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1
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Okudan B, Seven B, Ural B, Çapraz M. Detection of COVID-19 Incidentally in 68Ga-PSMA PET/CT for Restaging of Prostate Cancer. Curr Med Imaging 2022; 18:1532-1535. [PMID: 35490331 DOI: 10.2174/1573405618666220427134647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND A series of pneumonia cases with clinical presentations of viral pneumonia secondary to new coronavirus and subsequent global transmission arose in Wuhan, Hubei, China, in December 2019. Several cases of coronavirus disease 2019 (COVID-19) have been described incidentally in positron emission tomography-computed tomography (PET/CT) with 18F-fluorodeoxyglucose (FDG) as a result of the pandemic. Herein, we describe the findings of a patient with unknown COVID-19 in PET/CT with the other radiopharmaceutical, 68Ga-labeled prostatespecific membrane antigen (68Ga-PSMA). CASE REPORT A 69-year-old man had previously undergone radical prostatectomy for adenocarcinoma. 68Ga-PSMA PET/CT imaging was performed due to biochemical recurrence. 68Ga-PSMA uptake in the prostate bed suggestive of local recurrence was detected in PET/CT images. Also, bilateral groundglass opacities with slightly increased 68Ga-PSMA uptake were seen in the lungs, suspected of COVID-19. A reverse transcription-polymerase chain reaction test has confirmed the infection. CONCLUSION Even in asymptomatic patients, nuclear medicine departments must be aware of the possibility of COVID-19, take appropriate post-exposure procedures, and protect employees and other patients.
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Affiliation(s)
- Berna Okudan
- Department of Nuclear Medicine, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Bedri Seven
- Department of Nuclear Medicine, Sabuncuoğlu Şerefeddin Training and Research Hospital, University of Amasya, Amasya, Turkey
| | - Betül Ural
- Department of Nuclear Medicine, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Mustafa Çapraz
- Department of Internal Medicine, School of Medicine, University of Amasya, Amasya, Turkey
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Signore A, Lauri C, Bianchi MP, Pelliccia S, Lenza A, Tetti S, Martini ML, Franchi G, Trapasso F, De Biase L, Aceti A, Tafuri A. [ 18F]FDG PET/CT in Patients Affected by SARS-CoV-2 and Lymphoproliferative Disorders and Treated with Tocilizumab. J Pers Med 2022; 12:1839. [PMID: 36579547 PMCID: PMC9692335 DOI: 10.3390/jpm12111839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Interstitial pneumonia is a severe complication induced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Several treatments have been proposed alone or, more often, in combination, depending, also, on the presence of other organ disfunction. The most frequently related, well-described, and associated phenomenon is pan-lymphopenia with circulating, high levels of cytokines. We report, here, on two patients with COVID-19 and lymphoproliferative disorders treated with Tocilizumab (a humanized monoclonal antibody against the interleukin-6 receptor) and followed by an [18F]FDG PET/CT to early evaluate the therapy's efficacy. METHODS One patient with angioimmunoblastic T-lymphoma (A), one with Hodgkin lymphoma (A), and both with positive RT-PCR for SARS-CoV-2 and with similar clinical findings of interstitial pneumonia at the CT scan, were imaged by [18F]FDG PET/CT before and 14 days after a single dose of Tocilizumab. RESULTS In both patients, the basal [18F]FDG PET/CT showed a diffused lung parenchyma uptake, corresponding to the hyperdense areas at the CT scan. After 2 weeks of a Tocilizumab infusion, patient B had an improvement of symptoms, with normalization of the [18F]FDG uptake. By contrast, patient A, who was still symptomatic, showed a persisting and abnormal distribution of [18F]FDG. Interestingly, both patients showed a low bone marrow uptake of [18F]FDG at the diagnosis and after 15 days, while the spleen uptake was low only in lymphopenic patient A; both are indirect signs of an immune deficiency. CONCLUSIONS In conclusion, in these two patients, interstitial pneumonia was efficiently treated with Tocilizumab, as demonstrated by the [18F]FDG PET/CT. Our results confirm that interleukin-6 (IL6) has a role in the COVID-19 disease and that anti-cytokine treatment can also be performed in patients with lymphoproliferative disorders.
