VCOM Research Day Program Book 2023

Medical Student Research Case Reports

24 Severe Covid-19-Related Encephalopathy in a Patient with History of Ventriculoperitoneal Shunt Placement and Incidental Wolff-Parkinson-White Syndrome

There have been nearly 650 million confirmed global cases of severe acute respiratory syndrome coronavirus type 2 (SARS‐CoV‐2), otherwise known as COVID-19 reported in the pandemic. While the most common symptoms include fever, cough, fatigue, and dyspnea, neurological manifestations may include dizziness, headache, and impaired consciousness. Occasionally, there are complications, especially in severe cases. In November of 2021, a 33-year-old Caucasian male presented at an office visit for a month-long cough that had gradually gotten worse for a month. His past medical history included hydrocephalus treated with a ventriculoperitoneal shunt. He was not vaccinated, the reason being unknown. He was diagnosed with COVID-19 via PCR from nasal specimen. Four days after the initial presentation, the patient was seen at the emergency department (ED) for worsening symptoms. CXR found bilateral infiltrates consistent with pneumonia. EKG and negative troponins were consistent with myocarditis, and incidental Wolff-Parkinson-White Elizabeth A. McDonald, MA; Theresa J McCann, PhD, MPH Corresponding author: emcdonald@vcom.edu Edward Via College of Osteopathic Medicine-Virginia Campus Riverside Regional Medical Center

syndrome. Due to these concerns, he was admitted for two days and given acetaminophen, intravenous IV fluids, doxycycline, dexamethasone, zinc, and vitamin C. He was later discharged, with a plan including a f/u with his primary care provider (PCP). Discharge medications of note include prednisone, doxycycline, and vitamin C. He was instructed to come into the hospital for monoclonal antibody infusion the following day. However, the next day, he became hypoxic and was unable to receive the infusion. He was taken to the emergency department and transferred to the hospital for admission. He was diagnosed at this point with COVID-19 pneumonia and given oxygen supplementation, dexamethasone and remdesivir. Throughout this hospital admission, his O2 saturation continued to decline, necessitating the need for intubation. He later developed septic shock and was subsequently transferred to the intensive care unit on day 3. His neurological and pulmonary function continued to decline throughout

his stay. Due to his abnormal neurological symptoms, he was diagnosed with encephalopathy. Quetiapine, clonazepam, and low dose propofol were given to him, and later dexmedetomidine hydrochloride, and lorazepam for his delirium and agitation on day 15 17. On day 19, his delirium improved and was slowly able to follow simple commands. He continued to improve with this treatment regimen. On day 36, he was neurologically improved to be functional with help from family and stable, so he was discharged. This is a unique case of COVID-19 due to the patient’s medical history and age, so should be added to the growing body of medical literature as we continue to learn more about this condition in patients with different comorbidities.

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