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Muacevic A, Adler JR. COVID-19 Vaccination-Induced Cholangiopathy and Autoimmune Hepatitis: A Series of Two Cases. Cureus 2022; 14:e30304. [PMID: 36258805 PMCID: PMC9565316 DOI: 10.7759/cureus.30304] [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] [Accepted: 10/14/2022] [Indexed: 12/01/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been associated with significant morbidity and mortality. Following the introduction of vaccines, various side effects have been reported. Whilst those reported may be attributed to the vaccine itself, at times, it may simply incite an immunological phenomenon. We present a case series of two patients who presented with symptoms of yellowing of the eyes and the skin along with fatigue, and tiredness, following vaccination for COVID-19. The diagnosis of post COVID-19-vaccination related hepatitis is one of the fewer, less understood, yet reported side effects associated with significant morbidity. The diagnosis of COVID-19 vaccination-related cholangitis is an outcome reported here for the first time to the best of our knowledge. It was alarming that both patients did not have any significant past history of medical ailments. A prompt assessment followed by investigations including liver biopsy assisted in a timely understanding of the phenomenon with complete resolution of the symptoms.
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Zafar M, Saddler F, Parvin J, Hennebry E, Pereira R, Austin M. Complexities of Long-Term Care With Gastro-Jejunal (GJ) Feeding Tubes and Enteral Migration During COVID-19 Pandemic Times: A Case Report. Cureus 2022; 14:e27870. [PMID: 35968246 PMCID: PMC9366242 DOI: 10.7759/cureus.27870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 11/05/2022] Open
Abstract
Gastro-jejunostomy tubes, or percutaneous endoscopic gastrostomy tubes with jejunal extension (PEG-J), hold a significant role in the long-term nutritional management of patients with poor oral intake. This can be for a variety of reasons; ranging from metabolic conditions, including diabetes mellitus, inherited or congenital conditions like Ehler Danlos syndrome, or patients with neurological disorders, such as stroke, advanced Parkinson's disease or multiple sclerosis. Although they are very helpful for the overall nutritional needs of such patients, they are associated with complications, including the dislodging of jejunal tubes. The need to promptly recognise, investigate and manage this, in a timely manner, is vital, particularly during the COVID-19 pandemic times, as such patients may be associated with multiple comorbidities.
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Zafar M, Karkhanis M, Shahbaz M, Khanna A, Barry L, Alam S, Lawrence K, Pun B, Eldebri R, Makanjuola O, Safarova D, Farooq M, Nooredinavand H, Cuison F, Subba K, Singh Randhawa R, Hegner J, Oluwamayowa O, Elyasaky A, Adekunle B, Periasamy M, Abdelbagi M, Maryam Z, Khuu B, Esteves Morete A, Ciroi G, Moran S, O'Neill W, Zafar MJ, Zafar N, Patel M, Golez R, Hadid A, Muhammad T, Mayhead P, Whitehead M, Dashora U. Vitamin D levels and mortality with SARS-COV-2 infection: a retrospective two-centre cohort study. Postgrad Med J 2022; 98:523-528. [PMID: 34489318 PMCID: PMC8423517 DOI: 10.1136/postgradmedj-2021-140564] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/22/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The role of vitamin D in increased mortality with SARS-COV-2 virus, namely, COVID-19, remains uncertain. We analysed all the patients who were treated as COVID-19-positive with or without a positive swab and were tested for vitamin D levels. METHODS This was a retrospective, study involving 1226 patients swabbed for SARS-CoV-2 between the 10 February 2020 and 1 May 2020 at two hospitals of East Sussex Healthcare NHS Trust. Patients who were swab-positive for COVID-19 or treated as COVID-19-positive on clinical grounds even though swab results were negative were included in this study. We analysed the association of vitamin D levels and mortality, assessing linear and non-linear associations. RESULTS A total of 1226 patients had SARS-CoV-2 RNA swabs in this period with age range from 1 year to 101 years. A cohort of 433 of these patients had swabs and recent vitamin D levels anytime in the previous 3 months. Mortality rates were not found to be associated with vitamin D levels (OR=1.04, 95% CI 0.96 to 1.12). CONCLUSION Our findings suggest similar mortality risk from COVID-19 irrespective of the levels of vitamin D. Larger prospective studies will be needed to confirm these findings.