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Affiliation(s)
- Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Chiara Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Paola Bianchi
- Haematology, "Sant'Andrea" University Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Sabrina Pelliccia
- Haematology, "Sant'Andrea" University Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Andrea Lenza
- Nuclear Medicine Unit, AOU Sant'Andrea, 00189 Rome, Italy
| | - Simone Tetti
- Nuclear Medicine Unit, AOU Sant'Andrea, 00189 Rome, Italy
| | | | | | - Fabio Trapasso
- Nuclear Medicine Unit, AOU Sant'Andrea, 00189 Rome, Italy
| | - Luciano De Biase
- Heart Failure Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Antonio Aceti
- Infection Unit, Department NESMOS, Sapienza University of Rome, 00185 Rome, Italy
| | - Agostino Tafuri
- Haematology, "Sant'Andrea" University Hospital, Sapienza University of Rome, 00189 Rome, Italy
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3
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Chandekar KR, Satapathy S, Singh H, Bhattacharya A. Molecular imaging as a tool for evaluation of COVID-19 sequelae – A review of literature. World J Radiol 2022; 14:194-208. [PMID: 36160629 PMCID: PMC9350609 DOI: 10.4329/wjr.v14.i7.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/17/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by the novel viral pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 primarily involves the lungs. Nucleic acid testing based on reverse-transcription polymerase chain reaction of respiratory samples is the current gold standard for the diagnosis of SARS-CoV-2 infection. Imaging modalities have an established role in triaging, diagnosis, evaluation of disease severity, monitoring disease progression, extra-pulmonary involvement, and complications. As our understanding of the disease improves, there has been substantial evidence to highlight its potential for multi-systemic involvement and development of long-term sequelae. Molecular imaging techniques are highly sensitive, allowing non-invasive visualization of physiological or pathological processes at a cellular or molecular level with potential for detection of functional changes earlier than conventional radiological imaging. The purpose of this review article is to highlight the evolving role of molecular imaging in evaluation of COVID-19 sequelae. Though not ideal for diagnosis, the various modalities of molecular imaging play an important role in assessing pulmonary and extra-pulmonary sequelae of COVID-19. Perfusion imaging using single photon emission computed tomography fused with computed tomography (CT) can be utilized as a first-line imaging modality for COVID-19 related pulmonary embolism. 18F-fluorodeoxyglucose positron emission tomography (PET)/CT is a sensitive tool to detect multi-systemic inflammation, including myocardial and vascular inflammation. PET in conjunction with magnetic resonance imaging helps in better characterization of neurological sequelae of COVID-19. Despite the fact that the majority of published literature is retrospective in nature with limited sample sizes, it is clear that molecular imaging provides additional valuable information (complimentary to anatomical imaging) with semi-quantitative or quantitative parameters to define inflammatory burden and can be used to guide therapeutic strategies and assess response. However, widespread clinical applicability remains a challenge owing to longer image acquisition times and the need for adoption of infection control protocols.
