Reports of neuro-ophthalmological manifestations and complications in patients with coronavirus disease 19 (COVID-19) are still scarce. The aim of this article is to present optic neuritis, as possible post-infectious manifestation of COVID-19. Four weeks after hospitalization for seropositive coronavirus disease 19 (COVID-19), presented as bilateral bronchopneumonia, with radiology and laboratory findings also pointed to high clinical suspicion to COVID-19, a 63-year-old man developed a headache and subacute and profound visual loss on his right eye. The disease presentation was the right eye papillitis. Inflammatory parameters were normal at the time of hospitalization, and IgM and IgG for SARS-CoV-2 were still positive. After corticosteroid pulse therapy, his vision improved significantly and on follow-up visits returned to normal. All laboratory and radiology findings were unremarkable, except for antibodies against SARS-CoV-2 and myelin oligodendrocyte glycoprotein (MOG). We discuss about capacity of SARS-CoV-2 to cause optic neuritis and possible significance of MOG antibodies in similar cases.

/pdf/optic-neuritis-in-a-patient-with-seropositive-myelin-2t5v4m075n.pdf

Optic Neuritis in a Patient with Seropositive Myelin Oligodendrocyte Glycoprotein Antibody During the Post-COVID-19 Period

http://www.ajo.com/article/S0002939422000708/pdf

COVID-19 Vaccination and The Eye

Myelin oligodendrocyte glycoprotein antibody-associated optic neuritis in a COVID-19 patient: A case report.

The involvement of cranial nerves is being increasingly recognised in COVID-19. This review aims to summarize and discuss the recent advances concerning the clinical presentation, pathophysiology, diagnosis, treatment, and outcomes of SARS-CoV-2 associated cranial nerve mononeuropathies or polyneuropathies. Therefore, a systematic review of articles from PubMed and Google Scholar was conducted. Altogether 36 articles regarding SARS-CoV-2 associated neuropathy of cranial nerves describing 56 patients were retrieved. Out of these 56 patients, cranial nerves were compromised without the involvement of peripheral nerves in 32 of the patients, while Guillain-Barre syndrome (GBS) with cranial nerve involvement was described in 24 patients. A single cranial nerve was involved either unilaterally or bilaterally in 36 patients, while in 19 patients multiple cranial nerves were involved. Bilateral involvement was more prevalent in the GBS group (n=11) as compared to the cohort with isolated cranial nerve involvement (n=5). Treatment of cranial nerve neuropathy included steroids (n=18), intravenous immunoglobulins (IVIG) (n=18), acyclovir/valacyclovir (n=3), and plasma exchange (n=1). The outcome was classified as "complete recovery" in 21 patients and as "partial recovery" in 30 patients. One patient had a lethal outcome. In conclusion, any cranial nerve can be involved in COVID-19, but cranial nerves VII, VI, and III are the most frequently affected. The involvement of cranial nerves in COVID-19 may or may not be associated with GBS. In patients with cranial nerve involvement, COVID-19 infections are usually mild. Isolated cranial nerve palsy without GBS usually responds favorably to steroids. Cranial nerve involvement with GBS benefits from IVIG.

/pdf/covid-19-associated-cranial-nerve-neuropathy-a-systematic-bh0zifp3xx.pdf

COVID-19 associated cranial nerve neuropathy: A systematic review.

/pdf/adverse-ocular-events-following-covid-19-vaccination-mecjsqps0w.pdf

Adverse Ocular Events following COVID-19 Vaccination.

A 44-year-old male patient with no past medical history presented 2 weeks after seropositive coronavirus disease 2019 (COVID-19) infection with vision problems suggestive of optic neuritis. Radiological testing showed findings suspicious for acute bilateral optic neuritis. The patient had also anti-MOG antibodies. Whether this was an optic neuritis due to COVID-19, MOG antibody disease, or an activation of MOG antibody disease by COVID-19 is discussed in this case.

https://journals.sagepub.com/doi/pdf/10.1177/2324709620976018

COVID-19-Induced Acute Bilateral Optic Neuritis.

