，导致非典型表现。在我们的案例中,一名32岁的男性患者表现出疲劳，手上和脚上的疮,头痛,多产性咳嗽伴有带血的粘液，结膜充血，手上和脚上的紫癜性皮疹,指甲裂片出血持续2周。患者SARS-CoV-2抗原及PCR检测均为阳性。胸部X线显示两肺混合密度肺门周围混浊。胸部计算机断层扫描显示双肺有广泛的空域混浊，提示COVID-19多病灶，多叶肺炎。肾活检提示局限性血栓性微血管病和肾小管间质性肾炎，他开始服用类固醇，肾功能逐渐好转.在免疫检查期间，他的C-ANCA检测呈阳性。他因肾炎服用类固醇锥度而出院。一旦锥度达到小于10毫克/天，他发展为急性巩膜炎和新的肺空洞病变6厘米。通过支气管镜进行的活检显示具有含铁血黄素的巨噬细胞的急性炎症细胞。局部类固醇失效后，他因巩膜炎重新开始全身类固醇治疗，顺便也减少了空洞性病变的大小，表明免疫成分。我们的病例显示肾脏和皮肤血管炎受累，巩膜,和肺被COVID-19。除COVID-19外，患者的症状没有其他疾病的解释。COVID-19疾病的不典型病例，多灶性全身症状累及皮肤，巩膜,肺,肾脏的差异应该很高。早期识别和干预可以减少住院时间和发病率。