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Affiliation(s)
- Kunal R Chandekar
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Swayamjeet Satapathy
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Harmandeep Singh
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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4
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Ho TC, Chang CC, Chan HP, Huang YF, Chen YMA, Chuang KP, Lee CH, Yuan CH, Deng YZ, Yang MH, Tyan YC. Pulmonary Findings of [ 18F]FDG PET/CT Images on Asymptomatic COVID-19 Patients. Pathogens 2021; 10:839. [PMID: 34357989 PMCID: PMC8308606 DOI: 10.3390/pathogens10070839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 01/31/2023] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, several case studies demonstrated that many asymptomatic patients with COVID-19 underwent fluorine-18 fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) examination for various indications. However, there is a lack of literature to characterize the pattern of [18F]FDG PET/CT imaging on asymptomatic COVID-19 patients. Therefore, a systematic review to analyze the pulmonary findings of [18F]FDG PET/CT on asymptomatic COVID-19 patients was conducted. This systematic review was performed under the guidelines of PRISMA. PubMed, Medline, and Web of Science were used to search for articles for this review. Articles with the key words: "asymptomatic", "COVID-19", "[18F]FDG PET/CT", and "nuclear medicine" were searched for from 1 January 2020 to 20 May 2021. Thirty asymptomatic patients with COVID-19 were included in the eighteen articles. These patients had a mean age of 62.25 ± 14.85 years (male: 67.71 ± 12.00; female: 56.79 ± 15.81). [18F]FDG-avid lung lesions were found in 93.33% (28/30) of total patients. The major lesion was [18F]FDG-avid multiple ground-glass opacities (GGOs) in the peripheral or subpleural region in bilateral lungs, followed by the consolidation. The intensity of [18F]FDG uptake in multiple GGOs was 5.605 ± 2.914 (range from 2 to 12) for maximal standardized uptake value (SUVmax). [18F]FDG-avid thoracic lymph nodes (LN) were observed in 40% (12/40) of the patients. They mostly appeared in both mediastinal and hilar regions with an SUVmax of 5.8 ± 2.93 (range from 2.5 to 9.6). The [18F]FDG uptake was observed in multiple GGOs, as well as in the mediastinal and hilar LNs. These are common patterns in PET/CT of asymptomatic patients with COVID-19.
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Affiliation(s)
- Tzu-Chuan Ho
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-C.H.); (Y.-F.H.); (Y.-Z.D.)
| | - Chin-Chuan Chang
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
- School of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Electrical Engineering, I-Shou University, Kaohsiung 840, Taiwan
| | - Hung-Pin Chan
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan;
| | - Ying-Fong Huang
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-C.H.); (Y.-F.H.); (Y.-Z.D.)
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
| | - Yi-Ming Arthur Chen
- Graduate Institute of Biomedical and Pharmaceutical Science, Fu Jen Catholic University, New Taipei City 242, Taiwan;
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County 350, Taiwan
| | - Kuo-Pin Chuang
- Graduate Institute of Animal Vaccine Technology, National Pingtung University of Science and Technology, Pingtung 900, Taiwan;
| | - Che-Hsin Lee
- Department of Biological Science, National Sun Yat-sen University, Kaohsiung 804, Taiwan;
| | - Cheng-Hui Yuan
- Mass Spectrometry Laboratory, Department of Chemistry, National University of Singapore, Singapore 119077, Singapore;
| | - Yu-Zhen Deng
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-C.H.); (Y.-F.H.); (Y.-Z.D.)
| | - Ming-Hui Yang
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- Center of General Education, Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan
| | - Yu-Chang Tyan
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-C.H.); (Y.-F.H.); (Y.-Z.D.)
- School of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Animal Vaccine Technology, National Pingtung University of Science and Technology, Pingtung 900, Taiwan;
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung 804, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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5
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Abstract
Soon after reports of a novel coronavirus capable of causing severe pneumonia surfaced in late 2019, expeditious global spread of the Severe Acute Respiratory Distress Syndrome Coronavirus 2 (SARS-CoV-2) forced the World Health Organization to declare an international state of emergency. Although best known for causing symptoms of upper respiratory tract infection in mild cases and fulminant pneumonia in severe disease, Coronavirus Disease 2019 (COVID-19) has also been associated with gastrointestinal, neurologic, cardiac, and hematologic presentations. Despite concerns over poor specificity and undue radiation exposure, chest imaging nonetheless remains central to the initial diagnosis and monitoring of COVID-19 progression, as well as to the evaluation of complications. Classic features on chest CT include ground-glass and reticular opacities with or without superimposed consolidations, frequently presenting in a bilateral, peripheral, and posterior distribution. More recently, studies conducted with MRI have shown excellent concordance with chest CT in visualizing typical features of COVID-19 pneumonia. For patients in whom exposure to ionizing radiation should be avoided, particularly pregnant patients and children, pulmonary MRI may represent a suitable alternative to chest CT. Although PET imaging is not typically considered among first-line investigative modalities for the diagnosis of lower respiratory tract infections, numerous reports have noted incidental localization of radiotracer in parenchymal regions of COVID-19-associated pulmonary lesions. These findings are consistent with data from Middle East Respiratory Syndrome-CoV cohorts which suggested an ability for 18F-FDG PET to detect subclinical infection and lymphadenitis in subjects without overt clinical signs of infection. Though highly sensitive, use of PET/CT for primary detection of COVID-19 is constrained by poor specificity, as well as considerations of cost, radiation burden, and prolonged exposure times for imaging staff. Even still, decontamination of scanner bays is a time-consuming process, and proper ventilation of scanner suites may additionally require up to an hour of downtime to allow for sufficient air exchange. Yet, in patients who require nuclear medicine investigations for other clinical indications, PET imaging may yield the earliest detection of nascent infection in otherwise asymptomatic individuals. Especially for patients with concomitant malignancies and other states of immunocompromise, prompt recognition of infection and early initiation of supportive care is crucial to maximizing outcomes and improving survivability.