Drug-induced thrombocytopenia (DIT) is a differential diagnosis for consideration when acute thrombocytopenia is encountered in the outpatient or inpatient setting. The mechanism of thrombocytopenia induced by different antiplatelet therapies varies. DIT may occur due to antibody formation following the exposure to a drug, or naturally occurring preexisting antibodies may produce rapid-onset thrombocytopenia when a drug molecule binds to a platelet receptor inducing a conformational change thus rendering it to be an antigen target for naturally occurring antibodies. A 66-year-old female with history of hypertension presented with non-ST elevation myocardial infarction, had drug eluting stent placed in first obtuse marginal artery of left circumflex coronary artery. Started on antiplatelet medications aspirin 81 mg, ticagrelor 90 mg (which was later transitioned to clopidogrel 75 mg), as well as tirofiban 12.5 mg (for 12 hours only). Tirofiban is a GP IIb/IIIa antagonist, other drugs in this class have been documented to induce thrombocytopenia as well, but rates for tirofiban appear to be the highest, the reason is unclear. These antibodies are thought to be either naturally occurring or induced from conformational changes to GP IIb/IIIa binding site after binding to the GP IIb/IIIa receptor, binding of these drugs to the receptor precipitates an epitope much more specific for platelet surface antigens. Tirofiban and clopidogrel/ticagrelor can cause thrombocytopenia, but onset in this case is unusual: acute antibody reaction would be expected within hours, not delayed 30 hours after starting antiplatelet medication, and nonacute reaction would present 1 to 2 weeks out.

https://journals.sagepub.com/doi/pdf/10.1177/2324709620947891

An Unusual Case of Drug-Induced Thrombocytopenia.

A 28-year-old female presented to the emergency room with epigastric pain, nausea, and vomiting; her lipase was elevated, and computed tomography of abdomen showed evidence of acute pancreatitis. Her past medical history was significant for poorly controlled insulin requiring type 2 diabetes mellitus and 2 previous admissions for hypertriglyceridemia-induced pancreatitis. Due to the severity of her pancreatitis presentation, she was admitted to the intensive care unit. She received aggressive intravenous fluid hydration and was started on an insulin drip. Apheresis was strongly considered given the degree of her hypertriglyceridemia (11 602 mg/dL), but there was no timely access to this treatment option. She, however, significantly improved with insulin therapy alone. Her triglyceride levels decreased rather quickly to 4783 mg/dL within 24 hours and by the fourth day of admission were comfortably <1000 mg/dL with insulin infusion along with clinical improvement. She was discharged on niacin and insulin therapy along with her home medications of statin and fenofibrate.

https://journals.sagepub.com/doi/pdf/10.1177/2324709620940492

The Efficacy of Intravenous Insulin Infusion in the Management of Hypertriglyceridemia-Induced Pancreatitis in a Rural Community Hospital.

An 88-year-old male patient with a past medical history of hypertension and gastroesophageal disease presented with nausea, vomiting, and hypothermia. He was admitted for further testing, which revealed elevated creatine kinase and its MB isoenzyme (CK-MB) and troponin with no significant electrocardiogram changes. He denied cardiac symptoms or any previous cardiac history. The patient was treated with fluids and antibiotics in which improvement in his symptoms was noted. In this article, we share this rare case of hypothermia associated with elevation of CK-MB.

https://journals.sagepub.com/doi/pdf/10.1177/2324709621995335

CK-MB Elevation in Mild Hypothermia: What We Did and We Should Have Done.

Pancytopenia is a decrease across cellular hematological lines. Many different etiologies can cause this clinical picture including viral and bacterial infections, chemicals, malignancy, and medications. Particular attention should be paid to the onset, timing, and severity as they can indicate the underlying cause. In cases of iatrogenic-induced pancytopenia, the offending agent should be stopped immediately and the patient should be monitored for recovery of cell lines. While not well reported in the literature, trimethoprim-sulfamethoxazole (TMP-SMX) is a cause of pancytopenia. We present a case of drug-induced pancytopenia secondary to TMP-SMX that resolved quickly with cessation of use.

https://www.mdpi.com/2039-7283/11/2/50/pdf

Khalid Sawalha

Papers

COVID-19-Induced Acute Bilateral Optic Neuritis.

An Unusual Case of Drug-Induced Thrombocytopenia.

The Efficacy of Intravenous Insulin Infusion in the Management of Hypertriglyceridemia-Induced Pancreatitis in a Rural Community Hospital.

CK-MB Elevation in Mild Hypothermia: What We Did and We Should Have Done.

A Rare Cause of Drug-Induced Pancytopenia: Trimethoprim-Sulfamethoxazole-Induced Pancytopenia.