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Affiliation(s)
- Mansoor Zafar
- Gastroenterology, GIM, Conquest Hospital, Saint Leonards on Sea, UK
| | | | | | | | | | - Saba Alam
- Conquest Hospital, Saint Leonards on Sea, UK
| | | | - Bipin Pun
- Conquest Hospital, Saint Leonards on Sea, UK
| | | | | | | | | | | | | | | | | | | | | | - Amr Elyasaky
- Geriatric, Conquest Hospital, Saint Leonards on Sea, UK
| | | | | | | | | | - Bao Khuu
- General Internal Medicine, Conquest Hospital, East Sussex healthcare NHS Trust, St. Leonards-on-sea, UK
| | | | - Giulio Ciroi
- General Internal Medicine, Conquest Hospital, East Sussex healthcare NHS Trust, St. Leonards-on-sea, UK
| | - Steve Moran
- Microbiology, Eastbourne District General Hospital, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - William O'Neill
- Microbiology, Eastbourne District General Hospital, Eastbourne, UK
| | - Maaryah J Zafar
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Nadiyah Zafar
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Mirej Patel
- Medical School and Health Science Center, University of Debrecen, Debrecen, Hungary
| | - Raphael Golez
- Geriatric, Conquest Hospital, Saint Leonards on Sea, UK
| | - Abubakr Hadid
- General Internal Medicine, Conquest Hospital, Saint Leonards on Sea, UK
| | - Tila Muhammad
- Gastroenterology, East Sussex Hospitals NHS Trust, Saint Leonards-on-Sea, UK
| | - Philip Mayhead
- Gastroenterology, Eastbourne District General Hospital. East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - Mark Whitehead
- Consultant Physician and Gastroenterologist, Conquest Hospital, Saint Leonards on Sea, East Sussex, UK
| | - Umesh Dashora
- Diabetes and Endocrinology and General Internal Medicine, Conquest Hospital, Saint Leonards on Sea, UK
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Farooq M, Mohammed Y, Zafar M, Dharmasena D, Rana UI, Kankam O. COVID-19 Vaccine-Induced Pneumonitis, Myositis and Myopericarditis. Cureus 2022; 14:e20979. [PMID: 35004093 PMCID: PMC8733846 DOI: 10.7759/cureus.20979] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 12/26/2022] Open
Abstract
A 63-year-old male, with no significant past history and not on any regular medications previously, had mild respiratory symptoms post the first dose of the AstraZeneca (Cambridge, England) coronavirus disease 2019 (COVID-19) vaccine, which were self-limiting. Following the second dose of the vaccine, he arrived at the emergency department (ED) with worsening shortness of breath. During this admission, he was assumed to have interstitial lung disease due to a possible past history of occupational exposure. He responded to a short-term course of corticosteroids and antibiotics and was discharged home. However, he reported again to the emergency department three weeks later, with persistent dyspnoea along with myalgia. His blood tests and imaging from scans suggested myositis, pneumonitis, and myopericarditis. Since he recently had the COVID-19 AstraZeneca vaccine, it was postulated as the most likely cause of the symptoms. He was managed with intravenous (IV) corticosteroids followed by oral corticosteroids with symptom resolution.
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Butler-Manuel W, Rana UI, Zafar M, Gadi A, Kiani A. Post COVID-19 Vaccine Related Cerebral Venous Sinus Thrombosis and Thrombocytopenia. Cureus 2022; 14:e20932. [PMID: 35004085 PMCID: PMC8733850 DOI: 10.7759/cureus.20932] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 12/30/2022] Open
Abstract
During the height of the COVID-19 pandemic, there was great relief with the global mass rollout of the Covid-19 vaccination programs. While they have proven to be safe and effective, the gradual emergence of side effects to the vaccines has undermined public trust in the vaccination program and, whilst rare, can lead to significant morbidity and mortality. The most serious was the emergence of vaccine-induced immune thrombocytopenia and thrombosis (VITT), also known as thrombosis with thrombocytopenia syndrome (TTS) or vaccine-induced prothrombotic immune thrombocytopenia (VIPIT). VITT is a serious and often fatal complication of some COVID vaccines that seem more prevalent in younger people and women. We present a case of a 48-year-old woman who presented with VITT following COVID vaccination.
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Affiliation(s)
- William Butler-Manuel
- Internal Medicine, Conquest Hospital - East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Usman Iqbal Rana
- Internal Medicine, Conquest Hospital - East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Mansoor Zafar
- Gastroenterology and Hepatology, Conquest Hospital - East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Azeem Gadi
- Emergency Medicine • Accident and Emergency, Conquest Hospital - East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Amarah Kiani
- Radiology, Conquest Hospital - East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
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