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Key Words
- sars-cov, severe acute respiratory syndrome coronavirus
- covid-19, coronavirus disease 2019
- ct, computed tomography
- mri, magnetic resonance imaging
- pet, positron emission tomography
- ggo, ground-glass opacity
- rt-pcr, reverse transcription polymerase chain reaction
- 18f-fdg, 18f-labelled fluorodeoxyglucose
- suvmax, maximum standardized uptake
- mip, maximum intensity projection
- 68ga-psma, 68ga-labelled prostate-specific membrane antigen
- 18f-choline, 18f-labelled choline
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Affiliation(s)
- Brandon K K Fields
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Natalie L Demirjian
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America; Department of Integrative Anatomical Sciences, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Habibollah Dadgar
- Razavi Cancer Research Center, RAZAVI Hospital, Imam Reza International University, Mashhad, Iran
| | - Ali Gholamrezanezhad
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America; Department of Radiology, University of Southern California, Los Angeles, CA 90033, United States of America.
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6
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Piciu A, Manole S, Piciu D, Dreve T, Roman A. Asymptomatic COVID-19 cancer patients incidentally discovered during F18-FDG PET/CT monitoring. Med Pharm Rep 2021; 94:58-64. [PMID: 33629050 PMCID: PMC7880066 DOI: 10.15386/mpr-1776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/18/2020] [Accepted: 10/05/2020] [Indexed: 12/25/2022] Open
Abstract
Background The aim of the study was to present the PET/CT imaging features in a small series of asymptomatic patients with known cancer pathologies, infected with the SARS-CoV-2 virus, which were incidentally discovered during their monitoring scan of F18-FDG PET/CT. Methods We included in our study a number of five cases (3 female and 2 male) out of 478 patients examined by F18-FDG PET/CT between March - April 2020, with confirmed diagnostic of cancer. Four patients had lung damages suggestive for the mentioned viral infection and 1 patient had multiple lung metastases from thyroid cancer. All patients were asymptomatic for acute respiratory disease at the time of examination, being subsequently confirmed for the viral infection by specific PCR analysis. Results The asymptomatic positive SARS-CoV-2 cancer patients discovered incidentally in PET/CT F18-FDG represent 0.83% and their imaging characteristics were suggestive for high FDG activity in the lung despite the lack of respiratory symptoms. Conclusion The SARS CoV-2 viral infection in asymptomatic cancer patients is a very rare possibility, but represents a challenging scenario both for the differential diagnosis in cancer and also for the epidemiologic context.
