The most read medical case studies in 2021

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As countries continue to administer COVID-19 vaccines, including to children and those who require a third dose, scientific research into potential and rare vaccine side effects remains a priority for many.

Medical understanding of SARS-CoV-2 and how to protect people from the disease has evolved significantly since scientists first identified the novel coronavirus in Wuhan, China more than two years ago.

While COVID-19 vaccines currently approved for use have gone through rigorous clinical trials and approval processes by governing health agencies, individual patient case reports and their outcomes following infection or vaccination by COVID-19 are a key part of early-stage research.

Among the most popular sources for cutting-edge research is BMJ Case Reports, considered “the largest repository of case reports in the world”.

Not surprisingly, six of the journal’s 10 most-read case reports in 2021 were related to adverse events after COVID-19 vaccination, and three were related to symptoms of infection. But the most significant case report concerns a COVID-19 patient who made a miraculous recovery against all odds.

Here is a roundup of the most read case studies from BMJ case reports, all of which are freely available under the journal’s pandemic policy.

118 DAYS ON A FAN

The most read case report of 2021, published in March, describes a COVID-19 patient with multiple comorbidities who was successfully weaned from ventilation after 118 days, despite his recovery complicated by recurrent septic episodes, as well as the need for advanced cardiovascular treatment. support and renal replacement therapy.

“To the best of our knowledge, this is the longest ventilation time and ICU/hospital stay reported for a surviving patient with COVID-19 and underscores the importance of allowing sufficient time for that clinical interventions take effect, even when the prognosis appears poor,” the doctors wrote in the case report.

A 53-year-old Lebanese man was admitted to a UK hospital with COVID-19 pneumonia after suffering from a sore throat and cough for two weeks. Her comorbidities included type 2 diabetes, hypertension, obstructive sleep apnea, and severe gastroesophageal reflux disease. By the third day of his admission to hospital, he had developed hypoxia – a lack of oxygen in the tissues – and was intubated and transferred to intensive care for mechanical ventilation. He quickly developed acute kidney injury and cardiovascular collapse requiring inotropic support to alter the force of cardiac contractions. He also underwent a tracheostomy on day 23 of his ICU admission and began receiving continuous renal replacement therapy on day 24. Over the next two months, doctors say he had several episodes of “deterioration severe breathing” and pneumonia, which prolonged his need for ventilation. .

Following a “combination of steroids, antimicrobial optimization and better supportive care”, the patient was finally able to breathe without a ventilator on day 118 and was subsequently discharged from the ICU on day 134. After spending two additional months in rehabilitation (a total of six months as an inpatient), he was sent home, however, doctors say he continues to suffer from shortness of breath and needs mobility aids, including a wheelchair and a walker, due to back pain.

PUT IN AN ADULT AFTER VACCINATION

This case study, which was published in July, describes the first reported case of multisystem inflammatory syndrome (MIS) in an adult following a COVID-19 vaccination. Although COVID-19 vaccines are safe and effective, adverse events after vaccination can occur, including SIM, a rare but serious immune response that occurs when different parts of the body – including but not limited to , heart, lungs and skin – ignite. While SIM has been reported more frequently in children and some adults after COVID-19 infection, experts point out that the development of SIM after vaccination is very rare. According to the case study, there had been no other reports of MIS-C or MIS-A after COVID-19 vaccination at the time of publication.

Doctors say a 44-year-old British woman was admitted to hospital after experiencing pain in her arm at the vaccination site days after receiving the Pfizer-BioNTech vaccine, which progressed to fever, diarrhea and abdominal pain over the next few days. She also had a red rash on her chest and swollen muscles due to fluid buildup. According to the case report, the woman developed an “unprovoked” pulmonary embolism with acute kidney injury. After administration of an intravenous corticosteroid, the muscle swelling, skin rashes and acute kidney injury resolved. However, the patient needed an “extended hospital stay” for her rehabilitation.

HIVES AS THE INITIAL SYMPTOM OF INFECTION

The 54-year-old woman at the center of this case study, published in March, presented to the emergency room with shortness of breath, generalized weakness and hives associated with an itching and burning sensation that gradually worsened over the three days. prior. The woman had no other symptoms such as fever, chills, cough, nausea, diarrhea, abdominal pain or sore throat. She had no known exposure to COVID-19, but tested positive for the disease upon arrival at the hospital.

The woman had a generalized rash on her arms and legs that was abnormally red, raised and consistent with an urticarial rash. Treatment for the rash included oral antihistamines and a topical cream, given the intensity of her itching. Antiviral therapy was given intravenously once a day for five days to relieve his shortness of breath. Within 48 hours of starting this treatment, the woman’s rash had cleared up and she was discharged on the fifth day of hospitalization once she had completed the antiviral treatment.

According to the case report, skin manifestations, or rashes, as a symptom of COVID-19 infection are “predominantly described as self-limiting.” Although the report notes that urticarial rashes are not reported as the initial presenting symptom of COVID-19 infection, scientists say they can occur at the same time or after the onset of other more common symptoms. .


Here are the other most read case reports from the BMJ case reports:

4. Guillain-Barré syndrome after COVID-19 vaccination

5. Sequential paralysis of the contralateral facial nerve after the first and second doses of the vaccination against COVID-19

6. Reactivation of herpetic keratitis after vaccination

7. Adult MIS in a patient who recovered from COVID-19 after vaccination

8. COVID-19 Infection in Palatine Tonsil Tissue and Detritus

9. Immunological thrombocytopenic purpura and acute liver injury after COVID-19 vaccine

10. Reactive arthritis after COVID-19

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