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Bresler RM, Whelan J. Angiotensin-Converting Enzyme (ACE) Inhibitor-Induced Angioedema in an African American Male With Coronavirus Disease 2019 (COVID-19). Cureus 2024; 16:e60852. [PMID: 38910667 PMCID: PMC11191406 DOI: 10.7759/cureus.60852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
Angioedema is a condition characterized by non-pitting swelling of the subcutaneous or submucosal tissues in particular the face, lips, and oral cavity. Angiotensin-converting enzyme (ACE) inhibitors are known to contribute to the development of angioedema by increasing the levels of bradykinin and its active metabolites. Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is hypothesized to contribute to the development of angioedema by modifying ACE II levels and further increasing the level of bradykinin in patients taking ACE inhibitors. African Americans may be at particular risk of developing angioedema with concomitant SARS-CoV-2 infection and ACE inhibitor use. This case involves a 31-year-old African American male diagnosed with coronavirus disease 2019 (COVID-19) who developed angioedema while taking an ACE inhibitor.
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Affiliation(s)
- Richard M Bresler
- Internal Medicine, Baptist Memorial Hospital North Mississippi, Oxford, USA
| | - Jacob Whelan
- Internal Medicine, Baptist Memorial Hospital North Mississippi, Oxford, USA
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2
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Wang F, Yu X, Ren Z, Wang Y. Case report: Preliminary study on the diagnosis and treatment of respiratory distress in patients with giant nodular goiter complicated with severe COVID-19. Front Med (Lausanne) 2023; 10:1204658. [PMID: 37746076 PMCID: PMC10511868 DOI: 10.3389/fmed.2023.1204658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Background To investigate the practicality of emergency surgical and conservative medical treatments in patients with giant nodular goiter complicated by severe coronavirus disease 2019 (COVID-19)-related respiratory distress, evaluate the prognosis based on the two interventions, and explore the diagnosis and treatment plan of COVID-19-related respiratory distress in patients with giant nodular goiter. Methods Four cases were retrospectively collected. Among them, two cases underwent emergency surgery, one case was treated with conservative treatment, whereas the fourth case underwent emergency surgery after failure of conservative therapy. Results Dyspnea was significantly improved postoperatively, and the endotracheal tube was successfully removed 10.5 h after the operation, but inflammatory markers were greatly enhanced as compared to the preoperative values, patients with different degrees of fever, cough, and other discomforts postoperatively. Case 1 showed complete remission of all symptoms after 3 weeks, while case 2 displayed fever, cough, drowsiness, and other symptoms after the discharge and was eventually readmitted. In case 3, the conservative COVID-19 treatment marginally improved the pulmonary infection, fever, and other symptoms, but cough and other discomforts were persistent, along with delirium in later stages. Moreover, case 4 reported extubation failure after undergoing treatment with the standard new coronary pneumonia regimen in the tracheal intubation state; however, the patient was successfully weaned and extubated 9 days after emergency surgery to relieve the obstruction. Conclusion Our preliminary exploration suggested that patients with giant nodular goiter and respiratory tract obstruction post-acute COVID-19 infection can undergo early surgery after surgical tolerance evaluation for a better prognosis.
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Affiliation(s)
- Fang Wang
- Department of Thyroid and Breast Surgery, Guang'an People's Hospital, Guang'an, Sichuan, China
| | - Xing Yu
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhangxia Ren
- Department of Thyroid and Breast Surgery, Guang'an People's Hospital, Guang'an, Sichuan, China
| | - Yong Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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The Pandemic and Your Skin—Direct and Indirect Impact of COVID-19. COSMETICS 2023. [DOI: 10.3390/cosmetics10010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Apart from well-known respiratory symptoms, less frequent symptoms also appear as a direct result of COVID-19 infection, or as indirect effects of the recommended quarantine and related lifestyle changes. The impact of the COVID-19 pandemic on human skin is predominantly focused on in this article. Cutaneous manifestations, including redness, chilblain-like symptoms (COVID toes), hives or urticaria rash, water blisters, and fishing net-like red-blue patterns on the skin, may appear as accompanying or as systemic COVID-19 symptoms with potential lesions at different skin sites. These symptoms were related to skin phototypes and vitamin D deficiency. Moreover, Black, Asian, and minority ethnic origin patients are found to be more sensitive to COVID-19 infection than Caucasians because of vitamin D deficiency. The region of population with lighter skin phototypes have a significantly higher chance to develop cutaneous manifestations than population with dark skin. In addition, adverse effects, such as skin barrier damage and irritation, may also occur due to extensive personal protective equipment usage (e.g., masks, protective suits, and a few others) and predominately alcohol-based sanitizers. This manuscript covers various aspects of COVID-19 and its clinical skin manifestations.