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Affiliation(s)
- Andra Piciu
- Department of Medical Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Manole
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,CT Clinic, Cluj-Napoca, Romania
| | - Doina Piciu
- CT Clinic, Cluj-Napoca, Romania.,Department of Endocrine Tumors and Nuclear Medicine, Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | | | - Andrei Roman
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,CT Clinic, Cluj-Napoca, Romania
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Bolaman AZ, Selim C, Karaman C, Yavaşoğlu İ. Masquerading of COVID-19 Infection as Primary Mediastinal Large B-Cell Lymphoma. Turk J Haematol 2021; 38:77-78. [PMID: 33491812 PMCID: PMC7927458 DOI: 10.4274/tjh.galenos.2020.2020.0340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Ali Zahit Bolaman
- Aydın Adnan Menderes University Faculty of Medicine, Department of Hematology, Aydın, Turkey
| | - Cem Selim
- Aydın Adnan Menderes University Faculty of Medicine, Department of Hematology, Aydın, Turkey
| | - Can Karaman
- Aydın Adnan Menderes University Faculty of Medicine, Department of Radiology, Aydın, Turkey
| | - İrfan Yavaşoğlu
- Aydın Adnan Menderes University Faculty of Medicine, Department of Hematology, Aydın, Turkey
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Gupta K, Gandhi S, Mebane A, Singh A, Vishnuvardhan N, Patel E. Cancer patients and COVID-19: Mortality, serious complications, biomarkers, and ways forward. Cancer Treat Res Commun 2020; 26:100285. [PMID: 33360669 PMCID: PMC7832265 DOI: 10.1016/j.ctarc.2020.100285] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023]
Abstract
The SARS-CoV-2 (COVID-19) pandemic has particularly serious consequences for cancer patients, as they are at high risk for severe complications and mortality due to the virus since cancer patients are immunocompromised. Preliminary evidence suggests that patients with hematological, and metastatic malignancies are particularly susceptible to developing severe COVID-19 illness, which leads to poor prognosis. Biomarkers including C-reactive protein and interleukin-6 may be predictors of outcome and, therefore, crucial in assessing COVID-19 illness severity in cancer patients. A patient-specific risk and benefit inventory should be completed, and expert guidelines consulted when deciding to continue or postpone therapeutic interventions. This review presents preliminary evidence of COVID-19 infection and its impact on cancer, as well as discussion of general guidelines for the treatment and management of cancer patients with COVID-19.
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Affiliation(s)
- Kush Gupta
- Kasturba Medical College, Light House Hill Road, Mangalore, KA 575001, India.
| | - Shipra Gandhi
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA.
| | - Alexander Mebane
- Heart, Vascular & Leg Center, 5020 Commerce Dr, Bakersfield, CA, 93309, USA.
| | - Angelica Singh
- NewYork-Presbyterian/Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, New York, 11215 USA.
| | - Nivetha Vishnuvardhan
- NewYork-Presbyterian/Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, New York, 11215 USA.
| | - Eshan Patel
- NewYork-Presbyterian/Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, New York, 11215 USA.
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Adekanmi AJ, Baiyewu LA, Osobu BE, Atalabi OM. Where COVID-19 testing is challenging: a case series highlighting the role of thoracic imaging in resolving management dilemma posed by unusual presentation. Pan Afr Med J 2020; 37:284. [PMID: 33654511 PMCID: PMC7896536 DOI: 10.11604/pamj.2020.37.284.26697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022] Open
Abstract
The COVID-19 pandemic remains an evolving disease posing a challenge of incomplete understanding escalated by random atypical clinical presentations. Numerous challenges still exist with accessibility and availability of standard COVID-19 viral testing using real-time Polymerase Chain Reaction (RT-PCR), in low- and middle-income countries, especially in several hospital settings. The clinical information of three select patients at a major health facility in Southwestern Nigeria with unusual COVID-19 clinical presentation and clinical management dilemma related to challenges with COVID-19 viral laboratory testing, were retrospectively reviewed. The medical history in all three cases closely mimicked that of other medical conditions because of assumptions created by red herrings like an acute exacerbation of an underlying non-communicable disease (diaphragmatic eventration) in case 1, re-activation of a previously treated lung condition (tuberculosis) in case 2 and a sequalae of a previously diagnosed but poorly-managed chronic non-communicable disease (decompensated hypertensive heart disease). Also, viral testing was challenging in all cases due to reasons ranging from late turn-around time to inconsistent results. However, thoracic imaging was employed in all cases to heighten suspicion of COVID-19 infection, resolve management dilemma and limit intra-hospital spread. Thoracic imaging can play a major role within hospital settings in low-and middle-income countries in resolving diagnostic challenges of atypical COVID-19 clinical presentations, raising suspicion for early institution of intra-hospital disease containment measures, limiting exposure among hospital staff and guiding clinical case management of COVID-19; especially where challenges with confirmatory viral testing remain persistent.
