Unexpected SARS-CoV-2 cardiorespiratory arrest in a myopathy patient undergoing immunosuppressive treatment

Abstract

Rationale: It is recommended that patients with Rheumatic diseases that are at high risk of developing active infections be screened for Tuberculosis, Hepatitis B, and Hepatitis C before receiving second-line immunosuppressive therapies. With the emergence 2019 novel coronavirus (SARS-CoV-2), expanded guidelines have not been proposed for screening in these patients before starting advanced therapy. Patient concerns: We present an unique circumstance whereas a patient with a 5 year history of inflammatory muscle disease, diagnosed by clinical history and muscle biopsy with elevated creatine kinase levels, suffered a hypoxemic cardiopulmonary arrest due to asymptomatic SARS-CoV-2 after receiving advanced immunosuppressive therapy. Diagnoses: The patient presented with an acute exacerbation of inflammatory muscle disease with dysphagia, muscle weakness, and elevated creatine kinase. Interventions: After no improvement with intravenous immunoglobulin the patient received mycophenolate and plasma exchange therapy. Outcomes: Subsequently the patient suffered a fatal hypoxemic cardiopulmonary arrest. Polymerase chain reaction test was positive for SARS-CoV-2 RNA. Lessons: We conclude that rheumatic patients, asymptomatic for SARS-CoV-2 infection, be screened and tested before initiating second-line immunosuppressive treatment.

RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

“…Increasing publications of case series and case reports from centers across the world have now described the efficacy of TPE in over 60 COVID-19 patients that did not respond to initial therapies, with the majority having been treated with corticosteroids. 185 -195 Nearly all describe similar positive physiologic and clinical responses temporally associated with initiation or completion of TPE. Further, 3 retrospective, observational cohort studies including a total of 74 patients treated with plasmapheresis have reported dramatic differences in both extubation and survival.…”

Lupus Pneumonitis Therapy Masks Coronavirus (COVID-19)

“…In this case, coronavirus pneumonitis can mimic, or present as, lupus pneumonitis. Pairing this report with a previously reported case [14], we propose that lupus patients, even when asymptomatic, be tested for COVID-19 prior to initiating immunosuppressive therapy. Specifically, patients with lupus that develop pneumonitis and fail to respond rapidly to conventional treatments should be regarded with a high index of suspicion for coronavirus.…”

“…ere is evidence to support the beneficial effects of B-cell targeting and biological agents [12,13]. Anti-inflammatories and steroids are also treatments for coronavirus (COVID-19) [14]. When evaluating a lupus patient with shortness of breath, one must consider non-lupus-related conditions such as infections and viruses, including COVID.…”

“MATH+” Multi-Modal Hospital Treatment Protocol for COVID-19 Infection: Clinical and Scientific Rationale

“…Thirteen of the 16 were extubated and discharged while three failed to respond and later died. Increasing publications of case series and case reports from centers across the world have now described the efficacy of TPE in over 60 COVID-19 patients that did not respond to initial therapies, with the majority having been treated with corticosteroids [250][251][252][253][254][255][256][257][258][259][260][261]. Nearly all describe similar positive physiologic and clinical responses temporally associated with initiation or completion of TPE.…”