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Harada T, Kosaka S, Nakai M. Non-Episodic Angioedema Associated with Eosinophilia after COVID-19. Eur J Case Rep Intern Med 2022; 9:003671. [PMID: 36632536 PMCID: PMC9829018 DOI: 10.12890/2022_003671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/23/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction Non-episodic angioedema associated with eosinophilia (NEAE) has been reported primarily in young East Asian women and is characterized by a single episode of persistent limb oedema, peripheral eosinophilia, and transient joint pain. Although there are reports of eosinophilia disease after coronavirus disease 2019 (COVID-19), the occurrence of NEAE has not been previously reported. Case description A 29-year-old Japanese woman, with a history of allergic rhinitis and atopic dermatitis, sought a medical consultation for persisting oedema of the extremities, which developed about 2 weeks after she contracted COVID-19. Physical examination revealed symmetrical non-pitting oedema with peripheral predominance. Laboratory examination revealed a blood eosinophil count of 7536/μl. The patient was diagnosed with NEAE and a 7-day course of prednisolone (15 mg/day) was initiated, with rapid improvement in the oedema and no recurrence on follow-up. Discussion The exact aetiology of NEAE is unknown, but it may develop after infection or drug exposure. Eosinophilic disease after COVID-19 infection has been reported and, therefore, eosinophilic angioedema should be considered in the differential diagnosis of non-pitting oedema of the extremities after a COVID-19 infection. Early diagnosis of NEAE is important as rapid improvement can be achieved with low-dose steroid treatment. Conclusion NEAE can develop after COVID-19 and should be considered in the differential diagnosis of non-pitting oedema of the extremities. LEARNING POINTS Non-episodic angioedema associated with eosinophilia (NEAE) is characterized by a single episode of symmetrical non-pitting oedema with distal limb predominance.The case presented indicates that NEAE can occur after COVID-19 infection.Therefore, eosinophilic angioedema should be considered in the differential diagnosis of non-pitting oedema of the extremities in a patient with a positive COVID-19 history.
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Affiliation(s)
- Taku Harada
- Department of General Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan,Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Shintaro Kosaka
- Department of General Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Mori Nakai
- Department of General Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan
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Martinez Manzano JM, Ysea-Hill O, Chiang B, Jarrett SA, Lo KB, Azmaiparashvili Z. Coronavirus disease-19 infection and angioedema in African Americans: A case series. OTOLARYNGOLOGY CASE REPORTS 2022; 24:100457. [PMID: 35782753 PMCID: PMC9236619 DOI: 10.1016/j.xocr.2022.100457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
Rationale Few case series have described the simultaneous development of angioedema in patients with coronavirus 19 disease (COVID-19). Most of these reports were described in at-risk patients for developing bradykinin angioedema. Therefore, we aim to describe 5 African American patients who developed simultaneous COVID-19 and angioedema. Methods This was a case series of hospitalized patients with simultaneous angioedema and COVID-19 infection in a single center from May 2020 to February 2022. We used descriptive statistics. The study was approved by the institutional review board. Results Their median age was 55 years (range 28–66); all patients were African American, and 3/5 were males. All patients developed angioedema within a week of hospitalization. Two subjects had prior history of ACEI-related angioedema but were not exposed to ACEI recently, whereas 1 subject was on chronic lisinopril therapy for the last 3 years. All patients had orofacial involvement; the most common locations were lips (5/5) and tongue (3/5). None had histaminergic features of angioedema (either skin rash or peripheral eosinophilia). 4/5 subjects had respiratory symptoms and chest imaging features of COVID-19 pneumonia, whereas 3/5 subjects developed severe COVID-19 infection. Most patients were treated with standard combination of H1 and H2 blockers, and corticosteroids. A total of 2/5 subjects were intubated; one patient developed refractory tongue swelling, received tracheostomy for extubation, and died due to COVID-19 pneumonia. The median length of angioedema improvement was 44 hours (range 20–168 hours). The median length of hospital stay was 15 days (range 1–49). Conclusion We described 5 cases of angioedema in COVID-19 patients that shared risk factors and features of bradykinin-related angioedema.
