Introduction: Patients with severe COVID-19 can develop ventilator-dependent acute hypoxic respiratory failure (VDAHRF), which is associated with a higher mortality rate. We evaluated the clinical course of hospitalized COVID-19 patients and compared them with the patients who received invasive mechanical ventilation. Characteristics of intubated patients who were successfully weaned from the ventilator were compared with the patients who failed to be extubated or died in the hospital. Objective: To investigate the clinical course of hospitalized COVID-19 patients, and assess the possible predictors of the disease severity leading to VDAHRF. Methods: This is a single-center, retrospective study. The first 129 patients (18 years or older) with COVID-19 admitted to Monmouth Medical Center from March 1st to April 25th, 2020 were included. Results: Out of 129 patients, 23.25% (n = 30) required invasive mechanical ventilation, and of those, six patients were successfully weaned from the ventilator. Multivariable logistic regression analysis showed increased odds of intubation associated with hypoxemia (odds ratio 17.23, 95% CI 5.206-57.088; p < 0.0001), elevated d-dimer by one unit mg/L of FEU (odds ratio 1.515, 95% CI 5.206-57.088; p = 0.0430) and elevated ferritin by one unit ng/ ml (odds ratio 1.001, 95% CI 1.000-1.001, p = 0.0051) on admission, adjusted for other covariates. Conclusions: Patients who required invasive mechanical ventilation were more likely to have older age, male gender, coronary artery disease, diabetes, and obesity. The patients who were successfully weaned from the ventilator were more likely to be younger in age, and none of them had heart failure or CAD.

The COVID-19 pandemic caused by the SARS-CoV-2 virus has affected millions of people around the globe. The most common presentation of COVID-19 is fever and upper and lower respiratory tract infection. Myalgia is fairly common in the prodromal phase of the viral illness which self-resolves. There is very scant literature on autoimmune myositis triggered by COVID-19 infection. We report a case of SARS-CoV-2 infection, who presented with progressive muscle weakness with rhabdomyolysis and necrotizing autoimmune myopathy on muscle biopsy. This case report imposes awareness of musculoskeletal autoimmune processes triggered by COVID-19 which requires clinical suspicion for early diagnosis and initiation of treatment.

Volume 4: 1-3 discontinue this remitting therapy resulted in a prompt exacerbation of her RA. Case report 2A 56-year-old female with a history of penicillin allergy and osteoarthritis in her knees received a standard inactivated trivalent influenza vaccine in the fall of 2009. Eight hours later she developed progressively intense left shoulder pain, accompanied three days later by pain and swelling in her left hand. Five days after her vaccination she noted pain and swelling in both wrists and her right hand, followed four days later by pain in both ankles and feet. Her acute arthritis remained unremitting, and within one month of her influenza vaccination pain and stiffness and limited motion developed in her right shoulder. Two months later blood tests revealed a positive rheumatoid factor and and elevated sedimentation rate of 62. Rheumatology consultation five months after her vaccination verified a definitive diagnosis of rheumatoid arthritis, whereupon prednisone, methotrexate and hydroxychloroquine were prescribed. Despite significant improvement her polyarthritis has continued unabated. Case report 3A 29-year-old female, in excellent health and on no medications, received an unspecified influenza vaccine in the fall of 2013. Within 24 hours she developed fatigue which persisted unabated. Two weeks later she developed a chronic headache, myalgias in her calves and upper arms, arthralgias in multiple small and large joints, and

BackgroundMelanoma differentiation associated gene 5 antibody (anti-MDA5) dermatomyositis, is an idiopathic inflammatory musculoskeletal disorder with specific phenotypic manifestations of rapidly progressing interstitial lung disease (RP-ILD) and ulcerative skin lesions, with or without muscle involvement. [1] There is currently a lack of consensus and guidelines on early diagnosis and timely escalation of therapy to avoid untoward outcomes.ObjectivesTo identify distinguishing clinical and laboratory features to assess disease progression amongst individuals with anti- MDA5 dermatomyositis based on the serologic, histopathologic, and radiographic status. We identified and compared the disease phenotype in a racially diverse juvenile and adult population with anti-MDA5 dermatomyositis.MethodsAfter Institutional review board approval, we queried the electronic health record at the Montefiore Medical Center, NY, and identified a total of 194 dermatomyositis patients. We included 21 dermatomyositis patients with MDA5 antibody. We performed a retrospective chart review to extract clinical data and analyzed data using Fischer’s exact test.ResultsOf the 21 dermatomyositis patients with anti-MDA5, 12 adult patients represented 8% of all adult dermatomyositis cases (12/148) and 9 patients represented 19 % of the pediatric dermatomyositis cases (9/46). There was a 2:1 female to male predominance in both groups.In adults, the mean age of disease onset was 45.2 years (SD 14.4 years). Nine ILD cases were noted, of which 2 were RP-ILD. The presence of the Ro52 antibody was associated with rapid disease progression. In children, the mean age of onset was 6.6 years (SD 4.9 years). All children had muscle weakness, with only 5 having ILD. Myositis was noted to be more prevalent in the pediatric population, compared to adults (9/9 Vs 4/12 cases; P=0.005).In this patient cohort, ILD was statistically significant between the African American population (9/10 cases) and non-African American population (5/11 cases), p=0.03, of these 3 African American cases had RP-ILD with mortality. The combined mortality rate of 14.2% was superior to 40-60% reported in the literature. [2]ConclusionAnti MDA5 dermatomyositis is relatively rare and difficult to diagnose. In this study, the general disease characteristics of our cohort were similar in both adult and pediatric patients except for myositis, which was more common in the pediatric population. The incidence of ILD by contrast was higher in the adults, especially in the African American population who had worse outcomes. The rapid escalation of therapy and use of rituximab may have improved our outcomes over historic controls. Controlled studies are needed to evaluate patients with anti-MDA5 dermatomyositis for appropriate treatment interventions and to avoid untoward outcomes.References[1]Fiorentino D, et al. The mucocutaneous and systemic phenotype of dermatomyositis patients with antibodies to MDA5; J Am Acad Dermatol. 2011;65(1):25-34. doi:10.101[2]Koga T, et al. The diagnostic utility of anti-melanoma differentiation-associated gene 5 antibody testing for predicting the prognosis of Japanese patients with DM. Rheumatology. 2012;51(7):1278-1284. doi:10.1093Figure 1.Disclosure of InterestsNone declared