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Affiliation(s)
- Ademola Joseph Adekanmi
- Department of Radiology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Radiology, University College Hospital, Ibadan, Nigeria
| | - Lateef Ayodele Baiyewu
- Division of Cardiothoracic Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Omolola Mojisola Atalabi
- Department of Radiology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Radiology, University College Hospital, Ibadan, Nigeria
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10
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Hempel L, Piehler A, Pfaffl MW, Molnar J, Kirchner B, Robert S, Veloso J, Gandorfer B, Trepotec Z, Mederle S, Keim S, Milani V, Ebner F, Schweneker K, Fleischmann B, Kleespies A, Scheiber J, Hempel D, Zehn D. SARS-CoV-2 infections in cancer outpatients-Most infected patients are asymptomatic carriers without impact on chemotherapy. Cancer Med 2020; 9:8020-8028. [PMID: 33022856 PMCID: PMC7643635 DOI: 10.1002/cam4.3435] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022] Open
Abstract
Oncologic patients are regarded as the population most at risk of developing a severe course of COVID‐19 due to the fact that malignant diseases and chemotherapy often weaken the immune system. In the face of the ongoing SARS‐CoV‐2 pandemic, how particular patients deal with this infection remains an important question. In the period between the 15 and 26 April 2020, a total of 1227 patients were tested in one of seven oncologic outpatient clinics for SARS‐CoV‐2, regardless of symptoms, employing RT‐qPCR. Of 1227 patients, 78 (6.4%) were tested positive of SARS‐CoV‐2. Only one of the patients who tested positive developed a severe form of COVID‐19 with pneumonia (CURB‐65 score of 2), and two patients showed mild symptoms. Fourteen of 75 asymptomatic but positively tested patients received chemotherapy or chemo‐immunotherapy according to their regular therapy algorithm (±4 weeks of SARS‐CoV‐2 test), and 48 of 78 (61.5%) positive‐tested patients received glucocorticoids as co‐medication. None of the asymptomatic infected patients showed unexpected complications due to the SARS‐CoV‐2 infection during the cancer treatment. These data clearly contrast the view that patients with an oncologic disease are particularly vulnerable to SARS‐CoV‐2 and suggest that compromising therapies could be continued or started despite the ongoing pandemic. Moreover the relatively low appearance of symptoms due to COVID‐19 among patients on chemotherapy and other immunosuppressive co‐medication like glucocorticoids indicate that suppressing the response capacity of the immune system reduces disease severity.
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Affiliation(s)
| | | | - Michael W Pfaffl
- Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, Technical University of Munich, Munich, Germany
| | | | - Benedikt Kirchner
- Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, Technical University of Munich, Munich, Germany
| | - Sebastian Robert
- Fraunhofer Institute of Optronics, System Technologies, and Image Exploitation IOSB, Karlsruhe, Germany
| | - Julia Veloso
- Fraunhofer Institute of Optronics, System Technologies, and Image Exploitation IOSB, Karlsruhe, Germany
| | | | | | | | - Sabine Keim
- Department of Obstetrics, Helios Clinic Pasing, München, Germany
| | | | | | | | | | | | | | | | - Dietmar Zehn
- Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, Technical University of Munich, Munich, Germany
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11
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Singh J. Diagnostic dilemma, an incidental diagnosis of COVID 19. J Community Hosp Intern Med Perspect 2020; 10:389-390. [PMID: 33235668 PMCID: PMC7671727 DOI: 10.1080/20009666.2020.1800165] [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] [Indexed: 11/25/2022] Open
Abstract
COVID 19 or SARS-CoV-2 infection was first reported in December 2019 in Wuhan City of China. Since then, it continues to spread globally and has been declared a pandemic. These patients present predominantly with respiratory complaints; however, in this article, we describe a case that was detected incidentally during workup of another suspecting diagnosis. We also elaborate on the benefits and importance of rapid testing.
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Affiliation(s)
- Jaskeerat Singh
- Internal Medicine, Mid-Columbia Medical Center, The Dalles, OR, USA
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