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Colombo D, Del Nonno F, Nardacci R, Falasca L. May macroglossia in COVID-19 be related not only to angioedema? J Infect Public Health 2021; 15:112-115. [PMID: 34764043 PMCID: PMC8559420 DOI: 10.1016/j.jiph.2021.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022] Open
Abstract
SARS-CoV-2 infection can lead to a variety of clinical manifestations. The occurrence of tongue swelling has recently reported in severe cases of COVID-19, and angioedema has suggested as the causative mechanism. Several factors, such as genetic predisposing factor and angiotensin-converting enzyme inhibitors (ACEI) therapies, have proposed to induce angioedema, especially as concerns patients requiring ICU treatments. Nevertheless, the question is still debated and other causes not yet recognized should be considered. Here we present a case of macroglossia occurred in a patient deceased for COVID-19 disease, who had no family history of angioedema and did not receive ACEI as antihypertensive drug. Histological and immune-histochemical analysis revealed tongue muscle atrophy with infiltrating macrophages suggesting repair mechanisms, as seen in nerve injury recovery. These new pathological findings may open new fields of study on the pathogenesis of SARS-CoV-2.
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Affiliation(s)
- Daniele Colombo
- Pathology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Franca Del Nonno
- Pathology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Roberta Nardacci
- Laboratory of Electron Microscopy, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Laura Falasca
- Laboratory of Electron Microscopy, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy.
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Abstract
Coronavirus disease (COVID-19) skin manifestations have been increasingly reported in medical literature. Recent discussions have identified a lack of images of skin of color (SOC) patients with COVID-19 related skin findings despite people with skin of color being disproportionately affected with the disease. There have been calls to prioritize the identification of COVID-19 skin manifestations in patients with SOC and disseminate these findings. The objective of this article is to review the existing literature on COVID-19 skin manifestations and, where possible, discuss how they may present differently in patients with SOC. Further research is needed to allow primary care physicians and dermatologists to be aware of and easily identify patients with cutaneous findings that may be secondary to COVID-19. Patients presenting with idiopathic dermatologic manifestations should be considered for COVID-19 testing and follow public health guidelines for self-isolation.
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Affiliation(s)
- Edgar Akuffo-Addo
- 12366 Undergraduate Medical Education, Faculty of Medicine, University of Toronto, ON, Canada
| | - Mathew N Nicholas
- 7938 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - Marissa Joseph
- Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada.,Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
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Chotirmall SH, Leither LM, Çoruh B, Chan LLY, Joudi AM, Brown SM, Singer BD, Seam N. Update in COVID-19 2020. Am J Respir Crit Care Med 2021; 203:1462-1471. [PMID: 33835905 PMCID: PMC8483226 DOI: 10.1164/rccm.202102-0415up] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Lindsay M Leither
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, Utah.,Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Louisa L Y Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Anthony M Joudi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Samuel M Brown
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, Utah.,Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Benjamin D Singer
- Division of Pulmonary and Critical Care Medicine, Department of Medicine.,Department of Biochemistry and Molecular Genetics, and.,Simpson Querrey Institute for Epigenetics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and
| | - Nitin Seam
- Critical Care Medicine Department, NIH, Bethesda, Maryland
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Batarseh E, Kersten BP, Pinelo AC, Vertalino V, Nadler JN, Schwartz SA. Reply to Chan and Majluf-Cruz: Is the Angioedema Associated with COVID-19 a Real Entity, a Mimic, or Both? Am J Respir Crit Care Med 2021; 203:646-647. [PMID: 33357023 PMCID: PMC7924578 DOI: 10.1164/rccm.202012-4365le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chan ED, Majluf-Cruz A. Is the Angioedema Associated with COVID-19 a Real Entity, a Mimic, or Both? Am J Respir Crit Care Med 2021; 203:645-646. [PMID: 33357169 PMCID: PMC7924563 DOI: 10.1164/rccm.202011-4141le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Edward D Chan
- Rocky Mountain Regional Veterans Affairs Medical Center Aurora, Colorado.,National Jewish Health Denver Colorado.,University of Colorado Anschutz Medical Campus Aurora, Colorado and
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11
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Adesanya TMA, Campbell CM, Cheng L, Ogbogu PU, Kahwash R. C1 Esterase Inhibition: Targeting Multiple Systems in COVID-19. J Clin Immunol 2021; 41:729-732. [PMID: 33474624 PMCID: PMC7817248 DOI: 10.1007/s10875-021-00972-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/13/2021] [Indexed: 12/20/2022]
Affiliation(s)
- T M Ayodele Adesanya
- Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Courtney M Campbell
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lijun Cheng
- Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Princess U Ogbogu
- Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Rami Kahwash
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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12
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Multiple drugs. REACTIONS WEEKLY 2021. [PMCID: PMC7843863 DOI: 10.1007/s40278-021-90406-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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